Lab Objectives Thorax, Abdomen, Pelvis

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Lab Objectives Thorax, Abdomen, Pelvis
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2013-03-14 10:39:49
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Anatomy
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PAP-550 Lab Objectives
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  1. acromion
    off of spine, articulates with clavicle, prominence of shoulder, proximal point at which clinicians measure the length of the upper limb
  2. anterior, posterior intercostal a.
    part of the intercostal VAN that anastomose from internal thoracic and descending aorta, respectively
  3. auscultation points of heart:
    aortic R parasternal ICS [intercostal space] 2, pulmonic L parasternal 2-5 (2-3 L intercostal); tricuspid lower R (L possible too) sternal border near origin of xiphoid process; mitral around cardiac apex ICS 5, 8-10 cm L of midsternal line. These listening points are placed wide apart, and blood carries the sound in the direction of the flow (aortic and mitral are deep, so listen to where blood nearer chest wall).
  4. breast, nipple, areola:
    areola, pigmented region around nipple
  5. cephalic v.:
    same one as ant. lat. surface of armà axillary v.
  6. clavicle:
    first bone to ossify; most commonly broken; lung apex projects 2-4 cm above
  7. coracoid process (scapula):
    superior to glenoid cavity, ant. lat. (associated with pect. minor)
  8. costal cartilage:
    cartilage between rib and sternum, can be inflamed with costochondritis
  9. costal groove:
    show separate rib piece, VAN (sup. to inf.) : nerve not totally covered by rib
  10. external intercostal m.:
    fibers in same direction as external oblique m. of abdomen; help to elevate ribs in inspiration
  11. intercostal v., a., n.:
    ant. intercostals send branches through intercostal mm to supply pectoral region. Intercostal veins drain into the azygos vein. The nerves are ventral rami of T1-11 (T12 subcostal n)
  12. internal intercostal m.:
    more like internal oblique mm., more expiratory in function
  13. internal thoracic a., v.:
    supply breast, ITA (IMA; internal mammary artery) turns into superior epigastric a. to rectus sheath
  14. jugular notch: (suprasternal):
    easily found landmark
  15. lactiferous duct:
    drainage for each lobule (about 14-20) of breast
  16. pectoralis major m.:
    medially rotate, adduct, flex humerus (more details with upper extremity)
  17. pectoralis minor m.:
    O anterior of ribs 3-5, I coracoid process, N medial pectoral n, A protracts and depresses glenoid end of scapula
  18. rib, head, neck:
    3 contact points, T5, T4, transverse T5; all synovial joints, articular cartilage, etc. Note the articular facets on the head for articulation with the vertebral body
  19. serratus anterior m.:
    protracts scapula and holds it against thoracic wall; winging with limb abduction when paralyzed
  20. sternal angle:
    bifurcation of trachea at this level; 2nd rib joins in here.
  21. sternoclavicular joint:
    strongly supported articulation between upper extremity and axial skeleton, assists in shoulder movement
  22. sternum, manubrium, body, xiphoid process:
    Rib 1 travels deep to the clavicle at the manubrium. Rib 2 junction at the sternal angle. Body a possible marrow source for biopsy; xiphoid process a target to place your hand superior to for CPR
  23. suspensory (Cooper's) ligaments of breast:
    reach from deep fascia to dermis, defining the lobes (and shaping the breast)
  24. true rib, false rib, floating rib:
    ribs 1-7 directly connect to the sternum, hence are true, with ribs 8-12 more indirectly or not connected or false ribs, Ribs 11-12 are floating or vertebral ribs without any cartilaginous connection to the sternum.
  25. tubercle of rib, body, angle:
    ribs 1-7 true, 8-10 false, 11-12 floating, angle pt of greatest curvature and hence most likely to break there, note the facets on the tubercle for articulation with the transverse process
  26. apex of lung:
    round, tapered superior end of lung, above clavicle
  27. bronchopulmonary segments (I will not require memorization of the separate ones):
    While not for anatomy, look for an example of tertiary bronchi and the surrounding material; useful to know for extensive thoracic work, e.g., CXR, cardiothoracic surgery.
  28. costodiaphragmatic pleural recess:
    not occupied in quiet respiration parts, potential spaces for fluid accumulation, e.g., hemothorax
  29. hilum of lung:
    where the root is attached to the lung
  30. horizontal fissure:
    separates superior and middle lobe in R lung
  31. lobar (secondary) bronchus (bronchi):
    so 2 on L, 3 on R.
  32. lobes of lung (name them):
    surrounded by visceral pleura, a sub lung with a secondary bronchus (tertiary bronchi have bronchopulmonary segments not separated by the folds of visceral pleura). Right lung with superior, middle, inferior lobes; left lung with superior and inferior lobes.
  33. lung:
    fills pleural cavity
  34. oblique fissures:
    separates inf/sup lobes of L lung, and inf lobe of R lung from middle, superior lobes
  35. parietal pleura:
    adherent to thoracic wall (separable by thin layer of endothoracic fascia), diaphragm, and pericardium
  36. pleural sacs (cavities):
    lung is surrounded by a pleural sac, pleural cavity a closed, potential space containing pleural fluid
  37. primary (main) bronchus, l. and r.:
    R is wider, more vertical than L, so aspirated material there
  38. pulmonary a., v.
    2 pulm veins each side, superior, inferior
  39. segmental (tertiary) bronchus (bronchi):
    those bronchi supplying bronchopulmonary segments
  40. visceral pleura:
    closely adherant to all of the lung, continuous with parietal pleura at root of lung
  41. anterior interventricular branch of l. coronary a. or left anterior descending a. (LAD, but write out for a lab practical):
    in interventric groove, supplying ant. septum and ant. LV wall
  42. aortic semilunar valve:
    thicker valves than pulmonary valves; just superior to the valves are the origins of the coronary a.
