Heart Flashcards
(269 cards)
1
Q
What is the thoracic cage made from…
A
12 vertebrae /IVD
12 pairs of ribs/costal cartilages
Sternum
2
Q
What comprises the sternum?
A
Manubrium
Body
Xiphoid Process (T9)
3
Q
What is the sternal angle of Louis?
A
Manubriosternal junction T4/T5 IVD level - articulates at rib 2 - bifurcation of the trachea - arch of aorta
4
Q
How are intercostal spaces arranged?
A
Numbered according to the superior rib
5
Q
What is the superior thoracic aperture?
A
Superior opening of the thoracic cage
- esophagus
- trachea
- neurovasculature
Thoracic Outlet Syndrome = structures affected by the obstruction of superior thoracic artery
6
Q
What is the inferior thoracic aperture?
A
Bordered by..
- T12
- ribs 11-12
- costal cartilages 7-10
- xiphoid process at T9
Covered by diaphragm
7
Q
Where is the caval opening of the inferior thoracic aperture?
A
IVC
T8
8
Q
What is the esophageal hiatus?
A
vagus nerve CN 10
Esophagus
T10
9
Q
What is the aortic hiatus?
A
Aorta
Azygous
Thoracic duct
T12
10
Q
What is the mediastinum?
A
Houses the thoracic structures, excepts for the lungs/pleura
- fatty/loose connective tissue = facilitates movement
- becomes less flexible with age and repair
11
Q
What does widening of the mediastinum indicate?
A
Indicative of the laceration of the great vessels, lymphoma, cardiac hypertrophy
12
Q
What connects the superior mediastinum and inferior mediastinum?
A
Transverse thoracic plane
13
Q
What’s the pericardium?
A
Middle mediastinum
Outer fibrous
Inner serous
14
Q
What is the outer fibrous pericardium?
A
Thick, inelastic
Attached to central tendon/sternum
15
Q
What is the inner serous pericardium?
A
Mesothelioma with connective tissue
Contains the:
- parietal pericardium
- visceral pericardium: epicardium/covers the heart
16
Q
What is the pericardial cavity?
A
In between the parietal and visceral pericardium
Contains serous fluid
Pericarditis=inflammation of the pericardium
17
Q
What is the duodenalojejunum junction?
A
Where the duodenum emerges from behind the peritoneum
On the right side of the abdominal cavity
18
Q
What does the superior mesenteric artery branch to?
A
Right colic artery -> ascending colon
Jejunal arteries
Ileal arteries - - > make up the vasa recta, which in turn make up the intestinal wall
Ileocolic Artery - supplies the ileocolic junction
19
Q
What does the middle colic artery supply?
A
The transverse colon
20
Q
What is the first portion of the colon/ascending colon
A
Cecum
Attaches to ileum and the veriform appendix (found just posterior)
21
Q
What is the second portion of the colon?
A
Ascending colon Right colic/hepatic flexure Transverse Colon Left colic/splenic flexure Descending colon Sigmoid Colon Sigmoid Mesecolon - mesenteric that connects portions of the sigmoid colon
22
Q
Where do the preganglionic sympathetic neurons come for heart?
A
IMLCC T1-T4
23
Q
Where do the postganglionic neurons for heart innervation come from?
A
They exit the sympathetic chain to mix into the cardiac plexus before entering the heart tissue.
24
Q
What does sympathetic innervation to the heart cause?
A
Increases rate/force of contraction by…
- increasing the activity of SA/AV nodes
- vasodilating the coronary vessels (RCA, LCA)
25
Where does pregaglionic neurons in PARASYMPATHETIC to heart come from?
Vargas nuclei in the brain stem, these are parasympathetic branches of the vagus nerve
- they synapse in the cardiac plexus or the heart tissue
26
What does PARASYMPATHETIC innervation to heart cause?
Decreases the rate/force of contraction by...
- decreasing the activity of SA and AV nodes
- vasoconstriction get the coronary vessels
27
What is preganglionic sympathetic innervation to the lungs?
IMLCC T1-T4/T5
28
What is postganglionic sympathetic innervation to lungs?
Will exit the sympathetic chain medically as cervical/thoracic sympathetic nerves
Will mix with pulmonary plexus before following the bronchi into lung tissue
29
What does sympathetic innervation to the lungs cause?
Bronchodilation
Vasoconstriction
Inhibition of glandular secretions
30
What does parasympathetic innervation to lungs cause?
Bronchoconstriction
31
What else does parasympathetic innervation to lungs cause?
Vasodilation of blood vessels
32
Where do preganglionic neurons in parasympathetic division to lungs come from?
