Y2 Anatomy Flashcards
(268 cards)
1
Q
Identify the three divisions of the pharynx
A
2
Q
Where does the pharynx become continuous with the oesophagus?
A
At the lower border of the cricoid cartilage – C6
3
Q
Where are the sites of constriction in the oesophagus?
A
- Boundary between pharynx and oesophagus
- Where the arch of aorta crosses the oesophagus
- Where the left main bronchus crosses the oesophagus
- At the oesophageal hiatus
4
Q
Which structure would protect against reflux of food back into the airways?
A
Upper oesophageal sphincter
5
Q
The 4 main regions of the stomach are
A
- Cardia
- Fundus
- Body
- Pyloric part
6
Q
Which specialised feature of the stomach lining increases its surface area and allows for expansion?
A
Gastric rugae/folds
7
Q
Identify the 4 parts of the duodenum
A
Superior
Descending
Horizontal
Ascending
8
Q
Where is the boundary between the foregut and midgut?
A
Halfway down the descending duodenum
9
Q
What are the names of the duodenal openings and what are they for?
A
- Major duodenal papilla – opening for common bile duct and major pancreatic duct
- Minor duodenal papilla – opening for accessory pancreatic duct
10
Q
As you move form the jejunum to ilium what happens to fat content?
A
Jejunum:
The mesentery has less fat, and the vascular structures (vasa recta and arcades) are more visible and distinct.
This gives the mesentery a more translucent, lace-like appearance.
Ileum:
The mesentery contains more fat, often extending right up to the intestinal wall.
This makes the vascular patterns more obscured and the mesentery thicker and more opaque.
11
Q
As you move form the jejunum to ilium what happens to the arterial arcades?
A
Jejunum:
Features fewer, larger arterial arcades.
The vasa recta (straight arteries coming off arcades) are longer and more regular.
Ileum:
Contains multiple, complex, and smaller arcades (more “layers” of loops).
The vasa recta are shorter and more numerous.
12
Q
As you move from the jejunum to the ileum what happens to wall thickness?
A
Jejunum:
Thicker wall, due to a greater number of circular folds (plicae circulares) and more developed muscularis externa.
Gives it a more rigid and substantial feel as you pass it through your hands.
Ileum:
Thinner wall, as the circular folds are smaller and more sparse.
Feels softer and more compressible, especially near the ileocecal junction.
13
Q
What is the surface landmark for the apendix?
A
McBurney’s point
2/3 from naval to anterior superior iliac spine
14
Q
What are the 3 features of the large intestine that differentiate it from the small intestine?
A
- Taeniae coli
- Haustra/sacculations - hint - horse poo is in bulges
- Omental appendages/fat tags
15
Q
Where do the three taeniae coli descend to?
A
The appendix
16
Q
Following the ascending colon to the right colic flexure. Which structures lie near this flexure?
A
- Right kidney (posterior to flexure)
- Liver (anterior/ superior to flexure)
17
Q
Following the trnasverse colon to the left colic flexure. Which structures lie near this flexure?
A
- Spleen (superior to flexure)
- Left Kidney (posterior to flexure)
18
Q
What is the transverse mesocolon?
A
The transverse mesocolon is a mesentery that connects the transverse colon to the posterior abdominal wall
19
Q
Where is the boundary between the hindgut and the midgit?
A
20
Q
Which space lies lateral to the descending (and ascending) colons?
A
Paracolic gutters
21
Q
Which quadrant of the abdominal cavity is the sigmoid colon located in?
A
Lower left quadrant
22
Q
At which level does the inferior mesenteric artery leave the aorta?
A
L3
23
Q
What is the splenic flexure
A
Sharp bend in the colon where the transverse becomes to descending.
Also known as left colic flexure
24
Q
At what vertebral level is the rectosigmoid junction?
A
rectosigmoid junction, around S3
25
What are the transverse folds in the rectum?
They are valves
26
What are these layers of the oesophagus?
27
Which muscle type(s) form the muscularis externa layer as you move down the oesophagus?
Upper 1/3 = skeletal; Middle 1/3 = skeletal/smooth; Lower 1/3 = smooth
28
In the oesophagus what are the three layers of the muscosa moving out -> in?
Muscularis mucose (interna)
Lamina propria
Surface epithelium
29
How would you describe the lamina propria?
Layer of connective tissue in the mucosa that connects the epithelium to the muscularis mucosa
30
Which of these are which layers of the oesophageal mucosa?
What are the tags?
31
What is this?
