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Mid Term 3
Abdomen, Pelvis, and Perineurium
196
Anatomy
Undergraduate 3
03/07/2013

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Cards

Term
What separates the thorax from the abdomen
Definition
the diaphragm
Term
What is contained in the thorax
Definition
the heart, great vessels lungs and airways
Term
What is the mediastinum?
Definition
the space between the lungs
Term
What are the three functions of the chest wall
Definition
Protection of thoracic contents
Breathing - when diaphragm contracts and relaxes
Attachments for uppper limb at strenoclavicular joint
Term
What makes up the cages?
Definition
Twelve ribs, twelve vertebrae, and the sternum
Term
What is the inlet?
Definition
space defined by first thoracic vertebrae posteriorly, ribs at the side and superior aspect of the manubrium sterni
Term
What are some of the things that pass thorugh the inlet?
Definition
the esophagus, trachea, common carotid, subclavians arteries and veins
Term
what is the outlet?
Definition
the twelfth thoracic vertebrae, the twelth rib and then the costal margin (fused costal carilage of ribs seven to ten)
Term
What is the costal margin
Definition
fused costal cartilage of ribs 7 -10
Term
What are the three parts of the sternum
Definition
manubrium, body and xyphoid process
Term
Describe the features of the manubrium
Definition
suprasternal / jugular notch
Two articular surfaces for sternoclavicular joints
Inferior are vertically inclined facets for the first costosternal joints

Second rib articulates with a demifacet on manubirum and upper body of the sternum
Term
How does the manubrium join the body?
Definition
through creating an angle in the anteroposterior plane (called the sternal angle of louis)
Term
What articulations does the sternal body have?
Definition
lateral for costal cartilages 3,4,5,6.
7 articulates between the body and xyphoid process
Term
Which are false ribs and which are floating?
Definition
False are 8,9,10 --> don't directly attach to sternum
Floating are 11 and 12 --> have costal cartilages that don't articulate at all
Term
What is the widest shortest and flattest rib?
Definition
First rib - articulates with T1.
Term
Where does the subclavian vein and artery pass?
Definition
In front of and behind the scalene tubercle on the first rib
Term
what are the aspects of a typical rib
Definition
head/neck/tubercle/shaft and distal head
Term
what is a demifacet
Definition
a joint of two bones that articulates with a third bone
Term
Where does the head of rib 5 articulate with
Definition
T4 and T5
Term
describe the facets and demifacets of all vertebrae
Definition
T1 has 1.5 facets, T2 to10 have two demifacets each, and T11 and T12 each have a single facet
Term
What characterizes the distal end of the rib?
Definition
attachment of the costal cartilage, which itself attaches to the sternum via a synovial joint
Term
How many demifacets does a typical rib have?
Definition
two emifacets
Term
Describe the various attachment ligaments around the head of the rib
Definition
Held in place by anterior radiate ligaments, attached to the disc of the vertebrae by the intra-articular ligament. T
Term
Describe the various attachment ligaments around the tubercle of the rib
Definition
Attaches with part of the transverse process of the vertebrae wvia a large medial and small lateral costotransverse ligament.
Term
What ligamnet runs bewteen the neck of the rub and the transverse process above
Definition
the superior costotransverse ligament
Term
What are the three layers of intercostal muscles?
Definition
External, internal and innermost
Term
What direction do external intercostals point
Which is the musclar/aponeurotic parts
Definition
down and forward (medially)
Anterior are aponeurotic, posterior and lateral are muscular
Term
What direction do internal intercostals point
Which is the musclar/aponeurotic parts
Definition
Point outward (laterally) and down
Aponeurosis is posterior and muscular is lateral and anterior
Term
What makes up the innermost intercostals?
Definition
three parts - one part anterior/lateral/posterior
Term
What joins together the layers
Definition
thin aponeuroses
Term
where are the intercostal spaces?
Definition
Between the internal and innermost layers of muscles
contains intercostal vein, artery, and nerve in the subcostal groove
Term
Describe the intercostal nerves
Definition
11 pairs T1-T11
Actually the anterior rami of the spinal nerves
Term
What is special about intercostal nerve T1
Definition
It makes up part of the brachial plexus
Term
What is the role of the collateral branch of intercostal nerves
Definition
Sensory innervation for skin and merge with dorsal rami branches and anterior cutaneous nerves
Term
What arteries supply the intercostal spaces
Definition
Anterior and posterior intercostal arteries
Term
Where do posterior intercostal arteries arise from?