Vagal nuclei in the brainstem
- enter pulmonary plexus
- synapse on bronchi
33
What is myenteric plexus responsible for?
Motility in ENS
34
What is the submucosal plexus for?
Blood flow and secretions
35
Where does sympathetic innervation to abdomen come from?
IMLCC T5-L2
| - exit the sympathetic chain on splanchnic nerves, which then synapse on collateral ganglia to innervate the abdomen
36
What do the greater splanchnic sympathetic nerves innervate?
T5-T9
Foregut/liver/gallbladder/pancreas
Greater splanchnic nerve projects to the celiac ganglion -> synapses on post-ganglionic neurons
37
What nerve fibers parasympathetically innervate the foregut/liver/pancreas/gallbladder?
Anterior and Posterior Vagal Trunk
Post-ganglionic neurons lie at the viscera
38
What sympathetic nerves innervate the hindgut?
L1-L2
- exit as lumbar splanchnic nerves
> inferior mesenteric ganglion
> postganglionic follows the blood supply of the IMA to the viscera
39
What parasympathetic nerves innervate the hindgut?
Preganglionic S2-S4
- pelvic splanchnic nerves -> inferior hypogastric -> rectal plexus ->viscera
Causes:
- vasodilation
- secretormotor to the GI mucosa
- motor to the GI musculature
40
What are the sympathetic innervations to the kidney?
T12
Least Splanchnic Nerve
> aorticorenal plexus
> post-ganglionic synapse and follows blood supply to kidney
Sympathetic:
- vasoconstriction
- decreases urine production
41
What are the sympathetic innervation to the midgut?
T10-T11
Lesser Splanchnic Nerve
> Superior Mesenteric Ganglion
> postganglionic fibers follow the blood supply
Vasoconstriction
Inhibits GI musculature
42
What provides sympathetic innervation to the adrenal gland?
Greater splanchnic nerve (T5-T8) -> celiac ganglion
```
Pre-ganglionic = medulla cells (chromaffin) - synapse on cells and release NE/Epi
Post-ganglionic = blood vessels
```
43
What is the parasympathetic innervation to the midgut?
Vagal nuclei in the brainstem
44
What is the sympathetic preganglionic cell bodies?
T1-L2/L3
45
What are the preganglionic parasympathetic cell bodies?
CN X = thorax/abdomen
Abdomen/Pelvis = S2-S4
46
What is the white rami?
Preganglionic sympathetic axons
47
What is the grey rami?
Postganglionic sympathetic axons
48
What does vagal nerve of parasympathetic nervous system innervate?
Thorax and abdomen
Enters..
- esophageal plexus, forms an anterior/posterior vagal trunk before entering the abdomen
49
What is parasympathetic innveration?
Vagus Nerve (CN X)
```
Pelvic Splanchnic (IMLCC S2-S4)
- projects to inferior hypogastric plexus to supply parasympathetic innervation to the gut
```
50
What is referred pain?
Inability to distinguish between visceral and somatic sensory distribution
- referred pain from heart will result in pain of T1-T4 dermatologist of the chest wall and medial arm
51
Endocardium
Lines the blood filled chambers
52
Myocardium
Thick, middle layer
| Myocytes for contraction
53
Epicardium
Thin, external layer
| Connective tissue, coronary arteries, mesothelioma
54
Hemopericardium
Blood into the pericardial cavity
55
Cardiac Tamponade
Compression on heart
56
In cardiac tamponade, what is presentation?
Face and neck swell due to impeded venous return to the heart
57
Where does pericardiocentesis occur?
In cardiac notch
| - needle inserted superoposteriorly at infrasternal angle, at 5/6 LICS
58
What are the sequence of layers penetrated in pericardiocentesis?
AFPP
A- anterior body wall
F-fibrous pericardium
P-parietal layer of serous pericardium
P-pericardial cavity
59
What are the two pericardial sinuses?
Transverse sinus: horizontal gap, anterior to SVC, posterior to aorta-pulm trunk
Oblique sinus: under the apex
60
What is the base of the heart?
Posterior heart
Left atrium
Includes...
- proximal parts of the 4 pulmonary veins that empty into LA
(The RA and SVC/IVC form a small part of the heart
61
Where does the esophagus lie?
Posterior to the base of the heart
| Vertebral bodies lie posterior to the esophagus
62
Where is the heart located?
T5-T8 = supine position
T6-T9 = standing position
63
What does the apex consist of?
Left ventricle
Left tip of the LV
- projects anteriorly and left
5th LICS at the MCL
64
What is the apex beat?
5th LICS at MCL
| During auscultation, listen for sounds of the mitral valve
65
What blood flows into the RA?
