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Sectional Anatomy Flashcards

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1
Q

Gross Anatomy, Microscopic Anatomy & Physiology

A

Emphasis on BODY SYSTEMS

Look at SHAPE, LOCATION, FUNCTION

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2
Q

Sectional Anatomy

A

Regions of the body
Relationships with all structures of given region
Anatomy viewed in SLICES

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3
Q

Superior, Cranial, Cephalic

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Toward head or above

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4
Q

Inferior, Caudal,

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Towards feet or below

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5
Q

Anterior, Ventral

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Towards front of structure or surface

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6
Q

Posterior, Dorsal

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Towards back of structure or surface

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7
Q

Medial

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Toward midline

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8
Q

Lateral

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Towards side of body

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9
Q

Superficial, External

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Near body surface

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10
Q

Deep, Internal

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Away from body surface

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11
Q

Proximal

A

Closer to point of origin or trunk

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12
Q

Distal

A

Further from the point of origin or trunk

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13
Q

Ipsilateral

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On same side

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14
Q

Contralateral

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On opposite sides

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15
Q

Visceral

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Referring to organs

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16
Q

Parietal

A

Body walls

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17
Q

Prone

A

Patient lying face down

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18
Q

Supine

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Patient lying face up

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19
Q

True Lateral

A

On right or left side at 90 degrees LATERAL DECUBITUS

Name = side touching table

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20
Q

Lateral Oblique

A

Angle less than 90 degrees

Name = side touching able and surface closest to table

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21
Q

Erect

A

Standing or sitting upright

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22
Q

Semi-erect

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Partially upright

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23
Q

Trendelenburg

A

Feet higher than head

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24
Q

Reverse trendelenberg

A

Head higher than feet

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25
Body cavities
Natural spaces containing internal organs SEPARATES, PROTECTS, SUPPORTS Allows movement and expansion
26
Dorsal cavity
Posterior and superior CNS Cranial and spinal cavities
27
Cranial
contains brain and associated structures | Surrounded by bones
28
Spinal
Contains spinal cord and nerves | Protected by spinal vertebrae
29
Ventral cavity
Large space in anterior aspect of body Organs known as viscera Thoracic and abdominopelvic
30
Thoracic
Superior portion of ventral cavity Lungs and heart Diaphragm separates from abdominopelvic cavity Pleural cavity and mediastinum
31
Pleural cavity
Contains lungs | Lubricated to reduce friction
32
Mediastinum
Between the pleural cavities | Heart located in pericardium
33
Abdominopelvic cavity
Diaphragm to pelvis Lined with serous membrane Subdivided into superior abdominal cavity and inferior pelvic cavity with no muscular separation
34
Abdominal cavity
Upper portion abdominopelvic cavity | Inferior surface of diaphragm to superior bony pelvis
35
Pelvic cavity
Lower portion abdominopelvic cavity Within bony structure of pelvis True and false pelvis
36
True pelvis
Pelvic inlet to birth canal | Bladder reproductive organs
37
False pelvis
Above pelvic brim below iliac crests | Small intestine colon
38
Anatomical landmarks
``` Sternal notch Xiphoid process Subcostal margin Iliac crests Symphysis pubis ```
39
Arteries
Carry blood away from heart Carry oxygenated blood except pulmonary arteries Thick walls to withstand high pressure and high blood flow 3 layers
40
Lumen
Innermost portion of artery
41
Tunica intima
Inner layer of artery wall
42
Tunica media
Muscular middle layer of artery wall
43
Tunica adventitia
Outermost portion of artery wall
44
Aorta
``` Starts at AORTIC HIATUS level of T12 PROXIMAL portion = more POSTERIOR DISTAL portion = more ANTERIOR LEFT of MIDLINE BIFURCATES at L4 RETROPERITONEAL ```
45
Celiac Axis/=Trunk
First major branch of aorta 1cm in length ANTERIOR aspect of aorta Has 3 branches: COMMON HEPATIC ARTERY, LEFT GASTRIC ARTERY, SPLENIC ARTERY
46
Common Hepatic Artery
Branches toward the right and liver | Divides into HEPATIC ARTERY PROPER and GASTRODUODENAL ARTERY
47
Splenic Artery
Travels left along SUPERIOR aspect of PANC | Carries blood to SPLEEN and PANC TAIL
48
Left Gastric Artery
Travels along left and upward path along lesser curvature of stomach
49
Right and Left Adrenal (SUPRARENAL) Artery
Paired Arise from LATERAL side of aorta Between celiac axis and SMA Course OBLIQUELY to adrenal glands
50
Superior Mesenteric Artery SMA
Second ANTERIOR branch of aorta Travels ANTERIOR then INFERIOR Supplies SMALL INTESTINE, ASCENDING COLON, TRANS COLON
51
Renal Arteries
Paired LATERAL branches of aorta Just INFERIOR to level of SMA RRA slightly INFERIOR and LONGER than LRA Renal arteries run POSTERIOR to renal veins RRA passes POSTERIOR to IVC
52
Gonadal Arteries ( ovarian, testicular)
Paired, originate from ANTERIOR aorta INFERIOR to renal arteries Travel INFERIORLY OBLIQUELY
53
Inferior Mesenteric Artery IMA
ANTERIOR branch at L3 Travels INFERIORLY and LEFT Supplies LEFT TRANS COLON, DESCENDING AND SIGMOID COLON AND RECTUM
54
Lumbar Arteries
Paired with 4-5 sets LATERAL POSTERIOR Supply LUMBAR REGION
55
Median Sacral Arteries
Most INFERIOR branch | Supplies SACRUM
56
Common Iliac Arteries
Aorta BIFURCATES at L4 into RIGHT and LEFT common iliac arteries Arteries travel INFERIOR LATERAL Sit ANTERIOR yo COMMON ILIAC VEINS Further branch into internal and external iliac arteries
57
Veins
Return blood to the heart Carry deoxygenated blood back to heart except pulmonary veins Low pressure blood flow so walls collapsible Large veins formed by union of smaller veins
58
Inferior Vena Cava IVC
``` Largest vein in the body Formed by union of common iliac veins at L5 Pierce’s DIAPHRAGM at T8 SUPERIORLY = more ANTERIOR INFERIORLY = more POSTERIOR RIGHT of MIDLINE RETROPERITONEAL ```
59
Common Iliac Veins
Formed by union of external and internal iliac veins at S1 Travel OBLIQUELY from LATERAL to MEDIAL Sit POSTERIOR to common iliac arteries and ureters
60
Lumbar veins
4-5 pairs Enter at LATERAL walls of IVC Drain into IVC or AZYGOS system
61
Gonadal veins ( ovarian, testicular)
Paired Ascend along path of PSOAS muscle and run ANTERIOR to ureters RIGHT GONADAL VEIN = DIRECT TRIBUTARY LEFT GONADAL VEIN = DRAINS INTO LEFT RENAL VEIN
62
Renal Veins
Exit renal hilum and drain into LATERAL IVC Sit ANTERIOR to renal arteries RRV = SHORTER and INFERIOR to LRV LRV = runs POSTERIOR to SMA but ANTERIOR to AORTA LEFT GONADAL and LEFT SUPRARENAL drain into LRV
63
The Adrenal veins
Travel along same path as arteries Small not seen on US RIGHT ADRENAL directly into IVC but LEFT ADRENAL into lEFT RENAL
64
The Hepatic veins
Right Middle and Left = each drain different lobe Travel from INFERIOR ANTERIOR position to SUPERIOR POSTERIOR TO DRAIN INTO IVC Empty into IVC just INFERIOR to DIAPHRAGM each with own entrance into IVC One of two venous systems
65
Liver
Largest organ in the body INTRAPERITONEAL Fibrous GLISSONS CAPSULE covers external surface Almost completely covered by visceral peritoneum Size and shape are variable but triangular from anterior window
66
Function of liver
Metabolic activities PRODUCTION and SECRETION of bile Filtration of blood to remove toxins
67
Location of liver
RUQ sometimes extends into LUQ Right hypochondriac and epigastric region sometimes left hypochondriac Right kidney, gallbladder, right colon all inferior
68
Surfaces of liver
Diaphragmatic and visceral
69
Diaphragmatic surface of liver
Dome shaped/ convex and smooth ANTERIOR, SUPERIOR, PARTI POSTERIOR in contact with diaphragm Peritoneal membrane covers most of ANTERIOR SUPERIOR surface BARE AREA = posterior surface with no peritoneum, boundaries are coronary and triangular ligament FALCIFORM LIGAMENT divides ANTERIOR surface into LEFT and RIGHT
70
Visceral surface of liver
INFERIOR surface with OBLIQUE orientation Covered with peritoneum In contact with several organs forming grooves and undulations on surface
71
Lobes - traditional method
Liver divided into 4 lobes based on surface structure FALCIFORM LIG boundary for right and left lobe Quadrate and caudate part of right lobe but their own section
72
Lobes- functional/segmental method`
Liver divided into lobes according to hepatic function- true morphological and physiological divisions Boundaries are different than traditional method Each lobe has its own arterial blood supply and separate biliary drainage Right and left lobe are further divided into segments Named based on Couinauds classification Lobes= divisions according to anatomy Segments = divisions according to function
73
Liver lobes and major segments
Imaginary plane drawn joining gallbladder fossa to IVC - coincides with the MAIN LOBAR FISSURE and MIDDLE HEPATIC VEIN This plane divides the RIGHT and LEFT functional lobes of the liver MAIN LOBAR FISSURE = anatomical division MIDDLE HEPATIC VEIN = ultrasound division
74
Right lobe of liver
Divided into ANTERIOR and POSTERIOIR segments RIGHT INTERSEGMENTAL FISSURE = anatomical division RIGHT HEPATIC VEIN and RIGHT PORTAL VEIN = ultrasound division HEPATIC = superior PORTAL = inferior
75
Left lobe of liver
Divided into MEDIAL (USED TO BE QUADRATE) and LATERAL segments LEFT INTERSEGMENTAL FISSURE = anatomical division LEFT HEPATIC VEIN and LEFT PORTAL VEIN = ultrasound division - superior - inferior
76
Caudate lobe of liver
POSTERIOR and SUPERIOR in liver Separate structure and receives blood from both right and left side ANTERIOR BOUNDRY = LPV adn LIG VENOSUM POSTERIOR BOUNDARY = IVC
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Couinauds classification
