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notes from note packet up to abdominal organs of digestion

body plan

trophoblastic
tube with in a tube
coelom(true body cavity)
segmentation
symmetry

trophoblastic germ layer

ectoderm
mesoderm
endoderm

coleom

cavity lined with mesoderm during dev'l
entercoelimate

segmentation

repetition of body parts
specialization of body parts

symmetry

bilateral-mirror image

dorsal cavity

cranial
spinal

ventral cavity

thoracic-pleural, mediastinal(pericardial)
abdomniopelvid- abdominal, pelvic

coelom division

parietal and visceral

coelom membranes

pleura
pericardium
peritoneum
mesenteries

ventral mesentery

disappears

dorsal mesenteries

mesoesophagus-becomes part of diaphragm
mesogaster- becomes ligaments
mesentry-> mesentery proper
mesocolon- transverse and sigmoid

pleuroperitoneal membrane

sep pleural and peritoneal cavities
duses to form portion of diaphragm

pleuropericardial membrane

separates pericardial cavity from pleural cavity

diaphragm

-septum transversarium->central tendon
-mesoesophagus
-pleuroperitoneal membrane
-striated muscle from body wall

branches from aortic arch

-brachiocephalic-rt common carotid and st subclavian
-left subclavian
-left common carotid

branches from descending aorta

paired segmental
paired non-segmental
unpaired non-segmental

paired segmental

intercostal(posterior)
lumbars

paired non-segmental

phrenic
renal
gonadal

unpaired non-segmental

celiac trunk
superior mesenteric
inferior mesenteric
esophageal
bronchial

lines of thorax

midsternal
parasternal
midclavicular
anterior axillary
midaxillary

breast components

glandular-ducts and mammary
fatty tissue-adipose and connective

breast location

superior mid surface of chest wall

breast fx

auxillary reproductive organs
female: lactiferous
males: undeveloped

ductal system of breasr

glands form lobules
lobules form lobes (15-25)
lactiferous-sinsuses(ampullae)
-each have individual opening to nipple

fatty tissue of breast

80-85%
between lobes
gives bulk and shape to breast

areola

-4th intercostal interspace
-pigmented skin
-sebaceous glands-protection
-circualr smooth mm-contraction when stimulated

gynocomastia

enlargement of male breast that is caused by a high ratio of estradiol to testosterone; major concern with patient is psychological problems and potential for breast cancer

epigastric

lying on or over the stomach

hypochondriac

upper right and left regions beneath the ribs

thorax communication

neck=superior thoracic aperature(inlet)
ab=inferior thoracic aperature(outlet)
pectoral=anterior chest wall-attachment for mm

thoracic outlet syndrome vs anatomical thoracic outlet

STA vs ITA

TOS

arm numbness
brachial plexus entrapment
STA

thoracic landmarks

vertebral spinous processes
sternum: jugular notch, sternoclavicular joint, sternal angle(of Louis), xiphoid process(infrasternal angle)
ribs(true, false, floating)
pectoral girdle-clavicles, midclavicular line, scapula

pec minor

O: ribs 3-5
I: coracoid
A: depresses and rotates scapula
elevates ribs forced inspiration
N: med pectoral N (C6-8)

SCM

O: manubrium, prox clavicle
I: mastoid, sup nuchal line
A: ant neck flex, lat flex and contra rot of head
N: CN XI, C2-4)

scalenes

O:TP C3-7
I: ribs 1-3
A: accessory to inspiration, elevation of ribs
N: C4-8

intrinsic muscles of inspiration

external and internal intercostal
transverse thoracis, subcostalis, innermost intercostal, levator costorum
N: intercostal Nn

diaphragm regions

costal
sternal
crural
central tendon

diaphragm foramina

hiatus: aortic, esophageal, caval

diaphragm Action

radial arrangement pulls inferior increases thoracic volume for inspiration

thoracic vasculatrue

neurovascular bundle: post intercostal A/V/N
-posterior intercostal
-internal thoracic-anterior intercostals, superior epigastric
-highest intercostal- from costocervical trunk

mechanical respiration

costal
diaphragmatic

bucket handle effect

increase transverse diameter
-ribs move up and outward

pump handle effect

increase A- diameter

forced inspiration

addition of extrinsic respiratory mm
pec major/minor
SCM, scalenes (Runner's Posture)

