GA Study Guide PDF

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The No Bullshit Anatomy Review Table of Contents ! 1.!Embryology……………………………………………………………………………………………………1! ! a.!Human!Birth!Defects…………………………………………………………………………….2! 2.!Overview!of!the!Nervous!System……………………………………………………………………..8! 3.!Thoracic!Cage!and!Pectoral!Region………………………………………………………………….13! 4.!Mediastinum…………………………………………………………………………………………………..20! 5.!The!Heart……………………………………………………………………………………………………….26! ! a.!For!the!Prolific!Types…………………………………………………………………………...32! 6.!Thoracic!Organs!of!Respiration……………………………………………………………………….34! 7.!Anterior!Abdominal!Wall………………………………………………………………………………...40! 8.!Development!of!the!Heart!&!Lungs…………………………………………………………………..47! 9.!Abdominal!Cavity!and!Peritoneum…………………………………………………………………..50! 10.!Liver!and!Gallbladder……………………………………………………………………………………54! 11.!Stomach,!Pancreas,!and!Spleen……………………………………………………………………...59! 12.!Development!of!the!Digestive!Tract……………………………………………………………….64! 13.!Small!and!Large!Intestines…………………………………………………………………………….67! 14.!Suprarenal!Glands………………………………………………………………………………………...75! 15.!Posterior!Abdominal!Wall……………………………………………………………………………..78! 16.!Urinary!System……………………………………………………………………………………………..84! 17.!The!Pelvic!Cavity…………………………………………………………………………………………..90! 18.!Perineum……………………………………………………………………………………………………..95! 19.!Male!Reproductive!System……………………………………………………………………………99! 20.!Female!Reproductive!System………………………………………………………………………104! 21.!Development!of!the!Urogenital!System………………………………………………………..108! EMBRYOLOGY 1. What are the 4 phases of the female sexual cycle? 1. Follicular Phase 2. Ovulation 3. Luteal Phase 4. Menstruation 2. What hormone is released from the hypothalamus during the follicular phase that stimulates the pituitary gland to secrete FSH and LH? Gonadotroprin Releasing Hormone (GnRH) 3. GnRH stimulates the anterior pituitary gland to secrete which 2 hormones? 1. Follicle Stimulating Hormone (FSH) 2. Luteinizing Hormone (LH) 4. The release of FSH and LH stimulate the growth of what? The growth of several ovarian (Graafian) follicles 5. Which hormone is secreted by the developing ovarian follicles? Estrogen 6. What is the main function of the estrogen released from the ovarian follicles? To re-grow the endometrial lining of the uterus 7. A paradoxical positive feedback mechanism induces a spike in which hormone to induce ovulation? LH 8. Following ovulation, LH is continually secreted to maintain which structure of the ruptured follicle? Corpus luteum 9. Which hormone is secreted by the corpus luteum? Progesterone 10. What is the function of progesterone released from the corpus luteum? Maintains the uterine lining for implantation 11. Why is it important that progesterone and estrogen exhibit negative feedback on GnRH, LH, and FSH during the luteal phase? To prevent the development of multiple ova within the same cycle 12. If no fertilization of the oocyte occurs during the luteal phase, what process occurs? Menstruation 1 2 The Anatomy Review 13. Describe the physiological changes to the endometrium as menstruation progresses. Endometrial spiral arteries constrict  endometrial ischemia  necrosis of the endometrium  blood, mucus, and dead endometrial tissue is expelled from the body 14. How long can an unfertilized oocyte survive in the female abdominal cavity? 12 – 24 hours 15. How long can sperm survive inside the female reproductive tract? 48 hours 16. What is the normal site of oocyte fertilization? Ampulla of the fallopian tube 3 day 17. What is the first layer of the oocyte that the sperm must penetrate upon fertilization? Corona Radiata 18. What process must successfully occur in order for the spermatozoa to bind with the egg? Capacitation 19. Which reaction is triggered to allow spermatozoa entry into the egg following capacitation? The acrosomal reaction 20. How many hours after fertilization until the zygote reaches the two-cell stage? 30 hours 21. What is a morula? How many days following fertilization is the morula formed? A 16-cell embryo Day 4 solid cluster cells of 22. The morula develops into which structure by the 5th day? Blastocyst implantation 23. The blastocyst is made up of which two parts? Inner cell mass (embryoblast) Embryo insidemother Outer cell mass (trophoblast) _atmosphere gutside sphere Trop 24. How many days after fertilization does implantation occur? 7 days 25. Which part of the blastocyst penetrates the uterine mucosa as implantation progresses? The trophoblast cells surrounding the embryoblast Embryology 3 26. What are the penetrating finger-like projections of trophoblast into the uterine mucosa specifically called? Syncytiotrophoblast 27. Which hormone is secreted by the syncytiotrophoblast to maintain the corpeus luteum? Human Chorionic Gonadotropin (hCG) 28. During the 2nd week of development, the embryoblast develops into a bi-laminar disc consisting of which two layers? 1. Epiblast (upper layer) 2. Hypoblast (lower layer) 29. What specific type of cells make up the eipblast? Columnar cells 30. What specific type of cells make up the hypoblast? Cuboidal cells 31. What process of embryonic development begins during the 3rd week? Gastrulation 32. In one sentence, what is gastrulation? The epiblast differentiating into 3 distinct layers: ectoderm, mesoderm, and endoderm 33. Gastrulation begins with the formation of a line on the surface of the epiblast known as what? Primitive streak 34. As development continues during the 3rd week, the cells of the primitive streak migrate rostrally to form what cartilaginous structure? Notochord 35. What are the 2 main functions of the notochord? 1. Secretes chemical signals to induce formation of the neural plate 2. Also serves as an embryonic axis of support spine 36. The neural plate invaginates by day 28 to become which tube-like structure? Neural tube 37. The neural tube is made up of cells from which germ line? Ectoderm 38. Following the closure of the neural tube, a layer of neuroectodermal cells migrates between the surface ectoderm and neural tube to form what structure? Neural crest 4 The Anatomy Review 39. What term is given to the differentiation of the germ layers into tissues and organs? Organogenesis 40. Organogenesis takes place during which weeks of development? 3rd – 8th week 41. What structures does the neural crest give rise to? - Sensory ganglia of cranial and spinal nerves - Autonomic ganglia - Sheaths of peripheral nerves - Meningeal coverings of the brain and spinal cord 42. What does the neural tube eventually become? - Central nervous system - Retina - Pineal body - Posterior pituitary gland 43. In general, ectoderm gives rise to which organs and structures? outside Those structures that maintain contact with the outside world 44. During the 3rd week, the mesoderm arranges into which 3 distinct regions? 1.Paraxial mesoderm 2. Intermediate mesoderm 3. Lateral plate mesoderm 45. What are the 2 portions of the lateral plate mesoderm? 1.Splanchnic mesoderm a 2. Somatic mesoderm 46. On day 20 of development, the paraxial mesoderm begins dividing into segmental blocks known as what? Somites 47. How many pairs of somites are in a human embryo? 42 48. Each somite further differentiates into which 3 unique layers? 1. Sclerotome 2. Dermatome 3. Myotome 49. What does the sclerotome eventually become? - Bones - Cartilage - Ligaments of the vertebral column - Parts of the base of the skull Embryology 5 50. What does the dermatome eventually become? Dermis and hypodermis 51. The myotome further divides into which 2 layers? Hypomere and Epimere becomes sidetalgom 51 52. What does the hypomere eventually become? Muscles of the limbs and body wall 53. What does the epimere eventually become? Deep back muscles A 54. What does the splanchnic portion of the lateral plate mesoderm eventually become? - Smooth muscles of visceral organs - Cardiac muscle 55. What does the somatic portion of the lateral plate mesoderm eventually become? - Blood - Lymphatic vessels - Spleen - Serous membranes of pleura, pericardium, and peritoneum 56. What does the intermediate mesoderm eventually become? Urogenital system (kidneys, ureters, bladder, urethra etc.) 57. What does the endoderm eventually become? - Liver - Pancreas - Urinary bladder - Epithelium of GI tract - Epithelia of trachea, bronchi, lungs 6 The Anatomy Review Epiblast Differentiation reek means DISEASE HUMAN BIRTH DEFECTS in 58. What is teratology? Birth Earth tea The study of birth defects and their causes ffamanthe TURNER Timmy x isor Guy chromosome 45 11 42 The individual is born with only an X sex chromosome (45, X) X 10 59. What is the genetic basis of Turner syndrome? 60. What is the genetic basis of Klinefelter syndrome? Chris felt me so I feel Klein extressexyf The individual is born with an extra sex chromosome, (47, XXY) 61. What is the genetic basis of Down’s syndrome? the Trisomy of chromosome 21 ti 3tips 3 z t tr i one chromos a Trisomy 62. The presence of Barr Bodies in a male nucleus is a sign of which birth defect? Barr Klinefelter syndrome 63. What is the etiology of Cru di Chat syndrome? short Short word arm Terminal deletion of the short arm of chromosome 5 Cru die 5letters I 2 3 45 64. What is the etiology of Achondroplasia? Genetically inherited mutation Bodies bodies Bare Bare Kk bodies yours soundslike Anaconda man 65. What is the etiology of Fragile X syndrome?professor Chromosomes inherited mutation mutant genetic b of inherited retardation mind is Fragile c mental An X-linked disorder; is the most common inherited cause of mental retardation 66. What is the etiology of Angelman syndrome? 6wings Its chromosome maternal angelman mom angemon Deletion of a segment of maternal chromosome 15 67. What is the etiology of Prader-Willi syndrome? Deletion of a segment of paternal chromosome 1 prader paternal I chromosome 1 7 OVERVIEW OF THE NERVOUS SYSTEM 1. What are the physical components of the central nervous system (CNS)? The brain and spinal cord 2. What are the physical components of the peripheral nervous system (PNS)? Cranial nerves, spinal nerves and branches of spinal nerves 3. What are the 2 divisions of the PNS? 1. Autonomic nervous system (ANS) 2. Somatic nervous system 4. The autonomic nervous system regulates activity of which 3 types of tissue? 1. Cardiac muscle 2. Smooth muscle 3. Glands 5. The somatic nervous system regulates activity of which type of tissue? Skeletal muscle 6. In regards to the CNS, what is the definition of a nucleus? A collection of cell bodies within the CNS 7. Contrast the physical difference between gray matter and white matter in the CNS. - Gray matter is a collection of cell bodies (nuclei) - White matter is bundles of axons 8. Peripheral nerves include which 2 groups of nerves? 1. Cranial nerves 2. Spinal nerves 9. List the 12 cranial nerves. I. Olfactory II. Optic III. Oculomotor IV. Trochlear V. Trigeminal VI. Abducens VII. Facial VIII. Vestibulocochlear IX. Glossopharyngeal X. Vagus XI. Spinal Accessory XII. Hypoglossal 10. What are the 3 types of neurons found in the nervous system? 1. Unipolar 2. Bipolar 3. Multipolar 11. Processes that carry information away from a neuronal cell body are called what? Axons 8 Overview Of The Nervous System 9 12. Processes that bring information toward the neuronal cell body are called what? Dendrites 13. The dorsal root ganglion (DRG) houses what type of neurons? Unipolar (sometimes called pseudounipolar) - These DRGs receive sensory information 14. The dorsal horn of the gray matter of the spinal cord is composed of what type of neurons? Unipolar - Sensory neurons 15. The ventral horn of the gray matter of the spinal cord is composed of what type of neurons? Cell bodies of efferent (motor) neurons 16. What type of nerve fibers are found in the dorsal root of the spinal nerve? Afferent (sensory) only! 17. What type of nerve fibers are found in the ventral root of the spinal nerve? Efferent only! 18. The anterior and posterior rami of a spinal nerve carry what type of fibers? Both afferent and efferent fibers 19. What are the 2 types of somatic nerve fibers found in the body? 1. Sensory: General somatic afferent (GSA) 2. Motor: General somatic efferent (GSE) 20. What are the 2 types of visceral nerve fibers found in the body? 1. Sensory: General visceral afferent (GVA) 2. Motor: General visceral efferent (GVE) 21. Visceral efferent fibers are motor neurons to which 3 types of tissue? 