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2011-03-10 11:44:15

Anatomy Pre Midterms
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  1. Double Aortic arch
    • failure of distal R pharyngeal arch to disappear
    • encloses the esophagus
  2. L subclavian artery forms from?
    L 7th intersegmental artery
  3. Patent Ductus Arteriosis
    Ductus Arteriosus- pulmonary trunk to ascending aorta


    should close 24 hrs after birth but doesnt involute to form ligamentum arteriosum like it should
  4. Coarctation of Aorta
    • relative to the ductus arteriosus
    • -preductual
    • -post ductal (common)
    • -juxtaductal
  5. Fate of Aortic Pharyngeal Arches
  6. Maxillary a
  7. 2nd*
  8. Hyoid &
    stepedial a
  9. 3rd
  10. Common and
    internal corotid
  11. 4th
  12. Aortic arch (L),
    R. Subclavian (R )
  13. 5th**
  14. Disappears
  15. 6th*
  16. Pulmonary artery,
    ductus arteriosus
  17. Where are the insertions of the inguinal ligament
    • anterior superior illiac spine (ASIS)
    • to pubic tubercle
  18. Spinal innervation of Abdominal Wall
    • T7-L1 (Ventral root)
    • (xyphoid to pubic)
  19. Lymphatic Drainage of Ab Wall
    • above watershed (umbilicus) = axillary nodes
    • below watershed = superficial inguinal nodes
  20. Describe Abdominal Superficial Fascia
    • above umbilicus= 1 layer
    • below umbilicus = 2 layers
    • 1st is Campers (fat)
    • below is Scarpas (sutures)
  21. ´╗┐´╗┐Unilateral contraction of Ext/Int Obliques
    • External Oblique Uni: rotates trunk to opposite side
    • External = extraterrestrial = weird = opposite side
    • Internal Oblique Uni: rotates trun to same side
    • Internal = Intimate = wants to be on same side
  22. Outter to inner layer o Posteriolateral Abdomen
    • [skin, superficial fascia]
    • external oblique, internal oblique,transverse abdominus (all separated by layers of deep fascia)
    • last layer of deep fascia = transversalis fascia
    • extraperitoneal fascia (holds organs)
    • parietal peritoneum
  23. Where is the rectus sheath deficient?
    Lower 1/4 of posterior abdomen
  24. Umbilical folds of AnteriorAb wall
    • median = umbilical
    • medial = urachus (canal that drains fetal bladder)
    • lateral = inferor epigastric a&v
  25. Hasselbach's Triangle (Inguinal)
    • Medial border- rectus
    • abdominis
    • Lateral border & superior
    • border- inferior epigastric vein
    • Inferior border- inguinal
    • ligament
    • Note: location of inguinal
    • hernias
  26. Inguinal Canal (Anatomical)
    • passes obliquely through abdominal wall
    • superficial ring opens up as triangular space above the pubic tubercle
    • inguinal ligament divides:
    • medial crura = attaches to pubic symphysis
    • lateral crura= attaches to pubic tubercle
    • conjoint tendon- between the crura to prevent it from separating
  27. Deep vs Superficial Inguinal Ring
    Deep- opening in transversalis fascia at the midpoint of the inguinal ligament (contains spermatic cord, round ligament of uterus, and illioinguinal nerve)

    Superficial- triangular opening above pubic tubercle (bw crura). opens into external oblique
  28. Where are the testes located?
    • they lie OUTSIDE the processus vaginalis. the two developed alongside each other. vaginaliss forms from parietal peritoneum, while testes were from the EXTRAperitoneal cavity.
    • the processus vaginalis closes off only leaving behind the tunica vaginalis
  29. Medial vs Lateral Crura
    • medial crura: attaches to pubic symphysis
    • lateral crura: attaches to pubic tuburcle
  30. Direct vs Indirect Inguinal Hernia
    Deep- pass through Hasselbach's traingle (medial to epigastrics)