if bedridden with respiratory prob

should be propped up to allow gravity to aid respiration

costal vs diaphragmatic

costal: female, thin
diaphragmatic: male, heavy, children, elderly
other factors: age, sex, body type, profession, health, clothing

anterior mediastinum

inferior thymus
ligaments
connective tissue
potential space

middle mediastinum

pericardial cavity-heart
phrenic nerve
lung roots
pulmonary trunk and R/L pulm A
-L/R sup/inf pulm V
-sup/inf vena cava
-arch of azygos
ascending aorta
lymph nodes

posterior mediastinum

esophagus
thoracic ducts
inferior vena cava
azygos and hemiazygos veins
sympathetic chains
vagus nerves

superior mediastinum

superior part of thymus
aortic arch and great vessels
trachea
mainstem bronchi
esophagus
superior vencava
autonomic to heart and lungs

pleural regions

costal
diaphragmatic
mediastinal
cervical(cupula)

pleural recesses

rt and lft costodiaphragmatic
costomediastinal(left side)

pleural lines of reflection

-anterior border rt and left
left side-cardiac notch
-inferior at rib 12
-posterior at cupula to T12

pleural mesentery

pulmonary ligament

lung root (radix) structures

main stem bronchi
pulmonary artery
pulmonary veins
bronchial lymphatics

lingula

of left lung formed by cardiac incisure

hilum

"a small thing, a trifle, a little bit of nothing"
[-root of lung]

lung fissures

oblique -rt adn lft
horizontal- rt only

lung divisions

trachea to primary-> carina
primary bronchi-> rt and left
secondary bronchi->lobes rt(3) and lft(2)
tertiary->segments rt(8) and lft(8-10)
from tertiary->terminal->respiratory->alveoli

middle mediastinum boundaries

-R/L pleural cavities
-diaphragm
-ant and post portions of pericardium
-super of R/L pulmonary A (adventitia)

other heart terms

venous cross
ansa("foot") cervicalis

pericaridal cavity

heart
roots of great vessels
-aorta
-pulm trunk
-vena cavae
-pulm V

serosa layers

parietal(1)-lines
visceral(1)-covers
mesentery(2) supports

parietal pericardium

outer layer: fibrous-adventitia
inner: mesothelium
-attached to central tendon and sternal periosteum-sternopericardial ligement
-contiunous w adventitia of great vessels

parietal pericardium fx

prevents transient over distention
-will stretch over time ex: congestive heart failure

visceral pericardium

outer-mesothelium
inner-thin fibrous-intimate to heart

pericardial fluid secreted by

mesothelium

pericardial reflections

oblique sinus-post to heart
transverse sinus-behind ascending aorta and pulm trunk

right coronary

-from rt aortic sinus(of Valsalva)
-under rt auricular through sulcus(ant)

rt coronary branches

nodal
rt marginal
post interventrical/ rt post descending

rt coronary supplies

atrium
SA node
post 1/3 of interventricular septum
AV node
rt branch of AV bundle
anastomoses w circumflex

left coronary

from left sinsus
-bifurcates to left anterior descending/anterior interventricular

anterior interventricular supplies

ant lft&rt ventricle
ant 2/3 pf interventricular septum
lft AV bundle (of His)
anastomoses with PIA

coronary sinus

-most venous return
in post sulcus
opens to rt atrium

coronary sinus tributaries

great cardiac
middle cardiac
small(least) cardiac
oblique (marshall's)

anterior cardiac

one of several small veins
open into rt atrium

least cardiac (thesbian) (venae cordis minimae)

drain endocardium
and innermost myocardium
drain mostly to rt atria and ventricle
-valveless, very tiny

endocardium

inner lining of heart chambers
valve cusps formed by double layer of CT strpoma

cardiac muscle

3 layers: layers oriented perpendicular, arranged spirally
most in ventricular walls
originate from annulus fibrosis
do not cross coronary plane

conducting system

SA node
interatrial syncytium
AV node
AV bundle (of His)
bundle branches (purkinje fibers)

annulus fibrosis

fibrosus ring
DFCT
in AV plane
skeleton of heart
demarcates coronary sulcus
origin of myocardium
surrounds and supports valve openings
CT stroma of L/R AV valves and semilunar valves- cont w rings
only aV bundle passes thru

valves

double folding of endothelium(endocardium)
stroma of CT

stroma

the supporting tissue of an organ (as opposed to parenchyma)