1. Glands 2. Smooth muscle 3. Cardiac muscle 22. GVE fibers are further divided into which 2 subcategories? 1. Pre-ganglionic 2. Post-ganglionic 23. What is a dermatome? A strip of skin innervated by a single spinal nerve 24. The C2 dermatome covers what part of the body? Back of the head 10 The Anatomy Review 25. The C4 dermatome covers what part of the body? Superior portion of the shoulders 26. The C6 dermatome travels to which finger? Thumb 27. The C7 dermatome travels to which finger? Middle finger 28. The C8 dermatome travels to which finger? Pinky finger 29.The T4 dermatome is at the level of which anterior anatomical surface anatomy? The nipples 30. The T10 dermatome travels anteriorly at the level of which anatomical landmark? The umbilicus 31. The T12/L1 dermatomes cover which general areas of the thighs? The inguinal crease 32. The L4 dermatome includes which toe? Big toe 33. Which part of the foot is along the S1 dermatome? The pinky toe and sole of the foot 34. Which 2 cranial nerves carry special sensory afferent fibers? II and VIII (2 and 8) – Optic and vestibulocochlear nerves (sight and hearing) 35. Which 4 cranial nerves carry special visceral afferent fibers? I, VII, IX, and X (1, 7, 9, 10) – Olfactory n., facial n., glossopharyngeal n., and vagus n. (taste and smell) 36. Which 4 groups of muscles are supplied by special visceral efferent fibers? 1. Pharyngeal muscles 2. Laryngeal muscles 3. Muscles of facial expression 4.Muscles of mastication 37. Which 2 skeletal muscles (not in the 4 groups listed above) are also supplied by SVE fibers? 1. Trapezius 2. Sternocleidomastoid 38. GVE fibers send motor stimuli to which 3 types of tissue? 1. Glands 2. Cardiac muscle 3. Smooth muscle Overview Of The Nervous System 11 39. What is the function of GSA fibers? Receive sensory information from somatic structures – skin, tendons, ligaments, skeletal muscles, joints, and fascia 40. What is the function of GVA fibers? Receive sensory information from visceral organs 41. What is the function of SSA fibers? Receive special sensory information for sight and hearing 42. What is the function of SVA fibers? Receive special sensory information for taste and smell 43. What are the 2 components of the autonomic nervous system? 1. Parasympathetic nervous system 2. Sympathetic nervous system 44. The parasympathetic nervous system has origins from which 2 regions of the body? 1. Brainstem 2. Sacrum (S2-S4 vertebral levels) 45. The sympathetic nervous system has origins from which vertebral levels? T1 –L2 (sometimes as low as L3 or L4) 46. Which 2 sets of ganglia are associated with the sympathetic nervous system? 1. Paravertebral ganglia 2. Prevertebral ganglia 47. Differentiate between paravertebral and prevertebral ganglia location. Paravertebral ganglia – travel vertically along both sides of the spinal column, also called the sympathetic chain Prevertebral ganglia – are found on the anterior surface of the aorta, which runs anterior to the spinal column 48. Which 2 sets of ganglia are associated with the parasympathetic nervous system? 1. Cranial ganglia 2. Intramural ganglia 49. Differentiate between cranial and intramural ganglia location. Cranial ganglia – located within the skull Intramural ganglia – located in the wall of visceral organs 50. Which division of the autonomic nervous system is energy-conserving, promoting rest and digestion? Parasympathetic 51. Which division of the autonomic nervous system is energy-consuming, promoting fight or flight? Sympathetic 12 The Anatomy Review 52. What are the 4 pairs of cranial ganglia? 1. Ciliary ganglion 2. Otic ganglion 3. Pterygopalatine ganglion “COPS” 4. Submandibular ganglion 53. What is the overall major function of the autonomic nervous system? Maintain homeostasis 54. Compare the length of pre-ganglionic and post-ganglionic sympathetic fibers. SP fibers have short pre-gg fibers and long post-gg fibers 55. Compare the length of pre-ganglionic and post-ganglionic parasympathetic fibers. PS fibers have long pre-gg fibers and short post-gg fibers 56. Where are the cell bodies of pre-gg sympathetic neurons located? Lateral horns of gray matter from T1-L2 57. Which vertebral levels (variable) of the sympathetic fibers do not synapse at paravertebral ganglia? T5-L2 do not synapse at paravertebral ganglia but at prevertebral ganglia 58. What are the 2 communicating branches between the paravertebral ganglia and spinal nerves called? 1. White ramus communicans 2. Gray ramus communicans 59. White rami communicans are found along what vertebral levels of the sympathetic chain? T1-L2 60. What type of fibers travel through white rami communicans? Myelinated pre-gg sympathetic fibers 61. What type of fibers travel through gray rami communicans? Non-myelinated post-gg sympathetic fibers THORACIC CAGE AND PECTORAL REGION 1. What are the 3 main functions of the thoracic cage? 1. Breathing 2. Protection of vital organs 3. Acts as a conduit 2. The thoracic cage is a conduit for which 3 structures? 1. Esophagus 2. Trachea 3. Aorta 3. What are the 3 components of the thoracic cage? 1. 12 thoracic vertebrae 2. Ribs and intercostal muscles 3. Sternum 4. Describe the location of the sternal angle, and which IVD lies directly posterior? The horizontal line where the manubrium and sternum meet; T4-T5 5. The xyphosternal joint is at the level of which IVD? T9-T10 6. The jugular or suprasternal notch is found at the level of which vertebrae? T2 7. What is the Angle of Louis aka? Sternal angle 8. The xiphoid process is found at the level of which vertebrae? T10 9. The manubrium is on the same level as which vertebrae? T3-T4 10. Name the borders of the superior thoracic aperture. - Manubrium - First rib - T1 11. Name the borders of the inferior thoracic aperture. - Costal margins - T12 - Xyphosternal joint - 12th rib 12. Which structures pass along the costal groove? Intercostal vein, artery, and nerve 13. What are the 3 components of the sternum? 1. Manubrium 2. Body 3. Xyphoid process (ossifies near 40 yrs of age) 13 14 The Anatomy Review 14. What is costochondritis? Inflammation of the costochondral joint – does not cause chest swelling 15. What is Tietze’s syndrome? Painful costochondritis, causes chest swelling 16. What causes rachitic rosary? Vitamin D deficiency 17. What is cleidocranial dysostosis? Genetic anomaly in which the individual is born without clavicles 18. What is costoclavicular syndrome? When there is diminished space between the clavicle and first rib 19. Which structures pass through the superior thoracic aperture? - Trachea, esophagus, thoracic duct, phrenic nerve, vagus nerve, SP chain - L and R CCAs, L and R subclavian arteries, IJVs, subclavian veins, L and R brachiocephalic veins 20. Which structures pass through the inferior thoracic aperture? - IVC, esophagus, abdominal aorta, thoracic duct 21. Describe the anatomical location of the female breast. - Subcutaneous, overlies deep fascia covering pec major and serratus anterior muscles - Transversely extends from lateral border of sternum to MAL (mid axillary line) - Vertically extends from 2nd to 6th ribs 22. Describe the anatomical structure of the female breast. - Axillary tail - Retromammary space – gives breast mobility - Suspensory ligaments of Cooper - 15-20 lactiferous ducts - Sebaceous glands of Montgomery – lubricate areola for feeding - Mammary glands - Nipple, areola Thoracic Cage And Pectoral Region 23. List the blood supply for the female breast and draw the arteries in a schematic. 24. List the venous drainage of the breast and draw a schematic of the veins. 15 16 The Anatomy Review 25. List the lymphatic drainage vessels in the breast and draw a schematic. 26. List the nerve supply to the breast and draw a schematic. 27. What is polythelia? Polymastia? Amastia? Multiple nipples; 28. What is gynecomastia? Man boobs Multiple breasts; No breasts Thoracic Cage And Pectoral Region 29. List the origin, insertion, action, and nerve supply (OIAN) of pectoralis major. O: Sternum, clavicle, ribs I: Lateral lip of bicipital groove of humerus A: Int. rotation, adduction of humerus N: Medial and lateral pectoral nerves 30. List the OIAN of pectoralis minor. O: Ribs 3-5 I: Coracoid process of scapula A: Protraction of scapula N: Medial pectoral n. 31. List the OIAN of serratus anterior. O: Ribs 1-8 I: Medial border of scapula on ventral side A: Abd. of humerus above 90 degrees, holds scapula close to ribs N: Long thoracic n. 32. List the OIAN of the subclavius. O: First rib I: Clavicle (ventral surface) A: Depress clavicle I: Nerve to subclavius 33. Describe the anatomical location of the external intercostal muscles. - Begin at the posterior aspect of the ribs and run anteriorly - End at costochondral junction 34. Describe the anatomical location of the internal intercostal muscles. - Continue into costochondral junction all the way to sternum - End at angle of rib posteriorly 35. Describe the anatomical location of the innermost intercostal muscles. Span the interchondral portion of the ribs 36. Describe the anatomical location of the transversus thoracis (sternocostalis) muscle. Originate at sternum and insert into ribs 3-6 at costochondral junction 17 18 The Anatomy Review 37. Describe the anatomical location of the subcostal muscles. Travel from superior portion of rib upward to inferior portion of rib above 38. Describe the shape of the diaphram upon inspiration and expiration. Inspiration = contraction (flattens) Expiration = relaxation (dome-shaped) 39. Describe the muscles involved in inspiration and expiration. A. External intercostals = elevation = inspiration B. Internal intercostals = depression = expiration C. Innermost (chondral) interchondrals = elevation = inspiration A + C = inspiration = elevation B = expiration = depression 40. The intercostal nerves derive from which spinal nerves? T1 – T11 ventral rami 41. The ventral ramus of the T12 spinal nerve forms which nerve? Subcostal nerve 42. Define dermatome. Bandlike skin areas innervated by a single nerve 43. Which are the typical intercostal nerves and list their components. T3 – T6 - Rami communicantes - Lateral cutaneous branch - Collateral branches - Anterior cutaneous branch - Muscular branch 44. Which are the atypical intercostal nerves and list their components. T1 and T2 - Do not have lateral cutaneous branches 45. Which intercostal nerves are the thoracoabdominal nerves? T7 - T11 Thoracic Cage And Pectoral Region 46. Spinal nerves at which spinal levels are contained in the thoracic cavity? T1 - T6 47. List the arterial supply of the thoracic wall and draw a schematic. 48. Draw the venous drainage of the thoracic wall. 19 MEDIASTINUM 1. What is the superior boundary of the mediastinum? The plane connecting the cupolae (apices of lungs) and the superior thoracic aperture 2. What is the inferior boundary of the mediastinum? Inferior thoracic aperture 3. What is the anterior boundary of the mediastinum? Sternum and costal cartilages 4. What is the posterior boundary of the mediastinum? T1-T12 vertebrae and their associated ribs 5. What are the boundaries of the superior mediastinum? - Sternal plane is the lower boundary; T1 and 1st ribs form upper boundary - Superior mediastinum lies between upper 4 thoracic vertebrae - Laterally bound by mediastinal plurae 6. What are the contents of the superior mediastinum? Aortic arch Upper ½ of IVC Left common carotid a. Left subclavian a. Left recurrent laryngeal nerve Brachiocephalic aa and vv. Internal thoracic aa and vv. Superior intercostal v. Trachea Esophagus Thoracic duct Vagus nerves Phrenic nerves Thymic remnants Longus colli m. Sternothyroid m. Sternohyoid m. Paratracheal lymph nodes Brachiocephalic lymph nodes Tracheobronchial lymph nodes 20 Mediastinum 21 7. What are the contents of the anterior mediastinum? Sternal lymph nodes Sternal vessels Small portion of thymus gland Branches of internal thoracic vessels Sternopericardial ligament Adipose tissue 8. What are the contents of the middle mediastinum? Pericardium Heart Ascending aorta Lower ½ of IVC Arch of azygos vein Tracheal bifurcation Bronchi Pulmonary trunk R and L pulmonary aa. and vv. Phrenic nerves Deep part of cardiac plexus Tracheobronchial nodes 9. What are the contents of the posterior mediastinum? Descending aorta and its branches Posterior intercostal aa., vv., and nn. Azygos v. Hemiazygos v. Accessory hemiazygos v. Sympathetic trunks Thoracic splanchnic nerves Esophagus Thoracic duct Vagus nerves 10. Which structures are found in the superior anterior mediastinum? Internal thoracic aa. and vv. 11. Which structures are found in both the superior and middle mediastinum? - Phrenic nerves - Arch of aorta - Pericardiacophrenic aa. and nn. 12. Which structures are found in both the superior and posterior mediastinum?