Small bowel
32
What are the large folds of the small bowel called?
plicae
33
What small projections can be found on the plicae?
Villi
34
Fill in these when zoomed in on one plicae of a small intestine
35
Fill in this zoomed out of small intestine
Plicae
Muscosa
Submucosa
Muscularis externa
36
what do globlet cells secrete?
mucus
37
What is the predominant type(s) of cell present in the surface epithelium of the large bowel?
Enterocytes (absorptive cells) and goblet cells are both abundant
38
Fill in these layers of the colon
39
What's this?
Lamina propria of the colon
40
What's this?
Muscularis mucosae (interna) of colon
41
What's this?
Surface epithelium of the colon
42
Why might a tumour occurring in the head of the pancreas cause painless jaundice?
Distal obstruction of the common bile duct. Painless as opposed to the painful presentation of gallstones
43
44
What is the name of the reflection of peritoneum running between the diaphragm and the liver, which limits the right subphrenic space?
Anterior / superior coronary ligament
45
What is the name of the reflection of peritoneum running between the diaphragm and the liver, which limits the hepatorenal space?
Posterior / inferior coronary ligament
46
Name these liver ligaments
Hint:
Bald king
Around the bare area is a crown (coronary ligaments)
47
Fill in these impressions of the liver
48
The hepatic artery proper, hepatic portal vein and the common bile duct together form the (hepatic) portal triad contained within which ligament?
hepatoduodenal ligament
49
The hepatoduodenal ligament is the part of what greater structure?
hepatoduodenal ligament is the part of the lesser omentum
50
Fill in this liver histology
51
Fill in this pancreas histology.
What do the cells make?
Islet cells:
Alpha - glucagon
Beta - Insulin
Delta - somatostatin/gastrin
The exocrine cells are acinar cells which produce enzymes such as protease, lipase and amylase
52
Fill in this spleen histology
53
What type of epithelium lines the gallbladder?
Single layer of columnar epithelial cells
54
What is the purpose of the folds/ microvilli of the gallbladder epithelium?
They can flatten and provide more space as the gallbladder fills
55
Look at this gallbladder shit
56
This pituitary fossa is covered by a shelf of dura known as...
the sellar diaphragm
57
What structure passes through the sellar diaphragm and connects the pituitary gland to the base of the brain?
What are the two names for this?
- The infundibulum, or pituitary stalk
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What are Magnocellular neurons
large neurosecretory cells in the hypothalamus that synthesize and release the peptide hormones vasopressin (also known as anti-diuretic hormone) and oxytocin
These hormones are:
Made in the cell bodies in the hypothalamus
Transported down their axons through the pituitary stalk
Stored and released from the posterior pituitary (neurohypophysis)
61
Where are the cell bodies, axons and synapses of the magnocellular neurons located?
- Cell bodies: Hypothalamus
- Axons: Travel in the pituitary stalk
- Synapses: Posterior Pituitary
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What hormones travel down the axons of the magnocellular neurons?
- Oxytocin (for the cells which originate from the PVN (paraventricular nulei)) and Vasopressin (for the cells which originate from the SON(supraoptic nuclei)
63
What hormones are made in the anterior pituitary?
1. Adrenocorticotropic hormone ACTH
2. Luteinising hormone LH
3. Follicle stimulating hormone FSH
4. Thyroid stimulating hormone TSH
5. Growth hormone GH
6. Prolactin PRL
64
How is the release of these hormones controlled?
Inhibitory and releasing hormones are made in the hypothalamus and transported to the anterior pituitary in a system of small blood vessels known as the pituitary portal system.
65
What structure is located immediately below the pituitary fossa?
The sphenoid sinus
66
What nerve do the superior and recurrent laryngeal nerves both originate from?
- The vagus (CN-X)
67
The recurrent laryngeal nerve is vulnerable to damage during thyroid surgery. What would be the consequence of damaging these nerves?
Horseness of voice and idfficulty breathing
68
What hormone(s) are released by the thyroid gland?
- T3, T4, Calcitonin
69
Where would you expect to find the parathyroid glands?
- On the posterior aspect of the thyroid gland
70
71
Which veins do the thyroid veins drain in to?
- Superior and middle thyroid veins – to internal jugular vein
- Inferior thyroid veins – to the brachiocephalic veins.
72
What is the blood supply to the parathyroid glands?
- Primarily branches from the inferior thyroid arteries, collateral supply from superior thyroid arteries.
73
Where does the blood supply come from for the thyroid?
Superior and inferior thyroid arteries.