    Indirect- pass lateral to epigastrics (so not in Triangle)...passes THROUGH deep ring and inguinal canal but still contained WITHIN the spermatic cord
  31. Contents of Spermatic Cord
    • pampilliform venous plexus- puck up radiated arterial heat
    • testicular artery
    • genital branch of genitofemoral nerve
    • ductus (vas) deferns
  32. What does it mean to be a secondary retroperitoneal organ?
    An organ that began as intraperitoneal but then became retroperitoneal

    [ascending/descending colon, 2 3 4th parts of SI, rectum, head an body of pancreas]
  33. Retroperitoneal Organs
    • S = Suprarenal glands (aka the adrenal glands)
    • A = Aorta/IVCD =
    • Duodenum (second and third segments [some also include the fourth segment] )
    • P = Pancreas (tail is intraperitoneal)
    • U = Ureters
    • C = Colon (only the ascending and descending parts)
    • K = Kidney
    • sE = Esophagus
    • R = Rectum
  34. Hydrocele
    • failure of processus vaginalis to close and separate from the parietal peritoneum so fluid builds up in this area
    • -can occur in spermatic cord only (peritoneum slightly open), or spermatic cord and testes (completely open)
  35. Chryptorchid
    most common site?
    • undescended teste
    • inguinal canal
  36. Ectopic testes due to...
    problems with gubernaculum (testes dsescend into inguinal canal but then move interstiatlly elsewhere)
  37. Divisions of Greater Sac
    • divided in half by transverse colon
    • top half = supracolic = stomach, spleen, liver, gallbladder
    • bottom half = infracolic = small intestine, ascending and descending colon
    • note: paracolic gutters allows communication b/w these 2 regions VIA the right lateral paracolic gutter
  38. Paracolic gutters
    • spaces on the sides of the ascending and descending colon
    • L paracolic: can only go up so far because then it is blocked by the spleens phrenicolic ligament
    • R paracolic gutter: allows fluid to enter Epiploic foramen/Foramen of Winslow. Omental foramen
  39. Greater vs Lesser Omentum
    Greater: from greater curvature of stomach and 1st part of duodenum and aprons over the rest of the gut

    Lesser: lesser curvature and 1st part of duodenum to liver
  40. Hepatorenal Pouch (of Morrison)
    Subphrenic space
    • separates Liver from Right Kidney
    • * continuous w R paracolic cutter
    • subphrenic space: ontop of diaphragm

    fluid can go from R paracolic --> hepatorenal pouch --> lesser sac --> subphrenic space
  41. Ligament of Trietz
    b/w diaphragm and 4th part of duodenum [hence @ duodenal-jejunal jnx]
  42. Parts of Duodenum
    Duodenum I = Superior Part (SD)

    Duodenum II = Descending (DD)

    Duodenum III = Horizontal (HD)

    Duodenum IV = Ascending (AD) [Treitz]
  43. Omentum vs Mesentary
    • Omentum: parietal folds b/w organs
    • Mesentary: pareital folds bw/ organs and walls [carry all types of vessels]
  44. Intraperitoneal organs
    Primary Retro organs
    Secondary Retro Organs

    • Tail
    • (Pancreas), Jujenum/Ileum, Caecum/Appendix, Transverse Colon, Sigmoid Colon, Stomach, Liver,
    • Duodenum I, Spleen