  43. apex vs. base of heart:
    apex is blunt, formed by LV, L 5 ICS, medial to L MCL [mid clavicular line]; base is posterior, mostly LA (think of the body in a supine position to help orient for that). NOTE: the inferior surface of the heart is diaphragmatic
  44. ascending aorta, arch:
    R-L, brachiocephalic, L common carotid, L subclavian a. off of the arch
  45. atrial branch of r. coronary a.*:
    supplying right atrium
  46. atrioventricular groove (coronary sulcus):
    where the RCA runs through, encircles superior part of heart, separates atria from ventricles
  47. atrioventricular node position:
    interatrial septum on the ventricular side of the coronary sinus orifice
  48. chordae tendineae:
    threads from papillary mm, prevent cusp inversion in systole
  49. circumflex branch of l. coronary a.:
    L border of heart to poster. surface, commonly anastomosing with RCA, so LA and left surface of heart
  50. coronary sinus:
    main vein of heart post. part of coronary groove, other cardiac v. drain into this.
  51. crista terminalis:
    ridge between the pectinate muscles and the smooth part of the atrial walls
  52. fossa ovalis:
    remnant of the fetal foramen ovale, directionally "in line" with blood entering from IVC
  53. great cardiac v.:
    travels with LAD, then L circumflex a. to reach coronary sinus
  54. inferior vena cava:
    drains inf. body. Before birth, IVC valve aimed towards foramen ovale (valve on inf side, nonfunctional after birth).
  55. interventricular grooves, anterior and posterior:
    separates ventricles
  56. interventricular septum and membranous septum:
    contains conduction system; membranous portion is where VSDs more likely to occur, superior towards aortic valve
  57. left atrium:
    auricle primitive part, 4 pulmonary v. enter
  58. left border of heart -
    LV on CXR
  59. left coronary a.:
    between L auricle and pulm trunk to reach coronary groove. Supplies most of LV and LA and IV septum (including AV bundles)
  60. left ventricle:
    thick-walled to generate pressures for systemic circulation
  61. ligamentum arteriosum:
    remnant of ductus arteriosus in fetus. From pulm art to descending aorta. Often a site near coartaction; also a potential tethering site of aorta in trauma and subsequent rupture.
  62. middle cardiac v.:
    travels with posterior interventricular a. to coronary sinus
  63. mitral (bicuspid) valve:
    AV valve on left side, the valve most commonly affected by rheumatic fever (RF)
  64. moderator band (septomarginal trabecula)*:
    crosses from IV septum to ant. papillary mm., carries some of R branch of AV bundle
  65. nodal a. (sinus node a.)*:
    supplies SA node in majority of people--off of RCA and its atrial branch
  66. papillary m.:
    conical projections mentioned above with bases attached to wall of ventricle
  67. parietal pericardium and pericardiacophrenic a., v.:
    part of serous pericardium, underneath fibrous pericardium. The pericardiacophrenic a. (off of internal thoracic a.) and vein travel with the phrenic n.
  68. pectinate m.:
    anterior part with rough mm. edges, smooth part (sinus venarum) where the sinus venosus has grown in, developmentally speaking
  69. pericardial cavity:
    potential space with some serous fluid; cardiac tamponade as a concern
  70. posterior interventricular branch of right coronary a. (posterior descending a.):
    the largest branch of RCA, supplies both ventricles in that region
  71. pulmonary semilunar valve:
    ant., right, left cusps.
  72. pulmonary trunk and artery:
    R, L pulm arteries, with branches to lobar and segmental branches
  73. pulmonary v.:
    open to post. aspect of LA (bronchial veins of lung tissue into azygos system for comparison)
  74. right atrium:
    primitive RA is the auricle. Deoxygenated blood collected here.
  75. right border of heart:
    RA, e.g., on CXR [chest x-ray)
  76. right coronary a.:
    found in AV groove, supplies right side of heart and nodes (see separately listed branches). Overall, RCA supplies RA, RV; SA and AV nodes (in most people).
  77. right ventricle:
    tapers into conus arteriosus before pulm. Trunk, generates lower pressures than RV
  78. right marginal branch of r. coronary a. (right marginal a.):
    to supply R wall.
  79. sino(u)atrial node position:
    lateral RA where SVC enters, near muscle ridge
  80. small cardiac v.:
    paralleling right marginal artery and diaphragmatic RCA to drain into coronary sinus
  81. superior vena cava:
    returns blood from superior part of body: forelimbs, head, neck, and most of abdominal and thoracic body wall, with contributing tributaries of azygos and brachiocephalic veins
  82. trabeculae carneae:
    “fleshy little timbers”, anchored only at ends: highlights primitive spongy characteristics of myocardium
  83. tricuspid valve:
    AV valve of the right heart
  84. visceral pericardium (epicardium):
    part of serous pericardium, superficial to myocardium
  85. anterior vs. posterior walls of trachea:
    posterior wall muscular, so possibility of erosion with chronic intubation.
  86. azygos v.
    drains posterior wall of thorax on right side, drains into SVC
  87. brachiocephalic a.:
    (also seen as innominate artery or brachiocephalic trunk) soon divides into r. subclavian a., r. common carotid a.
  88. carina:
    keel-like ridge between the bronchal orifices, sensitive so cough reflex. Distortions seen in bronchoscopy imply disease process, e.g., from enlargement of tracheobronchial lymph nodes.
  89. common carotid a.:
    left coomon carotid a. as a direct branch off of the aortic arch, with the right common carotid a. coming off of the brachiocephalic a.
  90. descending aorta:
    in the posterior mediastinum; we will note the posterior intercostal arteries off of it.