Important for surgery 8 segments numbered from 1-8 Caudate lobe is number one
78
Normal variants of liver
Reidels lobe = inferiority segment of right lobe reach iliac crests
79
Ligaments and peritoneal attachments of liver
Fibrous stretchy attachments Tether liver to abdominal cavity Good ultrasound landmarks Form boundaries for lobes and segments
80
FALCIFORM ligament
Peritoneal fold Connects liver to diaphragm adn anterior abdominal wall Runs along anterior surface from diaphragm to umbilicus Continuous with LIG teres on visceral surface Division between RIGHT and LEFT SUBPHRENIC SPACES
81
Ligamentum teres
Known as round ligament Arises from umbilicus adn is remnant of fetal Left umbilical vein Connects to FALCIFORM LIG on ANTERIOR INFERIOR surface Extends POSTERIORLY on INFERIOR surface to join LIG VENOSUM DIVIDES LEFT LOBE INTO MEDIAL ADN LATERAL SEGMENTS AS ULTRASOUND SEGMENTS
82
Ligamentum Venosum
Obliterated remnant of ductus Venosus in fetus MARKS DIVISION OF CAUDATE LOBE FROM LEFT LOBE OF LIVER on ultrasound Runs aPOSTERIORLY from LIG TERES at level of PORTA HEPATIS on visceral surface Attaches INFERIOR surface of liver to stomach or duodenum
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Fissures
Groove cleft or deep furrow in organ Form NATURAL DIVISION Liver has several issuer where other structures run within them
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right Intersegmental fissure
DIVIDES RIGHT LOBER INTO ANTERIOR POSTERIOR segments | Right hepatic vein runs through it more SUPERIORLY. And portion of right portal vein more INFERIORLY
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Left Intersegmental fissure
DIVIDES LEFT LOBE INTO MEDIAL AND LATERAL segments Fissure divides into thirds - cranial = left hepatic vein in upper part Middle = anterior portion of left portal vein caudal = LIG teres in lower
86
main lobar fissure
Called middle Intersegmental fissure of interlobar fissure DIVIDES RIGHT AND LEFT LOBES Middle hepatic vein runs SUPERIORLY Can be seen in transverse plane as hyperechoic from GB to RPV
87
Hepatic veins
Drain blood from liver to IVC Course INFERIOR ANTERIOR to SUPERIOR POSTERIOR 3 major hepatic veins drains into IVC with accessory in 30% of pop RHV = RIF LHV = LIF MHV= MLF Hepatic veins join IVC just below diaphragm RHV= RL MHV= MLL ARL LHV= LL Wall less hyperechoic
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Hepatic arteries
Supply 20-30% of blood to liver | Right branch of celiac axis
89
Common hepatic artery
Origin at celiac axis to junction at gastroduodenal artery | EXTRAHEPATIC
90
Hepatic artery proper
From GDA to bifurcation of righ tand left hepatic arteries Courses SUPERIORLY and RIGHT LATERAL PORTA HEPATIS= entrance/exit to liver PORTAL TRIAD = hepatic artery, portal vein, and bile duct at PH it is PHA + CBD + MPV ANTERIOR to MPV MEDIAL to CBD EXTRAHEPATIC
91
Right and left hepatic artery
INTRAHEPATIC Travel in unison with biliary duct adn portal vein RHA= RIGHT LOBE AND BRANCHS TO CAUDATE LHA= LEFT LOBE
92
The portal system
Carries nutrient rich blood from GI tract to liver about 70-80% of blood Portal systems does not connect directly to IVC but to hepatic veins first Blood flows toward and within lobes MAIN PORTAL VEIN formed by union of SMV and SPLENIC VEIN at PORTAL CONFLUENCE behind neck of pancreas at L2
93
SMV
Drains SMALL INTESTINE ASCENDING COLON TRANS COLON Courses superiorly to meet splenic vein at portal confluence Distal end terminates POSTERIOR SURFACE of PANC NECK On RIGHT of SMA
94
Splenic vein
Drains SPLEEN and PANC ADN STOMACH Courses from hilum of spleen to meet SMV on RIGHT OF MIDLINE travels POSTERIOR SURFACE PAN INFERIOR to SA Terminates behind neck of pan at portal confluence ANTERIOIIR to aorta IVC SMA and renal vessels
95
IMV
Drains left small bowel descending colon sigmoid and rectum | Joins SV posterior to body of pan left of midline
96
Main portal vein
EXTRAHEPATIC Origin at junction of SMV and SV behind neck of Panc Ascends obliquely toward right side Enters liver at PORTA HEPATIS POSTERIOR to HAP AND BILARY DUCTS ( CBD AND CHD) Bifurcates into right and left portal veins at hilum Located POSTERIOR TO SUODENUM AND ANTERIOR TO IVS Encloses by free edge of LESSER OMENTUM
97
Right portal vein
Intrasegmental | Divides into ANTERIOR AND POSTERIOR branch’s in right lobe
98
Left portal vein
Intrasegmental Ascends anteriorly Divides into MEDIAL AND LATERAL branches in left lobe
99
The biliary system
Produces. Concentrates, secretes, and transports bile from liver to duodenum Bile formed in liver cells ( HEPATOCYTES) and drains through ducts Bile used in digestion of fats in diet
100
Location of biliary system
RUQ | Right hypochondrium and epigastric region
101
Gallbladder
Reservoir for bile Oblong/ pear sac Locates in depression on visceral surface of liver INTRAPERITONEAL = binds neck and body to liver Anterior landmark dividing right and left lobe with MLF LATERAL to IVC MEDIAL to RIGTH KIDNEY
102
Neck of gallbladder
Narrow tapered superior portion FIXED | MLF extends SUPERIORLY to RPV
103
Body of gallbladder
Middle portion between neck adn fundus FIXED
104
Fundus of gallbladder
INFERIOR ANTERIOR portion MOBILE | Sometimes extends beyond inferior margin of right lobe
105
Normal variants of gall bladder
Pharygian cap = fold in fundus Junctional fold = fold at junction of neck and body Hartmanns pouch = small posterior pouch near neck
106
The duct system
Pathway of ducts collecting and transporting bile secreted by liver to small intestine Subdivided into INTRAHEPATIC and EXTRAHEPATIC Ductal network has several branched along path
107
INTRAHEPATIC ductules
Very small bile ducts within liver collecting bile secretions from liver tissue Branches get LARGER along biliary tree Follow course of hepatic arteries and portal veins ( portal triad) Not usually on ultrasound except when blocked
108
Right and left hepatic ducts
RHD= bile from right lobe LHD = bile from left lobe Join at liver hilum
109
Common hepatic duct
Formed at junction of RHD and LHD Distal end courses along anterior aspect of R/MPV Terminates at junction of CYSTIC DUCT
110
Cystic duct
Drains gallbladder and merges with CHD to FORM CBD | Contains SPIRAL VALVES OF HEISTER - not true valves just folds that provide structural support
111
Common bile duct
Formed at union of CD and CHD Travels INFERIORLY towards HEAD OF PANC Junction of PANCREATIC DUCT AND CBD FORM AMPULLA OF VATER (DOOR WAY INTO DUODENUM) that dumps into DUODENUM AT SPHINCTER OF ODDI (DOOR) 6-8 cm ANTERIOR to MPV and LATERAL to HEPATIC ARTERY PROPER DISTAL CBD travels ALONG or within POSTERIOR aspect of PANC HEAD
112
Pancreas
Elongated lobular gland Lies in TRANSVERSE and OBLIQUE across MIDLINE and extends toward spleen at TRANSPYLORIC LEVEL NO CAPSULE = hard to see on ultrasound Predominately RETROPERITONEAL except portion of TAIL ENDOCRINE ( 1% ISLETS OF LANGERHANS) EXOCRINE ( 99% ENZYMES for DIGESTION) Duct system transports bile and pancreatic juices to the duodenum
113
Location of pancreas
Right upper quadrant and left upper quadrant | Epigastric and left hypochondrium regions
114
Head of pancreas
Bulbous portion located RIGHT of MIDLINE Surrounded by ALL 4 PARTS OF DUODENUM Lateral head edge= created by medial curve of DESCENDING DUODENUM Medial head edge= marked by SMV and NECK of PANCREAS IVC lies POSTERIOR to head RRA and RRV travel POSTERIOR to head Accessory pancreatic ducts found within pancreatic head
115
Landmarks of head of pancreas
GASTRODUODENAL ARTERY lies along ANTEROLATERAL portion of head CBD is positioned along POSTEROLATERAL aspect of head - eats pancreatic duct at HEPATOPANCREATIC AMPULLA ( ampulla of vater) within central portion of head - AMPULLA OF VATER drains secretions towards medial wall of the DESCENDING DUODENUM via SPHINCTER OF ODDI
116
Uncinate process
POSTEROMEDIAL EXTENSION of pancreatic head Directly POSTERIOR to SMV and ANTERIOR TO IVC Variable in size
117
Neck of pancreas
Directly ANTERIOR to SMV near PORTAL VEIN Directly POSTERIOR to PYLOROUS of STOMACH RIGHT side of SMA
118
Body of pancreas
Most ANTERIOR portion of Panc between neck and tail Lies POSTERIOR to ANTRUM of STOMACH Lies ANTERIOR to AORTA SMA SPLENIC VEIN LRV LRA SPINE INFERIOR to SPLENIC ARTERY
119
Tail
Most SUPERIOR portion of Panc | Extends from LEFT LATERAL EDGE OF SPINE to HILUM OF SPLEEN
120
Anatomical relationships to tail of pancreas
ANTERIOR to UPPER/MIDDLE portion LK POSTERIOR to STOMACH AND TRANSVERSE COLON LATERAL to SPINE MEDIAL to SPINE SPLENIC ARTERY runs SUPERIOR surface of PANC TAIL SPLENIC VEIN runs Alaina MID POSTERIOR surface of PANC TAIL
121
Main pancreatic duct/ duct of warsung
Extends entire length of Panc centrally ( 2mm in diameter) Joins distal CBD in HEAD OF PANC - forms AMPULAA OF VATER Seen in ultrasound
122
Accessory pancreatic duct/ duct of santorini
Secondary drainage of UPPER ANTERIOR portion of PANC HEAD | Enters MEDIAL aspect of DESCENDING DUODENUM about 2 cm PROXIMAL to AMPULLA OF VATER
123
The urinary system
Maintains CHEMIACAL BALANCE - water electrolytes blood pressure regulation and ph balance Excretes liquid waste products Consisted of kidneys ureters bladder urethra
124
Kidneys
``` 2 bean shaped organs OBLLIQUE lie in abdomen at T12-L4 Left kidney is HIGHER than right (liver pushes everything down ) 9-12cm RETROPERITONEAL ```
125
structural relationships in the kidney
LATERAL to SPINE AORTA IVC ANTEROLATERAL to PSOAS MUSCLE ANTERIOR to QUADRATUS LUMABORM MUSCLE UPPER POLE LIES POSTERIOR AND MEDIAL TO LOWER POLE
126
Outer portion of kidney
Between the RENAL CAPSULE and BASE OF PYRAMIDS= PARENCHYMA
127
Outer cortex
Between RENAL CAPSULE and MEDULLA Contains the NEPHRONS COLUMNS OF BERTIN= CORTEX extends BETWEEN PYRAMIDS
128
Inner medulla
Between CORTEX and SINUS | PYRAMIDS= HYPOECHOIC TRIANGLES 8-18
129
Inner portion/renal sinus
``` Includes CALYCES (major and minor) RENAL PELVIS, VESSELS Packed with FAT so HYPERECHOIC ```
130
Minor calyx
8-18 = correspond to number of pyramids | Receives the APEX of pyramids
131
Major calyx
2-3 | Receive URINE from MINOR CALYX
132
Renal pelvis
Flared portion of UPPER URETER | POSTERIOR to RENAL VESSELS
133
Vessels
RENAL VEIN is ANERIOR to RENAL ARTERY
134
Coverings of the kidney
Renal capsule= adheres DIRECTLY to the kidney Renal fascia/gerota’s fascia = attaches kidney to POSTERIOR abd. Wall Perirenal fat= DIRECTLY SURROUNDING KIDNEY Pararenal fat CAPSULE-PERI-GEROTAS-PARA
135
Normal variants of kidneys
Dromedary hump- only on LEFT kidney localized bulge of lateral border Hypertrophied column of Bertin = indents renal sinus and varies Parenchymal junctional defect= junction of upper and middle third of kidney Horseshoe kidney- congenital fusion of lower lobes Ectopic kidney- kidney located outside normal renal fossa
136
Ureters
Paired MUSCULAR tubes that carry URINE from kidney to urinary bladder Travel INFERIORLY through RETROPERITONUEM Extend from RENAL HILUM to POSTERIOR portion of BLADDER at TRIGONE DECREASE in DIAMETER as they course TOWARD BLADDER Lower half located in PELVIS ANTERIOR to INTERNAL ILIAC ARTERIES POSTERIOR to OVARY Enter bladder at OBLIQUE angle on POSTEROLATERAL surface Pelvic pathologies in female pelvis cause obstruction of ureter and can effect kidney