Coronary sinus
SVC
IVC
66
Where is the sternocostal/anterior border of heart?
5 LICS parasternally
67
When does the heart contract?
Day 21
68
What forms the cardiac veins?
Migration of neural crest cells in embryonic development
69
What is echocardiogram?
Cardiac ultrasound
70
What is an electrocardiogram?
Measures impulses
71
How can heart be catherization?
Femoral artery
72
What is the transposition of great arteries?
Aorta continues from the RV
Pulmonary trunk continues from LV
Congenital birth defect
- the NCC-derived aortiopulmonary septum that divides the common artery did not form
- “arterial switch” procedure carried out
73
What is dextrocardia?
Position of the heart is reversed
Apex is on the right, not the left
If dextrocardia occurs with general transposition of organs (situs I versus) = heart functions normally
Isolated dextrocardia = severe defects!
74
Where is blood oxygenated at placenta per tally?
Umbilical vein => IVC => right atrium
RA -foramen ovale -> LA -> LV -> Aorta (bypasses the. Lungs)
75
What is the foramen ovale called postnatally?
Fossa ovalis
76
What is the ductus arteriosus?
Shunts blood from the left pulmonary artery into the arch of aorta
Postnatally = called the ligamentum arteriosum
77
What muscles does the right atrium have?
Pectinate muscles
| - begins at the 3rd costal cartilage
78
What separates the RV/LV?
IVS
79
What is the LA?
Forms much of the base off the heart
- 4 pulmonary veins enter
- left auricle is made up of pectinate muscles
80
What is the LV?
Apex of the heart
Covers the diaphragmatic surface
Carries:
- traberculae carnae
- papillary muscles
81
Hoarse voice:
Stretching of the left recurrent laryngeal nerve
- loops under the arch of the aorta next to the ligaamentum arteriosum
LRLN - supplies muscles of the larynx
82
Where do the following structures exit the diaphragm?
```
Inferior vena cava = T8
Esophagus = T10
Aorta = T12
- aorta bifurcation L4
- inferior vena cava L5
```
83
Celiac Trunk Branching
T12
84
Superior Mesenteric Artery
L1
85
Inferior Mesenteric Artery
L3
86
How does the superior part of common hepatic artery branch?
```
Right gastric
Proper hepatic
- left hepatic
- right hepatic
- - cystic
```
87
Where does the inferior part of common hepatic Branagh to?
Gastroduodenal artery
- anterior/posterior superior pancreatoduodenal branch
- anastomoses with anterior/posterior inferior pancreatoduodenal
- gastroomenal (gastroploic artery)
88
Where does the trachea bifurcate?
```
T4/T5
Manubristernal junction (sternal angle of Louis)
```
89
Where is the superior opening of thorax?
T1
1st pair of ribs
Superior border of manubrium
90
Where is the inferior thoracic apeture?
Bordered by T12
Xiphoid process of T9
Covered by diaphragm
91
What is the caval opening?
T8 level
Allows the IVC to empty into the RA
During inspiration, the diaphragm contracts and widens the caval opening to allow increased blood flow through the IVS
92
What is the order of covering of heart?
Pericardium (multilayered sac that covers the heart vessels)
Fibrous Pericardium
- thick connective tissue
- protects against overfilling
- keeps heart in position — attaches to the central tendon
- phrenic nerve
Inner Serous Pericardium (mesothelium of 2 layers)
- parietal
- visceral (epicardium, covers heart, continuous with parietal pericardium)
93
What is VSD?
Causes left -> right shunting
- leads to pulmonary hypertension
- might cause cardiac failure
94
Muscular VSDs
Often spontaneously close during birth
95
Membranous VSDs
Occurs as a result of complex formation -> affects the AV bundle of cardiac conduction system
96
What are ASDs?
Atrial septal defects
- incomplete closure of the foramen ovale
- clinically significant bc:
Allows shunting of blood from LA -> RA
Leads to overload of the pulmonary vascular system
Leads to Right Ventricular Hypertrophy
97
What is the ductus arteriosus?
Prenatal structure
- shunts blood from the left pulmonary artery to the arch of the aorta (left side of the heart)
at birth:
Increase in O2, bradykinin, decrease in prostaglandins = smooth muscle contracts and forms the ligamentum arteriosum
98
What is the sinus venarum?
Openings into the RA
SVC (3rd rib)
IVC
Coronary Sinus (with it cardiac vein supply)
99
What is the fossa ovalis?
Separates the RA and LA
100
What is the coronary sinus?
Situated between the IVC opening and the RV opening
101
What muscles are in the Rough RA?
Pectinate muscles
102
What smooth muscles are in the RA?
Sinus venarum
103
What forms the largest part of the anterior surface of the heart?