  91. diaphragm:
    represents about 75% of respiratory effort
  92. esophagus and lower esophageal sphincter:
    posterior in position in thorax
  93. great radicular artery (of Adamkiewicz)*:
    major supply to lumbar spinal cord as it supplements the anterior spinal artery from a left posterior intercostal/lumbar a. (T8-L1 level), and so needs to be monitored, e.g., during thoracic surgery.
  94. greater (thoracic) splanchnic n.:
    splanchnic n. main source of symp. nerves into abdomen. Coming from T5-9 to celiac ganglion. Preganglionic fibers that pass via white rami comm. Greater runs medial to symp trunk to reach celiac ganglion and so supplies liver, spleen, stomach region (some visceral pain afferent fibers that pass back via rami comm to dorsal roots, so referred pain patterns accordingly)
  95. hemiazygos v., accessory hemiazygous v.:
    on left side, can be part of alternative venous drainage, there can be an accessory hemiazygos v. that is superior to that as well
  96. mediastinum:
    space between lungs and pleurae, with heart, great vessels, esophagus, ANS (autonomic nervous system), thymus, etc. Anterior: anterior to pericardium (post to sternum)à the (large) thymus in youth. Superior: thoracic inlet to sternal angle. Middle: pericardium and heart, main bronchi, lung roots. Posterior: posterior to pericardium, with esophagus and desc. thoracic aorta.
  97. phrenic n., l., r.:
    from C3, 4, 5, they course anterioromedially along pericardium, with motor and sensory to central diaphragm (and sensory to pericardium)--hence, referred pain patterns of say, right shoulder pain from inflamed gallbladder
  98. r., l. brachiocephalic v.:
    also known as innominate v., they are without valves, feed into SVC, from jugular, subclavian veins. R brachiocephalic receives R lymphatic duct, L brachiocephalic v. receives thoracic duct.
  99. rami communicantes*:
    white: myelinated preganglionic fibers from T1-L2. Grey (unmyelinated) postganglionic fibers into spinal nerves. "The further you get from home, the dirtier you get" as a mnemonic.
  100. recurrent laryngeal n., left*
    this hooks around ligamentum arteriosum (motor source to larynx, so hoarseness if damaged or impinged, e.g., by tumor or trauma)
  101. subclavian a.:
    left off of aortic arch, with the right off of the brachiocephalic artery
  102. sympathetic trunk (ganglia):
    collection of neuroectodermal ganglia, paravertebral. Thoracolumbar outflow from T1-L2, so first leg often into a chain of ganglia into each body segment. Consisting of ascending and descending fibers.
  103. thoracic (descending) aorta:
    thoracic duct, azygos v. on R side of it going through aortic hiatus of diaphragm as well
  104. thoracic duct:
    main lymphatic duct, starts from cisterna chyli, post.; drains into L subclavian/ L int. jugular junction
  105. thymus*:
    T cell maturation, large in childhood, involutes, ant./sup. mediastinum
  106. trachea and bifurcation:
    note how r. main stem bronchus is more in line and slightly wider than l. main stem bronchus, so more likely for aspirate to end up in right lung.
  107. tracheobronchial lymph nodes:
    drainage around the bifurcation
  108. vagus n. (CN X), l., r.:
    CN X that wanders down to be main thoracic, much of abd parasympathetic source, located near gut (esophagus). “Descending” (embryologically speaking) aortic arches pull vagal fibers to gill arch mm into a loop; think of the length of a giraffe’s l. recurrent laryngeal nerve!
  109. anterior superior iliac spine:
    inguinal ligament starts from here, TFL (tensor fasciae latae m.), rect. femoris mm. as well
  110. external oblique m.:
    note inferior, medial slanting of fibers
  111. extraperitoneal fat (fatty areolar tissue):
    another place to pack in fat within the layers of the abdominal wall (subserous fascia is another synonym)
  112. four quadrants of abdomen (name them):
    from median/transumbilical planes: LUQ (stomach); RUQ (liver), LLQ (sigmoid colon); RLQ (appendix)
  113. iliac crest:
    the tubercle is the most lateral point of iliac crest (as landmarks for regions), 6 cm post. to ant sup iliac spine
  114. internal oblique m.:
    note superior-aiming slant of fibers, as they spray up from iliac crest, most inferior fibers join with trans. aponeurosis for conjoint tendon used in hernia repair
  115. linea alba: aponeuroses fusing in midline:
    midline incision to avoid vessels and nerves
  116. medial umbilical ligaments (2)*:
    remnants of umbilical arteries that once fed into int. iliac arteries.
  117. median umbilical ligament (1)*:
    obliterated urachus (allantois) [fetal bladder component] from bladder to navel
  118. nine regions of abdomen (name them): MCL, SCP (subcostal plane), TTP (transtubercular: iliac tubercles on iliac crest, around L5):
    R, L hypochondriac, epigastric// R, L lateral/lumbar region, umbilical// R, L inguinal region, pubic or hypogastric. Major contents include thoughts such as pancreas in umbilical region and spleen in L hypochondriac
  119. paraumbilical and superficial epigastric veins*:
    small vessels in superficial fascia that are involved in caput medusae
  120. pubic symphysis:
    cartilaginous joint with disc
  121. pubic tubercle:
    terminates pubic crest, on pubic body where inguinal ligament attaches
  122. rectus abdominis m., rectus sheath, arcuate line:
    rectus element of abd. wall, surrounded by aponeurosis into rectus sheath; at the arcuate line (about 1/3 inferior from umbilicus to pubis), the rectus sheath is only anterior (so that rectus abdominis m. are backed by transversalis fascia)
  123. skin (epidermis and dermis):
    Note that a number of these abdominal wall objectives represent the layers of the abdominal wall, from superficial to deep.
  124. superficial fascia, with fatty layer (of Camper) and membranous layer (of Scarpa):
    can contain fat (see Camper's layer) and the deeper membranous layer (of Scarpa). These distinctions become more important in the lower abdominal wall and perineum because of urinary extravasation issues where urine and blood can be trapped between the membranous layer and the deep fascia over muscles. Sagging folds in the fatty layer (panniliculi) can be noticeable in very heavy individuals.