- Esophagus - Vagus nerves - Thoracic duct 22 The Anatomy Review 13. The thoracic aorta pierces the diaphragm at the level of which vertebrae? T12 14. What are the visceral arteries branching off the thoracic descending aorta? 1. Bronchial aa. 2. Esophageal aa. 3. Mediastinal aa. 4. Pericardial aa. 15. What are the parietal arteries branching off the thoracic descending aorta? 1. Subcostal aa. 2. Superior phrenic aa. 3. Posterior intercostal aa. 16. What are the tributaries of the superior vena cava? - Left and right brachiocephalic vv. - Right superior intercostal v. - Hemiazygos v. - Azygos v. - Accessory hemiazygos v. 17. Which 2 veins anastamose to form the azygos vein? Right ascending lumbar v. and right subcostal v. 18. What are the branches of the ascending aorta? Left and right coronary aa. 19. What are the branches of the arch of the aorta? Draw a schematic. 1. Right brachiocephalic trunk 2. Left common carotid a. 3. Left subclavian a. 20. List the branches of the descending aorta. 1. Subcostal aa. 2. Posterior intercostal aa. 4. Esophageal aa. 5. Bronchial aa. 3. Superior phrenic aa. 6. Mediastinal aa. 7. Pericardial aa. 21. Describe the esophagus. Include physical properties, anatomical location, blood supply, and nerve supply. - Collapsible tube of muscle 10 in long (1.5 inches lie within the abdomen) - Left gastric a., esophageal aa. - Vagus nerves (GVA and GVE), T1-T4 thoracic splanchnics (GVA and GVE) Mediastinum 23 22. Draw the azygos system of veins showing the main tributaries of the azygos, hemiazygos, and accessory hemiazygos veins. 23. Describe the thymus gland. Include physical structure, anatomical location, function, and blood supply. - Flattened bi-lobed structure, pink in color - Produces thymosin to stimulate T-lymphocytes to become immunocompetent - Grows until puberty but then atrophies - Inferior thyroid a., internal thoracic a. 24. Describe the path of the left and right vagus nerves. - Right descends anterior to right subclavian a. and gives off the right recurrent laryngeal n. - Left descends posterior to LCC a. and gives off left recurrent laryngeal n. (loops under arch of aorta) - Both vagi send branches to form the pulmonary, cardiac, and esophageal plexuses 25. Damage to which nerve may lead to dysphonia? What is dysphonia? Recurrent laryngeal nerve lesion Dysphonia = Difficulty producing vocal sounds 24 The Anatomy Review 26. What is the ligamentum arteriosum. What 2 structures does it connect? Remnant of ductus arteriosis Connects the pulmonary trunk to the arch of the aorta 27. In which section of the mediastinum are the phrenic nerves found? Middle and superior mediastinum 28. What do the phrenic nerves innervate? Sole motor supply to diaphragm 29. What types of fibers do the phrenic nerves carry? Phrenic n. arises from the ventral primary rami of C3-C5 - GSE and GSA (GSA fibers only to the central portion of the diaphragm) 30. Describe the thoracic duct. Include where it is located anatomically and the pathway it takes. -Found in superior and posterior mediastinum - Largest lymphatic channel in body - Drains into L brachiocephalic v. - Returns all lymph and chyle from the body below the diaphragm - Returns all lymph and chyle from the L half of the body above the diaphragm - Arises from the cisterna chyli at the level of L1/L2 - Cisterna chyli receives L and R lumbar lymphatic trunks 31. Describe the anatomical location of the sympathetic trunk. - In superior and posterior mediastinum - Most lateral structure in mediastinum - Leaves thorax at T12 through medial arcuate ligament 32. Sympathetic fibers destined to the head and neck arise from which vertebral levels? T1, T2, T3 33. What are the 3 cervical ganglia? 1. Superior 2. Middle 3. Inferior 34. From which vertebral level do the thoracic splanchnic nerves arise? What types of fibers do they carry? T1 – T5; carry post-gg SP fibers (GVA) Mediastinum 25 35. From which vertebral level do the abdominopelvic splanchnic nerves arise? What types of fibers do they carry? T5 – Sacral splanchnics; Pre-gg SP; GVA fibers 36. Classify the 12 thoracic intercostal nerves based on their location in the thorax. 1 is the First intercostal nerve 2 is the Second intercostal nerve 3 - 6 are termed typical 7 - 11 are termed thoracoabdominal 12th is termed subcostal 37. List the 3 functional types of fibers found in the phrenic nerves. 1. GSA 2. GSE 3. GVA (GVA from phrenic also go to gallbladder) 38. List the 4 functional types of fibers found in the vagus nerves. 1. GVA 2. SVA 3. GVE (pre-gg PS) 4. SVE (muscles of larynx & pharynx) 39. List the 3 functional types of fibers found in the intercostal nerves. 1. GSE 2. GSA 3. Post-gg SP (SP fibers go to erector pilli m., sweat glands, and vascular smooth muscle in the skin) THE HEART 1. The pericardium is located anterior to which vertebral bodies? Anterior to T5-T8 vertebral bodies 2. The pericardium is located posterior to which costal cartilages? Posterior to 2nd - 6th costal cartilages 3. The pericardium is anatomically located in which region of the mediastinum? Middle mediastinum 4. What are the two layers of the pericardium? Fibrous pericardium and serous pericardium 5. The serous pericardium is made up of which two layers? Parietal layer and serous layer 6. Which layer of the pericardium is referred to as the epicardium? The visceral layer of the serous pericardium 7. The serous cavity contains approximately how many mL of serous fluid in a healthy person? 5 – 30 mL 8. Which 5 arteries supply the pericardium with blood? Thoracic aorta NEED A MNEMONIC? Inferior phrenic aa TIM Played Ball Musculophrenic a. Pericardiacophrenic aa. Branches of internal thoracic a. 9. What is the nerve supply of the pericardium? - Phrenic n. - Vagus n. - Sympathetic trunk 10. In one sentence, what is pericarditis? Inflammation of the pericardium 26 The Heart 27 11. In one sentence, what is pericardial effusion? Excess serous fluid in the pericardial cavity 12. In one sentence, what is cardiac tamponade? How can pericarditis lead to cardiac tamponade? What is the implication of cardiac tamponade on heart function? Blood or fluid in the pericardial cavity that exerts pressure on the heart  Pericariditis  Pericardial effusion  Cardiac tamponade  Heart cannot fully expand  Venous return impeded  Cardiac output decreases  Leads to tachycardia, weak pulse, engorged neck veins 13. In one sentence, what is pericardiocentesis? Aspiration of fluid from the pericardial cavity 14. What anatomical structure(s) of the heart make up the sternocostal (anterior) surface? Mainly the Right Ventricle (RV) 15. What anatomical structure(s) of the heart make up the left pulmonary surface? Left Ventricle (LV) and part of Left Atrium (LA) 16. What anatomical structure(s) of the heart make up the right pulmonary surface? Right Atrium (RA) 17. What anatomical structure(s) of the heart make up the inferior (diaphragmatic) surface? LV and part of RV 18. What anatomical structure(s) of the heart make up the base? LA 19. What anatomical structure(s) of the heart make up the apex? Inferolateral portion of LV 20. What is the anatomical location of the heart apex using surface anatomy? Located in the left 5th intercostal space at the mid-clavicular line (MCL) 21. What does the interventricular sulcus separate? The RV from the LV, anteriorly and posteriorly (Make a cut roughly through the frontal plane of the heart) 22. What does the coronary sulcus separate? The two atria from the two ventricles (Make a cut through the transverse plane of the heart) 28 The Anatomy Review 23. Looking at a cardiac silhouette of an xray, the left border of the image would correspond to which structure(s) of the heart? LV and LA 24. Looking at a cardiac silhouette of an xray, the superior border of the image would correspond to which structure(s) of the heart? LA, RA, and the Auricles 25. Looking at a cardiac silhouette of an xray, the right border of the image would correspond to which structure(s) of the heart? RA 26. Looking at a cardiac silhouette of an xray, the inferior border of the image would correspond to which structure(s) of the heart? RV and slightly by the LV 27. What is the Sailboat Sign of cardiac imaging? The apex of the heart is shifted superiorly and to the left, indicating right ventricular hypertrophy 28. What is the anatomical extent of the right border in a cardiac silhouette? Extends from the Superior Vena Cava (SVC) to the Inferior Vena Cava (IVC) 29. Which 6 gross anatomical structures are found in the right atrium? 1. Cristae terminalis 2. Sinus venerum 4. Venous openings of SVC and IVC 3. Pectinate muscles 5. Tricuspid orifice 6. Fossa ovale 30. Which 2 gross anatomical structures are found in the left atrium? Pulmonary vein openings Bicuspid (Mitral) Orifice 31. Which 6 gross anatomical structures are found in the right ventricle? 1. Conus arteriosus (Infindibulum) 4. Tricuspid valve 2. Chordae tendinae 5. Moderator band 3. Papillary muscles 6. Trabeculae carnae 32. Which 5 gross anatomical structures are found in the left ventricle? 1. Chordae tendinae 2. Papillary muscles 4. Aortic valve 5. Trabeculae carnae 3. Bicuspid valve 33. What is the foramen ovale? What does it become after birth? Before birth it act as a shunt, connecting the RA and the LA so blood can bypass the lungs - It closes at birth and becomes the fossa ovalis The Heart 29 34. What is an apatent foramen ovale? Failure of foramen ovale to close after birth 35. What is the function of the moderator band? Connects the papillary muscles to the interventricular wall (Remember the moderator band is only found in the RV) 36. What is the function of the chordae tendinae? Prevent the AV valves from everting (This prevents backflow (regurgitation) of blood from the ventricles into the atria) 37. Which anatomical surface feature of the heart is outer to the internally located cristae terminalis? The sulcus terminales 38. Why does the LV have a thicker myocardium than the RV? Because the LV pumps blood to the entire body through the systemic circuit, a much higher pressure and larger circuit than the pulmonary circuit 39. Which 2 main regions of the heart are supplied by the right coronary artery? RA and RV 40. Which branch of the right coronary artery supplies the RV? The right marginal branch 41. Which 2 main regions of the heart are supplied by the left coronary artery? LA and LV 42. What are the 2 major branches of the left coronary artery? Anterior interventricular (IV) branch Circumflex branch 43. Which branch of the circumflex artery supplies the LV? The left marginal branch 44. What does the coronary sinus drain into? RA 45. What is meant by the dominance of the coronary artery system? Coronary dominance is defined by which coronary artery gives rise to the posterior IV artery 30 The Anatomy Review 46. Which 8 main veins drain the heart? Vena cordi minimi Coronary sinus Anterior cardiac vv Left marginal v. Left posterior ventricular v. NEED A MNEMONIC? Small cardiac v Venus CALLS Me Grandpa Middle cardiac v Great cardiac v. 47. What do the anterior cardiac veins drain into? RA 48. Which vein accompanies the posterior interventricular (IV) artery? Middle cardiac v 49. The great cardiac vein is accompanied by which artery? Anterior IV artery 50. The small cardiac vein is accompanied by which artery? Right marginal artery 51. The left marginal vein is accompanied by which artery? Left marginal artery 52. The vena cordi minimi drain directly into what? The atria 53. What are the 5 main components of the cardiac conduction system? 