137
Ureteral junctions
Uteropelvic junction UPJ = junction at RENAL PELVIS and URETER Uterovesicular junction UVJ = junction between LOWER URETERS and BLADDER where stones go
138
Bladder
Hollow symmetrical organ and muscular Reservoir for urine 4 layers= MUCOSA-SUBMUCOSA-MUSCULARIS-SEROSA Fixed INFERIORLY at BASE POSTERIOR to SYMPHYSIS PUBIS and ANTERIOR to UTERUS VAGINA Variable size and shape based on distention Relatively mobile except INFERIORLY AT NECK SUPERIOR surface COVERED with PERITNOEUM Peritoneal reflections from potentional spaces in pelvis
139
Apex of bladder
SUPERIOR portion | COVERED with peritoneum
140
Base
INFERIOR portion
141
TRIGONE
Triangular area in base of bladder accommodating bladder inlets and outlets Inlets= UVJs Outlets = urethra
142
Urethra
Female = short muscular tube 4cm POSTERIOR to PUBIC SYMPHYSIS runs OBLIQUELY INFERIORLY ANTERIORLY Male = first passes through PROSTATE the UROGENITAL DIAPHRAGM then PENIS 15-20 cm
143
Adrenals
Bilateral RETROPERITONEAL Pyramid shaped CAP on SUEPRIOR pole of kidney and sit slightly MEDIAL to kidney
144
Structure of adrenal
Capsule = outer surfaces Cortex Medulla = inner portion
145
Structural relationships of adrenals
Right adrenal = POSTERIOR and LATERAL to IVC Left adrenal = POSTERIOR to PANC TAIL LATERAL to AORTA SEPARATED BY PERIRENAL FAT AND CAPSULE
146
The spleen
INTRAPERITONEAL Part of bodies defense system but not essential to life Homogeneous, smooth surface, hilum
147
Functions of spleen
Defense- produces lymphocytes phagocytes plasma cells and antibodies Hematopoeises= red blood cell formation Filters out old RBCs and platelets Blood reservoir 200-400mL
148
Size and shape of pancreas
Variable - crescent or inverted comma | Normal adult = 12-13 cm long and 7-8 cm wide
149
Location of spleen
Left upper quadrant | Left hypochondrium
150
Splenic hilum
Central on visceral surface with no peritoneal covering | Structures = splenic artery and vein, lymph vessels and nerves
151
Splenic variant
Accessory spleen/Splenule= 10 % o pop at splenic hilum very small may have multiple
152
Gastrointestinal lining
4 layers = mucosa- submucosa-muscularis- serosa | Give GI tract distinct songraphic appearance because of different echogenicities
153
Digestive pathway
Salivary glands - region of mouth | Release enzymes that initiate breakdown of food adn help lubricate mouth
154
The esophagus
Muscular tube extends from below mouth to entrance of stomach Courses through stomach just ANTEROR to THORACIC SPINE Pierces diaphragm at T10 Peristalsis, gravity, swallowing move food and fluid to stomach ANTERIOR and LEFT of AORTA TERMINAL END = GASTROESOPHAGEAL JUNCTION (GE JUNCTION)
155
GE junction
Allows food into stomach and prevents gastric juices from refluxing INFERIOR to DIAPHRAGM ANTERIOR to AORTA and CRUX of DIAPHRAGM POSTERIOR to LEFT LOBE OF LIVER
156
Stomach
Large pouch shaped organ responsible for collection and breakdown of food and drink Secretes gastric juices (hydrochloride acid and pepsin) Food reduced and converted to solution to move through intestine called CHYME Located BETWEEN the ESOPHAGUS and DUODENUM INTRAPERITONEAL Left upper quadrant Internal folds call RUGAE used to increase surface area for expansion
157
Cardia of stomach
Entrance into stomach on SUPERIOR MEDIAL aspect
158
Fundus of stomach
Rounded portion ABOVE GE junction
159
Body of stomach
Major portion between PYLORIC and FUNDUS regions
160
Pylorus of stomach
Antrum- wider portion near MIDLINE of body - TRANSPYLORIC PLANE at L1-L2 - ANTERIOR to PANC BODY Canal- narrow portion between antrum and duodenum=communicates with duodenum - TRANSPYLORIC level L1-L2, RIGHT of MIDLINE, POSTERIOR TO LIVER, ANDTERIOR PANC HEAD
161
Greater curvature of the stomach
Left border
162
Lesser curvature of the stomach
Right border Cardiac orifice to pyloric orifice Site of attachment of lesser omentum to liver
163
Small intestine
6-7m in length | Right lower quadrant and left lower quadrant
164
Duodenum
Shortest connects to PYLORUS and PYLORIC SPHINCTER EPIGASTRIC REGION SUPERIOR-DESCENDING - TRANSVERSE-ASCENDING
165
Superior/bulb/ 1st part of duodenum
INTRAPERITONEAL ANTERIOR to PANC HEAD POSTERIOR to GALLBLADDER FUNDUS
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Descending / 2nd part of duodenum
RETROPERITONEAL VERTICAL portion RIGHT LATERAL to PANC HEAD POSTERIOR to TRANS COLON
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Transverse / 3rd part of duodenum
RETROPERITONEAL ANTERIOR to AORTA and IVC INFERIOR to PANC HEAD
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Ascending/ 4th part of duodenum
RETROPERITONEAL INFERIOR and MEDIAL to PANC HEAD ANTERIOR to AORTA
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Jejunum
INTRAPERITONEAL | Tightly coiled tubes located in UMBILICAL region
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Ileum`
Final and longest portion | Terminates at junction of cecum and ascending colon called ILEOCECAL JUNCTION
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Large intestine
Frames small intestine Greater in diameter Has HAUSTRA = puckered sacs Multiple division
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Cecum
Pouch like portion at origin of ASCENDING COLON Right lower quadrant and right iliac region APPENDIX extends from INFERIOR portion= blind ended tune, INFERIOR AND MEDIAL, 6-10cm , right lower quadrant
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Colon - ascending colon
SUPERIOR path on RIGHT of body RETROPERITONEAL HEPATIC FELXURE = 90 degree turn at liver into transverse colon
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Colon- transverse colon
HORIZONTAL across MIDLINE INTRAPERITONEAL HEPATIC FLEXURE to SPLENIC FLEXURE
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Colon - descending colon
Starts at SPLENIC FLEXURE SUPERIORLY INFERIOR path on LEFT side of body RETROPERITONEAL
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Sigmoid
S shaped terminal end | Left iliac and suprapubic region
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Rectum
TRUE PELVIS | POSTERIOR to BLADDER
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Anus
External orifice
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The peritoneal cavity
Potential space between the PARIETAL PERITONEUM and teh VISCERAL PERITONEUM Sterile spaces from abdomen to pelvis Closed to external environment EXCEPT in female it is open because FALLOPIAN TUBES pierce it. Contain small amount of CLEAR SEROUS. FLUID that serves as LUBRICANT Many folds and potential spaces
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The peritoneum
Is SEROUS membrane (very thin like sera wrap) -lubricated for motion adn acts as barrier for infection SUPPORTIVE layer to ANCHOR structures PARIETAL- covers ABDOMINAL and PELVIC WALLS VISCERAL- covers SOLID and HOLLOW VISCERA
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Intraperitoneal organs
``` Liver not bare area Glassbladder Spleen Stomach Ovaries 1st part of duodenum Transverse colon CANT APPRECIATE ALL SPACES TILL SOMETING IS IN IT LIKE BALLON ```
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Peritoneal folds - Mesenteries
Peritoneal folds CONNECTING SMALL AND LARGE BOWEL to POSTERIOR abdominal wall SUPPORT VESSELS. LYMPHATICS, NERVES PREVENTS TWISTING OF BOWEL
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Mesentary
DOUBLE layer fold LARGE and FAN SHAPED Encloses JEJUNUM, ILEUM, and CONNECTS THEM TO POSTERIOR abdominal wall
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Mesocolon
PERITNOEUM attached to COLON | CONNECTS TRANSVERSE ADN SIGMOID to POSTERIOR abdominal wall
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Omentum
Double layer of peritoneum | Folds of mesentary from STOMACH to INTRAABDOMINAL sites
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Greater omentum
APRON like fold CONNECTS greater curvature of the stomach and trans colon POSITION= drapes INFERIOR and ANTERIOR over TRANS COLON and SI then POSTERIOR and superior to attach to trans colon
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Lesser omentum
DOUBLE layer omentum | CONNECTS lesser curvature of stomach and 1st part of DUODENUM to VISCERAL surface of LIVER
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Peritoneal sacs
Large POTENTIAL spaces
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The greater sac
Most space in peritoneal cavity DIAPHRAGM to PELVIS Smaller spaces within it CONNECTS and COMMUNICATES with lesser sac in EPIGASTRIC region
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Location of greater sac
ANTERIOR to LESSER SAC SUPERIORLY POSTERIOR to LESSER SAC INFERIORLY Surrounds SMALL BOWEL INFERIORLY SUPERIOR to PELVIC STRUCTURES
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The lesser sac/ omental bursa
LOCATION = POSTERIOR to STOMACH | ANTERIOR to PANC
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Openings between teh sacs
``` Called NECK EPIPLOIC FORAMEN FORAMEN OF WINSLOW OMENTAL FORAMEN PORTA HEPATIS AND PORTAL TRIAD align with ANTERIOR margin of OPENING ```
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Compartments - Supracolic spaces- subphrenic
Between the DIAPHRAGM and ANTERIOR SUPERIOR LIVER | FALCIFORM LIGAMENT boundary between RIGHT and LEFT
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Compartments-supracolic-subhepatic
INFERIOR to VISCERAL LIVER RIGHT= MORISONS POUCH - lowest part where the fluid collects LEFT= ANTERIOR to ANTRUM of STOMACH
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Compartments - infracolic spaces- right paracolic gutter
Space between ASCCENDING COLON and RIGHT LATERAL abdominal wall
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Compartments- infracolic spaces- left paracolic gutter
Space between DESCENDING COLON and LEFT LATERAL abdominal wall
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The retroperitoneum
Located POSTERIOR to PERITONEUM Anchored to POSTERIOR abdominal wall Lined ANTERIORLY by peritoneum Not mobile
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Retroperitoneal structures
``` Kidneys Ureters Adrenals Pancreas (not tail) 2nd 3rd 4th part of duodenum Aorta IVC Ascending and descending colon ```
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Boundaries of retroperitoneal
POSTERIOR to PERITONEAL CAVITY ANTERIOR to TRANSVERSE FASCIA DIAPHRAGM to PELVIC BRIM
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Potential spaces - anterior pararenal space
POSTERIOR to PERITONEUM BETWEEN PERIATAL peritoneum and ANTERIOR RENAL FASCIA Crosses midline
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Potential spaces- perirenal space
Enclosed by RENAL FASCIA | Contains PERIRENAL FAT, KIDNEYS, ADRENALS
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Potential spaces- posterior pararenal space
POSTERIOR to RENAL FASCIA Between POSTERIOR RENAL FASCIA and TRANSVERSALIS FASCIA No solid organs Little fat