  125. transversalis fascia:
    abdominal fascia deep to body-wall mm,relatively firm and membranous, lining the transversus abdominis m.
  126. transversus abdominis m.:
    horizontal fibers; note internally the arcuate line marking when the rectus sheath does not have the aponeurosis of trans. abd. mm. running deep to it.
  127. conjoint tendon (inguinal falx):
    fibers of internal oblique m. joining with those of tranversus abdominis m. to form a structure that attaches to the pubic crest; can be used in hernia repair.
  128. cremaster m.:
    from int. oblique fascia. Cremasteric mm (strands) in there. Cremasteric reflex from ilioinguinal n (L1) region (thigh) and motor to cremasters from genital branch of genitofemoral n. (L1-2).
  129. dartos fascia (and muscle)*:
    firmly attached to skin, gives "ridging" (wrinkling), in superficial fascia (membranous layer)
  130. deep inguinal ring:
    through transversalis fascia. Indirect inguinal hernia lateral to inf. epigastric and down the deep inguinal ring (majority of inguinal hernias for both genders)
  131. ductus (vas) deferens:
    hard and cord-like in feel, a consideration for vasectomy, derived from mesonephric (wolffian) duct, carries sperm along from epididymis to the ejaculatory duct
  132. epididymis:
    sup/post to testis, storage there 18-24 h gives sperm mobility.
  133. gubernaculums testis (scrotal ligament)*:
    band of soft CT to inferior end of testis, guidance if not necessarily pulling, or keeping open inguinal canal. Gubernaculum a name really for the embryonic structure.
  134. inguinal canal:
    oblique passage, 4 cm long, ant wall ext oblique aponeurosis, post wall transversalis fascia, openings are rings. In here are spermatic cord, round ligament and ilioinguinal n.
  135. inguinal ligament:
    formed by foldover of ext oblique aponeurosis
  136. round ligament of uterus:
    "gubernaculum" of ovaries, attached to labia majora walls (ligament of ovary and round ligament of uterus)
  137. scrotum:
    from labioscrotal swellings of anterior abd. wall, raphe midline. Lymphatic drainage superficial
  138. seminiferous tubule:
    dense appearing, site of sperm production in testis
  139. spermatic cord and the three fascial layers (name them):
    the spermatic cord begins at deep inguinal ring, ends at post testis, with ductus deferens, VAN, and lymphatics. Varicocoele-varicosities of sperm cord veins. External spermatic fascia from external oblique aponeurosis, cremasteric fascia from internal oblique muscle, and internal spermatic fascia from transversalis fascia.
  140. superficial inguinal ring:
    opening in aponeurosis of external oblique. Direct inguinal hernia protrudes abd. wall, covered by peritoneum, medial to inf. epigastric, to superficial ring. "Turn head and cough"-the finger is positioned in the superficial ring
  141. testicular a. vs. pampiniform plexus:
    artery off of L2 or so from the abd. aorta, so deep lymphatics as metastasis in testicular CA. Pampiniform (venous) plexus, if dilated, form a scrotal varicocele; will eventually coalesce into testicular v.
  142. testis:
    should be descended into the scrotum in adults
  143. tunica albuginea:
    dense, white connective tissue capsule of testis
  144. tunica vaginalis:
    potential peritoneal space, distortable by hydrocoele
  145. cecum, ascending colon:
    cecum: pouch with no mesentery at beginning of large intestine (fermentation spot in rabbits and horses for cellulose). Ascending colon up R side.
  146. circular folds (plicae circulares, valves of Kerckring):
    mucosal/submucosal folds of small intestine that do not disappear with expansion.
  147. duodenum:
    C-shaped around the pancreas. Buffers chyme, duodenal ulcers here.
  148. gastric rugae:
    mucosal/submucosal folds of stomach to allow expansion
  149. greater curvature:
    left/inferior convex margin of stomach
  150. haustra (sacculation):
    the teniae coli keep colon under tension, hence forming this overall pouching pattern
  151. ileocecal junction:
    2-3 cm inferior to it, the appendix opens.
  152. ileocecal valve:
    at the ileocecal junction, to help prevent backflow
  153. ileum:
    distal 40% of small intestine. Peyer's patches more common here, vascular arcades more complicated. Bile acids absorbed here as part of enterohepatic circulation
  154. jejunum:
    proximal 40% of small intestine distal to duodenum. Thicker, more vascular, redder, often empty. Caliber of lumen larger, plicae circulares palpable here. Most of absorption here.
  155. l. colic (splenic) flexure:
    by inferior component of L kidney, transverse colonà descending colon. Superior and inferior mesenteric artery branches anastomose at this point.
  156. large intestine:
    larger lumen, slower passage, more bacteria (e.g., vitamin K production), water reuptake
  157. lesser curvature:
    right/superior concave margin of stomach
  158. lesser omentum:
    the "mesentery" between the liver and the stomach, so that the liver's mesenteric portal triad) run through this. With rotation of liver to R and stomach to L, end up with omental bursa dorsal to it.
  159. major duodenal papilla vs. hepatopancreatic sphincter (of Oddi) vs. hepatopancreatic ampulla (of Vater):
    8-10 cm distal to pylorus, the projecting opening into the duodenum is the papilla. The smooth muscle deep to that opening is the sphincter, and the dilated region deep to that where the bile and pancreatic ducts join is the ampulla.
  160. omental (epiploic) appendices:
    pouches of peritoneum filled with fat along the colon. Omental is L. and epiploic is Gr.
  161. pylorus, pyloric sphincter:
    exit from stomach, with sphincter a palpable band of smooth m. Pyloric stenosis in male infants: projectile vomiting.
