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Gross Anatomy > Heart > Flashcards

Flashcards in Heart Deck (269):
1

What is the thoracic cage made from...

12 vertebrae /IVD
12 pairs of ribs/costal cartilages
Sternum

2

What comprises the sternum?

Manubrium
Body
Xiphoid Process (T9)

3

What is the sternal angle of Louis?

Manubriosternal junction
T4/T5 IVD level
- articulates at rib 2
- bifurcation of the trachea
- arch of aorta

4

How are intercostal spaces arranged?

Numbered according to the superior rib

5

What is the superior thoracic aperture?

Superior opening of the thoracic cage
- esophagus
- trachea
- neurovasculature

Thoracic Outlet Syndrome = structures affected by the obstruction of superior thoracic artery

6

What is the inferior thoracic aperture?

Bordered by..
- T12
- ribs 11-12
- costal cartilages 7-10
- xiphoid process at T9

Covered by diaphragm

7

Where is the caval opening of the inferior thoracic aperture?

IVC
T8

8

What is the esophageal hiatus?

vagus nerve CN 10
Esophagus
T10

9

What is the aortic hiatus?

Aorta
Azygous
Thoracic duct
T12

10

What is the mediastinum?

Houses the thoracic structures, excepts for the lungs/pleura
- fatty/loose connective tissue = facilitates movement
- becomes less flexible with age and repair

11

What does widening of the mediastinum indicate?

Indicative of the laceration of the great vessels, lymphoma, cardiac hypertrophy

12

What connects the superior mediastinum and inferior mediastinum?

Transverse thoracic plane

13

What’s the pericardium?

Middle mediastinum

Outer fibrous
Inner serous

14

What is the outer fibrous pericardium?

Thick, inelastic
Attached to central tendon/sternum

15

What is the inner serous pericardium?

Mesothelioma with connective tissue

Contains the:
- parietal pericardium
- visceral pericardium: epicardium/covers the heart

16

What is the pericardial cavity?

In between the parietal and visceral pericardium
Contains serous fluid

Pericarditis=inflammation of the pericardium

17

What is the duodenalojejunum junction?

Where the duodenum emerges from behind the peritoneum
On the right side of the abdominal cavity

18

What does the superior mesenteric artery branch to?

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

What does the middle colic artery supply?

The transverse colon

20

What is the first portion of the colon/ascending colon

Cecum
Attaches to ileum and the veriform appendix (found just posterior)

21

What is the second portion of the colon?

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

Where do the preganglionic sympathetic neurons come for heart?

IMLCC T1-T4

23

Where do the postganglionic neurons for heart innervation come from?

They exit the sympathetic chain to mix into the cardiac plexus before entering the heart tissue.

24

What does sympathetic innervation to the heart cause?

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