    • Primary
    • Retroperitoneal

    • Kidneys, Ureters, Aorta, IVC,
    • Sympathetic Trunks

    • Secondary
    • Retroperitoneal

    • Head/Body
    • (Pancreas, Dudoenum II-IV,
    • Ascending/Descending Colon, Rectum
  45. Nutcracker Syndrome
    • SMA is infront of the 3rd part of the duodenum
    • Abdominal aorta is behind the 3rd part of the duodenum
    • ...hence, the 3rd pt of the duodenum is sandwhiched with these two structures (along with the left renal vein) so an aneurism to any of these structures can constrict the duodenum of LRV like a "nutcracker"
  46. appendix position
  47. Lymph drainage of abdominal aorta
    • Inferior messenteric trunk
    • drains into superior mesenteric trunk
    • drians into celiac trunk
    • which drains into cisterna chyli

    structures basically drain upwards
  48. Forgut, midgut, hindgut organs
    foregut: pharynx, larynx, esophagus, stomach upper duodenum, liver, gallbladder, pancreas

    midgut: remaining duodenum, jejunum, ileum, ascending colon. 2/3 transverse colon

    hindgut: last 1/3 transvers, left colic flexure, descending colon, sigmoid, rectum
  49. Whats significant about the cuadate lobe?
    it receives blood from both R & L systems
  50. Pringle's Maneuver
    • lamps hepatic artery
    • proper and portal vein to prevent excessive bleeding when liver is lacerated by
    • blocking bloodflow into the liver in the 1st place
  51. Callots Triangle
    • cystic duct
    • hepatic duct
    • liver
  52. What does the Portal Vein form from?
    • anastamosis of the superior messenteric vein with the splenic vein
    • occurs behind neck of pancreas
  53. Blood supply to pancreas
    gastroduodenal artery gives rise to the superior pancreaticoduodenal arteria (SPDA) (head)

    SMA gives rise to the IPDA (neck)

    Celiac trunk gives rise to splenic artery (which supplies pancreatic body and tail)

    note: celiac trunk --> common hepatic artery --> gastroduodenal artery --> SPDA
  54. Describe Gut Rotation
    posterior border (greater curvature) grows more rapidly than anterior border (lesser curvature)

    90 degree rotation around vertical axis brings lesser curvature to the right

    90 degree rotation around AP axis brings proximal end of stomach to left
  55. 1x3x5x7x9x11 rule
    applies to spleen

    • Measurements: 1x3x5
    • Weight: 7 oz
    • 9x11: between these ribs on L
    • hand side
  56. Describe how each part of the pancreas develops
    • Ventral bud- smaller bud that wraps around
    • ---forms the head and uncinate process
    • Dorsal bud- larger bud
    • ---forms the rest of the pancreas (neck body tail)

    *both form the main pancreatic duct, but accessory duct formed only by dorsal
  57. Annular pancreas
    when the ventral (smaller) bud is bifid and wraps around the second part of the duodenum forming a constrictive pancreatic ring around it
  58. Describe Midgut Development
    • Appears as U shaped tube on
    • vertical dorsal mesentery
    • Omphaloenteric duct connects
    • midgut loop to umbilical vesicle through umbilicus
    • Superior mesenteric artery
    • runs in the middle to the dorsal mesentery to reach the midgut loop

    • Artery divides the midgut
    • loop into cranial and cuadal limbs

    Cecum- caudal limb

    • As gut grows and elongates,
    • it herniates out into the umbilical cord
    • It rotates 90 degrees
    • counterclockwise around the axis of the superior mesenteric artery

    • Cranial to the right, caudal
    • to the left

    • As the midgut absorbs
    • mesentery, it is pulled back into the peritoneal cavity and continues to
    • rotate another 180 degrees (270 degrees total)

    • Cranial left, caudal right
    • Cecum is subhepatic (b/c no
    • ascending colon is developed yet)

    • It descends to the right
    • iliac fosa as the gut tube grows and forms the ascending colon

    • Note: duodenum is BEHIND the
    • SMA
    • Ascending and descending
    • colon become fixed to post abdominal wall as secondarily retroperitoena
  59. Omphalocele
    outpouching of intestines through the umbilical cord