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Pelvic Regions
Right Iliac Hypogastrium Left iliac
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Bony Structures of the pelvis
Framework=sacrum coccyx innominate(hip bones) Function = support and transmit weight of body Protect pelvic viscera Birth canal in females Muscle attachment Attach legs to torso
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Sacrum
Posterior midline portion Triangular shaped from 5 fused vertebral segments S1 articulates (connects) with L5 superiorly +sacral promontory on S1 -anterior ridge - landmark marks posterior portion of true pelvic inlet S5 articulates with coccyx Lateral portions connect with os coxae at sacroiliac joints laterally
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Coccyx
Inferior portion of vertebral column Tailbone 3-5 rudimentary vertebrae (poorly developed) Site of muscle attachment
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Hip bones / Os Coxae / Innominate
Each hip bone is formed by ILIUM ISCHIUM PUBIS | The 3 bones fuse at puberty to form one unit
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Ilium
Largest and most superior Ala = superior large flaring portion Iliac fossa = inner aspect of ala, upper basin covered with iliacus muscle Iliac crest = most superior portion, palpable SI joint = articulation betweeen ilium and sacrum posteriorly
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Pubis
Consists of a body and 2 rami (superior and inferior) Superior ramus extends laterally from body to connect with ilium Inferior ramus extends inferiorly to meet ischium Meet anteriorly to form pubis symphysis OBTURATOR FORAMINA = large opening formed by junction of public rami and ischium
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Ischium
Inferior and posterior extending from ilium Connect with public rami anteriorly Ischial tuberosity = bulky interior and posterior area Bone supports body in seated position
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Pelvic wall muscles
``` Psoas Iliacus Iliopsoas Obturator Piriformis ```
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Psoas muscle
Long muscle located lateral to vertebral bodies extending from upper abdomen to pelvis
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Iliacus
Triangular shaped Extends from iliac crest of ilium and sacrum and lines each iliac fossa Psoas muscle joins iliacus in pelvis to become iliopsoas
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Iliopsoas
Travels anteriorly over pelvic brim Inserts into lesser trochanter of femur Powerful flexor of thigh
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Obturator
Internal and external parts Originated from obturator foramen and attaches into greater trochanter of femur Aids in lateral rotation
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Piriformis
Triangular shape Large part of posterolateral wall of pelvic cavity Originates on anterior surface of sacrum and inserts into breather trochanter of femur Responsible for lateral rotation and abduction of flexed hip
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Pelvic diaphragm (floor) muscles
Levator ani | Coccygeus
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Levator ani
Largest and most important muscle in diaphragm Two levator ani muscles originate from the pelvic wall of pubis and fibers converge to insert into coccyx and muscles of the opposite size +puboccocygeus and iliococcygeus Integrity of pelvic floor depends on appropriate function of these muscles KEEPS EVERYTHING UP
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Coccygeus
Smaller of two diaphragm muscle Two coccygeus muscles form posterior aspect of pelvic floor Originates on the spine of ischium Triangular sheet fans out to insert on the sacrum and coccyx
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Potential spaces in pelvis
``` Female = anterior cul de sac Posterior cul de sac Space of retzius Male= posterior cul de sac Space of retzius ```
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Female - Anterior cul de sac/vesicouterine pouch
Peritoneum drapes over posterior bladder wall and anterior surface of uterus Usually empty but some loops of bowel
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Female - posterior cul de sac/rectouterine pouch/pouch of Douglas
Peritoneum covers the anterior surface of rectum and posterior surface of uterus MOST DEPENDANT
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Female - space of retzius
Small space anterior to bladder posterior to symphysis pubis | Filled with extraperitoneal fat
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Male - posterior cul de sac/ rectovesicular pouch/ pouch of Douglas
Peritoneum covers th anterior surface of rectum and posterior surface of bladder MOST DEPENDANT
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Space of retzius
Small space between symphysis pubis and anterior to bladder | Filled with extraperitoneal fat
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Uterus
Hollow muscular organ Pear shaped PRIMARY FUNCTION- menstraution, pregnancy, labor 5 regions Uterine wall has 3 layers Size- 7-8 cm Varies in size and shape - prepubertal, repro. Age, gravida, postmenopausal, disease
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Regions of uterus (inferior to superior)
``` Cervix Isthmus Body/corpus Cornua Fundus ```
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Uterus - cervix
``` Lowest most inferior Cylindrical shape Extends from isthmus and projects into vagina Endocervical canal 2-3 cm Internal os=superior opening External os= inferior opening FIXED ```
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Uterus - isthmus
Narrowest portion of uterine body | Superior to cervix
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Uterus - body/corpus
Largest portion Between cervix and fundus Somewhat mobile
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Uterus - cornua
lateral extension of uterus continuous with Fallopian tubes
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Uterus - fundus
Widest, roundest most superior portion | Superior to insertion of Fallopian tubes and cornua
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Uterine wall (inner to outer)
Endometrium Myometrium Perimetrium
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Uterine wall - endometrium
Inner layer Highly vascular Composed of epithelial and glandular FUNCTIONALIS AND B...
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Uterine wall - myometrium
Middle MUSCULAR layer Thickest Muscle allow enlargement and contraction
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Uterine wall - perimetrium/serosa
Outer layer composed of serous peritoneum | Covers outer surface of uterus continuous with broad ligament
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Uterus location
``` Anterior to rectum Inferior to peritoneum MEDIAL TO OVARIES posterior to distended bladder Superior to empty bladder ```
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Uterine positions
Anteverted Anteflexed Retroverted Retroflexed
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Anteverted
Uterus tilts anteriorly
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Anteflexed
Uterus bends in body anteriorly
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Retroverted
Uterus tilts posteriorly
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Retroflexed
Uterus bends in body posteriorly
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Vagina
Muscular tube Cervix to external orifice Between bladder (anterior) and rectum (posterior) Fornices - spaces in upper vagina where it encircles cervix
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Fallopian tubes/uterine tubes/oviducts
Paired Muscular tube extending from cornua of uterus to ovaries within peritoneum Along superior margin of broad ligament Conducts ovum from ovary to uterus by peristalsis of muscle wall Conducts sperm toward ovum Location of fertilization of ovum and sperm Tube open into peritoneal cavity
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Segments of Fallopian tube (uterus-ovary)
Interstitial Isthmus Ampulla Infundibulum
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Fallopian tube - interstitial
Narrowest part of tube | Encloses within muscular wall of uterus superiorly (cornua)
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Fallopian tube - isthmus
IImmediately adjacent to the uterine wall laterally | Short straight narrow part of tube
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Fallopian tube- ampulla
Longest most coiled section Widens laterally Most common site of fertilization
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Fallopian tube - infundibulum
Funnel shaped lateral portion of tube Fimbria at the ends to sweep ovum into tube Close proximity to ovaries Opens into peritoneum
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Ovaries
Bilateral Ellipsoid / almond shapes Storehouse for ova Production of estrogen and progesterone Size varies - age,menstrual phase, pregnancy In reproductive ovary many follicles are normal
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Location of ovary
True pelvis Lateral to uterus POSTERIOR TO BROAD LIGAMENT anterior to ureter, gonadal vessels and IIA
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Blood supply and drainage for female pelvis
Uterine arteries branch off IIA +Uterine Artery travels superiorly along lateral aspect of uterus * branches supply uterine layers + joins ovarian artery at level of Fallopian tubes Venous vessels follow arteries in same way
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Female pelvis - ligaments
Broad Round Cervical Ovarian
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Female ligaments- broad
Peritoneal extensions support uterus and enclose oviducts + double fold Extends from anterior and posterior uterus to lateral pelvic wall Divides pelvis into anterior and posterior compartments Prevents SIDE TO SIDE
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Female ligaments - round
Extends from lateral walls of uterus to anterior pelvicwall Responsible for anterior tilt and stabilizing of fundus (Retro and anteflexed have too long or short round ligaments)
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Female ligaments - ovarian
Between ovary and lateral uterus
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Female ligaments- cervical/cardinal
From lateral cervix to pelvic floor | Stabalizes cervix and prevents downward displacement of uterus
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Scrotum
Saclike structure continuous with abdominal wall + contains testes epididymus and part of ductus deferens EXTERNALLY sac divided into lateral compartments by MEDIAN RAPHE/RIDGE/SEPTUM
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Muscles related to scrotum
Dartos | Cremaster
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Dartos