RV
- muscular traberculae carnae = internal RV
- papillary muscles = finger-like projections internal RV
104
What is systole?
ventricular contraction
AV valve stops regurgitation = blocks backflow into atrium
- blood outflows via conus arteriosus/infundibulum into pulmonary trunk
105
What is the conus arteriosus/infundibulum?
Outflow of blood from RV to pulmonary trunk
106
The pulmonary trunk bifurcated where?
Below the arch of aorta into left and right pulmonary arteries
107
What does the left pulmonary artery contain?
Ligamentum arteriosum, connects to the arch of the aorta
108
Where does the right pulmonary artery pass?
Posterior to the ascending aorta
109
Left Atrium
Has pectinate muscles
Has 4 pulmonary veins
Forms much of the base of the heart
110
Left Ventricle
Forms the apex. Of the heart
| Traberculae carnae and papillar muscles = coral tendinae
111
What supplies muscles to the larynx for phonation?
Recurrent laryngeal branch
Loops under arch of aorta
Adjacent to ligamentum arteriosum
112
What causes hoarse voice?
Aneurysm (widening) of the arch of aorta = might stretch laryngeal nerve
113
What does the AV have?
Chorale tender and papillary muscles
114
What are the SL values?
Between the ventricles and pulmonary trunk/aorta
115
When the aortic valve is closed..
Blood in the right and left aortic sinuses flow into the right and left coronary arteries
Occurs during diastole
116
What is systole?
AV valves closed
Prevents back flow
Blood proceeds through the open SL valves into pulmonary trunk or aorta
117
What is Diastole?
SL valves close shut during ventricular filling
Blood flows from the atria into the ventricles
118
What is the LUB sound?
Closure of the AV valves for systole
119
What is the DUB sound?
Closing of the SL valves for diastole
120
What is a stenotic murmur?
Narrowing of the vavle
| Slows blood flow
121
What is insufficiency?
Prolapse insufficiency
- failure of valve to close completely
- results in the backflow of blood into the chamber it was just ejected from
122
What is mitral valve insufficiency?
Occurs 1 in 20
| Chest pain and fatigue
123
What is aortic valve insufficiency?
Collapsing pulse
| Blood flow back into the left ventricle
124
What is semilunar valve stenosis?
Might lead to ventricular hypertrophy
125
What is aortic valve?
Occurs at the 2nd RICS parasternally
Closed during DIASTOLE = if defect, there is an insufficient murmur
Open during SYSTOLE = if defect, there is a stenoic murmur
126
What is the pulmonary valve?
2nd LICS parasternally line
Closed during diastole = if defect, there is an insufficient murmur
Open during systole = if defect, there is a stenoic murmur
127
What is the tricuspid valve?
5th LICS parasternal
Closed during Systole = if defect, there is an insufficient murmur
Open during Diastole = if defect, there is a stenoic murmur
128
What is the Mitral Valve?
5th LICS mid clavicle are line
Closed during systole = if defect, insufficient murmur
Open during diastole = if defect, stenoic murmur
129
What is cardiac referred pain?
Sympathetic to the heart, courses with sensory dorsal roots of upper thoracic segments
Pain from fibers in upper dermatology course with the pain fibers from the heart and the brain cannot distinguish between the two
130
Patent ductus arteriosus (PDA)
Detected as a machine like continuous heart murmur throughout systole/diastole
Treated with prostaglandin inhibitor
- otherwise, RV will become hypertrophic over time
131
What is tertraology of fallot?
Cyanosis
Malposition of aorticopulmonary septum:
- aorta widens
- pulmonary trunk narrows = PULMONARY STENOSIS
Due to:
- pulmonary stenosis
- overriding aorta
- VSD
- Right Ventricular Hypertrophy
blood from RV passes into overriding aorta
Murmur heard due to pulmonary stenosis
132
Coronary Arrteries
Located in the visceral pericardium
- supply the epicardium/myocardium
- Epicardium: receives nutrients from the blood in chambers
133
What lies in the coronary sulcus?
RCA
LCA - Circumflex Artery
Coronary Sinus (carries great cardiac vein)
134
What is the right coronary artery?
Arises from the ascending aorta, passing through the coronary sulcus
Splits into:
- marginal artery
- PIV (posterior interventricular)
Supplies:
- RA, RV
- SA/AV node
- part of the LV
- posterior IVS 1/3
135
What is the left coronary artery?
Arises from the ascending aorta
- passes between left auricle and pulmonary trunk
Branches into:
- circumflex: coronary sulcus around the left border to posterior side to supply the LA
- Left anterior descending:
- - anterior 2/3 of the IVS with the AV bundle
- - supplies part of the LV
136
What is the coronary sinus?
