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What are the three functions of the lymphatic system?
- Fluid/Protein Balance.
- Immune Defense.
- Fat absorption.
What're the components of the lymphatic system from distal to proximal?
Capillaries -> vessels -> nodes -> trunks -> ducts -> heart
Where are lymphatic capillaries NOT present?
CNS and bone.
Lymphatic vessels have valves; true or false?
What three regions contain the largest amount of lymph nodes?
Axilla, groin and mammary glands.
Right lymphatic duct drains what areas?
Right limb, right side of head, neck and thorax above umbilicus (skin and subcutaneous)
Thoracic duct drains what regions of the body?
Entire left side of head, neck and thorax, left limb and both lower limbs and also the viscera of the abdomen.
1. In upper limb lymphatic drainage, the superficial lymphatic vessels draining skin and subcute tissue follow which vessels?
2. In upper limb lymphatic drainage, the deeper superficial lymphatic vessels follow which vessel?
- 1. Basilic and cephalic veins
- 2. Brachial vein.
1. Head and neck lymphatic drainage is bilaterally symmetrical; true or false?
2. Thoracic lymph drainage is symmetrical; true or false?
3. Abdominal lymph drainage is symmetrical; true or false?
- 1. True.
- 2. True.
- 3. False.
Cisterna Chyli collects lymph from what regions?
All viscera inferior to the diaphragm and lower limbs.
Normal lymph + fat collected by lacteals in the small intestines.
1. What are the primary sites (lymphoid organs)?
2. What're the secondary sites?
3. What happens in primary and secondary sites?
- 1. Thymus and bone marrow
- 2. Spleen, lymph nodes, tonsils and GALT
- 3. Primary: Formation and maturation. Secondary: storage and maturation.
1. Which organ is the largest single mass of lymphoid tissue?
2. What does it filter?
3. What are its three other functions?
- 1. Spleen
- 2. Blood.
- 3. a. Produce fetal RBCs.
- b. Store platelets
- c. remove old, defective RBCs
1. 70% of what is found througout the Gastro-Intestinal tract?
2. This tissue is found where?
- 1. Immune system
- 2. Appendix and small intestines (Peyers patches)
What are the components of the anterior, posterior, roof and floor of the inguinal canal?
- Anterior: External Oblique aponeurosis, reinforced laterally by fibers of int. obl.
- Posterior: transversalis fascia and conjoint tendon (fusion of int obl apo + trans abd apo)
- Roof: Internal obl and trans abd
- Floor: Superior part of inguinal ligament.
Origin of External Oblique?
Insertion of External Oblique?
- Linea Alba
- Iliac crest
- Pubic tubercle
Origin of Internal Oblique?
Thoracolumbar fascia, ant 2/3 Iliac crest, lateral 1/2 of Inguinal ligament
Insertion of internal oblique?
10-12 ribs, linea alba, conjoint tendon
Origin of transversus abdominis?
7-12 costal cartilages, thoracolumbar fascia, iliac crest, ant 1/3 inguinal ligament.
Insertion of transversus abd?
- Conjoint tendon
- Pubic tubercle
1. Ext Obl
2. Int Obl and Trans Abd
- 1. Inf 6 thoracic + subcostal (T12)
- 2. Inf 6 thoracic + first lumber nerves (L1)
- 1. Pubic tubercle and pubic crest. (OPP)
- 2. Xyphoid Process and 5-7 costal cartilages (XP 57)
- 3. Ventral rami of Inf 6 thoracic
1. What does the iliohypogastric nerve pierce?
2. What thoracic muscles does it supply?
- 1. Trans abd near ASIS, external and internal oblique.
- 2. Trans abd and int obl
What is the course of the ilioinguinal nerve and what does it supply?
It goes between 2nd and 3rd layer of abdominal muscles and crosses inguinal canal. Supplies inf internal oblique and trans abd.
Inferior epigastric vessels:
- 1. External iliac vessels
- 2. Enters rectus sheath inf to arcuate line
- 3. Supplies rectus abdominis and medial part of anterolateral abd wall.
Superior epigastric vessels:
- 1. Internal thoracic artery
- 2. Goes deep to rectus abd
- 3. Rectus abd and superior part of anterolateral abd wall.
- 1. Abdominal aorta at L2.
- 2. Goes retroperitoneally in oblique direction, cross inf part of external iliac and goes into spermatic cord.
- 3. Testes.
- 1. Comes out of testes and epidydimus to form a plexus (pampiniform plexus)
- 2. Surrounds the testicular artery and goes up the spermatic cord. Left testicular empties into left renal. Right testicular into IVC (RIVc)
- 3. Empties the testes.
Where does the spermatic cord begin?
Deep inguinal ring, laternal to inf epigastric vessels.
Where is the internal, cremasteric and external fascia of the spermatic cord derived from?