Thin muscular layer lies below skin of scrotum Gives wrinkled appearance to scrotum Merges centrally to form internal scrotal septum +INTERNALLY DIVIDES SCROTUM INTO 2 SACS
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Cremaster
Surrounds each testis Arises from internal oblique muscles of abdomen Lifts and lowers testes towards and away from body (temp control)
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Testes
Primary reproductive organ producing sperm and male sex hormones Testes arise from level of kidneys in fetus and descend into scrotum after 7th month Ovoid paired glands Suspended in scrotal sac
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Testicular coverings
Tunica albuginea | Tunica vaginalis
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Tunica albuginea
Dense outer capsules adhering to both testes Extensions p (septa) Inward divides each testi into lobules Septa converges posteriorly at MEDIASTINUM
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Tunnica vaginalis
Serous sac derived from peritoneum Consists of 2 layer +visceral + parietal
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Internal testicular architecture - seminiferous tubules
1-3 convoluted tuber per lobe Sperm production Converge at mediastinum testes and empty into straight tubule towards mediastinum teste amd rete teste
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Internal testicular architecture - straight tubule
Short section to tube connecting the seminiferous tubule to rete testis
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Internal testicular architecture- mediastinum testes
Located posterior aspect of testis ti support converging tubules Wedge of connective tissue on posterior aspect of testis Continuous with tunica albuginea and septa Structural support Encloses rete testis
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Internal testicular architecture- rete testis
Network of ducts in posterior aspect of testis Ducts located within mediastinum testes Inlet - straight tubules Outlet - efferent ductile
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Internal testicular architecture- efferent ducts
Ducts exiting the rete testis and connecting to th ductus epididymus
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Epididymus
Tightly coiled tubular structure Located on posterolateral surface of each testis Storage and maturation of sperm Continuous with ductus deferens
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Epididymus - Head/globus major
Largest portion Superior to testis Formed by efferent ductules
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Epididymus- body
Along posterolateral aspect of testis | Ductus epididymus travels along length of body and tail
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Epididymus- tail / globus minor
Empties into ductus deferens within spermatic chord at inferior border of testis
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Ductus deferens / vas deferens
Long tube originating from tail of epididymus Proximal end widens to meet duct draining the seminal vesicles to form ejaculatory duct Ascends within the spermatic cord and travels through inguinal canal to pelvis Within pelvis- travels along lateral pelvic wall to posterior bladder Crosses between ureter and bladder Descends medially to seminal vesicles and urteter Joins ejaculatory duct near base of bladder Opens into prostatic urethra
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Seminal vesicles
Paired accessory glands Coiled tubes form pouches or vesicles Each SV duct joins the vas deferens ronform ejaculatory Duct Secretions of SV provide energy to sperm
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Spermatic cord
``` Paired Outer tough covering extending from testis to pelvis providing protection Encases numerous structures Vas deferens Arteries and veins Nerves and lymph ```
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Seminal vesicles - location
Posterior and inferior of bladder Lateral to ductus deferens Superior to prostate Anterior to rectum
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Ejaculatory duct
Extensions of seminal vesicles Direct SV secretions to prostatic urethra Ducts travel obliquely in posterior aspect of prostate
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Prostate
Composed of fibromuscular and glandular tissue + secretions aid in motility and fertility of sperm Conical in shape Proximal urethra travels centrally through prostate Ejaculatory ducts descend inferiorly through posterior portion of gland and open into prostatic urethra Glandular portion has 3 zones
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Prostate - peripheral zone
Largest zone Posterior and lateral to distal prostatic urethra Surgical capsule isolates it CANCER
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Prostate- central zone
Extends from base of prostate to verumtanum Surrounds ejaculatory ducts Located between peripheral and transitional zone
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Prostate - transitional zone
Smallest zone | Located on lateral aspect of proximal urethra
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Prostatic orientation
Base - superior portion of glands adjacent to neck (base) of bladder Apex - inferior portion of gland in contact with pelvic diaphragm
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Prostate location
Midline inferior to base of bladder Superior to pelvic diaphragm Anterior to rectum Posterior to symphysis pubis
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Penis
External reproductive organ | 3 cylindrical masses of erectile tissue
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Penis - corpora cavernosa
Dorsilateral location | Becomes enlarge when filled with blood
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Penis - corpus spongiosum
Midventral location Encircles spongy urethra Expands distally to form glans penis
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Blood supply and drainage - male pelvis
Testes - arterial blood supply originates in the abdomen and venous blood returns to abdomen + arterial - testicular Artery originates off aorta + venous - right testicular vein drains into IVC and left drains into LRV Penis - blood supply to penis and urethra via internal pudendal arteries which are branches off the IIA - main venous drainage of penis is the superficial and deep dorsal veins which connect with the pudendal venous plexus
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Arteries and arterioles
Strong and flexible Blood flow from arteries to arterioles High pressure system
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Veins and venuoles
Less elastic than arteries Blood flow from venuoles to veins Low pressure system
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Capillaries
Link betweeen arteries and veins Webs of microscopic vessels Main exchange between blood and tissue fluids, gases, wastes
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Vessel differences
``` Arteries - tunica media + thicker + holds shape - no valves Veins - tunica media + much thinner + veins more compressible - valves + present + one way flow towards heart + in upper and lower extremities only - has both deep and superficial venous systems ```
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Aortic arch branches (1,2,3)
1) brachiocephalic/innominate 2) left common carotid artery 3) left subclavian
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Brachiocehalic/innominate
First branch off aortic arch Anterior position compared to other branches Branches into red got common carotid artery and right subclavian artery
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Left common carotid artery
Second branch of aortic arch | Middle and posterior to innominate
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Left subclavian
Third branch of aortic arch | Most posterior branch
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Arterial branches of upper extremities (proximal to distal)
Left arm - subclavian Right arm - brachiocephalic branches into right subclavian ``` Axillary Artery Brachial Artery Radial Artery Ulnar artery Palmar Artery Digital artery ```
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Subclavian Artery
Travel horizontally toward shoulders | Become axillary arteries @ level of humoral head (armpit)
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Axillary Artery
Extension of subclavian Originates @ level of humoral Head Shout segment travel along axilla(armpit)
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Brachial Artery
In region of upper/mid humerus axillary becomes brachial Continues to elbow @ elbow divides into ulnar and radial arteries
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Radial Artery
Travel along LATERAL forearm to wrist | Located on THUMB SIDE of arm
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Ulnar Artery
Travel along MEDIAL arm to wrist
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Palmar arteries
Distal extensions of radial and ulnar arteries | Form deep and superficial arches in hand
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Digital arteries
Arteries to fingers
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Deep veins of upper extremities (distal to proximal)
``` Digital and palmar veins Radial vein Ulnar vein Brachial veins Axillary veins Subclavian veins Right and left brachiocephalic veins ```
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Digital and palmar veins
``` Return blood from fingers and hands Palmar arches (superficial and deep) ```
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Radial veins
Ascends along the LATERAL aspect of forearm
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Ulnar veins
Ascends along MEDIAL aspect of forearm | RADIAL AND ULNAR UNITE BELOW ELBOW TO FORM BRACHIAL VEINS
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Brachial veins
Often Paired Travel superior to join basilic vein Union of basilic and brachial form axillary vein
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Axillary vein
Travel up medial aspect of arm | Passes behind clavicle to form subclavian
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Right and Left brachiocephalic Veins
Formed by junction of subclavian veins to jugular veins | R and L join to form superior vena cava which drains into right atrium
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Superficial veins of upper extremities
Cephalic Basilic Median cubital vein
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Cephalic veins
Starts at lateral aspect of hand Ascends along lateral arm Drains directly into the axillary vein (then becomes subclavian)
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Basilic vein
Starts at medial aspect of hand Ascends along posterior medial aspect of arm Located MEDIAL to brachial vein Joins brachial veins to form axillary vein
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Median cubital vein