Main vein of the heart
| Runs left to right int he posterior part of the coronary sulcus
137
Great cardiac vein:
Runs along the LAD artery (anterior side), back to the circumflex artery (anterior side) and empties into the coronary sinus
138
Angina
Transient pain that results from myocardial ischemia (inadequate blood to the heart)
Pain is product of anaerobic metabolism (lactic acid) - stimulates pain receptors
139
Angina treated with..
Sublingual nitroglycerin to dilate coronary arteries
Disappears with rest
140
Coronary Artery Bypass Grafting
Surgery where the blood is rerouted to reach the myocardium
- uses portions of an alter artery and vein
Most common:
Internal thoracic arteries
Great saplenous vein
141
CAD
Myocardial ischemia that eventually leads to necrosis
142
What is myocardial infarction?
Ischemic necrosis of the myocardium
143
Coronary Atherosclerosis
Lipid deposition in the coronary artery causing ischemic heart disease
144
Angioplasty
Catheter with small balloon
- inflates and flattens plaque against the vessel wall
Femoral artery = access to the left heart
Femoral vein = access to the right heart
145
What are angiograms and arteriograms for?
Catheter into the femoral artery by wall of the inguinal region, passes into the ascending aorta
Uses a radiopaaque dye contrast
- injected into vein to allow visualization of lumen of vessel; allows for visualization of stenosis/occlusion
146
Where are the most common occlusion sites?
LAD (40-50%)
RCA (30-40%)
LCA circumflex (15-20%
147
Tracheal bifurcation
T4
148
What courses with the esophagus?
Vagus nerve
149
What drains structures above the diaphragm?
SVC at the 1st costal cartilage
150
Azygous Vein
Courses along the posterior thoracic wall
Arch of the azygous vein empties into the SVC
151
Esophagus
Found to the right of the aorta
Shifts left as it descends to eventually meet the stomach (exits diagphram as esophageal hiatus with the vagus nerve at T10)
152
Thoracic Duct
Arises below the diaphragm
Ascends vertically through the diaphragm, just right to the midline
Drains into the:
- left subclavian vein
- left internal jugular vein
153
Sympathetic trunk
Lies posterior to the mediastinum
Made up of paravertebral postsynaptic sympathetic ganglia
Greater, lesser, lesser splanchnic nerves = arise from the lower thoracic levels
154
Sympathetic nerve fibers
```
Increases:
- contractility
- rate of impulses in nodal tissues
- force of contraction
- coronary artery vasodilation
Relaxation of vascular smooth. Muscle with B2 adrenergic receptors
```
155
Parasympathetic fibers
Decrease heart rate via innervation of the vagus nerve (CN 10)
Vasoconstriction the arteries (decreases rate of impulses in nodal tissue via the Ach-muscarinic receptor interactions)
156
Pain sensations of heart due to ischemic myocardium
Course afferently along
| Cardiac sympathetic nerve fibers
157
Cardiac Pain
Skin in upper left arm bc spinal cord segments of cutaneous sensory nerves share common terminations for afferent visceral pain sensations
158
Fibrillation
Rapid twitches of cardiac muscle that occur in atria/ventricle
Ventricular fibrillation = poor pumping activity (defibrillator elective shock might reset ventricular contraction)
159
SA node
SVC-RA junction
Heart pacemaker
~70 impulses per minute
SA -> atrium -> AV node
160
AV node
Interarterial septum
Ventricular contraction after atrial contraction
AV node delays the SA node impulse before signaling to the AV bundle
161
AV Bundle of His
Membranous IVS
Right bundle branches - muscular
Left Bundle Branches (muscular IVS)
Purkinje Fibers in ventricular Walls
If damaged: no conduction signal from atria->ventricles (results in heart block)
162
Septomarginal Trabercula
Cardiac muscle band is shortcut with purkinje fibers that transit:
Right bundle branch in muscular IVS -> across RV -> anterior papillary muscle to coordinate conduction for contraction timing
163
Heart Block
Not enough blood is getting to the heart
Occlusion in the LAD (most of AV bundle, anterior 2/3 of IVS)
OR
Occlusion in the RCA (supplies the SA/AV nodes)
164
Bundle Branch Block
Ventricular contractions are impaired
Late and asynchronous ventricular contraction
Subcutaneous and artificial pacemaker might be implanted
- produces electrical impulses that initiate ventricular contractions
Occurs if damage to the bundle branches (located in the ventricles)
165
Nodal Tissues...