- Internal fascia: Transversalis fascia
- Cremasteric: Internal obl fascia and trans abd fascia
- External: External obl apo and fascia
Superior mesenteric artery:
- 1. Abdominal Aorta L1
- 2. Goes into root of mesentery to ileocecal junction
- 3. Part of GI tract derived from midgut
Inferior mesenteric artery:
- 1. Abd aorta L3
- 2. descends retroperitoneally to the left of aorta
- 3. descending colon
List the organs that are retroperitoneal.
- Suprarenal glands
- Ureters and urinary bladder
- Colon (ascending and descending)
What are peritoneal folds?
- Areas of peritoneum raised by underlying structions such as blood vessels, ducts or obliterated fetel vessels.
- Median umbilical fold: fetel urachus
- Medial umbilical fold: umilical arteries of the fetus
- Lateral umbilical folds: inferior epigastric vessels
The main veins of the portal venous system are:
Hepatic portal vein, which is composed of superior mesenteric vein and splenic vein.
- 1. Esophageal branches of gastric artery, branch of celiac trunk and inferior phrenic artery.
- 2. Portal venous system through left gastric vein. Proximal thoracic part drained by caval system through esophageal vein going into azygos.
- 3. Para: Vagal trunks. Symp: Greater splanchnic
- 1. Right and left gastric A - lesser curvature. Right and left gastro-omental - greater curvature. Short and posterior gastric arteries from Splenic artery - Fundus
- 2. Right and left gastric V -> hepatic portal vein. Short gastric and left gastro-omental V -> splenic vein -> SMV -> hepatic portain vein. Right gastro-omental -> SMV
- 3. Para: Vagal trunk. Symp: T6-9, passes through celiac plexus via greater splanchnic.
- 1. Gastro-duodenal A which comes off common hepatic which comes off Celiac trunk. SMA.
- 2. Veins that drain into hepatic portal vein.
- 3. Para: Vagus. Symp: Greater and less splanchnic by way of celiac and superior mesenteric plexuses.
What are arcades? What do they give rise to?
Arterial loops formed by branches coming to supply the small and large intestines. They give rise to straight arteries called Vasa Recta.
What are teniae coli? Where are they located?
3 thickened bands of longitudinal smooth muscles. Located on the large intestine.
What are haustra?
Pounches of colon between the teniae.
What are the epiploic appendices?
Small, fatty appendices of the colon
What two ducts come together to form the bile duct?
Common hepatic duct and the cystic duct.
The superior mesenteric artery arches over what structure?
The left renal vein.
What is the dividing line between the right and left functional lobes of the liver?
Gallbladder and IVC
Trace the bile transport ducts from the liver to the duodenum.
Right and left hepatic duct -> common hepatic duct joins cystic -> bile duct which is joined by pancreatic duct right before draining into the duodenum.
Which organ is secondarily retroperitoneal?
- 1. Up to 10 branches of splenic.
- 2. Tributaries of splenic and SMV, most drain into splenic v.
- 3. Para: Vagus. Symp: Abdominopelvic splanchnic from celiac plexus and sup mesenteric plexus.
Is the spleen completely enclosed by peritoneum?
No. There's no peritoneum on the spleen at its hilum.
1. The lateral arcuate ligament arches over which muscle?
2. The medial arcuate ligament arches over which muscle?
- 1. Quadratus lumborum.
- 2. Psoas major
Where is the femoral nerve in relation to the psoas muscle?
Emerges from the lateral border of psoas major
1. Where do iliohypogastric and ilioinguinal enter the abdomen?
2. What muscle do they pierce and where?
3. What do they innervate?
- 1. Posterior to medial arcuate ligament.
- 2. Transversus abdominis near ASIS and pass through ext and int obliques.
- 3. Skin of suprapubic and inguinal region and abdominal muscles.
1. What muscle does genitofemoral pierce?
2. Where does it divide and what branches does it give off?
- 1. Psoas major
- 2. Later to common and external iliac. Gives off femoral and genital branches.
Where does the subcostal nerve run?
Posterior to lateral arcuate ligament.
1. Where are the parasympathetic preganglionic nerve fibers located?
2. What is their target organ?
- 1. Dorsal motor nucleus of X (Vagus nerve)
- 2. Gut, extending to the left colic flexure.
1. Explain how parasympathetic nerve fibers Sacrel 2-4 leave the spinal cord.
2. What do they innervate?
- 1. They leave spinal cord via ventral root, enter spinal nerve and leave as pelvic splanchnic nerves, going to different plexuses.
- 2. They supply descending colon, sigmoid colon, rectum and pelvic organs.
1. Explain how the sympathetic lumbar splanchnic nerves leave spinal cord.
2. What do they innervate?
- 1. Fibers go through ventral root, enter spinal nerve and leave through white rami communicantes to go to intermesenteric, inf mesenteric or sup hypogastric plexuses.
- 2. Distal large intestine.
Where is the lymphatic drainage of the testis?
Abdominal lymph nodes.
Mesentary comes from which germ layer in development?
Left vagus nerve, shortly after recurrent laryngeal leaves, turns into ________ vagal trunk.
(Left Anterior : LA)
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