Joins cephalic and basilic at the elbow joint
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Arteries of lower extremities (proximal to distal)
``` Aorta Common iliac arteries Internal and external iliac arteries Common femoral arteries Superficial and deep femoral arteries Popliteal Artery Anterior Tibial Artery Tibioperoneal trunk - posterior tibial artery and Peroneal artery ```
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Aorta - arteries of legs
Bifurcates at L4 into right and left common iliac arteries
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Common iliac arteries
Travel inferiorly and slightly lateral in pelvis Common iliac arteries pass laterally and anterior to common iliac veins Divide into internal and external arteries
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Internal iliac artery
Descend posterior and medial into pelvis | Supplies pelvic viscera and muscles
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External iliac arteries
Travels laterally toward leg
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Common femoral Artery
External iliac becomes the common femoral artery at inguinal ligament
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Superficial and deep femoral Artery
Common femoral Artery bifurcates to become superficial femoral Artery (femoral Artery) and deep femoral Artery (profunda)
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Popliteal Artery
The superficial femoral Artery travels down thigh and passes through adductor canal to become popliteal Artery Posterior to knee Popliteal Artery ANTERIOR to popliteal vein
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Anterior tibial Artery
Branches off popliteal Artery Travels along anterior part of lower leg Becomes dorsalis pedis arteries in foot
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Tibioperoneal trunk
Branches into posterior tibial artery ( posterior and medial) and th peroneal Artery (posterior and lateral)
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Deep veins of the leg
*accompany Artery and share same name ``` Anterior tibial Veins Posterior tibial veins Peroneal veins Popliteal veins Superficial femoral vein Deep femoral vein Common femoral vein External iliac vein Common iliac vein ```
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Anterior tibial Veins
Paired Ascend along anterior aspect of lower leg Unite to form the anterior tibial trunk which drains into the popliteal vein
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Posterior tibial vein
Paired Ascend along posterior medial aspect of lower leg Drain into tibioperoneal trunk
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Peroneal veins
Paired Lie deeper than posterior tibial Veins Runs adjacent to fibula
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Popliteal vein
Formed by union of anterior tibial trunk and tibioperoneal trunk Located in posterior knee Vein POSTERIOR to artery Becomes superficial femoral vein superior to knee at adductor hiatus
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Superficial femoral vein
Popliteal vein becomes superficial vein superior to knee | Also none as femoral vein
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Common femoral vein
Superficial femoral vein joins deep femoral vein at inguinal ligament to become common femoral vein
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External iliac vein
As it enters pelvis the common femoral vein becomes the external iliac vein Takes a superior and medial course Then Joins internal iliac vein to form common iliac vein
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Common iliac veins
Forms at level of SI joint Common iliac veins unite at L5 to form IVC Veins run POSTERIOR to arteries
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Superficial venous system
*veins running superficial to deep fascia Greater saphenous vein Lesser(smaller) saphenous vein
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Greater saphenous vein (GSV)
Longest vein in body Ascends along medial aspect of leg Extends from foot to groin Empties into CFV
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Lesser (small) saphenous vein
Ascends along calf laterally to greater saphenous vein | Empties into popliteal vein
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Perforating veins
Connects deep and superficial venous systems
340
The central nervous system
``` Components - brain and spinal cord Cavities - immersed in cerebrospinal Nerves ```
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Brain information
Located in cranial cavity ( subdivision of dorsal cavity) Weighs 3 pounds Has regions of white matter and gray matter Enclosed by protective meninges Surrounded by cerebrospinal fluid (provides cushioning and protection) Responsible for transmitting electrochemical messages in body
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Main sections of brain
Cerebrum Cerebellum Brainstem
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Nerve cell construction
Nerves made up of white matter and gray matter
344
White matter
Composed of nerve cell axons which are covered with myelin | Axons carry nerve impulses between neurons
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Grey matter
Composed of nerve cell bodies which are unmyelinated Nerve cell bodies are control centers Route sensory and motor stimuli and create a response
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Th cerebrum
Largest part of brain Divided into right and left hemispheres - connected in midline by corpus callosum - separated by falx cerebri - each hemisphere has 4 lobes Consists of both white matter and grey matter - grey matter + cortex (outer layer) and basal nuclei (deep in midline) - white matter + lies deep to cortex 4 lobes correspond to the adjacent cranial bone - parietal, temporal, frontal, occipital
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The cerebrum- folds and grooves
``` Gyri- small folds Sulci- shallow grooves Fissures- deep grooves + longitudinal + lateral (Sylvian) ```
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Corpus callosum
``` Bundle of white matter located in midline Creates connection between right and left hemispheres - neural bridge FORMS ROOF OF LATERAL VENTRICLES 4 parts - rostrum - genu - body - splenium ```
349
Basal nuclei/ganglia
Distinct regions of grey matter located deep within the cerebral white matter Serve as relay stations for sensory stimuli Lie adjacent to the lateral ventricles Examples +caudate nucleus + lentiform nucleus -putamen, globus pallidus
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Thalamus
Ovoid masses of grey matter Base of cerebral hemispheres Relay stations for nerve impulses Right and left thalami located on either side of third ventricle + FORM LATERAL WALL OF THIRD VENTRICLES the massa intermedia is tissue bridge between right and left thalami + passes through third ventricle in the midline
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The brain stem
Connects brain to spinal cord Controls vital function such as breathing rate and heart rate 3 parts - midbrain, pons, medulla oblongata
352
Midbrain
Superior and smallest portion of brainstem Directly superior to pons Surrounds cerebral aquaduct
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Pons
Prominent anterior bulge Located between the midbrain and medulla oblongata Acts as a bridge between the cerebrum and cerebellum FORMS ANTERIOR WALL OF FOURTH VENTRICLE controls involuntary function
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Medulla oblongata
Inferior portion of brainstem Extends from pons to the foramen magnum Continuous with spinal cord Regulates vital function
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The cerebellum
Consists of right and left hemispheres Situated posterior to pons and medulla oblongata FORMS POSTERIOR WALL OF FOURTH VENTRICLE center for motor function Tentorium cerebelli separates the cerebrum from cerebellum
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Parts of cerebellum
Vermis | Cerebellar peduncles
357
Vermis
Midline structure | Connects two hemispheres of the cerebellum
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Cerebellar peduncles
Nerve tracts that connect the cerebellum to the other parts of the brain stem Superior, middle, and inferior peduncles
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Cavities in the brain
The ventricles | - lateral (2), third, fourth,
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The ventricles
Fluid filled cavities within the brain All four ventricles are interconnected by channels Ventricles both produce and provide pathway for CSF to circulate
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Cerebrospinal fluid (CSF)
Clear colorless fluid Produced by choroid plexus of ventricles Circulates in subarachnoid space Acts as protective cushion, buoyancy, and nourishment Drains into the blood via Duran sinuses
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Lateral ventricles
Paired Largest of ventricles C shaped One lateral ventricle / hemisphere
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Lateral ventricles - location
Lateral to midline Separated medially by Cavum septum pallucidum Communicates with third ventricle via foramen of Monroe
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Lateral ventricles - feature
Body- central portion Horns - extensions of body Frontal/anterior Occipital/posterior Temporal/inferior Tigone/atria - triangular area of the body connected to all horns Interventricular foramen (foramen of Munro) - channel between the lateral ventricles and the third ventricle
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Lateral ventricles - relationships
Anterior horns medial to posterior horns Anterior horns superior to posterior horns Anterior horns anterior to foramen of Munro Third ventricle medial to lateral ventricles
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Lateral ventricle - cavum septum pallucidum
Thin triangular membrane Midline inferior to corpus callosum SEPARATES MEDIAL WALLS OF LATERAL VENTRICLES
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Choroid plexus
``` Lines area within each ventricles Produces continuous supply of CSF Location - floor of lateral ventricles - roof of third ventricle - posterior wall of fourth ventricle ```
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Third ventricle
Midline slit like cavity Inferior to lateral ventricles LATERAL WALLS FORMED BY RIGHT AND LEFT THALAMI massa intermedia of the thalamus runs through third ventricle
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Third ventricle- cerebral aqueduct (aqueduct of Sylvius)
Connection between the third and fourth ventricle | Aqueduct extends posterior from third ventricles
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Fourth ventricle
Inferior and posterior to third ventricle Diamond shape Anterior to cerebellum and posterior to pons Three channels drain fourth ventricle