Superior originates from the internal carotod and the inferior from the thyrocervical trunk
74
What imaging technique do you need ot view the parathyroid and thyroid glands?
Ultrasound
75
How do you know you are looking at the common carotid arteries, and not the internal / external carotid arteries?
- The bifurcation of the common carotid artery to form the internal and external carotid arteries happens above the level of the upper border of the thyroid cartilage: we are viewing a region inferior to this.
76
Name these parts of the pancreas
77
Which branches of the abdominal aorta does the pancreas recieve blood from?
The pancreas receives its blood supply via branches of both the celiac trunk and superior mesenteric.
78
Which arteries from the coeliac trunk supply the pancreas?
- Splenic artery (which gives rise to the great pancreatic artery)
- Common Hepatic artery, which gives rise to the gastroduodenal, which in turn gives rise to the anterior and posterior superior pancreaticoduodenal arteries.
79
Which arteries form the superior mesenteric supply the pancreas?
- Inferior pancreaticoduodenal arteries
80
81
Pituitary low zoom histology
82
Pituitary hgih zoom
83
Low zoom thyroid
84
High zoom thyroid histology
85
Parathyroid histology
86
Low zoom pancreas
87
What structures travel through the following openings in the skull:
* The optic canal
* The carotid canal
* The foramen magnum
* The optic canal transmits the optic nerve (and ophthalmic artery) – there are a pair of them
* The carotid canal transmits the internal carotid artery – there are a pair of them
* The foramen magnum transmits the spinal cord and vertebral arteries – there is only one
88
Which parts of the brain does the falx cerebri separate?
The falx cerebri separates the left and right cerebral hemispheres of the brain
89
Which parts of the brain does the tentorium cerebelli separate?
The tentorium cerebelli separates the occipital lobe (above) from the cerebellum (below)
90
What would you normally expect to find in the subarachnoid space?
The subarachnoid space should contain CSF and arteries
91
Where are the external viens that drain the brain loacated?
Within the dura mater
92
What is the name given to the large cleft separating the two cerebral hemispheres?
Great longitudinal fissure
93
What type of nerve fibres are most likely to be carried in the corpus callosum (e.g. association, commissural or projection fibres). Why is this?
Commissural: these fibres are responsible for connecting one cerebral hemisphere to the other
94
The thalamus, hypothalamus and pineal gland (epithalamus) are part of which larger brain structure?
Diencephalon
95
What is the difference in what is highlighted between a CT, MRI T1 and MRI T2?
CT: bone
T1: fat and tissues
T2: water and fluid
96
What is the name given to the specialised structures lining the ventricles that generate cerebrospinal fluid (CSF)?
The choroid plexus (specialised areas of the ependymal cells that line the ventricles)
97
How does CSF get into the subarachnoid space from the 4th ventricle?
Through one of 3 apertures (two lateral, and one median; also known as the foramen of Luschka and Magendie respectively)
98
Where is CSF resorbed back into the general circulation?
Via arachnoid granulations (little sponge-like structures) located around the superior sagittal sinus (one of the dural venous sinuses)
99
Where is spinal chord white and grey mater?
What is important to remember?
Remember that spinal cord sections such as this are nearly always stained (with the myelin picking up the stain), therefore the white matter appears dark and the grey matter appears light.
100
How many pairs are there in each region of the spinal cord?
Cervical: 8 pairs
Thoracic: 12 pairs
Lumbar: 5 pairs
Sacral: 5 pairs
Coccygeal: 1 pair
101
How does a cross section of spinal chrod change between regions?
As you decrease you get less white mater and less neurons are required to be travelling in it.
Cervical is oblong
Thoracic is spindally
Lumbar has chonky grey horns
Sacral is wee
102
Draw out the spinothalamic tract
103
Fill out the sensory tract areas on this cross sections of the brain stem.
Which of these belong to which tract?
Dorsal collumn pathway:
Fasciculus cuneatus/gracillis
Nucleus cuneatus/gracillis
Internal arcuate fibres
Medial lemniscus
Spinothalamic tract:
Spinal lemniscus
104
Draw out the dorsal column pathway
105
Which is more medial:
Fasciculus gracillis
Fasciculus cuneatus
Fasciculus gracillis - just like the muscle
106
What's this?
Mid medulla
107
What's this?
Rostral medulla (upper)
108
What's this?
109
What's this?
Pons
110
What's this?