1. Sinoatrial (SA) node - Primary pacemaker of the heart 2. Atrioventricular (AV) node 3. Internodal fasciculi 4. AV bundle of His 5. Purkinje fibers 54. The SA node is located specifically in which layer of the epicardium? Subepicardium smart unstoppable am I am thankful beautiful I am I am Blessed I am The Heart 31 55. What is the general nerve supply to the heart? This should include the functional types of fibers found in the cardiac plexus. Preganglionic parasympathetic  Vagus n.  GVA & GVE Postganglionic sympathetic  Thoracic Splanchnic nn. (T1-T4)  GVA & GVE 56. What are the cardiac reflexes and which nerve fibers are responsible for them? Cardiac reflexes are involved in the homeostatic control of heart rhythm and myocardial contractility i.e. Baroreceptors in the heart sense increase in blood pressure  GVA fibers of Vagus n. will send sensory info to brain  GVE fibers of Vagus n. then slow down the heart rate 57. What is the surface anatomy that maps the superior border of the heart? Draw a line from inferior margin of L 2nd costal cartilage to superior margin of R 3rd costal cartilage 58. What is the surface anatomy that maps the right border of the heart? Draw a line down from the R 3rd costal cartilage to R 6th costal cartilage 59. What is the surface anatomy that maps the inferior border of the heart? Draw a line from R 6th costal cartilage to L 5th intercostal space (ICS) at the mid-clavicular line (MCL) 60. What is the surface anatomy that maps the left border of the heart? Draw a line from the L 5th ICS at MCL to inferior L 2nd costal cartilage 61. Where are the 5 auscultatory points of the heart? Make sure to describe where each is. Pulmonic valve: 2nd L ICS lateral to the sternum Aortic valve: 2nd R ICS lateral to the sternum Tricuspid valve: 4th ICS at sternal border on the L Mitral valve: 5th L ICS ½ inch medial to the MCL Erb’s point: 3rd L ICS at the sternal border 62. What causes the first heart sound? Simultaneous closure of the tricuspid and mitral valves (the AV valves) 63. What causes the second heart sound? Closure of the pulmonic and aortic valves (the semilunar valves) 64. Where are 2 classic locations for cardiac referred pain? Left shoulder Stomach region (especially in women) 32 The Anatomy Review FOR THE PROLIFIC TYPES Describe the anatomical structure of the pericardium Fibroserous sac that encloses the heart and great vessles Influenced by movements of the diaphragm, sternum, heart, and great vessels Bound by the sternopericardial ligaments and pericardiacophrenic ligament Describe the histological composition of the fibrous pericardium Dense irregular connective tissue Describe the serous pericardium including the layers Parietal and visceral layers; parietal layer adheres to fibrous pericardium Visceral layer adheres to surface of heart How pericarditis can lead to cardiac tamponade: Inflammation of the pericardium causes serous fluid to flow into the pericardial cavity due to a variety of factors, leading to pericardial effusion. Fluid in the pericardial cavity exerts pressure against the heart, preventing the heart from fully expanding, a condition called cardiac tamponade. As a result, venous flow to the heart is impeded, leading to engorged neck veins and weak pulse. To make up for the concurring decreased cardiac output (Cardiac Output = Heart Rate x Stroke Volume), the heart goes into tachycardia Right coronary artery blood distribution (structures supplied by the RCA): RA, RV, 60% SA node, 80% AV node, Posterior 1/3 of the AV septum Left coronary artery blood distribution (structures supplied by the LCA): LA, LV, IV septum, AV bundle, 40% SA node, 20% AV node Describe the population variability of the dominant coronary artery system Dominance of R coronary artery is typical (75%) Dominance of LCA in 10% of people Codominance in 15% of people Describe the skeleton of the heart Fibrous/fibrocartilaginous tissue Central support of heart Fibrous rings give rigidity to AV orifices and roots of pulmonary and aortic aa Provides attachment to valves, prevents outlets from becoming dilated Provides attachment to cardiac muscle fibers For The Prolific Types More detail on the cardiac conduction system: The SA node – located at upper end of the cristae terminalis where SVC enters RA AV node – located in interatrial septum where IVC and coronary sinus drain into RA Internodal fasciculi – in between SA and AV nodes AV bundle of His – located in interventricular septum What happens if a heart attack is suffered and the SA node dies? If SA node dies, AV node can take over If SA node and AV node die, multiple ectopic nodes will develop and ventricular fibrillation may develop  pacemaker is needed What is the third heart sound? Normally heard in children If heard in older person it is abnormal, may indicate congestive heart failure Is heard as a “gallop” rhythm 33 THORACIC ORGANS OF RESPIRATION 1. Which 3 structures make up the lower respiratory tract? 1. Trachea 2. Bronchi 3. Lungs 2. At what vertebral level does trachea begin? C6 – below the cricoid cartilage 3. At what vertebral level does trachea split? T4-T5 4. What is name of the last tracheal cartilage? Corinal cartilage 5. How low is trachea pulled during deep inspiration? T6 6. Describe the anatomy of the trachea. - Tube 5 in long and 1 inch in diameter - Fibroelastic wall with U-shaped hyaline cartilage rings - Trachealis smooth muscle connects the U rings 7. What are the 2 pleural layers surrounding the lungs 1. Parietal pleura 2. Visceral pleura 8. What are the 4 regions of the parietal pleura? 1. Cervical (cupola) 2. Diaphragmatic 3. Mediastinal 4. Costal 9. What is the suprapleural membrane? Membrane covering the cervical pleura – provides support 10. Where do the parietal and visceral pleurae meet? At the lung root 11. What are the 2 potential pleural spaces? 1. Costodiaphragmatic recess 2. Costomediastinal recess (completely enclosed spaces) 12. What is hydrothorax? Excess fluid leaking into the pleural cavity 34 Thoracic Organs Of Respiration 35 13. Describe the location of the costomediastinal and costodiaphragmatic recesses. Which part of each lung fits into each recess? Costomediastinal – between pericardium and costal pleura; anterior margin of lung rests here Costodiaphragmatic – inferior margin of lung rests in this space 14. What is hemothorax? Blood collecting in the pleural space 15. What is pneumothorax? What are the implications? Air in the pleural cavity  lung compression  atelectasis (collapsed lung) 16. What is pleuritis? Inflammation of the pleura 17. What is pleurisy? Serous fluid accumulating in the pleura 18. What is chylothorax? Chyle in the thorax 19. Where is best location to aspirate a lung? T8 intercostal space superior to 9th rib 20. What surface anatomy of the body map out the lung pleurae? Anterior: MCL @ 8th rib Lateral: MAL @ 10th rib Posterior: T12 21. What surface anatomy of the body map out the lungs? Anterior: MCL @ 6th rib Lateral: MAL @ 8th rib Posterior: T10 22. Where do you find the transverse fissure? - Only in right lung - Deep to superior border of 5th rib 23. What surface anatomy of the body maps out the oblique fissures? Start posterior at T4 and follow 6th rib anterior to costalchondral junction 24. What is another name for secondary bronchi? Lobar bronchi 36 The Anatomy Review 25. What is another name for tertiary bronchi? Segmental bronchi 26. What are the 2 surfaces of the lungs? 1. Mediastinal 2. Costal 27. What are the 3 borders of each lung? 1. Anterior 2. Posterior 3.inferior 28. Into what space does the posterior border of the lung rest in? Paravertebral gutter (where ribs and vertebral bodies meet) 29. What is the lung root? Which structures make up the lung root? - A stalk of structures entering the lung that are covered by mediastinal pleura - Is formed by the bronchial vessels, the bronchus, lymphatics, a pulmonary artery, nerves, and pulmonary veins 30. What is the lung hilum? A depression in the lung where the contents of the lung root enter the lung 31. What is the pulmonary ligament and what does it allow for? - Extension of the mediastinal sleeve covering the lung root - Allows for free movement of the root contents 32. Where is the lingula of the lung located? Superior lobe of the left lung, where the middle lobe would be 33. Which 2 structures make large grooves in the mediastinal surface of the left lung? 1. Arch of aorta 2.Descending aorta 34. Which 4 structures make large grooves in the mediastinal surface of the right lung? 1. Arch of azygos vein 2. SVC 3. IVC 4. Esophageal groove 35. Describe the shape and arrangement of the bronchopulmonary segments. They are shaped pyramidally and their apices point toward the lung hilum 36. What is the significance of having multiple bronchopulmonary segments? One segment becomes diseased  easily removable without harming the other segments 37. Describe the anatomy of a tertiary bronchus from proximal to distal. Large subsegmental bronchus  small subsegmental bronchus  bronchiole (cartilage free)  terminal bronchiole (smooth muscle)  respiratory bronchiole (covered in alveoli)  alveolar sacs Thoracic Organs Of Respiration 37 Tertiary Bronchiole Anatomy 38. What are the 2 types of cells within alveoli? Include the structure and function of each. Type I – simple squamos for gas diffusion Type II – cuboidal for secretion of surfactant 39. From which vessel do the bronchial arteries branch off from? Descending aorta 40. Draw a schematic of the bronchial veins. 41. What is the innervation of the lungs? 1. Vagus nerve 2. Thoracic splanchnic T1-T4 42. What is the parasympathetic nerve supply to the lungs and bronchi? Vagus  pulmonary plexus (GVA and GVE) 38 The Anatomy Review 43. What is the sympathetic nerve supply to the lungs and bronchi? T1-T4 thoracic splanchnic (GVA and GVE) 44. Compare sympathetic effects versus parasympathetic effects on the bronchi. Sympathetic: bronchodilation Parasympathetic: bronchoconstriction 45. Describe the anatomy of the diaphragm. - Musculotendinous partition between thoracic and abdominal cavities - Convex on thoracic cavity side and concave on abdominal side - Higher on the R side due to right lobe of liver (hemidiaphragm) 46. What is the origin and insertion of the diaphragm? O: Posterior aspect of xiphoid process, inner surface of lower 6 costal cartilages, arcuate ligaments, upper lumbar vertebrae I: Central tendon 47. At what vertebral level is the caval opening of the diaphragm and which structures pass through? T8 – IVC, terminal branches of right phrenic nerve 48. At what vertebral level is the esophageal opening of the diaphragm and which structures pass through? T10 – Vagal trunks, esophagus, esophageal branches of the left gastric vessels 49. At what vertebral level is the aortic opening of the diaphragm and which structures pass through? T12 – Aorta, thoracic duct, azygos vein, hemiazygos vein 50. What is the vertebrocostal triangle? The portion of the diaphragm attaching to the lateral arcuate ligament  potential weak spot 51. Which ligament arches over psoas major? Medial arcuate 52. Which ligament arches over the quadratus lumborum? Lateral arcuate 53. Which structures pass through the median arcuate ligament? Aorta, thoracic duct, azygos vein, hemiazygos v. 54. What is the nerve supply of diaphragm? Phrenic nerve (C3-C5) motor supply; sensory to central portion only Lower intercostal nerves T6-T12 give sensory supply to peripheral diaphragm Thoracic Organs Of Respiration 39 55. Draw schematic of the blood supply to the diaphragm. 