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Fourth ventricle - foramen of magendie
Single posterior MIDLINE opening | Connected to central canal of spinal chord
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Fourth ventricle - foramen of luschka
2 LATERAL openings
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Meninges
``` 3 distinct membranes that cover the brain and spinal cord Function - protect neural cells - provide support for vessels - creates venous sinuses in the head - forms partitions in head - allow for circulation of CSF Layers - dura mater, arachnoid, pia mater ```
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Meninges- dura mater
Strong outer covering Double layered membrane - periosteal- adheres to bone - meningeal - adheres to brain and spinal cord Subdural space lies inferior to dura mater
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Meninges- dura mater - dura partitions
Falx cerebri - projects vertically between the cerebral hemisphere - runs along longitudinal fissure Falx cerebelli - vertical separations of the cerebellar hemispheres - inferior and posterior to the falx cerebri Tentorium cerebelli - horizontal fold in transverse fissure - separates cerebrum and cerebellum
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Meninges- dura mater - dura venous sinuses
Dura layers separates along fissure to form sinuses - all veins of head drain into the sinuses - blood moves from the sinuses to internal jugular veins - communicates with the arachnoid area Major dura sinuses - superior, inferior, transverse, straight, sigmoid
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Meninges- arachnoid
Middle layer of meninges Cobweb appearance Arachnoid villi/granulation - outgrowths of arachnoid kid mater penetrate the dura - outgrowths project into venous sinuses - allow for reabsorption of fluid into venous system
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Meninges- arachnoid- subarachnoid space
Important area for circulation of CSF Surrounds brain and spinal cord Receives CSF from ventricles Between arachnoid and pia
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Meninges- arachnoid- subarachnoid- cisterns
``` Widened areas located within the subarachnoid space Pools of CSF Located at base of skull CISTERNA MAGNA -largest pool - continuous with spinal space ```
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Meninges- pia mater
``` Delicate connective tissue Adheres directly to surface of the brain Follows contour of brain -enters grooves and fissures Highly vascular ```
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Arterial pathways in the brain
Internal carotid arteries Vertebral arteries Circle of Willis
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Internal carotid arteries
Branches of common carotid arteries Take tortuous (twisty) route within the brain Connect with middle cerebral arteries
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Vertebral arteries
Branches of subclavian arteries Ascend cranially through transverse foramina of cervical spine Enter skull through foramen magnum Unite to form basilar Artery in posterior brain
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The circle of Willis
Arterial circle of major vessels @ base of brain Unites anterior and posterior blood supply Collateral blood flow between hemispheres (In case of blockage) Allows continuous flow to brain in cases of damages to one area
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Parts of circle of Willis (posterior to anterior)
Posterior cerebral arteries (R&L) - branch from the basilar artery Posterior communicating arteries (R&L) - runs between posterior cerebral arteries and middle cerebral arteries Middle cerebral arteries (R&L) - branch from internal carotid arteries Anterior cerebral arteries (R&L) - bilateral anterior arteries Anterior communicating artery - single midline Artery - connects R and L anterior cerebral arteries
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The spinal cord
``` Nerve cable Continuous with brain medulla Extends to level of L2 Cord tapers distally Nerves associated with each vertebrae Cervical and lumbosacral widening ```
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Spinal cord features
Conus medullaris Cauda equine Filum terminale Denticulate ligaments
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Spinal cord features- conus medullaris
Distal tapering of the cord | Tip should not extend below level of L2
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Spinal cord features- cauda equine
Nerve bundles inferior to the conus medullaris | Horses tail appearance
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Spinal cord features- filum terminale
Slender strand from the cornus medullaris to the coccyx | Anchors spinal cord
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Spinal cord features- denticulate ligaments
Secure cord laterally to vertebral canal
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Anatomy of the neck - function
``` Support for head Allow for motion of head Passage way for -respiratory and digestive systems - spinal cord -major blood vessels - nerves and lymph Contains important organs ```
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Bony components of the neck
``` C-spine - 7 vertebra Hyoid bone - anterior (C3 level) - mobile - muscle attachment and aid to keep airway open ```
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Soft tissue and glands of the neck
Thyroid Parathyroid Salivary glands
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Thyroid gland
``` Butterfly shaped - 2 lobes bridged by and isthmus Thin and fibrous capsule Endocrine gland (hormones) Extends from level of C5 to T1 Rich blood supply ```
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Thyroid gland - right and left lobes
``` Lateral to midline Wrap posteriorly from the isthmus Superior and inferior poles Posterior to the strap muscles Anterior to longus Colli muscle ```
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Thyroid gland- right and left lobes- isthmus
Relatively thin midline bridge Anterior to trachea and esophagus Sits @ C5 level
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Parathyroid gland
Four small glands Lie on posterior surface of each thyroid gland Lie external to the fibrous capsule Regulate calcium levels
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The salivary glands
``` Accessory glands for digestion Lie in jaw and lower ear area Produce and secrete saliva into the oral cavity via ducts 3 paired salivary glands - parotid, sublingual, submandibular ```
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The salivary glands- parotid
Largest Wedges between the mandible and sternocleidomastoid muscle Extends from the ear orifice to the angle of mandible Drain vie STENSENS DUCT into the mouth
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The salivary glands- submandibular
Second largest Located at the angle of the jaw behind the mandible Drainage via WHARTONS duct situated posterior to teeth
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The salivary glands- sublingual
Smallest of salivary glands Lie under tongue Drain via BARTHOLINS duct
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The pharynx
``` Fibromuscular passageway - respiratory and digestive function “Throat” Tonsils located in the pharynx 3 sections -nasopharynx, oropharynx, laryngopharynx ```
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The pharynx- nasopharynx
Superior portion of pharynx Directly behind the nose Adenoids tonsils on posterior wall Auditory tubes enter laterally
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The pharynx- oropharynx
Middle portion of the pharynx Directly behind the mouth Palatine tonsils on posterior wall
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The pharynx- laryngopharynx
Inferior portion of the pharynx | Adjacent to opening of the larynx and esophagus
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The larynx
Modified part of air passage - voice production Important cartilages - thyroid + shield shape + anterior ridge forms Adam’s apple - cricoid cartilage + inferior to thyroid cartilage + marks start of esophagus and trachea Epiglottis -elastic flap that prevents food from entering trachea
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Trachea
``` Airway to the lungs Divides into right and left main bronchi Reinforced by C shaped cartilage Passes through mediastinum Bifurcation at level of L5 Location - anterior to esophagus - posterior to thyroid isthmus ```
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Esophagus
``` Muscular canal from the mouth to the stomach Travels through the mediastinum Sits directly anterior to spine Posterior to trachea and heart Ends at GE junction ```
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Vasculature of the neck
``` Carotid arteries Vertebral arteries Jugular veins Location - lateral aspect of neck - lateral to thyroid gland ```
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Vasculature neck- common carotid arteries
Common carotids have no side branches Surrounded by carotid sheath Bifurcates into the internal and external carotids Thyroid lobes medial to common carotids CCAs MEDIAL to jugular veins Right common carotid is branch of brachiocephalic artery Left common carotid is second branch of aortic arch
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Vasculature neck- internal carotid arteries
Enter at base of the skull through temporal bone NO BRANCHES Connect to circle of Willis Supply blood to the brain
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Vasculature neck- external carotid arteries
Numerous branches Tortuous path Blood supply to face and scalp
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Vasculature neck- vertebral arteries
``` First branch off subclavian Artery Bilateral Ascend through transverse foramina if cervical vertebra POSTERIOR to CCA Enter head via foramen magnum Form basilar veins within the head ```
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Vasculature neck- internal jugular vein
``` Bilateral Drain venous sinuses of the head Lie LATERAL to internal and common carotids Run within carotid sheath Collapse easily with compression ```
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Vasculature neck- carotid sheath
Strong fascia surrounds structures to prevent easy compression Surrounds - CCA, IJV, and vagus nerve + vagus nerve lies POSTERIOR to vessels and in between CCA and IJV
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Muscles of face and neck - functions
Facial expression Mastication Support of head and neck structures Movement
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Muscles of neck and face - masseter
Primary muscle of chewing Lies deep to parotid gland Elevates mandible
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Muscles of neck and face- platysma