Midbrain
111
Anterior brainstem
112
Posterior brainstem
113
Useful landmark for indentifying thalamus?
the thalamus forms the wall of the third ventricle. If you can identify the location of the third ventricle it can help you find the thalamus
114
Find the thalamus
115
What is the internal capsule?
White matter tracts in the central brain.
Anterior limb contains fibres associated with higher functions. Posterior limb contains major ascending somatosensory fibres and
descending motor fibres
116
What 3 areas of grey matter form the boundaries of the internal capsule?
Caudate nucleus, Lentiform nucleus, Thalamus
117
What is the principal arterial blood supply to the sensory cortex receiving information
from the lower limb?
Anterior cerebral artery
118
What is the principal arterial blood supply to the cortex receiving information from the
head?
Middle cerebral artery
119
What is a dorsal root ganglion?
A collection of sensory neuron cell bodies outside of the CNS
120
Trigeminothalamic fibres will then decussate in the brain stem and travel to the thalamus. Can
you remember where exactly in the thalamus these fibres will synapse?
Ventroposteriomedial nucleus of thalamus
121
What type of information is associated with which sensory synapse nucleus in the brainstem?
(trigeminal)
- mesencephalic nucleus - proprioception
- chief sensory nucleus – touch and pressure
- nucleus of the spinal tract of the trigeminal – pain and temp
122
123
What kind of information if required for proprioception?
* Muscles stretch
* Tendon stretch
* Pressure
124
Which spinocerebella tracts travel contra and ipsilaterally?
There are 2 principle tracts relating to the spinocerebellar pathway:
dorsal spinocerebellar tract - does not cross - travels up ipsilaterally
ventral spinocerebellar tract – does cross - travels up contralaterally
125
Which of the cuneatus/ gracilis pathways carries information from the lower/ upper body?
Cuneatus - upper
Gracillis - lower
Only both are in the dorsal column by the time it is the cervical chord
Can remember by:
Gracilis - the muscles is in the leg so this lower. The cuneatus then joins later which is why it is more medial.
126
What are the putamen and globus pallidus called together?
lentiform nucleus
127
What are the four areas of the internal capsule?
128
Where in the internal capsule are the corticospinal and corticobulbar fibres located?
Corticospinal and corticobulbar fibres are both located in the posterior limb of the internal capsule. The corticospinal fibres are nearer the retrolenticular region, corticobulbar fibres are nearer the genu.
129
Draw out the corticospinal tract
130
Where are the cell bodies of upper motor neurons in the corticospinal tract primarily located?
Principally in the primary motor cortex
131
Where are the cell bodies of lower motor neurons located?
In the ventral grey horn of the spinal cord. Their axons exit the spinal cord in the ventral root, and merge with the dorsal root to form a mixed spinal nerve.
132
What happens to the majority of descending corticospinal motor axons at the decussation of the pyramids?
They decussate into the lateral corticospinal tract
133
What is the main difference in when the lateral and ventral corticspinal tracts decussate?
Fibres in the lateral tract decussated in the medulla; fibres in the ventral tract are ipsilateral and will decussate in the spinal cord close to the vertebral level where their target lower motor neurons are located
134
Considering the four main extrapyrimidal tracts which does each one revieve commands form and what does each one activate?
135
Where are each of the cells bodies in the various extrapyrimidal tracts?
- Rubrospinal – UMN cell bodies in the red nucleus
- Vestibulospinal – UMN cell bodies in the vestibular nuclei
- Tectospinal – UMN cell bodies in the superior colliculus
- Reticulospinal – UMN cell bodies in the reticular formation (hard to find)
136
Thinking of extrapyramidal tract cell bodies. Where is the red nucleus and the superior colliculus in a cross section of the midbrain?
137
Thinking of extrapyramidal tract cell bodies. Where are the vestibular nucleii in the pons?
138
What are these?
139
When it comes to the basal ganglia.
What structure is the striatum part of?
The caudate nucleus
140
Which cranial nerves are attached directly to the cerebrum?
Olfactory, Optic
Sequence is 22134
141
Which cranial nerves are attached directly to the midbrain?
Occulomotor and Trochlear
Sequence is 22134
142
Which cranial nerves are attached directly to the pons?
Trigeminal
Sequence is 22134
143
Which cranial nerves are attached directly to the pontomedullary junction?
Abducens, Facial, Vestibularcochlear
22134
144
Which cranial nerves are attached directly to the medulla?