Provide action potentials to the cardiac myocytes (signal is propagated myogenically via gap junctions)
Into chamber wall, all contract in a coordinated effort
166
Connections of intercostal artery
Origin: posterior from thoracic aorta
Distributes: intercostal spaces
167
Connections of Superior Epigastric Artery
Origin: internal thoracic artery
Distribution: abdominal muscle, anastomoses with inferior epigastric
168
Connections of inferior epigastric
Origin: external iliac artery
Distribution: courses deep to the rectus; anastomoses with superior epigastric artery
169
Lumbar artery
Origin: abdominal aorta
Distribution: posterior abdominal wall
170
Umbilicus Nerve Supply
T10 dermatologist
171
Where are the nerves in the anterolateral abdominal wall located?
Between the transversus abdominus and internal oblique muscles
172
Anterolateral abdominal wall nerves
Ventral rami of six intercostal nerves
Subcostal nerves (T12)
Iliohypogastric (L1)
Ilioinguinal (L1) - emerges from the inguinal canal
173
Iliolingual Nerve
Emerges from the inguinal canal, lateral to the spermatic cord or the round ligament of the uterus
174
Inguinal canal
4cm in length
- passage way for the testes to descend from the kidneys and into the scrotum
- transmits the spermatic cord in male and round ligament of uterus in females
175
Superficial / External Ring
Gap in aponeurosis in external abdominal oblique
| Opens up into the subcutaneous layer
176
What does formation of the inguinal canal begin with?
Process vaginalis
- formed by invagination of the peritoneum, which then Eva giants the other layers of the abdominal wall
- except the transversus abdominus
177
Gubernaculum
Connective tissue
Connects the caudal end of the testes with the scrotum
- When it shortens, it pulls the testes into the canal
- In females, the gubernaculum becomes the round ligament of uterus
178
Anterolateral Abdominal Wall - 4 quadrants
Median plane
Trans umbilical plane (L3/L4)
179
Anterolateral Abdominal Wall’s. 9 Regions
```
HEH:
Hypochondriac - Epigastric - Hypochondriac
LUL:
Lumbar - Umbilical - Lumbar
IHI:
Inguinal - hypogastric - Inguinal
```
Cut by:
2 midclavicular vertical planes
Subcostal Plane (L2 - inferior to the 10th rib)
Transtubercular (L5)
180
Iliac Crest
Attachment site for muscles (L4)
181
Iliac Tubercle
Corresponds to L5
182
ASIS: anterior/superior iliac spine
Attachment for muscles and the inguinal ligament
Pubic Tubercle - attachment site for the inguinal ligament
183
Layers of the abdominal wall
```
SEITTEP
Subcutaneous Tissue
External Abdominal Oblique
Internal Abdominal Oblique
Transversus Abdominal Muscle
Transversalis Fascia
Extraperitoneal Fat
Parietal Peritoneum
```
184
What are flat muscles of abdomen for?
Primarily responsible for compression of the broken/modulating intra-abdominal pressure
185
What is the rectus abdominus?
T7-T12
Flexes the trunk
- originates at the pubic symphysis and inserts onto the xiphoid process
186
Linea Alba
Midline of the rectus abdominus (aponeurosis of rectus abdominus)
187
Acurate Line
All 3 muscles pass anteriorly
188
Posterior Lamina of the Rectus Sheath
Aponeurosis of the transverses abdominus
189
Anterior Lamina of the Rectus Sheath
Formed from the
- aponeurosis of the external oblique
- 1/2 of internal oblique
190
Contents of the Inguinal Canal for Males
Ductus deferens
Testicular Vessels
Autonomic Nerve
Lymphatics
191
What are the coverings of the inguinal canal?
Internal Spermatic Fascia (transversalis fascia)
Chemasteric Fascia (Internal Abdominal Oblique)
External Spermatic Fascia (External Oblique Fascia)
192
Inguinal Hernias
Portions of fat/bowel might protrude when intra-abdominal pressure is increased (laughing fit or urination)
Reducible - contents can be returned
Irreducible - contents can’t be returned
Strangulated Hernia - contents of sac become ischemic as a result of arrested circulation
193
Direct Inguinal Hernia
Inferior to the epigastric blood vessel (artery that arises from the external iliac artery)
- extends through Hesselbach triangle
- acquired over time as transversalis becomes stretched
194
Indirect Inguinal Hernia
Process vaginalis typically obliterates
- occurs lateral to the inferior epigastric blood vessels
- most commonly congenital
- occurs into the deep inguinal ring
Tunica vaginalis remains anterior to the testes
195
What supplies the midgut?
SMA
2nd part of duodenum -> left 1/2 transverse colon
Anastomoses with IMA via the marginal artery
196
What branches off the SMA?