  162. r. colic (hepatic) flexure:
    near by the R liver lobe, ascending colonà transverse colon
  163. rectum:
    fixed terminal part of intestine. Pelvic, begins at S3 level.
  164. sigmoid colon:
    at distal end of descending colon, at the level of the iliac crest
  165. small intestine:
    6 meters, most of digestion and absorption here
  166. stomach:
    most dilated portion of alimentary canal, prepares food for small intestine, also useful for vomiting
  167. teniae coli:
    3 longitudinal bands begin at appendix (location guide for it as a result) and run in colon outer surface.
  168. transverse mesocolon:
    mesentery of transverse colon, attached near inferior pancreatic border.
  169. transverse, descending colon:
    transverse is large and mobile, descending down the L side. Descending colon often site of "apple core" colon cancer lesions.
  170. vermiform appendix:
    variable position, lymphoid organ, small lumen, so often obstructed into appendicitis
  171. bare area of liver:
    area of liver uncovered by peritoneum near diaphragm
  172. caudate lobe:
    functionally part of L lobe; located by IVC
  173. common bile duct:
    fusion of cystic and hepatic ducts in edge of lesser omentum
  174. common hepatic duct:
    fusion of R, L hepatic ducts
  175. coronary ligament:
    peritoneal reflections around the bare area
  176. cystic duct:
    drainage of gall bladder
  177. falciform ligament:
    sickle-shaped" remnants of ventral mesentery of liver that connect towards the umbilicus
  178. gallbladder:
    inf. to liver, storage for bile (contraction stimulated by CCK if fatty meal)
  179. l., r. hepatic ducts:
    from separate liver lobes
  180. ligamentum teres hepatis:
    obliterated umbilical v in inf. margin of falciform ligament (round lig. of liver another name for lig. teres)—leads to ductus venosus (lig. venosum) in liver
  181. ligamentum venosum*:
    remnants of ductus venosus shunting umbilical blood around liver; along side the caudate lobe.
  182. liver, r., l. lobes:
    as divided by falciform ligament, function separately (own arteries, veins)
  183. omental (epiploic) foramen (of Winslow):
    the opening that is posterior to the portal vein, hepatic artery, and bile duct; possible trapping spot for small intestine loop
  184. omental bursa (lesser sac):
    space behind stomach partially created by lesser omentum (and splenic ligaments), so a concern if a posterior perforation of stomach
  185. porta hepatis:
    deep transverse fissure inferiorly that contains portal vein, hepatic artery, bile duct. "Crossbar of H", with L side for ligamenta venosa and teres, and R side for gall bladder, IVC fossa.
  186. quadrate lobe (of liver):
    functionally part of L lobe; by gall bladder
  187. (hepatic) portal v.:
    venous supply of digestion products from intestine, created by junction of splenic and superior mesenteric veins. Valveless, so when backed up, clinically relevant anastomoses, e.g., hemorrhoids, varices, occur.
  188. celiac trunk a.:
    supplies stomach, duodenum, and other regional viscera. 3 branches of common hepatic a., left gastric a., splenic a.
  189. common hepatic a.:
    from celiac trunk, drains into hepatic sinusoids, along with portal vein blood
  190. common iliac a., v.:
    artery stems from bifurcation of abdominal aorta; veins contribute to IVC
  191. cystic artery*:
    supply to gall bladder, may be variable in its origin (important for cholecystectomy!)
  192. esophageal v.:
    as part of azygos v., involved in varices, along with l. gastric v. of portal system.
  193. gastroduodenal a.:
    off of common hepatic a., supplies stomach, pancreas, first part of duodenum
  194. hepatic a.:
    off of celiac trunk, arterial supply to liver tissue
  195. hepatic v.:
    several veins draining into IVC, representing coalesced central veins from liver lobules
  196. ileocolic vs. r. colic vs. middle colic a.:
    these have implications in colon surgery, hence the encouraged effort to highlight them separately; branches of SMA that supply appendix and cecum, ascending colon, and transverse colon, respectively.
  197. inferior epigastric a., v.:
    enters rectus sheath inferiorly from external iliac, hernia landmark
  198. inferior mesenteric a.:
    supplies from L colic flexure to rectum
  199. inferior mesenteric v.:
    typically drains into splenic v.
  200. inferior vena cava:
    drainage of lower part of body except for portal system
  201. l. gastric a., v.:
    aims towards stomach lesser curvature (left portion). L. gastric a. off of celiac trunk; l. gastric v. can anastomose with esophageal v. and generate esophageal varices in portal hypertension.
  202. l., r. gastroepiploic (gastroomental) a.:
    right off of gastroduodenal a., left off of splenic a.; they supply the greater curvature of the stomach and the greater omentum.
  203. l., r. hepatic a.:
    from common hepatic art. Right hepatic a. supplies right lobe and the left hepatic a. supplies left, caudate, and (most of) quadrate lobes.
  204. left colic a. vs. sigmoid a.:
    l. colic a. as portion of inf. mesenteric that supplies descending colon vs. the sigmoid arteries that upply the sigmoid colon (4 branches), where the IMA continues inferiorly as the superior rectal arter.
  205. r. gastric a.:
    off of hepatic art., supplies right portion of stomach's lesser curvature
  206. r., l. renal a., v.:
    short, at right angles off of abdominal aorta and inferior vena cava, respectively.
  207. r., l. testicular vs. ovarian (gonadal) a., v.*:
    note difference of veins, with R vein into IVC, L vein into L renal vein, whereas the arteries are relatively unpaired coming off of the abdominal aorta.
  208. splenic a:
    "Mr. Squiggly," supplies the dorsal mesogastrium organ of the spleen; off of celiac a.