Glossopharyngeal, Vagus, Accessory, Hypoglossal
22134
145
146
Match the foramen that the cranial nerves exit from
Hints for harder ones:
All the nerves to do with eye motion travel through the superior orbital fissure
The Maxillary nerve exits the skull through the foramen rotundum - remember Max is a bit rotund
Mandibullar -> foramen ovale - mandibulla does the mouth which is oval
Facial + Vestibulocochliar -> Internal acoustic meatus - Whiskers and ears sense small things together
Rest of the hard ones are jugular
147
Can you name each of the nuclei in the coloured diagram and state what the function of the information passing through it is? Use the large illustration to help you.
Use the whole brain with the cranial nerves attached to help you identify the nuclei. Remember, where the nerves emerge from the brainstem will be closely associated with the location of the associated nuclei.
148
What nerves innervate these muscles?
149
150
151
152
One cranial nerve perceives general sensory information from the pharynx making up the afferent limb of the gag reflex. What nerve is this?
Glossopharyngeal nerve
153
In general where are sensory nerve bodies located?
Where are motor nerve bodies located?
First order sensory nerve bodies are located in ganglia outside of the CNS such as the dorsal root ganglia and the trigeminal ganglia. Second order are in grey metter nuclei in spinal chord/brainstem (at synapse). Third order are int he thalamus (synapse).
First order motor nerve bodies are located in grey matter nuclei in spinal chord/ brainstem (synapse). Second order motor neuron bodies are located in the primary motor cortex
154
Describe the trigeminal dermatomes
155
What are the four cranial nerves carrying autonomic innervation?
III - Oculomotor nerve
VII - Facial nerve
IX - Glossopharyngeal nerve
X - Vagus nerve
156
What are the parasympathetic funtions of each cranial nerve?
Bonus points for the site of action
157
What are the three cranial nerves that contribute to general sensation at the ear?
Mandibular branch of trigeminal
Facial
Vagus
158
How is the relationship between dura matter and bone different in the spinal chord and brain
In the cranium the dura is formly attached to the bone
Int he spine there is an epidural space between the dura matter and vertebra consisting of epidural fat and small blood vessels
159
Draw out the brachial plexus
160
Out fo the three main nerve which arrise out of the lumbosacral plexus which one takes some from the sacral part of the plexus?
Sciactic
161
How many pairs of spinal nerves are there?
31
8 Cervical
12 Thoracic
5 Lumbar
5 Sacral
1 Coxxygeal
162
Why does the intermediate/lateral grey horn tell you that this is definitely a section through thoracic spinal cord?
The intermediate/lateral grey horn is a specific feature of the thoracic spinal cord, housing the cell bodies of pre-ganglionic sympathetic neurons
163
Where in the spinal chord does the sympathetic division of the autonomic nervous system arise from?
Thoracic spinal chord
164
Identify the numbered structures on the diagram below, which shows the sympayhetic communications formed by the thoracic region of spinal cord.
165
How many pairs of thoracic splanchnic nerves are there, and what are they called?
Where are each of the thoracic splanchnic nerves passing to?
* Greater splanchnic nerve goes to the coeliac ganglion
* Lesser splanchnic nerve goes to the superior mesenteric ganglion
* Least splanchnic nerve goes to the inferior mesenteric ganglion (or the renal ganglia/plexus, depending on which book you consult!)
166
Describe the path of the left renal vein
Travels in front on the aorta and behind the superior mesenteric
Hint: lay the letters of the alphabet down on a table and v stack on top of a
167
Describe the path of the right renal artery
Travels behind the IVC
Hint: lay the letters of the alphabet down on a table and v stack on top of a
168
Which is more superior right or left kidney?
Left kidney is more superior as right gets pushed down by the liver
169
Which ribs do the kidneys have a relationship with?
Left is posteriorly protected by ribs 11 and 12, right only has a relationship with rib 12
170
This is part of kidney, identify the blotted out parts and the part pointed to.
At what points here is renin involved?
171
This is a kidney
172
The blood supply to the adrenal glands is from three different arteries: the superior, middle and inferior adrenal arteries. Where do each of these arteries branch from?
Superior adrenal artery from inferior phrenic artery
Middle adrenal artery from abdominal aorta
Inferior adrenal artery from renal artery
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174
What is the difference between left and right sides in the venous drainage pattern of the adrenal glands?
Right:
One single adrenal vein drains into the IVC
Left:
A collection of adrenal veins drain into the inferior phrenic and renal veins
175
176
Layers of adrenal gland
Hints:
Zona Glomerulosa is on the outside as it makes aldosterone which is to do with the glomerulus.
Then we know after aldosterone it's glucocorticoids.