  60. Describe the following midgut anomolies
    nonrotation, reverse rotation, subhepatic cecum, midgut volvus
    • NR: small bowel on right
    • RR: transverse colon BEHIND SMA
    • SHC: cecum can adhere to the liver and not descend
    • MV: bowels not fixed so very mobile
  61. Ileal Merkel Diverticulum
    • -small buldge (persistence) in the small intestine from remnant of omphaloenteric duct
    • may be connected to umbilicus by fibrous cord or fistula
    • -most common GI malformation

    • rule of 2's : 2 inches long, 2 ft from cecum, in 2% of the population
  62. Duodenal Papillae
    where common bile duct and pancreatic duct preforate the 2nd part of the duodenum
  63. Hirsprung's Disease
    • congenital megacolon caused by the abscene of parasympathetic ganglia in segment of descending colon so neural crest cells fail to migrate
    • no peristalsis motion in this part of gut, so fecal matter can back up
  64. blood supply to posterior abdominal wall?
    nerve supply?
    • blood supply- phrenic artery, inferior phrenic artery
    • nerve supply- phrenic nerve (C3,4,5)
  65. Psoas Major
    • origin: body of lumbar vert
    • insertion: femur
    • function: flexion of thigh @ hip joint
    • Innervation: L1-3
  66. Psoas Minor
    • origin: body of lumbar vert
    • insertion: pelvis
    • function: weak flexion of vertebral column
    • innervation: L1
  67. Quadratus Lumborum
    • origin: transverse processes of lumbar vertebrae
    • insertion: transverse processes of lumbar vertebrae & 12th rib
    • function: deprersses and stabalizes 12th rib and lateral abduction of trunk
    • innervation: T12-L4
  68. Iliacus
    • origin: pelvis
    • insertion: femur
    • function: flexion of thigh @ hip joint
    • innervation: Femoral nerve L2-4
  69. Nerves of Posterior Abdomin
    • subcostal: t12
    • illiohypogastric: L1
    • illioinguinal: L1
    • Genitofemoral: L1,L2
    • Lateral femoral cut: L2, L3
    • Femoral: L2,3,4
    • Obturator: L2,3,4
    • Lumbosacral: L4,5
  70. Ureter Constriction Points
    • -renal pelvis
    • -pelvic brim
    • -bladder
  71. Hydronephros
    buildup of urine in the kidneys due to the inferior renal artery obstructing the pelvis/ureter
  72. Where are parasympathetic ganglia located?
    WITHIN the WALLS of organs
  73. Preaortic/Paravertebral ganglia innervate...?
    abdominal viscera
  74. Responsible for GENERAL visceral sensations (ie: blood pressure, blood gas levels, etc)?
    Parasympathetic PREganglionics
  75. Responsible for visceral pain from infection, ischemia, or distension?
    Sympathetic POSTganglionic
  76. Difference b/w visceral and somatic pain?
    • Visceral: dull, diffuse
    • Somatic: sharp, localized
  77. What type of visceral pain travels with sympathetics, parasympathetics?
    • General Visceral sensations-
    • travel with parasympathetics

    • Ex: Blood pressure, blood
    • gases

    • Visceral pain from infection,
    • etc- travel with sympathetics

    • Visceral pain below parietal
    • peritoneal floor of pelvis- travel with parasympathetics of S2-4
  78. Cyanotic Heart Defects
    Cyanotics = Trouble = T = R --> L

    • Tetrology of Fallot
    • Transposition of great vessels
    • patent Trunkus arteriosus
  79. Acyanotic Heart Defects
    • Acyanotic = any defects you can abbreviate = L --> R
    • ASD
    • VSD
    • PDA
  80. Quadrangular Space
    • Teres Major
    • Teres Minor
    • Triceps Long Head
    • Humerus

    [axillary artery, posterior humeral circumflex a]
  81. Triangular Space
    • Teres Minor
    • Teres Major
    • Triceps Long head