  209. splenic v.:
    inferior to splenic artery—follow it to portal vein
  210. superior epigastric a., v.*:
    continuation of internal mammary a. for rectus sheath and its overlying skin
  211. superior mesenteric a.:
    blood supply of primary intestinal loop, covers from (partway through) duodenum to L colic flexure
  212. superior mesenteric v.:
    largest portal v. tributary, follows the artery but drains into hepatic portal v.
  213. femoral n.:
    (lumbrosacral plexus, L2-4) exits under inguinal ligament, major supply to anterior thigh mm. Large n. between psoas major and iliacus mm.
  214. genitofemoral n.:
    from L1/L2, on anterior surface of psoas major. Cremaster muscle innervation.
  215. iliohypogastric n.:
    the superior portion of L1 (vs. ilioinguinal n.), innervates hypogastric region and internal oblique and transversus abdominis (transverse abdominal) mm. Cutaneous branch (on R) innervates McBurney’s point of appendicitis fame.
  216. ilioinguinal n.:
    collateral branch of L1 ventral ramus, sensory to scrotum, labia majora. Note it "swooping from high" from the quadratus lumborum m. to its course in the inguinal canal.
  217. lateral femoral cutaneous n. (lateral cutaneous n. of thigh):
    from L2/L3 (also known as lateral cutaneous n. of thigh). Deep to inguinal ligament near ASIS. Meralgia paresthetica or burning sensation on lateral femoral region if there is impingement of this nerve.
  218. obturator n.:
    (lumbrosacral plexus, L2-4), leaves through obturator foramen, adductor muscles of thigh; find at medial border of psoas major m.
  219. calyx (major vs. minor):
    branches of renal pelvis; you may note the difference between minor calyces that drain the renal papillae and major calyces they coalesce into.
  220. central tendon of diaphragm:
    aponeurosis of diaphragm
  221. greater omentum:
    a "double fold" of mesentery hanging down from stomach, secondary fusion with transverse colon (for support) laden with fat. Prevents adhesions between visceral/parietal peritoneum. With mobility, can "wall off" infections.
  222. iliacus m., iliopsoas m.:
    iliacus from iliac crest to blend in with psoas major; femoral n; major hip flexor
  223. main pancreatic duct:
    runs through length of pancreas, for exocrine function
  224. pancreas:
    retroperitoneal, head surrounded by duodenum
  225. perirenal fat (adipose capsule):
    lots of packing for the kidney, in addition to pararenal retroperitoneal fat.
  226. peritoneal cavity vs. retroperitoneal space:
    lined by peritoneum vs. deep to peritoneum (and deep to the body wall muscles), respectively.
  227. peritoneum, visceral vs. parietal:
    remember, both visceral and parietal. Expanses of peritoneum and how some things become retroperitoneal (kidneys developed from posteriorly-placed mesoderm, the pancreas, duodenum, ascending and descending colons by fusion of dorsal mesentery to dorsal parietal peritoneum).
  228. psoas major m. and psoas minor m.:
    O: T12-L5, I: lesser trochanter, N: L1, L2 rami, O: flexes thigh at hip joint. Psoas abscess from vertebral lesion (e.g., TB) draining into psoas sheath. About half of individuals will have a psoas minor strap-like muscle superficial to psoas major.
  229. quadratus lumborum m.:
    affect on vertebral column, extend, laterally flex (still a hypaxial muscle, innervated by ventral rami of T12-L4 as it reaches from last rib and lumbar vertebrae to iliac crest).
  230. r., l. crus (crura) of diaphragm:
    (L. “leg”) arise from lumbar vertebrae, blend in with anterior longitudinal ligament along the vertebral bodies. Right crus > left. The ligament of Trietz that suspends the duodenum originates from the right crus.
  231. r., l. kidneys:
    note the amount of protection surrounding them
  232. renal cortex:
    outer functional layer of kidney: Bowman's capsule, convoluted tubules (renal columns are extensions of cortex between medullary pyramids, consisting mostly of interlobar arteries)
  233. renal hilum:
    e.g., pelvis draining into ureter
  234. renal medulla (pyramids):
    8-18, represent loops of Henle, vasa recta, and collecting ducts
  235. renal papilla (ae):
    apex of each renal pyramid, opens into a (minor) calyx
  236. renal pelvis:
    enlargement leading to ureters
  237. spleen:
    lymphoid organ, not from gut tube, removes abnormal RBCs, stores Fe from recycled RBCs, and initiates immune responses. Worry about rupture with L thoracoabdominal injuries, esp. if already enlarged, e.g., mononucleosis.
  238. splenic hilum:
    note the different vessels entering here
  239. splenorenal vs. gastrosplenic ligament:
    think of the spleen growing in the dorsal "mesogastrium" and splitting it, hence forming a dorsal portion of splenorenal ligament, and a ventral portion of gastrosplenic lig.
  240. suprarenal (adrenal) gland:
    cortical hormones (aldosterone, cortisol), medullary hormones of epinephrine and norepinephrine
  241. ureter:
    muscular ducts; renal colic from kidney stones
  242. anterior vs. posterior sacral foramina:
    our of each, for sacral nerves, for their ventral and dorsal rami, respectively.
  243. r., l. coxal b. (hip bones, innominate bones) with ilium, ischium, pubis:
    that meet at acetabulum
  244. coccyx:
    tail remnant, usually 4 rudimentary vertebrae; coccydynia or pain in coccygeal region from falling
  245. greater pelvis (false):
    part of abdominal cavity, between ilia
  246. greater sciatic foramen:
    defined as superior to the the ischial spine and defined by the sacrospinous ligament. Items to the lower extremity leave pelvis through here.
  247. ischial spine:
    separates greater from lesser sciatic notch, project towards the fetal passageway
  248. ischial tuberosity:
    weight-bearing when sitting
  249. lesser pelvis (true):
    pelvic cavity, integral part of birth canal
  250. lesser sciatic foramen:
    defined by ischial spine, the lesser sciatic notches and both the sacrospinous and sacrotuberous ligaments. Items to the perineum leave pelvis through here.