And after that androgen production in zona reticularis. Remember because adrogens activate you just like reticular activation
HINT:
They are on top of the kidneys -> GFR
177
178
What are the main ligamnets connecting to the ovaries?
179
Where does the ovarian artery originate from?
Abdominal aorta
180
What is the name for the venous drainage of the ovary?
Pampiniform plexus
Hint:
It tangles and drape around the ovary/testes pampering it
181
Identify the different features of this ovarian histology.
Which of this produces oestrogen. Which produces progesterone?
* Cortex
* Medulla
* Immature follicle
* Mature follicle
* Corpus luteum
* Corpus albicans
* Mature follicle - Oestrogen
* Corpus luteum – Progesterone
182
183
184
Which cells make testosterone?
Leydig cells
185
Fill in this male hormone chart
Hint: L -> L
In females LH acts to stimulate androgens (testosterone like) as an oestrogen precurser
186
Fill in these female hormones
187
188
The blood supply to the uterus is via the uterine artery. What is this artery a branch of?
Internal iliac artery
189
What is the uterine artery a branch of?
Internal iliac artery
190
The uterine artery creates a plexus on the lateral aspect of the uterus that anastomoses with which other arteries
The uterine artery creates a plexus on the lateral aspect of the uterus that anastomoses with the ovarian and vaginal arteries.
191
Where does blood from the uterine vein drain into?
Internal iliac vein
192
Identify these layers of the uterus
193
How can you tell the difference between what phase the uterus is in by histology?
The development of saw tooth glands, there are some in the secretory phase and lots in the mentrual.
194
What hormones are being made duirng the proliferative and secretory phases of the mentrual cycle?
Proliferative:
o FSH from anterior pituitary
o Oestrogen from mature follicles
Secretory:
o Oestrogen from mature follicles
o Progesterone
195
What are the unique features of the maternal and foetal surfaces of the placenta?
Foetal surface is smooth and covered by the chorion. The maternal surface is rough containing a very thin layer of decidua which is of maternal origin and derived from the endometrium.
196
Fill out this histology of the uterus
Hint for name of two layers:
Mum decides hence decidua
Foetus is a child like zagreus - choranaught
197
What is the outermost layer of foetal cells that completely surrounds the foetus and ALL foetally-derived tissues, and lies adjacent to the maternal tissue?
The chorion – an outer layer formed by trophoblasts and an inner layer formed by somatic mesoderm.
198
Which hormone do trophoblast cells secrete in the first few weeks of pregnancy? What does it do?
Human chorionic gonadotrophin (hCG)
hCG is an analogue of pituitary LH and maintains the function of the corpus luteum during the first few weeks of pregnancy to maintain progesterone
199
After approximately 8 weeks, the placenta takes over the production of which hormone from the corpus luteum?
Progesterone
200
Function of progesterone
Oestrogen grows and prepares the lining of the uterus for implantation. Progesterone then maintains this.
Fall in progesterone causes mentruation.
After pregnancy progesterone therefore must be maintained
201
How much of the placenta is foetal tissue?
More than 99% of the tissue in the placenta is foetal, consisting of branching villi containing the foetal capillary bed.
202
What vertebral level do the kidneys sit at?
The kidneys sit at vertebral level T12-L3.
203
There are three common sites of narrowing in the ureters. Can you list these? Why are these may be clinically relevant?
Three common sites of narrowing in the ureters;
1. Junction of the ureter and renal pelvis
2. Crossing the common iliac artery at the pelvic brim
3. Passing through the wall of the bladder
These are common sites where kidney stones may get stuck.
204
Identify these features of a female bladder?
205
What are the parts of the male urethra?
1. Pre-prostatic - passes through internal urethral sphincter
2. Prostatic - passes through prostate
3. Membranous urethra - passes through the urogenital diaphragm and is surrounded by the external urethral sphincter.
4. Spongy - part in the penis
206
Identify the structures in contact with the kidney at these points
207
208
Name these and point to the hilum and the ureta
Hilum - where all the vessels go in
209
Identify these internal renal arteries?
210
Describe how the renal artery splits down
Renal artery ->
Anterior and posterior branches ->
5 segmental arteries ->
Interlobar ->
Arcuate ->
Interlobular
211
Kidneys
212
What are these parts of the ureta
213
What is the urethral epithelium called?
Why is it special?
It is called urothelium/ uroepithelium/ transitional epithelium
It is special beause it is stratified to allow the ureta to stretch while maintaining it impermeability to urine
214
Bladder
215
What is the name given to the muscular wall of the bladder and why is this unusual?