56. Which nerve gives sensory innervation to the pericardium? Phrenic n. 57. The spleen is susceptible to trauma and where does referred pain often go? Why? Left shoulder; Splenic pathology may irritate the diaphragm and the phrenic nerves pass near the shoulders ANTERIOR ABDOMINAL WALL 1. Which surface features demarcate the anterior abdominal wall? - Iliac crest - Xiphoid process - Pubic symphysis -ASIS - Costal margins 2. At what vertebral level does the abdominal aorta end? Bifurcates @ L4 3. At what vertebral level does IVC begin? L5 4. Describe the location of the transpyloric plane. Horizontal line at the level of L1 - Halfway point between the jugular notch and the pubic symphysis 5. Describe the location of the subcostal plane. Horizontal line at the level of L3 - The lowermost portion of the costal margin 6. Describe the location of the intertubercular plane. Horizontal line at the level of L5 - Midway point between transpyloric plane and pubic symphysis (draw a line connecting the iliac crest tubercles) 7. In which abdominal quadrant is the head of the pancreas? RUQ 8. In which abdominal quadrant is the tail of the pancreas and spleen? LUQ 9. What are the 2 layers of the abdominal superficial fascia? 1. Camper's fascia 2. Scarpa's fascia 40 Anterior Abdominal Wall 41 10. What is another name for extraperitoneal fascia? Subserous fascia 11. What is the origin and insertion of the external abdominal oblique? O: Lower 8 ribs I: Lateral lip of iliac crest, linea alba 12. What is the origin and insertion of the internal abdominal oblique? O: Thoracolumbar fascia, iliac crest, lateral 2/3 of inguinal ligament I: Inferior border of lower 3-4 ribs, linea alba, pubic crest, pectineal line 13. What is the origin and insertion of the transversus abdominis? O: Thoracolumbar fascia, medial lip of iliac crest, lateral 1/3 of inguinal ligament, costal cartilages of lower 6 ribs I: Linea alba, pubic crest, pectineal line 14. What is the origin and insertion of the rectus abdominis? O: pubic crest, pubic tubercle, pubic symphysis I: Costal cartilage of ribs 5-7 15. What is the origin and insertion of the pyramidalis muscle? O: Front of pubis and pubic symphysis I: Linea alba 16. Describe the location of the fundiform ligament. Originates from membranous layer of superficial fascia and extends from symphysis pubis to linea alba 17. Describe the location and function of the suspensory ligament. Found deep to the fundiform ligament - Originates from deep fascia extending from pubic symphysis to base of penis or clitoris 18. Describe the location of the inguinal ligament. Forms the inguinal crease - Creates “V” shape with the point toward the genitals 19. What is the semilunar line? Vertical line that demarcates the lateral border of rectus abdominis 20. What is the linea alba? Aponeurosis running vertically from xiphoid through umbilicus down the rectus abdominis 42 The Anatomy Review 21. Describe the layers of the rectus sheath above the arcuate line. Posteriorly: transversus abdominus, deep layer of internal oblique (Posterior rectus sheath) Anteriorly: Superficial layer of internal oblique, external oblique 22. Describe the layers of the rectus sheath below the arcuate line. All three layers pass in front of rectus abdominis 23. What is the arcuate line? Halfway point between the pubic symphysis and umbilicus where the posterior rectus sheath ends 24. What are the functions of the anterolateral abdominal muscles? 1. Support the abdominal wall 2. Support and protect abdominal viscera 3. Move the trunk / maintain posture 4. Compress abdominal contents to maintain / increase intra-abdominal pressure to oppose the diaphragm 25. Where do you find the superior epigastric artery and vein? Posterior to rectus abdominis muscle 26. List the nerves of the anterior abdominal wall. 1. Thoracoabdominal nerves (T7-T11) → supply muscles and skin overlying 2. Lateral cutaneous branches (T7-T9) → supply skin of L and R hypochondriac regions 3. Subcostal n. (T12 spinal nerve) → supplies skin and muscles above iliac crest and below the umbilicus 4. Iliohypogastric n. (ventral ramus of L1) → supplies iliac crests, hypogastric regions, transversus abdominis and internal obliques 5. Ilioinguinal n. (ventral ramus of L1) → supplies lower portions of transversus abdominis and internal obliques, anterior scrotum, medial thigh, and groin 27. What are umbilical folds? Peritoneal folds on internal surface of anterior abdominal wall 28. Describe the location of the median umbilical fold. Runs superiorly from apex of urinary bladder to umbilicus 29. What is the median umbilical ligament? Remnant of urachus ⇒ was once the allantois Anterior Abdominal Wall 43 30. What is the urachus and what may happen if it persists? Remnant of allantois - If it persists, urachal cysts may form  urine comes out of umbilicus 31. Describe the location of the medial umbilical folds. Run from pelvis to umbilicus, overlying the medial umbilical ligaments 32. What are the medial umbilical ligaments? Remnants of the obliterated umbilical arteries 33. Describe the location of the lateral umbilical folds. Overlie / contain the inferior epigastric vessels which enter the rectal sheath - Form the lateral border of “Hasselbach’s Triangle” 34. Which vessel do the inferior epigastric artery and vein anastomose with? Superior epigastric artery and vein 35. Describe the anatomy of the inguinal canal. 4 cm long; Oblique passage in adults - Found along inferior portion of the anterior abdominal wall 36. What is the superficial inguinal ring? The exit from the inguinal canal; an opening in the aponeurosis of the external abdominal oblique 37. What is the deep inguinal ring? The entrance to the inguinal canal; an opening the deep transversalis fascia - Covered by parietal peritoneum 38. What makes up the floor of the inguinal canal? Inguinal ligament and lacunar ligament 39. What makes up the roof of the inguinal canal? Arching fibers of transversus abdominus and internal abdominal oblique 40. What makes up the anterior wall of the inguinal canal? Aponeurosis of external abdominal oblique - Laterally supported by the internal abdominal oblique 41. What makes up the posterior wall of the inguinal canal? Transversalis fascia (medially supported by the conjoint tendon) 44 The Anatomy Review 42. Which structure does the spermatocord come out of? Superficial inguinal ring 43. Which structure does the round ligament of the uterus come out of in females? Superficial inguinal ring 44. List the functions of the inguinal canal and distinguish between males and females. Males: passageway for contents of spermatic cord running from testis to abdomen Females: passageway for round ligament of uterus running from uterus to labia majora Both: passageway for the ilioinguinal nerve (L1 ventral ramus, lower branch) 45. Describe the origin of the ilioinguinal nerve. The ventral ramus of the lower branch of L1 46. What structures does the peritoneum become in development of the inguinal canal? Processus vaginalis and tunica vaginalis 47. What does the transversalis fascia become in development of the inguinal canal? Internal spermatic fascia 48. What does the internal oblique muscle become in development of the inguinal canal? Cremasteric fascia 49. What does the external oblique aponeurosis become in development of the inguinal canal? External spermatic fascia 50. Which structure pulls the testes downward in development of the spermatic cord? Gubernaculum 51. What is the processus vaginalis; what happens if it persists? A tissue layer derived from parietal peritoneum during development of the inguinal canal - If it persists, leaves predisposition to inguinal hernia 52. Which abdominal muscle does not get pulled down with the inguinal canal during development? Transversus abdominus 53. What is cryptorchidism? Testis do not drop out of abdomen during development 54. Describe the anatomy of the spermatic cord. 1. Holds up testis in scrotum 2. Runs from deep inguinal ring to posterior border of testis Anterior Abdominal Wall 45 3. Covered by the 3 layers of the anterior abdominal wall (internal spermatic fascia, cremasteric fascia, and external spermatic fascia) 55. What are the contents of the spermatic cord? - Vas deferens - Testicular aa., deferential aa., cremasteric aa. - Pampiniform plexus of vv. - Genital branch of genitofemoral nerve (L1, L2) - Automatic and sensory nerves - Lymph vessels - Remnants of processus vaginalis 56. What is the function of the cremasteric muscle? What is the cremasteric reflex? Pulls testes closer to body ⇒ for temperature regulation - Stroking the inner upper thigh causes contraction of the cremasteric muscle (reflex) 57. What does the dartos muscle do? Wrinkles the testicles 58. What is a direct inguinal hernia? Protrusion of intestinal contents medial to inferior epigastric vessels → weak abdominals, common in older males 59. What is an indirect inguinal hernia? Protrusion of intestinal contents into the inguinal canal → often a result of persistent processus vaginalis 60. Where and what is the inguinal triangle? What else is it called? Found lateral to rectus abdominus, potential weak area - aka Hasselbach’s triangle 61. What are the borders of Hasselbach’s triangle? Medially: border of rectus abdominus Laterally: inferior epigastric vesses contained in lateral umbilical fold Inferiorly: inguinal ligament 62. Which type of hernia is most common among females? Femoral hernia 46 The Anatomy Review 63. Where is Mcburney’s point? Clinical significance? Approximately ½ way between ASIS and umbilicus – location of the appendix 64. Which nerves are possibly injured during a Mcburney’s incision? Branches of L1 → could lead to anesthesia in the area 65. Pfannenstiel incision (bikini incision) is done where and what vascular structures are possibly damaged? Along inguinal crease - Inferior epigastric vessels, ilioinguinal nerve potentially damaged 66. Trace the nerve pathway of the cremasteric reflex. Lightly stroke upper medial thigh → femoral branch of the genitofemoral nerve (sensory) → L1 + L2 spinal nerve → genital branch of genitofemoral n. (motor) → cremaster muscle contraction 67. Describe how to differentiate a direct from an indirect hernia. Place finger in inguinal canal, ask patient to cough ⇒ hernia pushes on top of finger = indirect hernia ⇒ pushes on side of finger = direct hernia DEVELOPMENT OF THE HEART & LUNGS 1. What germ layer does cardiac muscle develop from? Splanchnic mesoderm surrounding the endothelial heart tube 2. What structures do intercalated discs arise from? Once were specialized attachments between myoblasts 3. What is the truncus arteriosus? In fetal development, pulmonary artery + aorta = truncus arteriosus 4. When and where does the primitive heart begin to develop? What from? Before end of 3rd week; mesoderm; ventral region of embryo below foregut 5. What is the primitive heart tube? Fusion of the endocardial tubes 6. What 5 regions does the heart develop into? 1. Ventricle 2. Bulbus cordis 5. Truncus arteriosus 3. Atrium 4. Sinus venosus “VBAST” 7. Describe the anatomy of the heart after the primitive heart tube reorients. Top: sinus venosus, atrium Bottom: bulbus cordis, ventricle, truncus arteriosus 8. What is function of fossa ovalis? Shunts blood from R atrium to L atrium ⇒ so blood avoids the lungs 9. On what day does primitive heart start to contract? Day 22 10. What happens at 7th week of heart development? Interatrial septum forms; interventricular septum develops 11. The bulbus cordis and truncus arteriosus divide into what structures? Pulmonary trunk and aorta 12. What embryological structures do the IVC and SVC develop from? The venous end of the primitive heart tube 47 48 The Anatomy Review 13. What is the number one reason for congenital malformations? Multifactorial inheritance 14. What malformations are present in teratology of fallot? 1. Pulmonary trunk stenosis 2. R ventricular hypertrophy 3. VSD 4. Overriding aorta 15. What is a patent ductus arteriosus? Failure of ductus arteriosus to close after birth - Associated with maternal rubella infection 16. List three other congenital heart malformations. 