Anterior and posterior inferior pancreatic duodenal artery
Intestinal Arteries (jejunum/ileum branches)
Ileocolic Artery
Right Colic Artery
Underneath the intestines = middle colic artery - anastomoses into marginal artery
197
Inferior Mesenteric Artery
L3 (SMA is at L1)
Supplies the hindgut
Left transverse 1/3 colon -> Superior Rectum
- Left Colic Artery
- Sigmoidal Artery
- Superior Rectal
198
What branches do the abdominal aorta give off?
```
Inferior phrenic - Parietal
Lumbar artery - Parietal
Middle suprarenal - Visceral
Renal - Visceral
Gonadal testicular artery - Visceral
ILMRG
```
199
What are the terminal branches of the abdominal aorta?
Common iliac -> Internal Iliac and External Iliac
| Median sacral
200
I 8
10 E
A 12
Inferior Vena Cava = T8
T10 = esophagus
Aorta = T12
201
What are abdominal branches off the aorta?
Celiac Trunk (T12)
SMA (T1)
IMA (T3)
202
What does the celiac trunk supply?
```
T12
Foregut
- lower esophagus
- duodenum 1st half
- liver
- gall bladder
- pancreas/spleen
```
*anastomoses wit the SMA via the pancreaticduodenal arteries*
203
Celiac Trunk branches off into..
Left Gastric
Splenic (coiled)
Common Hepatic
204
Superior branches of the common hepatic
Right gastric (over the lesser curvature)
Proper Hepatic
- Left Hepatic
- Right Hepatic (-> Cystic)
205
Gastroesophageal Anastomoses
Left Gastric -> Esophageal vein -> Azygous Vein
206
Anorectal Anastomoses
Superior rectal vein -> Middle and Inferior Rectal Vein -> Internal Iliac Vein
207
Paraumbilical Anastomoses
Paraumbilical vein -> superficial epigastric vein -> axillary or femoral vein
208
Retroperitoneal Anastomoses
Colic Vein -> Retroperitoneal Vein -> IVC
209
Abdominal Aorta Aneurysm
Dilation of the aorta 1.5x the normal size
- occurs when a wall becomes weakened/expands
- 75% of patients are asymptomatic, males more likely to have, confirmed by ultrasound
210
Terminal branches of the IVC
median sacral
Common iliac, external and internal iliac vein
Lumbar veins
211
What drains into the left renal vein?
Left suprarenal vein
| Left testicular/ovarian vein
212
Hepatic Portal Venous System
Splenic Vein/Superior Mesenteric Vein/Inferior Mesenteric Vein
Blood with nutrients from the GI course into the Liver
Liver -> Hepatic Vein (processing/detoxification) -> IVC
213
What is enclosed in the hepatoduodenal ligament?
Portal Triad
- hepatic portal vein (to the liver!)
- common bile duct
- proper hepatic artery
214
Liver Lobectomy
Removal of the lobe = possible if a tumor is isolated to a certain region
Due to: organized blood supply of hepatic arteries/venous branches
215
Hepatic Proper Artery
Provides 30% of total blood to the liver
Whereas...
Hepatic Portal Vein = 70% of the blood to the liver
Then both travel through hepatic veins -> IVC
216
Portal Hypertension
Increased resistance forces blood into alternative pathways and back to systemic circulation.
Might cause varies (dilation of veins) at the site of anastomoses.
Occurs secondary to liver pathology (cirrhosis, tumor, thrombosis of portal vein)
Common in chronic alcoholism
217
What are the vessels to the diaphragm?
Phrenic nerves
Inferior phrenic arteries
Azygous Vein
218
What are the muscles in the posterior abdominal wall?
```
Diaphragm
Quadratus Lumborum
Psoas Major
Psoas Minor
Iliacus
```
Most laterally:
- external oblique
- internal oblique
- transversalis
219
What are the nerves of the abdomen?
Celiac ganglion
Superior mesenteric ganglion
Aorticorenal ganglion = supplies ureters
Inferior mesenteric ganglion
Sympathetic Trunk - lumbar splanchnic nerves
Superior Hypogastric Plexus - at the bifurcation of aorta
220
Where do the ureters naturally constrict at?
1. Renal pelvis
2. Crossing the pelvic brim
3. Entering the bladder
221
Where do the adrenal veins drain into?
The renal veins
222
Where does the left gonadal vein drain into?
The renal vein
The arterial connection on th aorta reminds us of the origin of the testes on the posterior abdominal wall
223
What is the SMA in a position to do?
Compress the left renal vein
224
Major Calyx
Where multiple minor calyces join
Multiple major calyx join into the renal pelvis
225
What is the papilla?