The muscular wall of the bladder is called the detrusor muscle. It is made from smooth muscle and it is unusual for smooth muscles to be named in the human body.
216
How is voiding of the bladder controlled?
Parasympathetic
217
Which 3 muscles are in contact with the posterior surface of each kidney?
Tranversus abdominus, quadratus luborum and psoas major are in contact with the posterior surface of each kidney.
218
Abdo muscles
219
Which direction to each of the muscle fibres go int he four muscles of the abdominal wall?
Rectus abdominus - verticle
External oblique - hands in outside jacket pocket
Internal oblique - hands in internal pockets
Transverse abdominus - transverse
220
What are the origins and insertions of transverse abdominis
Origin:
Costal margin, thoracolumbar fascia, iliac crest, lateral one-third (1/3) of inguinal ligament
Insertion:
Linea alba (via rectus sheath), pubic crest + pectineal line (via conjoint tendon)
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What are the origins and insertions of rectus abdominis
Origin:
Pubic crest
Iinsertion:
Costal cartilages 5, 6, 7
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What are the origins and insertions of internal oblique
Origin:
Thoracolumbar fascia, iliac crest, lateral two-thirds (2/3) of inguinal ligament
Insertion:
Costal margin, linea alba (via rectus sheath), pubic crest + pectineal line (via conjoint tendon)
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What are the origins and insertions of external oblique
Origin:
Lower 8 ribs
Insertion:
Linea alba (via rectus sheath), iliac crest, lower border forms inguinal ligament
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The neurovascular plane for the abdomen wall lies between which two muscle layers?
The neurovascular bundle lies between the middle and inner layers of the body wall (internal
oblique and transversus abdominis in abdomen; internal and innermost intercostal in thorax)
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What are the nerve supplies the muscles of the abdominal wall?
What movements do they do?
lower 6 thoracic spinal nerves (T7-T12) + iliohypogastric & ilioinguinal (L1) for the fibres of the conjoint tendon (‘inguinal shutter mechanism’)
move trunk (flexion, lateral rotation), compress abdomen (expiration, evacuation),
support of viscera, control of inguinal shutter mechanism
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When describing the rectus sheath what is meant by above the costal margin, below the costal margin and below the arcuate line
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What is meant by the semilunar line?
Edge of rectus abdominus?
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What are the inferior and superior epigastric arteries?
They run posteriorly to rectus abdominus
Superior is found between costal margin and arcuate line and contained within the posterior sheath.
Inferior is found below arcuate line
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What is the meaning of Aponeurosis?
The flattening of a tendon to form a sheath and attachment
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Describe the rectus sheath and what makes it up at the three different points:
Above costal margin
Below costal margin
Below arcuate line
a) Anterior sheath only (from EO aponeurosis)
b) Anterior and posterior sheath (note the splitting of the IO aponeurosis)
c) Anterior sheath only (from all 3 aponeuroses)
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What does the rectus sheath contain?
Rectus abdominis (+/- pyramidalis)
Superior and inferior epigastric vessels
Lower 6 intercostal nerves (T7-T12) and accompanying vessels
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In a midline incision (e.g. laparotomy) what 6 layers would be traversed before entering
the abdominal cavity?
Skin
Superficial fascia (fatty layer of Camper; membranous layer of Scarpa)
Linea alba
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
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What structures form the anterior wall, posterior wall, roof and floor of the inguinal
canal?
Anterior wall:
* Superficial ring (medially; weak), EO aponeurosis and IO muscle (laterally; strong)
Posterior wall:
* Conjoint tendon (medially, strong); transversalis fascia and deep ring (laterally; weak)
Roof:
* Lowermost fibres of IO and TA muscles (insert via conjoint tendon; form ‘inguinal shutter’)
Floor:
* Inguinal and lacunar ligaments
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From where are the coverings of the spermatic cord derived?
External spermatic fascia – from EO aponeurosis
Cremasteric fascia – from IO and TA muscles - hint sperm -> cream
Internal spermatic fascia – from transversalis fascia
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What are the contents of the spermatic cord?
* 3 arteries: testicular, cremasteric, artery of vas
* 3 nerves: ilioinguinal, genital branch of genitofemoral, sympathetic fibres
* 3 others: corresponding veins (incl. pampiniform plexus), lymphatics, vas deferens
…and the most easily forgotten:
Obliterated remains of processus vaginalis (this forms the sac of an indirect inguinal hernia)
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What is the difference between:
a) mid-point of inguinal ligament
b) mid-inguinal point
How do you find them?