1. Aortic coarctation 2. Atrial septal defect 3. Persistent truncus arteriosus 17. What is persistent truncus arteriosus? Aorta and pulmonary trunk share the same trunk 18. What is coarctation of the aorta? Constriction of the aorta 19. What vascular structures are located in the umbilical cord? Two arteries, one vein (umbilical v. and umbilical arteries) 20. What does the umbilical vein become? Round ligament of the liver 21. What is the ligamentum venosum? Ductus venosis shunts blood away from liver and becomes ligamentum venosum 22. What embryological structure is the lower respiratory tract derived from? Foregut 23. What embryological structure does the lower respiratory tract start as? Respiratory diverticulum (lung bud) 24. What embryologic structure is the endodermal lining of the tracheobronchial tree derived from? Foregut 25. What embryologic layer covers the respiratory diverticulum? Invested by splanchnic mesoderm 26. What is a tracheoesophageal fistula (TEF)? Failure of trachea and esophagus to separate during development Development Of The Heart & Lungs 49 27. What are the four periods of lung maturation? Describe each. 1. Pseudoglandular period (6-16 weeks) - Resembles exocrine gland - All major components of lung develop except those involved with gas exchange 2. Canalicular period (16-26 weeks) - Lamina of bronchi and terminal bronchioles enlarge and lungs become highly vascular 3. Terminal saccular period (26 – birth) - Alveolar ducts give rise to terminal saccules (primordial alveoli) - Terminal saccules lined with Type I and Type II cells - Sufficient surfactant produced 4. Alveolar period (32 weeks to 8 yrs) - Alveolocapillary membrane becomes sufficiently thin to allow for gas exchange - 95% alveoli develop postnatally 28. In what period of lung development is surfactant produced in? Terminal saccular period 29. What percentage of mature alveoli develop postnatally? 95%. Premature birth ⇒ children more prone to RDS (respiratory distress syndrome) because the alveoli are not yet fully developed ABDOMINAL CAVITY AND PERITONEUM 1. What specific germ layer is the peritoneum derived from? Lateral plate mesoderm 2. Describe the anatomical structure and location of the peritoneum. Serous membrane that lines the walls of the abdominal and pelvic cavities and invests the abdominal and pelvic organs 3. What are the 2 layers of the peritoneum? 1. Parietal layer 2. Visceral layer 4. What is the parietal peritoneum? Outer layer of the peritoneum that lines the walls of the abdominal cavity 5. What is the visceral peritoneum? The inner layer of the peritoneum that invests the organs 6. What is the peritoneal cavity? The potential space between the parietal and visceral peritoneum 7. What is nerve supply of the parietal peritoneum? GSA fibers from T7 – L1 8. What is nerve supply of the visceral peritoneum? GVA fibers from T7 – L1 9. What is peritonitis? Inflammation of the peritoneum  Increased production of serous fluid 10. What is an omentum? A double layer of peritoneum that connects the stomach to another visceral organ or to the abdominal wall 11. What is a peritoneal ligament? A double layer of peritoneum that connects any abdominal visceral organ other than the stomach to another organ or to the abdominal wall 12. What is a mesentery? A double layer of peritoneum that connects an intraperitoneal organ to the body wall; a means for neurovascular communication between the two 50 Abdominal Cavity and Peritoneum 51 13. What is a peritoneal fold? A section of peritoneum that is elevated by underlying blood vessels, ducts, or obliterated fetal vessels 14. What is an intraperitoneal organ? An organ completely enveloped in peritoneum that is fixed to the abdominal wall by a mesentery or peritoneal ligament; is partially free to move 15. Which organs of the abdominal cavity are intraperitoneal? Stomach Duodenum (first 2 cm) Cecum Ileum Transverse colon Gallbladder Jejunum Need a Mnemonic? Appendix Sigmoid colon Liver Tail of pancreas Some dads just can’t imagine a toddler saying lets go to sleep Spleen 16. What is a retroperitoneal organ? Give examples of retroperitoneal organs. An organ partially enveloped peritoneum completely fixed to the abdominal wall; does not have mesentery or peritoneal ligament; cannot move 17. Which organs of the abdominal cavity are extraperitoneal? Suprarenal gland Pancreas (head and neck) Ascending colon Need a Mnemonic? Rectum Kidneys & Ureters SPARKI DAD IVC Duodenum (past first 2 cm) Abdominal aorta Descending colon 18. What are the 7 broad sections of the mesentery? 1. Small intestine mesentery 2. Transverse mesocolon 3. Mesosigmoid 4. Left mesocolon 5. Right mesocolon 6. Mesoappendix 19. The transverse mesocolon is a mesentery that attaches what two structures? Attaches the posterior abdominal wall to the transverse colon 20. What are the 2 divisions of the peritoneal cavity? 1. Greater sac 2. Lesser sac 21. What is the extent of the greater sac? From diaphragm to pelvis 22. What are the 2 compartments of the greater sac? 1. Supracolic 2. Infracolic 7. Mesorectum 52 The Anatomy Review 23. What is the extent of the lesser sac? Lies behind the stomach – a small space 24. What are the paracolic gutters? Channels running vertically along the lateral aspects of the ascending and descending colon 25. Into what compartment does peritoneal fluid flow when sitting or standing? Contrast male vs. female. Male: rectovesical pouch (between rectum and urinary bladder) Female: rectouterine pouch (between rectume and uterus) 26. Into what compartment does excess peritoneal fluid flow when supine? Upwards to the subphrenic and hepatorenal recesses  potential diaphragm irritation 27. What is the greater omentum? What functions does it carry? Peritoneal fold that hangs down from greater curvature of the stomach and proximal part of the duodenum; folds back and ascends to attach to anterior surface of transverse colon - Functions as a fat reserve 28. What is the lesser omentum? A peritoneal fold that connects the lesser curvature of stomach to inferior surface of the liver 29. Which 3 ligaments are arise from the lesser omentum? 1. Hepatoesophageal ligament – connects esophagus to underside of liver 2. Hepatogastric ligament – connects lesser curvature to the liver 3. Hepatoduodenal ligament – contains the portal triad; connects duodenum to the liver 30. Which structures make up the portal triad? 1. Common bile duct 2. Portal vein 3. Proper hepatic artery 31. What is the epiploic foramen? What is its function? An oval window connecting the lesser sac to the greater sac, allowing for communication between the two 32. What is another name for the epiploic foramen? Foramen of Winslow 33. What structure forms the superior boundary of the epiploic foramen? Caudate lobe of liver 34. What structure forms the anterior boundary of the epiploic foramen? Hepatoduodenal ligament Abdominal Cavity and Peritoneum 35. What structure forms the inferior boundary of the epiploic foramen? First part of the duodenum 36. What structure forms the posterior border of the epiploic foramen? Inferior vena cava 53 LIVER AND GALLBLADDER 1. Describe the anatomical location of the liver. Deep within the costal margin - In R hypochondrium extending to the L hypochondrium 2. What are 6 major functions of the liver? 1. Site of intermediary metabolism 2. Secretes bile 3. Processes endogenous and exogenous substances 4. Eliminates senescent cells and particulate matter 5. Synthesizes serum proteins and lipids 6. Site of fetal hematopoiesis 3. What are the 2 surfaces of the liver? 1. Diaphragmatic surface 2. Visceral surface 4. What 2 recesses are associated with the liver? 1. Subphrenic recess 2. Hepatorenal recess 5. The visceral surface of the liver is covered by visceral peritoneum except for which 2 areas? 1. Gallbladder fossa 2. Porta hepatis 6. The visceral surface of the liver is related to which abdominal structures? 1. R anterior part of stomach 2. Lesser omentum 3. Gallbladder 4. Superior part of duodenum 5. R colic flexure 6. R transverse colon 7. R kidney and suprarenal gland 7. Where does excess fluid in the abdominal cavity flow? Toward hepatorenal recess 54 Liver And Gallbladder 55 8. Which 3 structures make up the hilum (porta hepatus) of the liver? 1. Portal vein 2. Common bile duct 3. Hepatic artery (R & L) 9. What type of nerve fibers are found in the porta hepatus? 1. Post-gg sympathetic 2. Pre-gg parasympathetic 3. GVA 10. Where is the falciform ligament and what is its function? - Runs between L and R lobes of liver - Connects liver to underside of diaphragm and connects to R rectus sheath just above the umbilicus 11. List the 4 peritoneal ligaments associated with the liver. 1. Falciform 2. L and R triangular ligaments 3. Coronary 4. Lesser omentum - They all attach liver to underside of diaphragm 12. List the 2 non-peritoneal ligaments of the liver and say their location and function 1. Ligamentum venosum – remnant of ductus venosus 2. Round ligament – remnant of umbilical vein 13. What is the ligamentum teres also known as? Round ligament – remnant of umbilical vein 14. What is the ligamentum teres a remnant of? Umbilical vein 15. Between which 2 lobes is the ligamentum venosum? Caudate lobe and L lobe of liver 16. Between which 2 lobes is the ligamentum teres? Quadrate lobe and L lobe 17. Between which 2 lobes is the IVC? Caudate lobe and R lobe 18. Between which 2 lobes is the gallbladder? Quadrate lobe and R lobe 19. Which 3 structures do the quadrate, caudate, and left lobe share? 1. Hepatic artery 2. Hepatic vein 3. Bile duct 56 The Anatomy Review 20. Trace the flow of blood through the liver starting with portal vein. Portal v → portal venules → liver sinusoids → central v. → sublobar v. → hepatic vv. → IVC 21. What type of blood do liver sinusoids carry? Oxygenated and de-oxygenated blood 22. What type of cells do liver lobules contain? Reticulo-phagocytic cells to filter blood 23. Draw a schematic of the liver blood supply. 24. What is the venous drainage of the liver? Hepatic vv. - carry blood out to IVC Portal v. - brings blood in (deoxygenated) 25. What is the function of the protein albumin? Produced by liver → maintains osmotic pressure → ↑ ability of blood to attract H2O into blood vessels → ↑ blood pressure 26. List and draw out the portacaval anastomoses. Liver And Gallbladder 57 27. What causes capute medusa? ↑ Hydrostatic pressure at the portacaval anastomosis of paraumbilical v. and superficial epigastric vv. → distended abdomen with radiating vv. around umbilicus 28. What is ascites? Accumulation of serous fluid in abdominal cavity - Associated with ↑ hydrostatic pressure in the capillaries 29. What is esophageal varices? ↑ Hydrostatic pressure and dilation of vessels at the portacaval anastomosis between L gastric v. and esophageal vv. 30. Pressure buildup in which portacaval anastomosis will lead to hemorrhoids? Superior rectal vv. and inferior rectal vv. 31. What is the lymphatic drainage of the liver? Hepatic nodes → celiac nodes → cisterna chyli 32. What is the nerve supply of the liver? Celiac plexus 33. What nerve fibers are found in the celiac plexus? 1. Post-gg sympathetic 2. Pre-gg parasympathetic 3. GVA 34. What structure shunts blood away from the liver before birth? What does it become? Ductus venosus; becomes the ligamentum venosum 35. Where is the hepato-pancreatic sphincter, what does it do? Between common bile duct and duodenum; controls flow of bile into intestines 36. What is the function of the gallbladder? What is its capacity? Store bile, has a capacity of 30-50 ml 37. What are the 5components of the biliary system? 1. R & L hepatic ducts 2. Common hepatic duct 4. Common bile duct 5. Gallbladder 3. Cystic duct 38. Which 2 ducts combine to form the common bile duct? 1. Cystic duct 2. Common hepatic duct 39. Which duct joins the common bile duct prior to entering the duodenum? Main pancreatic duct 58 The Anatomy Review 40. Where is the gallbladder found, and what is its capacity to hold bile? - Between quadrate lobe and R lobe of liver - 30-50 ml 41. What are the anatomical parts of the gallbladder? Briefly differentiate each different segment. Fundus – rounded and projects beyond inferior boundary of liver Body – lies in contact with visceral liver surface Neck – continuous with cystic duct 42. What does the gallbladder do? Concentrates bile, releases bile when stimulated by CCK (cholecystokinin) 43. What is the blood supply of the gallbladder? Cystic a. (a branch of R hepatic a.) 44. What is the nerve supply of the gallbladder? Celiac plexus, which contains the following fibers: 1. Pre-gg PS 2. Post-gg SP 3. GVA 45. Describe the anatomy of the cystic duct. - 1.5 inches long - Mucous membrane is folded to keep the duct patent (open) 46. What is hepatomegaly? Enlarged fatty liver, may be due to liver cirrhosis or metastatic carcinoma 47. What is jaundice? Yellowing of the skin due to hyperbilirubinemia - Bilirubin is a by-product of RBC metabolism/catabolism 48. What is alcoholic cirrhosis? Progressic destruction of hepatocytes which become fibrotic; usually leads to portal hypertension 49. What is cholelithiasis? What is a treatment? Gallstones due to crystallization of bile salts and/or cholesterol Laparascopic cholecystectomy 50. What demographic is most at risk for developing gallstones? The 5 F’s: Fat, Fertile, Forties, Flatus, Female STOMACH, PANCREAS, AND SPLEEN 1. In general terms, what is the stomach? The dilated portion of the GI tract from the esophagus to the duodenum 2. What are the functions of the stomach? 