Definition
The aorta (except for 1 and 2 which are from the supreme intercostal artery, a branch of the subclavian)
Term
What are the anterior intercostal come from?
Definition
internal thoracic - a branch of the subclavian and runs lateral to the sterum behind the costal cartilages.
Runs with the venae comitantes
Term
Where does the internal thoracic branch?
Definition
in the costal margin (cartilages of rib 7-10) into the superior epigastric and musculophrenic arteries
Term
Where do the rest of the anteior intercostal arteries come from (not hte upper six)
Definition
from the musculophrenic artery
Term
What supplies the skin of the chest wall
Definition
The perforating branches of the anterior and posterior intercostal arteries
Term
Where does the right side of the thorax drain? the left side?
Definition
azygos vein, the hemiazygos veins
Term
where do the anterior intercostal veins drain into
Definition
the venae comitantes of the internal thoracic artery -- and eventually into the brachiocephalic veins
Term
What is the diaphragm
Definition
a thin, musculotendinous partition separating the contents of the thorax from those of the abdomen
Term
What innervates the diaphragm
Definition
L and R phrenic nerves (C3,45 keep the diaphagm alive)
Term
What three origins does the diaphragm have?
Definition
a lumbar, costal and sternal origin.
Term
Where does the lumbar portion arise
Definition
via two crura from the first three lumbar vertebrae - create an arch for the aorta to pass through
Term
what are the arcuate ligaments
Definition
medial and lateral ligaments that bridge across two posterior abdominal muscles (quadratus lumbroum and the psoas).
Term
Where does the right dome of the diaphragm rise to ?
Definition
1 cm below the right nipple in the male
Term
Where do the fibres of the arcuate ligamnets attach?
Definition
tonto the central tendon
Term
what happens to the central tendon during inspiration?
Definition
the fibres contact, pulling the central tnedon downward, flattening the diaphragm and expanding the vertical diameter of the thoracic cavity
Term
Where does the aorta piece the diaphragm
Definition
between the crura at level T12
Term
Where do the esophagus and vagi pierce the central tendon of the diaphagm?
Definition
at level T10
Term
Where does the IVC pierce the central tendon of the diaphragm?
Definition
at level of T8
Term
what is the portal system
Definition
delivers nutrients from GI tract to the liver directly
Term
Where is the heart located?
Definition
located in the middle mediastinum
Term
Valves of the heart
Definition
Tri, pulmonary, mitral(bicuspid), aortic
Term
pulmonary valve becomes?
Definition
pulmonary trunk --> L and R pulmonary arteries
Term
What are the parts of the aorta?
Definition
Brachiocephalic --> Right common carotid and right subclavian

Left common carotid
Left subclavian
Term
What does the aorta become
Definition
First the ascending, then descending then abdominal (after the diaphragm) then the L And R common iliac to supply the pelvis and lower limbs
Term
What are the layers of the pericardium
Definition
The fibrous
Parietal
Visceral

Note: Parietal and visceral make up the serous pericardium (not a layer in itself)
Term
What makes up the fibrous pericardium
Definition
dense CT, fused with the central tendon of the diaphgram. Fused with the serous pericardia
Term
Describe the serous pericardium
Definition
a double layer
Parietal layer is fused with the fibrous pericardium, while the visceral layer is fused to the myocardium
Term
How many borders, surfaces and bases does the heart have?
Definition
Four borders, three surfaces ,a base and apex
Term
What makes up the right border of the heart
Definition
wall of RA
Term
Inferior border
Definition
RA and Ventricle (plus a little of LV)
Term
Left Border?
Definition
LV and L auricle (part of atrium)
Term
superior border?
Definition
The roots of the great vessels
Term
What is the apex of the heart
Definition
the bottom --> the tip of the LV
Term
What makes the anterior surface?
Definition
RA and RV
Term
Left Surface
Definition
LV
Term
Diaphragmatic surface?
Definition
LV, RV and base of LA and roots of great vessels
Term
What are two prominent sulci?
Definition
AV and IV (where blood vessels to the heart are found)
Term
Where do the sulci lie?