    [circumflex scapular artery]
  82. Position of Triceps Lateral head vs Triceps long head
    • Triceps lateral is actually lateral to the body!
    • Triceps long is next to it and more posterior
  83. Scapular Anastamosis
    • transcerse cervical a
    • posterior circumflex humoral a
    • subscapular a
  84. Brachial Plexus "Categories"
    • "Royce Totally Drinks Cold Beer"
    • Roots 5 (c5,6,7,8, t1)
    • Trunks 3 (upper middle lower)
    • Divisions 6 (3 ant 3 post)
    • Cords 3 (LPM)
    • Branches 5 (MARMU)
  85. Dorsal Scapular Nerve
    • rhomboids
    • c4 c5
  86. suprascapular nerve
    • supraspinatus and infraspinatus
    • c5 c6
  87. long thoracic nerve
    • serratus anterior
    • c5 6 7
  88. Lateral Pectoral n
    pec major minor
  89. medial pectoral n
    pec major/minor
  90. thoracodorsal n
    latissimus dorsi
  91. upper subscapular n
  92. lower subscapular n
    subscapularis + teres major
  93. musculocutaneous n
    • c5 6 7
    • biceps, brachialis, coracobrachialis (BBC)
  94. axillary nerve
    • teres minor and deltoid
    • c 5 6
  95. radial nerve
    • c5-t1
    • extensors of upper limb
  96. median n
    • c5-t1
    • flexors of forearm
  97. ulnar n
    • c8-t1
    • intrinsic hand muscles
  98. Dermatomes of thumb, pinky, index
    • thumb: c6 (digit 1)
    • index: c7
    • pinky: c 8 (digt 5)

    pinky is always last!
  99. Rotator Cuff Muscles
    • SITS
    • Supraspinatus (0-15 degree abduction)
    • Infraspinatus (lat rotator)
    • Teres minor (lat rotator)
    • Subscapular (medial rotator)
  100. Describe the Biceps
    • biceps brachi short head: medial
    • biceps brachi long head: lateral (looks shorter because deltoid covers it)

    *coracobrachialis is deep to short head, so also medial
  101. cubital fossa
    borders: brachioradialis, pronator teres, line between humeral epicodyles "BEP"

    located near anterior elbow

    contains: bifurcation of brachial artery into radial and ulnar nerve, and also has median nerve
  102. Superficial Flexor Muscles of Forearm
    "Radical Palm Trees Down Under"" + Pronator (From thumb to pinky...follow tendons)

    • Flexor Carpi Radialis (largest)
    • Palmaris Longus (above retinaculum)
    • Flexor Digitorum Superficialis
    • Flexor Carpi Ulnaris (by pinky)
  103. What is the only nerve to enter Carpal Tunnel?
    Median Nerve (+9 tendons)
  104. What vein starts at the snuff box?
    cephalic vein
  105. Forearm Extensors
    "Uncle Max Drinks Blue Label BA!"

    • EC Ulnaris
    • E Digiti Minimi
    • E Digitorum
    • EC Radialis Brevis
    • EC Radialis Longus
    • Brachioradialis
    • Aconeus

    • Blue = Radial N
    • Green= Posterior Interossei N

  106. snuff box boundaries
    • pollicis longus
    • pollicis brevis
    • abductor pollicis longus
  107. What radiocarpal joint is most dislocated? fractured?
    • dislocated: lunate
    • fractured: scapphoid
  108. collies fracture
    fracture of distal end of radius
  109. Dupuytren's Contracture
    • thickening of palmar aponerosis
    • ring finger affected first
    • then pinky
    • then middle
  110. Describe the synovial sheath of the fingers
    All fingers initially share a common synovial sheath except the thumb, which has its own.

    The synovial sheath extends into the pinky, but then the other fingers also develop their own.

    infection can spread easily.
  111. Abdominal Wall Spinal Innervation
    T7 (xiphoid) to L1 (pubic)
  112. Lymphatic Drainage of Abdominal Wall
    Above watershed line (umbilicus) = axillary nodes (the regular)

    Below watershed line= superficial inguinal nodes