Large thin muscular sheath Extends from mandible to clavicle Anterior to strap muscles and sternocleidomastoid muscle Creates ridges in neck
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Anterior muscles of neck- sternocleidomastoid muscle (SCM)
Broad muscle crossing diagonally in the neck Extends from sternum and clavicle to mastoid tip Lateral and anterior to strap muscles Turns head from side to side and flexes neck
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Anterior muscles neck- strap muscles
``` Anterior and lateral to thyroid Sternohyoid - closest to midline, sternum to hyoid Sternothyroid -posterior and lateral to sternohyoid - close contact with anterior thyroid surface Omohyoid -lateral to sternohyoid -anterior to sternothyroid ```
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Posterior muscles neck
``` Scalene Levator scapulae Trapezius -most posterior - superficial ```
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Cervical lymphatic system
``` Extensive lymphatic network in neck More than 1/3 of the body’s total number of lymph nodes Location -deep nodes clustered along vessels - along lower jaw - anterior and inferior to ear ```
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The thorax
``` Area between the neck and abdomen Framework -bones, muscles, cartilage Functions -respiration, protection of vital organs, pathway ```
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Thoracic cage
``` Formed by - sternum and costal cartilages (anterior) - ribs and intercostal spaces (lateral) - vertebral column (posterior) + 12 thoracic vertebrae ```
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The sternum
``` Dagger appearance Anterior thoracic bone Parts -manubrium=handle + superior part + square shaped - body + long and narrow + ribs attach to body laterally + hinge joint located between the body and manubrium for respiration -xiohoid/xiphoid process + small inferior tip ```
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Superficial landmarks of the sternum
``` Suprasternal/jugular notch - central depression - superior surface of manubrium Sternal angle - hinge joint -palpable ridge 5cm below notch - level of aortic arch Xiphoid process - where right and left costal margins meet ```
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Ribs of thoracic cage
7 true ribs - connect DIRECTLY to the sternum 5 false ribs - INDIRECTLY connect to sternum + ribs 8-10 = costal cartilage articulate with each rib above + ribs 11-12 = floating ribs (no anterior attachment)
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Thoracic cavity
3 compartments - 2 pleural spaces - mediastinum
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The thoracic inlet
``` Superior thoracic aperture Small yet very important Numerous structures pass through this opening - trachea and esophagus - arteries and veins - nerves and Lymph - apex of lungs ```
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The thoracic outlet
Larger than inlet | Diaphragm forms partition between the thorax and abdomen
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The diaphragm
Partition between the thoracic and abdominal cavity Upward arching some Crura attach the diaphragm to the lumbar spine - right and left Openings - I8 10Eggs At12
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Muscles of chest - anterior
Pectoralis major
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Muscles of the chest- posterior
Trapezius & latissimus - superficial Rhomboid and levator scapulae - deep to trapezius
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Muscles of the chest- intercostal
Located between the ribs Allow for expansion/contraction during respiration 3 layers -external, internal, innermost Often a window used when scanning difficult patients
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The lungs
Apex - domed superior portion that projects about the inlet Base - inferior aspect -broad -rest on diaphragm extend lower in back and sides than front Hilum - depression on mediastinal surface where structures enter and exits + primary bronchi, pulmonary blood vessels, lymph nodes, nerves Primary bronchi -right and left Secondary bronchi - branch from primary bronchi - one branch per lobe (right=3, left =2) Tertiary bronchi -bronchial tree -alveoli + functional unit of the lung ; oxygen and carbon dioxide exchange
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The pleura
Double layer membrane sac which encloses the lungs +visceral = adheres directly to lung surface + parietal = lines wall of thoracic cavity and upper surface of diaphragm
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The pleural cavities
``` Right and left spaces Situated lateral to mediastinum Fluid or air can collect in these cavities -pneumothorax = air in cavity - pleural effusion = fluid in cavity ```
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The thymus gland
``` Immunity Location -anterior to great vessels - posterior to manubrium Bilobed structure Size - largest during childhood - atrophies with age and almost disappears ```
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The heart
``` Muscular organ Main pump of body Has oblique lie in mediastinum -45* angle toward left side Sits slightly left of sternum Site of attachment of great vessels ```
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Th heart - cardiac orientation
``` Apex - projects inferior , anterior and left - formed entirely by left ventricle Base - projects superior and posterior - pulmonary and aortic vessel sit superior to base ```
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The heart- cardiac cycle
Rhythmic cycle - chambers alternately contract and relax Systole= contraction Diastole = relaxation Once complete cycle of filling and emptying = one heart beat
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Heart structures
``` 4 chamber and 4 valves - atria + upper chambers + receiving chambers - ventricles + lower chambers + pumping chambers - valves + 4 total ~ 2 types = semilunar and atrioventricular ```
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The heart valves
``` 2 types -atrioventricular - semilunar Each type consists of - ring/annulus = opening - leaflets + AV leaflets also have papillary muscles and chords tendinae ~ serve as anchors for the leaflets ```
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Atrioventricular valves
``` Inflow valves Blood flows from atria to ventricles AV valves open during ventricular diastole AV valves - tricuspid and mitral (bicuspid) ```
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Semilunar valves
``` Outflow valves Valves between the great vessels and the ventricles Contain 3 crescent shaped cusps Opens during ventricular systole Semilunar valves - aortic and pulmonary ```
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The heart walls
``` Epicardium - outer layer - smooth thin visceral Myocardium -middle layer - thick contractile muscle Endocardium -inner layer - thin membrane lining chambers ```
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Pathway of blood through the heart
``` Vena Cavae Right atrium Tricuspid valve Right ventricle Pulmonary valve Pulmonary artery (trunk) Lungs Pulmonary veins Left atrium Mitral valve Left ventricle Aortic valve Thoracic aorta Coronary arteries ```
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Pathway- vena cavae
Return deoxygenated blood to right side of heart Both drain into right atrium -superior vena cava + formed by union of right and left brachiocephalic veins - inferior vena cava + formed by union of common iliac veins + carries blood from abdomen to the right atrium
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Pathway - right atrium
Receives SVC and IVC AV valve (tricuspid) located at outlet Located ANTERIOR in chest cavity
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Pathway- tricuspid valve
Located between the right atrium and right ventricle Contains 3 leaflets of cusps Has vertical orientation
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Pathway - right ventricle
Receives blood from right atrium Has ANTERIOR position in heart Ejects blood into the pulmonary artery Contains chordae tendinae and papillary muscles
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Pathway- pulmonary valve
Semilunar valve 3 leaflets Outflow valve from right ventricle to pulmonary artery Pulmonary valve located anterior to aortic valve
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Pathway- pulmonary artery (trunk)
Originates at right ventricle Divides into right and left pulmonary arteries Carried DEOXYGENATED blood AWAY from heart to lungs
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Pathway - lungs
Remove carbon dioxide and add oxygen to the blood
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Pathway - pulmonary veins
Four veins Superior and inferior veins from each lung Carries OXYGEN rich blood TO the left atrium
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Pathway- left atrium
Receives oxygenated blood via pulmonary veins MOST POSTERIOR part of heart The interatrial septum divides the atria medially
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Pathway- mitral valve
``` Locate between the left atrium and ventricle Bicuspid valve - 2 unequal leaflets + anterior (larger) + posterior (smaller) ```
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Pathway - left ventricle
Receives blood from the atrium via the mitral valve Contains chordae tendinae and papillary muscles Muscles of the left ventricle is much thicker than right (pump to all body) Pressure greater in left than right
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Aortic valve
Semilunar valve - 3 leaflets Located between the left ventricle and aorta Positioned POSTERIOR to pulmonary artery
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Pathway - thoracic aorta
Candy cane shape Travels superiorly, curves posterior then dives inferior toward diaphragm 3 branches (anterior to poster) - brachiocephalic (innominate), left common carotid, left subclavian
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Pathway- coronary arteries
Supply oxygen and nutrients to heart muscle Allow for continual contraction and relaxation of heart Arise just above cusps of aortic valve - right and left coronary arteries
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Electrical activity in heart
Electrical input initiates the heart contraction and relaxation Impulses start in the right atrium and travel toward the ventricles
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Path of electrical impulse
Stars contraction in right atrium at SINOATRIAL NODE (SA) - pacemaker of heart Impulse travels along nodal pathway Moves from the SA node to the ATRIOVENTRICULAR NODE (AV) from AV node onwards to the AV BUNDLE (BUNDLE OF HIS) AV bundles branch into right and left bundles along interventricular septum Impulse continues to the PURKINJIE FIBERS in ventricular muscles

Sectional Anatomy (1 decks)

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