Definition
superfically to the AV and IV septa
Term
What makes the RA?
Definition
the venae cave, interatrial septum, and RAV septum containing the right AV orifice
Term
what separates the smooth wall from muscular walls in the venae cavae
Definition
the crista terminalis (anterior wall of the atrium)
Term
what are the pectinate muscles
Definition
parallel ridges on the muscular wall of the RA, that run into th right atrial appendage
Term
What is found near the left of the IVC
Role?
Definition
the coronary sinus
drains most of the myocardium
Term
What is the fossa ovalis
Definition
former foramen ovale --> found in interatrial septum
Term
what is the infundibulum
Definition
the path towards the pulmonary valve
Term
What prevents the tricuspid valve from evaginating into the atrium
Definition
the chordae tendinae, which themselves are contorlled by papillary muscles
Term
What are the ridges of muscle in the Rv
Definition
the trabeculae carnae
Term
What might link the IV spetum within the RV
Definition
the moderator part
Term
describe the LA
Definition
forms the base of the heart, thin walled, has a left auricle appendage, empties into LV via the left AV orifice
Term
Describe the LV
Definition
3x as thick as RV, reflecting the much higher pressure in systemic circulation (that forces it to push out in the cirulation). Has a bicuspid valve into the atrium and aortic valve out.
Term
Where do the roots of the pulmonary trunk and ascending aorta lie
Definition
in fibrous pericardium, and are lined with serous pericardium
Term
What is found at root of both pulmonary trunk and aorta?
Definition
three bulges, called the sinuses. Each sinus is located above the cusps of the plumonary and aortic valves.
Term
What arises from the sinuses on the great vessels?
Definition
the coronary arteries
Term
What are the two main arterial supplies to the heart?
Definition
tR and L coronary arteries
Term
Where do the coronary arteries arise from?
Definition
their aortic sinuses and run forward unde the cover of the L and R auricles
Term
Describe the path of the R coronary artery
Definition
runs down to the Anterior AV sulcus and then runs near the posterior IV sulcus as posterior descending IV artery. IT also gives off a brach called the right marginal branch that supplies part of the RV wall
Term
Describe the path of the L coronary artery
Definition
Branches into the Ant descending IV artery (runs down the anterior IV sulcus) and the left circumflex which passes between the AV sulcus
Term
What is the circle and loop circle
Definition
The Left circumfelx and ant descending IV artery form anastamoses with each other
Term
Describe the venous drainage of the heart?
Definition
Great cardiac vein passes up the ant. IV sulcus and around the left border. Becomes the coronary sinus and empties in right atrium.
Term
What also supplies the coronary sinus
Definition
Middle cardiac vein from Post IV sulcus
Small cardiac vein (right border of heart)
Term
Describe the innervation of the heart?
Definition
Via the cardiac plexus, efferent autonomic fibres lying posterior to the heart and anterior to bifurcation of trachea
Term
Where do innervation of the heart derive?
Definition
From T1-5 sympathetics.
Preganlionics fibres ascend in the sympathetic trunk, snpase in the superior, middle and inferior cervical ganglia and the cardiac splanchnics
Term
Where do all postganglionic fibres to the heart pass ?
Definition
Through the cardiac plexus and most synpase in the SA node or AV node
Term
What effect does SNS have on heart?
PSNS?
Definition
SNS - increases HR, contractile force and coronary artery flow
PSNS - oppose SNS, via vagus nerves
Term
What is the all important node in a healthy heart
Definition
the SA node (right atrium near SVC opening)
Not AV node (lower part of interatrial septum)
Term
Describe the conduction mechanisms in the heart
Definition
SA - AV - bundle of his - L and R bundle branches
Term
What is the pleura?
Definition
Double walled serous membranous sac that contains the lung
Term
What are the two layers of the pleura?
Definition
the parietal and visceral pleura
Term
Where does pleura not surround the lung?
Definition
the hilus, which is the root of the lung where airways and blood vessels enter and leave
Term
What is found between the two pleural layers?
What is contained?
Definition
The pleural sac and contains serous exudate
Term
What covers the sthree surfaces of the lung?
What covers the curved lung surface defined by the rib cage?
Definition
parietal pelura, costal pleura
Term
What pleura covers the base of the lungs
Definition
the diaphragmatic pleura
Term
What separates the lungs?