The tip of the renal pyramid
226
Ureter
Retroperitoneal space
| - muscular duct that conveys urine from renal pelvis into the urinary bladder
227
What is the pain of kidney stones being lodged at...
1. Renal pelvis
2. Pelvic brim
3. Entrance to bladder
Experience flank pain: loin to groin pan (T11-L2)
228
Where are kidneys usually transplanted to?
Iliac fossa
Make the ureter as short as possible, yet must have a good supply=therefore you take the 1st third of ureter with it.
The renal artery and vein is anastomosed to the external/internal iliac artery/vein.
229
What holds the valve closed in the bladder?
Pressure
| Urine enters the bladder via peristalsis in the ureter
230
What innervates the ureter?
Aoritcorenal plexus
Blood supply: renal artery/gonadal artery
231
What artery lies just inferior to the renal arteries?
Gonadal arteries
232
Where does the testicular artery go into?
Deep inguinal ring
233
Where do the ovarian arteries go into?
Pelvic Brim
234
Where do the suprarenal arteries drain into?
Drain into the renal veins
235
Where does the left gonadal vein drain into?
Renal vein
236
Where can the gonadal veins be traced from?
From the pelvis (women) or from the deep inguinal ring (male)
237
Lumbar Plexus = SIIGLFO
```
Subcostal
Iliohypogastricc
Ilioinguinal
Genitofemoral (emerges from psoas major)
Lateral Femoral Cutaneous Nerve (passing along the ilacus muscle)
Femoral
Obturator (medial to the psoas major)
```
238
For renal innervation...
Preganglionic sympathetic: directly onto the cells of the adrenal medulla
Postganglionic sympathetic: blood vessels
239
Iliohypogastric nerve
Found along the Iliac crest
240
Ilioinguinal nerve
Found exiting the superficial inguinal nerve
241
Femoral nerve
Found lateral to the distal end of the psoas major
242
IMV courses into the...
Hepatic portal vein
243
What lies more left in the abdomen?
Aorta
244
What lies more right in the abdomen?
IVC
245
Aortic bifurcation occurs at...
T4
246
Where does IVC bifurcate?
L5
247
What are the branches off the splenic artery?
Pancreatic artery
| Left gastroomentum / gastroeploic = anastomoses with the right gastroomentum
248
What is the branch off the left gastric?
Anastomoses with right gastric artery on the lesser curvature
249
What are the branches off the common hepatic?
Gastroduodenal
Right Gastric
Proper Hepatic
250
What are the branches off the gastroduodenal?
Posterior and anterior superior pancreatic duodenal
| Right Gastroomenal
251
When does abdominal aortic anuerysm occur?
1.5x more dilation of aorta (occurs when the segment becomes weakened and expands)
252
What branches off the IMA?
To the hindgut at L3
- left colic (descending colon)
- sigmoid artery (3-4, sigmoid colon)
- superior rectal artery
Left 1/3 transverse -> superior rectal
253
SMA
Supplies the midgut
2nd half of duodenum to the left 1/3 transverse colon
Compression on SMA leads to obstruction of renal vein
Anastomoses with IMA via marginal artery
254
What are the left side contributors of the SMA?
Jejeunal intestinal arteries
Ileum intestinal arteries
Arterial arcades/vasa recta
255
What are the right side contributors from SMA?
```
Ileocolic (ileum-colon junction)
Right Colic (ascending colon)
Middle Colic (transverse colon)
```
256
What part of duodenum does the common bile duct exit into?
Mid way down (retroperitoneal)
257
Spleen
Filters blood and not lymph
Recycles Hb to the liver to make bile salts
Aids in immune function
258
Ligamentum Venosum
Obliterated ductus venosus
259
Cantile’s Line
Divides the left and right lobes
260
Epiploic Foramen of Winslow
Opening into lesser sac (omental bursa)
261
Parietal peritoneum
Lines the walls of the abdominal cavity
262
Visceral peritoneum
Covers organs
263
Mesentery of GI
Double layer of peritoneum that connects organ to the body wall
264
Ligament of GI
Double layer of peritoneum that connects one organ to another
265
Falciform ligament -
Ligamentum teres hepatis in the liver
266
Intraperionenal organs
Organs surrounded by peritoneum
| Suspended from abdominal wall by mesentery
267
Tanea Coli
Longitiudinal muscle layers in the intestines
268
Umbilicus
L4
269
9 regions in the abdominal planes
```
Midclavicular lines
Subcostal line (L2 - Rib 10)
Transtubercular line (L5)
```
HEH - right hyogastric, epigastric, left hypogastric
LUL - right lumbar, umbilical (L3/L4), left lumbar
IHI - right inguinal, hypogastric, left inguinal