  251. obturator foramen:
    covered by obturator fascia, obturator nerve enters thigh via it.
  252. pelvic brim, pelvic inlet, arcuate line, pectineal line:
    overall formed by pubic crest—iliopectinal (iliac arcuate) lines laterally—sacral promontory. Arcuate line along ilium, pectineal line along pubis.
  253. pelvic outlet (inferior aperature):
    bounded by sacrum (+ coccyx), ischial spines, and pubic symphysis.
  254. pubic arch:
    inferior to symp. pubis, wider in females than in males
  255. sacral canal:
    sacral hiatus leads into this, the end of the vertebral canal. Site for caudal anesthesia, with extradural spread of anesthesia.
  256. sacral promontory:
    encroaches upon pelvic inlet, created by anterior projection of S1 body
  257. sacroiliac articulation:
    strong synovial joints held into place by sacroiliac ligaments
  258. sacrospinous ligament:
    runs from sacrum (and coccyx) to ischial spine
  259. sacrotuberous ligament:
    runs from sacrum to ischial tuberosity
  260. sacrum, ala; posterior superior iliac spine:
    fused vertebrae S1-S5, 4 pairs of foramina for sacral nerves; ala as the large triangular part that articulates with ilium. PSIS is a nearby landmark, as a dimple at the S2 vertebral level.
  261. symphysis pubis:
    with a thick fibrocartilage disc
  262. bulbospongiosus m.*:
    surround the bulb of the penis (beginning of corpus spongiosum in between the crura).
  263. bulbourethral (Cowper's) gland *:
    in deep perineal space, these form a lubricating secretion into the membranous urethra.
  264. corpus cavernosum:
    paired erectile tissues.
  265. corpus spongiosum:
    the midline, unpaired body that has the spongy urethra running through it (although not on list, there are clitoral homologues)
  266. dorsal artery of penis; deep dorsal vein of penis:
    the dorsal artery of the penis supplies the glans penis, while the deep arteries of penis (off of internal pudendal artery) suppliy the corpora cavernosa. The deep dorsal vein drains the glans penis and corpora cavernosa, and is deep to the dorsal artery within the within the deep fascia of the penis.
  267. ductus (vas) deferens and ampulla:
    rom tail of epididymis to seminal vesicle; lies external but adherent to parietal peritoneum; carry sperm. The ampulla of ductus deferens. Sperm stored here prior to ejaculation.
  268. ejaculatory duct:
    leading from these to run through prostate to reach urethra
  269. external urethral orifice (meatus):
    meatus/opening of penis
  270. glans penis, prepuce:
    head of penis and foreskin, respectively
  271. ischiocavernosus m.*:
    surround the crura of the penis (beginnings of the corpora cavernosa); help to maintain erection
  272. membranous urethra:
    that part of the urethra that goes across the urogential diaphragm and therefore surrounded by the sphincter urethrae; hence, in the deep perineal space
  273. penile (spongy) urethra:
    the part of the urethra going through the penis
  274. prostate gland:
    largest accessory gland of male reproduction, BPH and prostate CA; watery, acid phosphatase secretions (and PSA). Superior to urogenital diaphragm. The utricle is the male "homologue" of the vagina, found in the prostatic urethra flanked by the openings of the ejaculatory ducts.
  275. prostatic urethra:
    that part that goes through the prostate, widest and most dilatable spot of the urethra
  276. rectovesical pouch (fossa):
    a peritoneal-lined pouch between anterior rectum and posterior bladder
  277. seminal vesicles:
    next to ampullae on posterior bladder, create most of secretions, with sucrose
  278. broad ligament (uterus):
    draping of peritoneum over uterus and fallopian tubes
  279. bulbospongiosus m.*:
    note that it's divided by the vaginal orifice in women
  280. bulbs of vestibule*:
    separated from the clitoris and spaced apart by the vagina
  281. cervical canal:
    endocervix, as part of swab for Pap smears, in addition to ectoocervical samples.
  282. cervix:
    protrudes into vaginal canal. Opening may appear lacerated after childbirth.
  283. clitoris:
    homologous to penis, with erectile tissue (no urethra running through it, so no corpus spongiosum)
  284. endometrium:
    mucosal lining of uterus in uterine cavity
  285. fornix:
    vaginal recess around cervix
  286. greater vestibular gland (Bartholin)*:
    open on either side of vagina, lubricating, often infected; below bulb of vestibule; in superficial perineal space
  287. ischiocavernosus m.*:
    this and bulbospongiosus are harder to find in women than in men, but are in homologous locations
  288. labia majora:
    homologous to male scrotum, filled with subcutaneous fat
  289. labia minora:
    hairless skin folds in between the labia majora
  290. mesosalpinx, mesovarium:
    mesosalpinx that part of the broad ligament between the ligament of the ovary (gubernaculum remnant), ovary, and fallopian tube, with the mesovarium a fold of peritoneum that connects ovary to broad ligament
  291. mons pubis:
    fatty pad anterior to symphysis pubis, covered with pubic hairs
  292. myometrium:
    thick smooth muscle wall of uterus; fibroids as leiomyomas.
  293. ovarian ligament:
    gubernaculum remnant, does "berm shot" off of uterus, continues as round ligament of uterus (heading off to inguinal canal, right?)
  294. ovary
    female gonad, lateral and posterior to uterus
  295. perineal body:
    located at center of perineum, where a number of muscles and CT (connective tissue) converge. External anal sphincter, urogenital diaphragm, some of levator ani's preanal thickening, etc. Particularly important in women as a site of perineal support.