Definition
The mediastinum
Term
Describe the left lobe?
Definition
superior and inferior lobe, serparated by the oblique fissure
Term
What is the cardiac notch?
Definition
Feature in the left lung, that occurs because of the indentation caused by the heart
Term
What is the top of the left lung called?
Definition
the cupola, and it extends up into the root of the neck
Term
describe the right lung?
Definition
is larger (no heart in the way) and has an extra fissure (along with the oblique one, the horizontal fissure.
Three lobes (superior - horiztonal fissure - middle - oblique fissue - inferor lobe)
Term
What does the hilus of the lung contain?
Definition
branches of the pulmonary artery, the pulmonary veins, and the bronchi
Term
What are superior, the pulmonary arteries or veins?
Definition
the arteries tend to be superior
Term
What splits the chest into L and R bronchi?
Definition
The trachea
Term
Describe the bronchial tree
Definition
R splits into three secondary bronchi (one per lobe)
L splits into two

Each secondary bifurcates into two or three tertiary bronchi.
Term
What do tertiary bronchi supply?
Definition
a bronchopulmonary segment
Term
How does CT from the lungs get oxygenated blood?
Definition
via the bronchial arteries
Term
describe the role the phrenic nerves have on breathing
Definition
cause the diaphragm to contract, pulling the dome down and having air rush from the mouth and nose into the trachea
Term
What happens in the walls of the alveoli?
Definition
The blood is oxygenated and decarbonated
Term
What occurs during exhalation?
Definition
The diaphragm rises and air reverse its course
Term
What are secondary muscles of respiration?
Definition
The itercostals , the scalene muscles in the neck, the pectoral muscles
Term
Where are pulmonary muscles innervated?
Sympathetics?
Parasympathetics
Definition
Through the pulmonary plexus (around the birfucation of the trachea)
Sympathetics --> From T2-4, synapses at the same level and the postganglionics travels as pulmonary splanchnics to the pulmonary plexus.
PSNS si from Vagus - synapses in the pulmonary plexus, postganglionics predominantly go to smaller airways (bronchioles)
Term
what does the vagus nerve do to the lung?
the sympathetics?
Definition
Vagus - constriction
Sympathetics - dilation of the bronchioles
Term
What is the mediastinum?
Definition
The space between the lung
Divided into parts - the superior, anterior, middle, and posterior portions.

(anterior, middle and posterior compose the inferior mediastinum)
Term
What is contained in the superior mediastinum?
Definition
above the level of T4/5 and contains the great vessels (SVC, Aortic arch), the trachea, the esophagus, L and R vagus and phrenic nerves
Term
What is found in the anterior mediastinum
Definition
Fat and the thymus
Term
What's found in the middle mediastinum?
Definition
contains the heart and pericardia, the ascending aorta, the pulmonary trunk and lower SVC
Term
What is found in posterior mediastinum
Definition
Descending aorta, lower esophagus, root of lungs and technically the posterior thoracic wall structures
Term
Describe the great veins of the thorax
Definition
L and R jugular veins descend from neck and join L and R subclavian vein to form L and R brachiocephalic veins.
The brachiocephalics coalesce to form the SVC, which is joined by the arch of the azygos veins as it enters the RA
Term
Describe the path of the aorta
Definition
The ascending aorta comes from LV - travels 5cm to the right - branches twice to the coronary arteries. Then, it becomes the arch of the aorta curving over to the left before straightening to become the descending aorta
Term
What are the important branches of the arch of the aorta?
Definition
First brach is brachiocephalic --> bifurcates into R common carotid and R subclavian
2 and 3rd branch are L carotid and subclavian
Term
What is the ligamentum arteriosium
Definition
Runs below the arch of the aorta , a vestige of the ductus arteries, which used to attach the aorta directly to the pulmonary trunk
Term
What three branches does the descending aorta give?
Definition
1) (most posterior) - intercostal arteries
2) Bronchial arteries
3) esophageal arteries --> unpaired and supply esophagus and like rest of digestive tract they arise from front of aorta
Term
Where does the esophagus penetrate the diaphragm
Definition
AT t10
Term
What runs to the L and R of the esophagus
Definition
To the left is the left vagus nerve, right is the right vagus nerve while the thoracic duct of the lymphatic system sits posteriorly to its right
Term
Where does the trachea bifurcate
Definition
Around T4/5 (and its underside is considerd the carina)
Term
Where do the vagi nerves enter the thorax?