What structures are found here?
Mid-point of inguinal ligament:
- midway between ASIS and pubic tubercle
- indicates position of deep ring
Mid-inguinal point:
- midway between ASIS and pubic symphysis
- indicates position of femoral artery
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What are the three hernias?
How are they distinguished?
Indirect inguinal vs direct inguinal:
- distinguished based on relationship to inferior epigastric vessels
- indirect passes lateral to vessels
- direct passes medial to vessels
Indirect inguinal vs femoral:
- distinguished based on relationship to pubic tubercle
- inguinal emerges above and medial to tubercle
- femoral emerges below and lateral to tubercle
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What is often the case with indirect inguinal hernias and is mistakenly used to define them?
They often pass through the inguinal canal and end up in the spermatic chord as this is the path of least resistance.
However they are actually defined by whether or not they pass laterally or medially to the inferior epigastric artery
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What are the boundaries of the inguinal triangle of Hesselbach and why is it useful to define?
Boundaries: inguinal ligament, inf. epigastric vessels, edge of rectus sheath (linea semilunaris)
Significance: a direct inguinal hernia pushes forward through the triangle (medial to the IEA)
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The peritoneum is a ………….. sac
serous -> it makes serous fluid
241
Is the peritoneal sac open or closed?
It is closed in males and open in females by the uterine tube.
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What counts as visceral and parietal peritoneum?
If it's on organs is visceral.
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What is the greater vs lesser sacs of the peritoneum?
245
Borders of the lesser sac of the peritoneum?
Caudate lobe of the liver
Posterior lesser omentum
Posterior stomach
Inside of greater omentum fold
Anterior of trnasverse mesocolon
Peritoneum that covers organs that form the bed of the stomach
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What apperture communicates the greater and lesser sacs?
epiploic foramen
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Where is the epiploic foramen?
Posterior to the free margin of the lesser omentum.
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What structures are found in the lesser omentum?
Hepatogatric lagament
Hepatoduodenal ligament -> inside this is the portal triad
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What is the greater omentum?
It is a peritoneal fold extends from the greater curvature of the stomach to the transverse colon folded up on itself.
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What is the lesser omentum?
: It is a fold of peritoneum extends from the liver to the lesser curvature of the stomach and 1st inch of duodenum.
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What is the falciform ligament?
252
What is the Gastrosplenic ligament?
It is a peritoneal fold connecting the spleen to the stomach.
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What is the Splenorenal (lienorenal) ligament
It is a peritoneal fold connecting the left side kidney to the spleen.
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What is the Mesentery
Mesentery: It is a fan-shaped peritoneal fold (formed of two layers) enclosing the free part of the small intestine.
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What is the Sigmoid mesocolon
Sigmoid mesocolon: It is a peritoneal fold enclosing the sigmoid colon.
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What is the Transverse mesocolon
Transverse mesocolon: It is a peritoneal fold enclosing the transverse colon.
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What is the Mesoappendix
Mesoappendix: It is a triangular peritoneal fold enclosing the vermiform appendix.
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Where are the following spaces in the perintoneum?
Right paracolic gutter
Left paracolic gutter
Right infracolic space
Left infracolic space
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What are the three pounches that form the base of the paritoneum?
Two in women
One in men
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What si the hepatorenal recess and subphrenic recess?
Pouches in the upper perintoneum
Both are part of the greater sac (although hepatorenal looks like lesser in these cross sections it is actually lateral to the right where it is greater. I think lesser is quite medial.
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What are the arterial arcades and vasa recta?
Aterial arcades -> anastamosing loops of jejunal and illial arteries
Vasa recta -> essentially the arterioles of the small intestine
262
What's this?
The round ligament of the liver, also known as the ligamentum teres, is a remnant of the left umbilical vein. It runs along the free edge of the falciform ligament, connecting the liver to the umbilicus
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What does the term Splanchnic mean?
"Splanchnic" refers to the viscera, or internal organs, particularly those within the abdominal cavity.
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What is the semicircular line?
A horizontal line on the posterior of rectus abdominus.
Another word for the arcuate line
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What is a tendenous intersection?
Horizontal break in the abs
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What is another word for the arcuate line
semicircular line
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At which vertebral level does the pharynx become continuous with the oesophagus?
C6
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Where is CSF resorbed back into the general circulation?
Arachnoid granulations -> pertrustions through the arachnoid mater and into the dura that allow csf to drain in the venous sinuses