1. Reception and storage of food – 1.5 L capacity in adults 2. Mechanical and chemical digestion – secrete gastric juices to make chyme 3. Release chyme into the duodenum 3. Describe the anatomical location of the stomach. Beneath L costal margin extending from epigastric region to the umbilical region 4. What are the 3 major attachments of the stomach? 1. Lesser omentum 2. Greater omentum 3. Gastrosplenic omentum (ligament) 5. Describe the anatomy of the stomach. J-shaped, fundus, body, pyloric antrum, pylorus – intraperitoneal organ 2 openings, 2 curvatures – mucous membrane folds called rugae 6. What 3 groups of muscles make up the stomach? 1. Inner oblique 2. Middle circular 3. Outer longitudinal 7. Which structures are found anterior to the stomach? 1. Anterior abdominal wall 2. L costal margin 3. L lobe of liver 4. Diaphragm 5. L lung and plurae 59 60 The Anatomy Review 8. Which structures are found posterior to the stomach? Lesser sac Left suprarenal gland Upper portion of L kidney Pancreas Spleen Diaphragm Transverse colon Transverse mesocolon Splenic artery 9. What is the blood supply of the stomach? Draw a schematic. 10. What is the venous drainage of the stomach? The veins run with the arteries and have the same names 11. The short gastric artery is a branch of which artery and supplies what? Branch of the splenic a.; supplies blood to fundus of the stomach 12. What is another name for the L and R gastroepiploic arteries? Gastro-omental arteries 13. What is the lymphatic drainage of the stomach? Celiac nodes → intestinal trunk → cisterna chyli 14. What is the nerve supply to the stomach? 1. Vagus (pre-gg PS) → to gastric glands: secretomotor (GVE) → inhibitory fibers to pyloric sphincter 2. Greater Splanchnic n. (post-gg SP) → celiac ganglion: blood vessels (GVE) and GVA → excitatory fibers to pyloric sphincter Stomach, Pancreas, And Spleen 61 15. Describe the anatomical location of the pancreas. Mostly posterior to stomach, extends from the duodenum to the spleen - Crosses the L1 and L2 vertebrae along posterior abdominal wall 16. What type of viscus is the pancreas classified as? Tail – intraperitoneal Head, neck, body – extraperitoneal 17. What are the anatomical segments of the pancreas? Uncinate process, head, neck, body, tail 18. How can pancreatitis cause lower back pain? Enlarged pancreas presses against L1 and L2 vertebrae 19. What type of gland is the pancreas? Exocrine and endocrine 20. What are the 2 main ducts within the pancreas? 1. Main pancreatic duct 2. Accessory duct 21. What is the ampulla vator? Small cavity within the duodenal papilla 22. What and where is the sphincter of Oddi? Inside major duodenal papilla; controls flow of pancreatic juices into duodenum 23. What is another name for sphincter of Oddi? Hepatopancreatic sphincter 24. What is the blood supply of the pancreas? Draw a schematic. 62 The Anatomy Review 25. What is the venous drainage of the pancreas? The veins follow the arteries: → superior mesenteric v. → portal v. → splenic v. 26. What is the lymphatic drainage of the pancreas? Pancreatico-splenic nodes → pyloric nodes → celiac nodes → hepatic nodes → superior mesenteric nodes 27. What is the nerve supply of the pancreas? 1. Pre-gg PS → secretomotor (glandular secretions 2. Post-gg SP → vasomotor (blood vessels) 3. Greater splanchnic GVA and SP from celiac plexus 28. What is the spleen? Largest single mass of lymphoid tissue in body Oval in shape; reddish appearance because very vascular 29. Describe anatomical location of the spleen? Deep in L hypochondrium under ribs 9, 10, 11 30. Which structures are anterior, medial, inferior, and posterolateral to the spleen? Anterior - stomach Medial – L kidney and tail of pancreas Inferior – splenic flexure Posterolateral – L lung and plurae, diaphragm, ribs 9-11 31. What are the functions of the spleen? 1. Blood reservoir 2. Site of lymphocyte proliferation (immunity) 3. Removal of expended RBC's 4. Pre-natal hematopoiesis 5. Filters blood particulate matter 32. What classification of viscus is the spleen? Intraperitoneal Stomach, Pancreas, And Spleen 63 33. What 2 ligaments are associated with the spleen? 1. Gastrosplenic (gastrolienal) – from spleen to upper part of greater curvature of stomach 2. Splenorenal (lienorenal) – from spleen (hilum) to left kidney 34. What is the blood supply of the spleen? 1. Splenic artery – runs along superior surface of pancreas 35. What is the nerve supply of the spleen? 1. Celiac plexus (greater splanchnic post-gg SP, pre-gg PS vagal, GVA) vasomotor in function 36. What is the venous drainage of the spleen? 1. Splenic vein – runs posterior to pancreas 37. What is the lymphatic drainage of the spleen? 1. Pancreatico-splenic nodes → celiac nodes → cisterna chyli 38. What are 2 common causes gastric ulcers? H. pylori bacteria and mucosal erosions by acid 39. What part of the pancreas is highly susceptible to pancreatic cancer and what may it lead to? Usually occurs in head of pancreas → constricts common bile duct → jaundice (hyperbilirubinemia) 40. What are 3 conditions that may cause splenomegaly? 1. Leukemia 2. Lymphoma 3. Infections 41. What is the significance of a ruptured spleen? Suturing the spleen is very difficult because it is a highly vascular and fragile structure DEVELOPMENT OF THE DIGESTIVE TRACT 1. Which embryological layer do smooth muscle of the intestines and visceral peritoneum arise from? Splanchnic lateral plate mesoderm 2. In terms of folding, how is the primitive gut formed? Cephalocaudal and lateral folding 3. What are the 3 divisions of the primitive gut? 1. Foregut 2. Midgut 3. Hindgut 4. Which embryological layer is the peritoneum derived from? Somatic and splanchnic mesoderm of the lateral plate mesoderm 5. Which embryological layer is parietal peritoneum derived from? Somatic lateral plate mesoderm 6. What is the space between the somatic and splanchnic lateral plate mesoderm called? Pleuroperitoneal canal 7. What structure separates the pleural and peritoneal cavities? Diaphragm 8. What structures does ventral mesentery give rise to and where is it found? 1. Falciform ligament (found above umbilicus) 2. Lesser omentum 9. What structures does dorsal mesentery give rise to? 1. Greater omentun 2. Gastrosplenic ligament 10. Which structures does the foregut develop into? Upper respiratory system Lower respiratory system Gallbladder Liver Pancreas Superior 2/3 of duodenum Esophagus Stomach 64 Development of the Digestive Tract 65 11. What is polyhydramnios? Accumulation of excessive amniotic fluid possibly due to esophageal or duodenal atresia 12. Which structures does the midgut develop into? - Inferior 1/3 of duodenum - All the small intestines and the right-sided structures of the GI tract including the right 2/3 of transverse colon 13. Which structures does the hindgut develop into? - Left 1/3 of transverse colon - Descending colon - Sigmoid colon - Rectum - Anal canal 14. Which structures are derived from the primitive gut endoderm? 1. Epithelium and glands of GI tract 2. Parenchyma of liver and pancreas 15. Which structures of the gut are derived from splanchnic mesoderm? 1. Muscles 2. Connective tissues 3. Blood vessels 16. In general terms, describe the manner in which the stomach develops. - Posterior portion grows faster than the anterior portion - Rotates clockwise as it develops as seen from above, then tips down and to the left 17. What is omphalocele? Failure of intestinal loops to return to the abdominal cavity 18. Which way do the intestines rotate during development? Counterclockwise 19. What is gastroschisis? Herniation of abdominal contents through body wall into amniotic cavity 20. What is an imperforate anus? Persistence of the anal membrane 21. What is meconium? The first post-natal poop - Bile-stained 66 The Anatomy Review 22. List 5 abnormalities of the proctodeum. 1. Rectal atresia 2. Anal stenosis 4. Rectocloacal fistula 3. Rectourethral fistula 5. Rectovaginal fistula 23. Which 3 main arteries supply blood to the GI tract? 1. SMA 2. IMA 3. Celiac trunk 24. What is the sympathetic nerve supply to the GI tract? 1. Greater splanchnic nerve  celiac ganglion 2. Lesser and least splanchnic nerves  superior mesenteric ganglion 3. Lumbar splanchnics  inferior mesenteric plexus 4. Sacral splanchnics  inferior hypogastric plexus 25. What is the parasympathetic nerve supply to the GI tract? 1. Vagus n. 2. Pelvic splanchnic nerves (S2, S3, S4) Small And Large Intestines SMALL AND LARGE INTESTINES 1. Describe the anatomical location of the small and large intestines using quadrants. Duodenum – URQ Ileum – LLQ, LRQ Jejunum – All 4 quadrants, mostly ULQ Cecum – LRQ Ascending colon – LRQ, URQ Transverse colon – URQ, ULQ Descending colon – ULQ, LLQ Sigmoid colon – LLQ 2. Classify the 3 segments of the small intestine based on organ type (intra – or retroperitoneal). Duodenum – mostly retroperitoneal Ileum – Intraperitoneal Jejunum – Intraperitoneal 3. Describe the anatomy of the duodenum. 10 inches long 1. Superior portion: 2 inches long, back and to the right of L1 vertebral body 2. Descending portion: 3 inches, vertical along L1 - L3 3. Horizontal portion: 3 inches, horizontal across L3 4. Ascending portion: 2 inches, travels up and to the left ending at duodenojejunal flexure 4. What is the duodenojejunal flexure? What else it called? The flexure used to determine where the duodenum ends and the jejunum begins - Is caused by the Ligament of Trietz, which connects the duodenum to the celiac trunk - Is used as a surgeon’s landmark for orientation 5. What are the plicae circularis for? What else are they called? Increase surface area within the duodenum for absorption; Valves of Kerkring or semilunar folds 67 68 The Anatomy Review 6. What is the blood supply to the duodenum? → 2. Gastroduodenal a. 1. Superior mesenteric artery (SMA) → 3. Superior pancreaticoduodenal a. → 4. Inferior pancreaticoduodenal a. 7. What is lympathic drainage of duodenum? 1. Pancreaticoduodenal nodes 2. Superior mesenteric nodes 3. Celiac nodes 8. Describe the anatomy of the jejunum and ileum, in which abdominal quadrants do they lie? Together they are 20 ft long. Freely mobile, attached to posterior abdominal wall by mesentery Jejunum Ileum 1. Coiled in upper quadrants 1. Coiled in the lower quadrants 2. Wider lumen, thicker walls, more vasculature 2. Thinner lumen, thinner walls, not as vascularized 3. Mesentery attaches above and to the left of the aorta 3. Mesentery attaches to the right and below the aorta 4. Taller and more circular folds 4. Folds are shorter and not as circular 5. Vessels form few arcades with few long branches 5. Vessels have more arcades with numerous short terminal branches 9. What structure attaches the jejunum and ileum to the posterior abdominal wall? Mesentery 10. Where does most nutrient absorption occur in the small intestines? Jejunum 11. Describe how fat is distributed differently between the jejunum and ileum. Jejunum – mesentery has more fat toward the root area, less toward intestine Ileum – fat distributed evenly throughout mesentery 12. What and where are Peyer’s patches found? Lymphoid follicles distributed evenly throughout ileum - At terminal ileum, they cluster together along anti-mesenteric wall and are called Peyer’s Patches → sites of lymphocyte production Small And Large Intestines 69 13. Describe the anatomy of the blood vessels as they branch from the SMA to the jejunum and ileum. SMA → 1. Jejunal aa: Tall arcades, long vasa recti → 2. Ileal aa: Small arcades, short vasa recti 14. What is the blood supply of the small intestine? SMA 15. What is the venous drainage of small intestine? Vena rectae → anastomotic loops (arcades) → ileal and jejunal vv. → SMV, Portal vein 16. What is the lymphatic drainage of the small intestine? 