Definition
With the common carotid and end up attached to the esopahgus (one L and R).
Term
What is the path of the Left Vagus
Definition
runs around the right of side of the aortic arch before heading to the esophagus --> It gives off a major brnach called the left recurrent laryngeal nerve which goes back up the neck to the larynx.
Term
What is the path of the Right Vagus
Definition
Enters the thorax in front of the right subclavian, and ascends on the right side of the esophagus to the larynx.
R and L vagus stay close to the esophagus as they pass with it through the diaphragm into the abdomen
Term
Where do the phrenic nerves arise from?
Definition
In the neck from roots C3, 4, 5. Attach to the side of the pericardium
Term
What are the three important structures in the posterior wall of the thorax?
Definition
Thoracic duct (unpaired) --
Sympathetic trunk (paired)
Azygos and hemi-azygos veins (sort of paired)
Term
Describe the sympathetic trunks in the posterior wall of the thorax
Definition
the paired structure is the sympathetic trunbks - all contianined the outflow of the SNS. Coming from here are the Splanchnic nerves - Greater, lesser and least. Go into the three ganglia - celiac, superior, and renal ganglia
Term
Describe the pathway of the thoracic duct
Definition
arises from cisterna chyli in the upper abdomen, enters the thorax via the aortic hiatus and usually enters the subclavian veins at the junction of the internal jugular
Term
Describe the pathway of the azygos and hemiazygos veins
Definition
Drain into the SVC via the arch of the ayzgos
The hemiazygos drain groups of intercostal veins and then drain into the azygos.

The azygos itself drains the right intercostal veins and enters the SVC at T4 via the azygos arch
Term
what is larger abdomenopelvic or thoracic?
Definition
APelvic
Term
What makes up the pelvic diaphragm
Definition
the levator ani muscle
Term
List some structure contained in the cavity
Definition
GI tract, glands, urinary system, spleen etc.
Term
What makes up the abdominal wall
Definition
the lumbar vertebrae and its associated muscles
Term
describe the musculature of the abdominal wall
Definition
three layers of lateral musculature and anateriorly a longitudinally aligned muscle
Term
How are the abdominal muscles like that of the thorax
Definition
Both have three sets of lateral muscles (but abd also have one longitudinal and two posterior muscle
Term
What are the layers of muscles
Definition
lateral- external and internal obliques, transverse abdominus.
longitudinal - rectus abdominus
Post - Iliopsoas and quadratus laborum
Term
Which way do the external obliques run
Definition
down and medially
Term
Which do internal obliques run
Definition
They run laterally outwards, but the middle fibres are more horizontal while the lower fibres are more vertical and thus run parallel to the external obliques
Term
Where do external obliques originate from?
Definition
the lower ribs and the upper half as part of the rectus sheath.
Term
Where do the lower fibers of the external obliques insert onto?
Definition
the iliac crest (with help from the inguinal ligament)
Term
Where do the internals originate from?
where do the various fibres insert?
Definition
the iliac crest

Posterior insert onto lower 4 ribs
Middle insert onto rectus sheath
lower insert onto inguinal ligament
Term
What forms the cremaster muscle?
Definition
Part of the lower fibers from the internal obliques
Term
Which two muscles of the posterior abdominal wall run vertically?
Definition
ilipsoas and the quadratus lumborum (posterior two muscles)
Term
Where does the quadratus lumborum O, I, N?
Definition
O - lower part of the 12th rib and lumbar vertebrae (transverse processes) and then onto the posterior iliac crest
Innervated by L1-4
Term
O,I of the transverses abdominus?
Definition
iliac crest as well as the lower six costal cartilages, and the lumbar vertebrae via the lumbar fascia
inserts onto the rectus sheath
Term
Descrieb the rectus abdominus muscles
Definition
Each extend the length of the anterior wall, each being separated by the other via the linea alba.
It is attached at its upper margin to the ribs 5-7 costal cartilages, and its lower margin to the symphysis pubis and pubic crest
Term
What is the lateral margin of the rectus abdominus called?