  296. rectouterine pouch:
    (of Douglas), lined by peritoneum between uterus and rectum, reachable by culdoscopy through fornix
  297. round ligament (uterus):
    the female adult version of the fetal gubernaculum that ends in the labia majora
  298. superficial vs. deep perineal pouches (spaces):
    deep to the perineal membrane would include a compressor urethrae and a sphincter urovaginalis along with the sphincter urethrae.
  299. suspensory ligament of ovary:
    connects ovary to lateral wall, contains ovarian vessels and nerves
  300. transverse cervical (cardinal) ligaments*
    ?
  301. urethral orifice:
    anterior to vaginal orifice
  302. uterine (fallopian) tube with isthmus, ampulla, infundibulum, fimbriae:
    isthmus as the narrow component, ampulla as the lateral swollen component where fertilization typically occurs, infundibulum is the funnel-shaped distal end of the fallopian tubes, while the finger -like fimbriae help to "sweep" the egg up during ovulation
  303. uterine a., v.*:
    runs deep to the ureter as the artery runs to the uterus. The artery then runs along side of uterine body and supplies superior vagina as well.
  304. uterosacral ligaments*:
    (uterosacral lig.) condensation of pelvic (extraperitoneal) fascia containing smooth mm.; from sides of cervix to middle of sacrum, deep to peritoneum and superior to levator ani
  305. uterus:
    body, fundus, cavity: body palpable on bimanual exam, fundus: the rounded part of the uterine body above where the uterine tubes enter, cavity as space inside body of uterus
  306. vagina:
    muscular sheath, copulatory organ
  307. vaginal orifice:
    opening to vagina
  308. vesicouterine pouch:
    lined by peritoneum between bladder and uterus
  309. vestibule of vagina:
    space between labia minora, containing vagina, urethra, and greater vestibular (Bartholin's) glands
  310. anal canal:
    4 cm long, from puborectalis sling on inferiorly
  311. anal triangle (region):
    posterior triangle of perineum
  312. anorectal flexure:
    the bend in the rectum that is maintained by the puborectal sling of levator ani.
  313. coccygeus m.*:
    the other muscle of pelvic diaphragm, posterior (in dogs, the m. responsible for "tail between the legs")
  314. common iliac a., v.:
    a. as major bifurcation of abdominal aorta; union of L & R vein forms the IVC [inferior vena cava]
  315. external anal sphincter m.:
    voluntary sphincter, blends with puborectalis part of levator ani; innervated by pudendal n. and S4. Anococcygeal lig. Is the anterior joining raphe (joining suture) of levator ani.
  316. external iliac a., v.:
    origin of femoral artery, extension of femoral vein, respectively, with inferior border at inguinal ligament
  317. gluteus maximus m.:
    large heavy m. over ischial tuberosity, powerful extensor (more detail with lower extremity)
  318. internal iliac a., v.:
    a. supplies most of blood to pelvic viscera and gluteal region, while vein is the main drainage of pelvis
  319. ischioanal (ischiorectal) fossa:
    on either side of anal canal, expansion space for feces (can get ischioanal abcesses in there)
  320. levator ani m.:
    the main muscle of the pelvic diaphragm, funnel-shaped; puborectalis part forms a sling around rectum that relaxes during defecation; off of obturator internus fascia; innervated by pudendal n., additional S3, S4 innnervation.
  321. obturator a., v.
    variable origin; supplies and drains medial thigh muscle region, respectively.
  322. obturator internus m.:
    covers much of the internal wall of the true pelvis, leaves via lesser sciatic foramen to reach greater trochanter (so a lateral rotator).
  323. pectinate (dentate) line (anorectal junction):
    rectal or anal columns are folds of mucuous membranes. Anal valves connect them distally. The level of anal valves is the pectinate line, above which internal hemorrhoids (which typically don't hurt), and below which, external hemorrhoids, which are painful.
  324. perineal membrane:
    a fibrous membrane that separates the superficial and deep perineal spaces
  325. perineum:
    that part of the trunk inferior to the pelvic diaphragm, with a diamond shape created by pubic symphysis, ischial tuberosities, and coccyx
  326. piriformis m.:
    landmark for greater sciatic foramen; sciatic nerve protrudes inferiorly; a lateral hip rotator
  327. pudenal n.:
    Pudendal nerve (ventral rami of S2-4) supplies most of innervation to perineum.
  328. sacral plexus*:
    from S1-S4 ventral rami, main nerves from it are sciatic and pudendal nerves
  329. sphincter urethrae m.*:
    with the voluntary external urinary sphincter muscle (contrasting with the involuntary internal urethral sphincter m.), in the deep perineal space.
  330. superficial fascia with fatty and membranous layers:
    this distinction made because of the phenomenon of urinary extravasation (e.g, secondary to straddle injury).
  331. superficial vs. deep perineal pouches (spaces):
    superificial:perineal pouch the space between the inferior fascia of the urogenital diaphragm (perineal membrane) and the membranous layer of subcutaneous tissue (superficial fascia) of the perineum (called Colles' fascia here; remember that discussion with the abdominal wall with Scarpa's fascia?). Dramatic urinary extravasation can occur here. The deep perineal pouch is more consistent with the “urogenital diaphragm” and the external urethral sphincter (and associated urethral and vaginal muscles) that lie deep to the perineal membrane.
  332. superificial transverse perineal m.*
    along the edge of the perineal membrane, helping to stabilize the perineal body. (originates from ischium, pudendal nerve innervation).
  333. trigone:
    triangle on post. wall of bladder formed by uretal and urethral orifices
  334. ureter:
    anterior to internal iliac arteries. In women, crosses underneath uterine artery, “water under the bridge” (important for hysterectomy-don't tie off the ureters!)
  335. urethra:
    shorter in women than men,so higher UTI rate than in males
  336. urinary bladder; detrusor m.:
    lined with transitional epithelium. Detrusor m. is the smooth muscle of the bladder wall.
  337. urogenital triangle (region):
    anterior triangle of perineum

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