1. Mesenteric nodes → 2. Superior mesenteric nodes → 3. Intestinal trunk → 4. Cisterna chyli 17. Describe the basic general anatomy of the large intestine. Extends from ileum to anus, 5 ft long 18. What structure maintains the pubarectalis angle? The puba rectalis muscle 19. What happens when the puba rectalis muscle relaxes? Anal canal straightens with rectum → defecation 20. Describe the anatomical location of the sigmoid colon. LLQ; Starts @ pelvic inlet and ends @ level of S3 21. Descibe the anatomical location of the rectum. Starts @ S3, follows curvature of the sacrum, ends @ the tip of the coccyx 22. Which 3 structures make up the pelvic inlet? 1. Sacral promontory 2. Pectineal line 3. Arcuate line 23. The descending colon ends at the level of which anatomical landmark? Pelvic inlet 24. What are tenia coli? What are the 3 groups of tenia coli? Longitudinal muscles aiding in peristalsis along the ascending colon to the sigmoid colon - There are no more tenia coli in the rectum 1. Tinea mesocolica 2. Tinea omentalis 3. Tinea libera 70 The Anatomy Review 25. What are haustrations? Sacculations of the wall of the colon between the tenia coli 26. What are epiploical (omental) appendages? Coming off of tenia coli, small fatty projections covered in visceral peritoneum 27. What type of tinea coli are found at the attachment of the greater omentum? Tinea omentalis 28. Describe the anatomical location of the cecum. RLQ; in R iliac fossa, below ileocecal junction - Appendix is attached to posteromedial side 29. What is the blood supply to the cecum? SMA → 1. Ileocolic a. → 2. Posterior cecal a. → 3. Anterior cecal a. 30. What is the lymphatic drainage of the cecum? Mesenteric nodes → Superior mesenteric nodes 31. What is ilioapsoas sign? Pain on R hip extension or flexion → appendicitis possible 32. What is Rovsing’s sign? When you press on L side and when you release pain is felt on the R side → possible appendicitis 33. Describe the anatomy and anatomical location of the appendix. 3-5 in long, muscular tube located in R iliac fossa below McBurney’s point - Contains lymphoid tissue 34. What is the blood supply to the appendix? 1. Appendicular a. 2. Via a branch of the posterior cecal a. 3. Via a direct branch of the ileocolic a. 35. What is the lymphatic drainage of the appendix? Mesenteric nodes → Superior mesenteric nodes 36. What is the nerve supply to the appendix? 1. Superior mesenteric plexus 2. GVA of T10 spinal nerve (umbilicus) Small And Large Intestines 71 37. Where may you feel pain during first few hours of appendicitis? Umbilicus → pain localizes after a few hrs 38. Describe the anatomy and location of the ascending colon (AC). 5 in long, ascends from cecum to underside of the liver at the R colic flexure - Retroperitoneal! 39. What is the blood supply to the AC? SMA → 1. Right colic a. → 2. Ileocolic a. 40. What is the nerve supply to the AC? 1. Superior mesenteric plexus 41. What is the anatomy and location of the transverse colon (TC)? 15 in long; Runs across the umbilical region - Suspended by the transverse mesocolon from the anterior surface of the pancreas 42. What is the blood supply to the TC? SMA → 1. Middle colic a. IMA → 2. Ascending branch of L colic a. and descending branch of L colic a. 43. What is the nerve supply to the TC? 1. Superior mesenteric plexus 2. Inferior mesenteric plexus 44. What is anatomy of the descending colon (DC)? 10 in long; Runs from L colic flexure to pelvic inlet - Retroperitoneal! 45. What is the blood supply to the DC? Inferior Mesenteric artery (IMA) → 1. L colic aa. → 2. Sigmoidal aa. 46. What is the nerve supply to the DC? Inferior mesenteric plexus 47. What is the anatomy of the sigmoid colon? 10-15 in long; Runs from pelvic inlet to the front of S3 - Attached to posterior abdominal wall by sigmoid mesocolon 72 The Anatomy Review 48. What is the blood supply of the sigmoid colon? IMA → 1. Sigmoidal aa. 49. What is nerve supply of the sigmoid colon? 1. Inferior mesenteric plexus 2. Hypogastric plexus 50. What is the lymphatic drainage of the sigmoid colon? Inferior mesenteric nodes 51. What is basic anatomy and location of the rectum? 5 in long; Starts at S3, ends at tip of coccyx - Outer longitudinal muscle surrounds the entire circumference 52. What is the blood supply to the rectum? a. IMA → 1. Superior rectal a. b. Internal iliac a. → 2. Middle rectal a. → 3. Inferior rectal a. 53. What is the nerve supply to the rectum? 1. Superior hypogastric plexus 2. Inferior hypogastric plexus - Both contain pelvic splanchnic and sacral splanchnic fibers 54. What is the lymphatic drainage of the rectum? Superior half: Pararectal nodes → inferior mesenteric nodes Inferior half: Internal iliac nodes 55. What is the general anatomy and location of the anal canal? 1.5 inches long; passes downward and posteriorly from the rectal ampulla - Involuntary internal sphincter - Voluntary external sphincter (innervated by the pudendal nerve) 56. What is the blood supply to the anal canal? 1. Superior rectal aa. 2. Inferior rectal aa. 57. What is the nerve supply to the anal canal? Superior portion: Hypogastric plexus (sacral and pelvic splanchnics) Small And Large Intestines 73 Inferior portion: 1. Inferior rectal n. 2. Perineal branch of S4 n. 58. What is the lymphatic drainage of the anal canal? Superior portion: Internal iliac nodes Inferior portion: Superficial inguinal nodes 59. What is the rectal ampulla? Dilatation @ inferior end of the rectum 60. How is the internal anal sphincter different from the external anal sphincter? Internal = smooth muscle (involuntary) External = skeletal muscle (voluntary) 61. Which line demarcates the change in the mucosa in the anal canal? Dentate line (pectinate line) 62. What are the longitudinal folds in the anal canal called? Anal columns @ inferior border are the anal valves 63. What is the histology of the anal canal above the dentate line? Simple columnar; Endoderm 64. What is the histology of the anal canal between the dentate line and anocutaneous line? Stratified squamos non-keratinized; Ectoderm 65. What is the histology of the anal canal below the anocutaneous line? Stratified squamos keratinized 66. What is the overall blood supply to the large intestines? a. SMA → 1. Ileocolic a. → 2. R colic a. → 3. Middle colic a. b. IMA → 1. L colic a. → 2. Sigmoidal aa. → 3. Superior rectal a. c. Internal iliac a. → 1. Middle rectal a. → 2. Inferior rectal a. 74 The Anatomy Review 67. What is the blood supply, SP and PS supply to the foregut? Blood supply: Celiac trunk SP: 1. Greater splanchnics 2. Celiac ganglion PS: Vagus n. 68. What is the blood supply, SP and PS supply to the midgut? Blood supply: SMA SP: 1. Lesser splanchnics 2. Least splanchnics 3. Superior mesenteric ganglion PS: Vagus n. 69. What is the blood supply, SP and PS supply to the hindgut? Blood supply: IMA SP: 1. Lumbar splanchnics 2. Inferior mesenteric ganglia PS: Pelvic splanchnics (S2-S4) 70. What spinal levels does most of the sensory innervation to the small intestine come from? T8 - T10 Suprarenal Glands 75 SUPRARENAL GLANDS 1. What are the general anatomical features of the adrenal glands? 1. Paired endocrine glands 2. Located on superior medial surface of kidney 3. Retroperitoneal 4. Have a capsule of perinephric fascia 5. Right is pyramidal, left is crescental in shape 6. Two layers: cortex and medulla 2. What is the main mineralcorticoid? What is the general physiologic function of mineralcorticoids? Aldosterone; Regulate H2O and electrolyte balance 3. What are the 3 zones of the adrenal cortex? 1. Zona glomerulosa 2. Zona fasciculata 3. Zona reticularis 4. What type of hormones are secreted from the zona glomerulosa? Mineralcorticoids (salt and H2O balance); Aldosterone is the main mineralcorticoid 5. What type of hormones are secreted from the zona fasciculata? Glucocorticoids (for carbohydrate, lipid, and protein metabolism); Cortisol is the main glucocorticoid 6. What are the basic physiologic functions of glucocorticoids? Carbohydrate, lipid and protein metabolism 7. What type of hormones are secreted by the zona reticularis? Sex hormones; Androgens (primarily) and estrogens 8. What hormones are secreted from the adrenal medulla? Catecholamines: epinephrine and norepinephrine ⇒ “Fight or flight” systemic mechanism 9. What is the adrenal medulla composed of, histologically? Modified post-gg sympathetic neurons (they have no axons) 76 The Anatomy Review 10. What is the blood supply to the adrenal glands? Draw a schematic. 11. What is the venous drainage of the adrenal glands? 12. What is the lymphatic drainage of the adrenal glands? Para-aortic nodes 13. What is the nerve supply to the adrenal glands? 1. Lesser and least splanchnic nerves: to cortex (vasomotor only) 2. Abdominopelvic splanchnics (post-gg SP): to cortex (vasomotor) and to medulla (secretomotor) 3. Vagus n. (pre-gg PS) 14. What type of nerves supply the cortex of the adrenal gland? Post-gg SP: Vasomotor only  controls caliber of blood vessels 15. Which 3 ganglia do the lesser and least splanchnic nerves travel to that supply the adrenals? 1. Aorticorenal ganglion 2. Celiac ganglion 3. Renal ganglion 16. What is aldosteronism? What are symptoms and signs? Hypersecretion of aldosterone ↑ aldosterone secretion → ↑ Na + retention → Hypertension Hypokalemia + ↑ K excretion → ↓ muscle and ↓neuron response to stimulation Suprarenal Glands 77 17. What is Conn’s syndrome? Hypersecretion of aldosterone (aka aldosteronism) 18. What is congenital adrenal hyperplasia? What are some signs? Incomplete development of adrenal glands  increased androgen production via ACTH stimulation from pituitary gland (ACTH stimulates hormone secretion from the adrenal cortex) - Masculinized female genitalia, facial hair, masculine features 19. What is precocious puberty? In males, increased androgen production leads to enlarged male genitalia; 5 yr old will have large penis 20. What is the chemical/hormonal basis for adrenogenital syndrome? Anterior pituitary secretes ACTH  ACTH stimulates adrenal cortex  androgen production by adrenal cortex (no negative feedback) 21. What is Cushing’s syndrome? What are common signs? Hypersecretion of glucocorticoids - “Buffalo hump” - Hyperglycemia - Poor wound healing (glucose attracts bacteria which interferes with healing) - Moon face - Pendulus abdomen with striations 22. What is Addison’s disease? What are common signs? Decreased secretion of glucocorticoids - Brown skin (hyperpigmentaton) via ↑ ACTH  ACTH stimulates melanocyte activity 23. What is chemical/hormonal basis for Addison’s disease? Anterior pituitary secretes increased ACTH to compensate for lack of glucocorticoid secretion 78 The Anatomy Review POSTERIOR ABDOMINAL WALL 1. List the 5 muscles that make up the posterior abdominal wall. 1. Psoas 2. Iliacus 3. QL 4. Transverse abdominis 2. List the 5 remaining components of the posterior abdominal wall. 1. Lumbar plexus 2. L/S bodies and IUD’s 3. Theracolumbar fascia 4. Diaphragm 5. Fat, nerves, blood vessels, lymphatics 3. List the OIAN of psoas major. O: T12 – L5 bodies, IVD’s, L/S TP’s I: Lesser trochanter of femur A: Hip flexion / trunk flexion N: L2, L3, L4 ventral rami 4. What percentage of the population does not have a psoas minor? 40% 5. List the OIAN of psoas minor. O: T12, L1 bodies I: Iliopubic eminence A: Flex the pelvis on the trunk N: Ventral rami L1 and L2 6. List the OIAN of iliacus. O: Superior 2/3 of iliac fossa I: Tendon of psoas major and lesser trochanter A: Hip / trunk flexion N: Femoral nerve (L2 - L4) 7. At what landmark does the iliacus blend with psoas major? At the level of the inguinal ligament 5. Obliques Posterior Abdominal Wall 8. List the OIAN of quadratus lumborum. O: Iliolumbar ligament, iliac crest I: Medial 1/2 of 12th ribs, L/S TP’s A: Spine ext, lateral flexion N: T12 – L4 ventral rami 9. What structures does the iliolumbar ligament co

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