Definition
the linea semilunaris
Term
What gives the washboard stomach appearance?
Definition
tendinous intersections
Term
What is found in the rectus sheath?
Definition
the two recti muscles enclosed by an aponeurosis of the other abdominal muscles
Term
How are the abdominal muscles innervated?
Definition
Innervated segmentally by the lower thoracic nerves and spinal nerve L1
Term
What is the level of the umbilicus?
Definition
Always at T10
Term
What is the function of the abdominal muscles?
Definition
Flexing (via the rectus abdominus) and rotating and abducting the trunk (via the lateral muscles)
Term
What is the inguinal ligament?
Definition
Material found running between the ASIS And the pubic tubercle
Term
What makes up the inguinal ligament
Definition
It is made up of CT fibres derived from the lateral abdominal muscles
Term
What does the inguinal ligmanet do?
Definition
Delineates the boundary between the abdomen and the thigh
Term
What passes through the inguinal canal
Definition
Spermatic cord, vas defererens, testicular arteries and veins (males)
Round ligament of uterus (in femlaes)
Muscular fibers from internal obliques (in both)
Term
Where does inguinal tissue derive from?
Definition
the lateral abdominal muscles
Term
What is an indirect inguinal hernia
Definition
when adbominal contents enter the scrotum
Term
What are the two openings in the inginal canal?
Definition
the deep inguinal ring and the superficial inguinal ring
Term
What is the superficial inguinal ring?
Definition
IT is a hiatus in the external oblique fascia (located just above the pubic tubercle)
Term
Where is the deep inguinal ring found?
Definition
as a hiatus in the transverse abdominus fascia
Term
What is defined as the foregut
Definition
proximal part of the GI tract and includes the esophagus, stomach and first part of duodenum
Term
midgut?
Definition
second half of the duodenum and encompasses the jejunum, ileum and colon (up to 2/3rds across the transverse colon)
Term
hindgut?
Definition
remaining distal end of the GI tract
Term
What provides symapathetic innervation to the abdominal viscera?
Definition
preganglionic fibers from thoracic splanchnic nerves (greater, lesser and least splanchnics) and also lumbar splanchnics
Term
Where do greater, lesser, least and lumbar splanchnics go?
Definition
G - from T5-9 via the celiac ganglion and supply foregut
Lesser - From T10-11 via superior mesenetier - midgut
LEast - kidneys
Lumbar - hindgut via the inferior mesenteric ganglion
Term
What is the sympathetic innervation to the pelvis?
Definition
Via T10 to L2, travels via the lesser, least and lumbar splanchnics, to the preaortic plexuses to reach the inferior hypogastric plexus
Term
What does PSNS to the fore and midgut?
Definition
Vagus nerve
Term
hingut PSNS?
Definition
pelvis splanchnic nerves (S2-4) which passes through the inferior hypogastric plexus and then up the hypogastric nerves to the superior hypogastric plexus
Term
What are the two networks in the ENS?
Definition
myenteric (external) and submucosal (meissners) plexus
Term
Where do postganglionic sympathetics that are targeted to the gut synpase?
Definition
In the three pre-aortic ganglia (superior, inferior and celiac)
Term
Where does PSNS presynaptics comes from?
Definition
vagus and pelvis splanchnics
Term
What stimulates sphincter contraction in the gut?
Definition
sympathetics
Term
What is in a plexus
Definition
Network of axons and cell bodies (considered a ganglia)
Term
What are the various plexi?
Definition
Head - carotid plexus near carotid artieres
Thorax - cardiac, pulmonary and esophageal plexuses
Abdomen - plexuses assciated with the pre-aortic ganglia on the anteior surface of the aorta and are designated the celiac, superior and inferior mesenteric and renal plexuses
Term
what is the most important thing about plexis?
Definition
Innervation follows blood supply
Term
T/F the plexuses are found in a somatotopic distribution
Definition
T b/c they form a vertical chain
Term
What is found in the scrotum?
Definition
male reproductive glands, the testes, epididymis, and distal spermatic cord
Term
What is found in the superifical fascia of the scrotum
Definition
the dartos muscle
Term
What is the spermatic fascia derived from
Definition
the abdominal muscles
Term
Wha tis the tunica vaginalis
Definition
a closed serous sac, pinched off from the abdominal peritoneum
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