other heart structures

chordae tendinae(prevent regurgitation)
papillary mm

diastole

relaxation of ventricles

systole

contraction

inflammation of cusps

scars may form along margins

valve stenosis

narrowing

incompetency

valces can't close completely

Atrioventricular valves (AV)

rt-tricuspid(ant, post, septal cusps)
lft-bicuspid/mitrial (ant/post cusps)

semilunar valves

aortic
pulmonary
3 cusps
close by reflexive turbulence

heart sounds

2nd intercostal interspace
-Rt-pulm semilunar
-Lft-aortic semilunar
5th intercostal space
-rt-tricuspid
-lft(mid-clav(apex of heart))- bicuspid

fetal circulation

oxygenation at placenta

fetal shunts

-foramen ovale-fossa ovalis
-ductus arteriosus-ligamentum arteriosus
-ductus venosus-ligamentum teres hepatica(umbilical veins)
-umbilical arteries->medial umb fold/umb ligaments

ductus arteriosus

a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta

ductus venosus

the fetal structure that allows most of the blood to bypass the liver and to flow from the umbilical vein to the vena cava

foramen ovale

Connects the left and right atria, allowing blood to flow directly from the right to the left side of the fetal heart

external abdominal landmarks

xiphoid process
costal margins
iliac crest
ASIS
pubic tubercle and crest
inguinal ligament
linea semilunaris and linea alba
tendinous intersections
umbilicus

quadrants

vertically and horizontally dividing through umbilicus
-RUQ, LUQ, RLQ, LLQ
[McBurney's pt-thumb length from umbilicus towards ASIS]

regional dividing lines

transpyloric
intertubercular/transtubercular
midclavicular(R/L)

regions

R/L hypochondriac
R/L lumbar/flank/lateral
R/L inguinal/ilian
epigastric
umbilical
pubic/hypogastric

aorta palpation

below umbilicus
also with ab aneurysm

liver palpation

RUQ
R hypochondriac
epigastric

gallbladder palpation

if enlarged
R hypochondriac
R lumbar

stomach/spleen, urinary bladder, ovaries palpation

only if enlarged/distended

kidneys

lower poles of lateral region

ascending colon palpation

only if distending by gas or chyme

descending/sigmoid colon palpation

only with solid feces

uterus

bimanually

R hypochondriac

Liver
Gall Bladder
Small Intestine
Ascending Colon
Transverse Colon
Right Kidney

L hypochondriac

Stomach
Liver (tip)
Small Intestine
Transverse Colon
Descending Colon
Pancreas
Left Kidney
Spleen

R Lumbar

Liver
Gall Bladder
Small Intestine
Ascending Colon
Right Kidney

L lumbar

Small Intestine
Descending Colon
Left Kidney

R inguinal

Small Intestine
Appendix
Cecum & Ascending Colon
Female -
Right Ovary
Right Fallopian Tube

L inguinal

Small Intestine
Descending Colon
Sigmoid Colon
Female -
Left Ovary
Left Fallopian Tube

epigastric

Esophagus
Stomach
Liver
Pancreas
Small Intestine
Transverse Colon

umbilical

Stomach
Pancreas
Small Intestine
Transverse Colon
Cisterna chyli

hypogastric

Small Intestine
Sigmoid Colon
Rectum
Right & Left Ureters
Urinary Bladder
Female -
Uterus
Right & Left Ovaries
Right & Left Fallopian Tubes
Male -
Vas Deferens
Seminal Vessicle
Prostate

Auscultation

empty stomach(sitting ULQ-supine epigastric)-> borborygmi (peristalsis)
bowel-when gassy
ab aorta and IVC-pulse sounds and bruits

bruits

abnormal swishing sounds heard over organs, glands or arteries

cleavage line (Langer's)

direction of fibers
incisions should be made with these lines for best healing

stretch marks

rupture of CT fascicles
-perpendicular to langer's

scar formation

striae

superficial fasciae

superficial layer-Camper's-adiposee over ab
deep layer-Scarpa's-cont with fasciae lata

deep fasciae

over musculature and aponeuroses
cont over spermatic cord, pubis and penis
as spermatic fascia, depp perineal fascia and deep penile fascia

arcuate line

The inferior border of the rectus sheath posteriorly

instrinsic abs

3 layers
3-ply bias bond
provides max strength

External oblique

O: ribs 5-12
I: iliac crest, aponeurosis, pubic tub and crest
N: intercostal T5-12

internal oblique

O: iliac crest, thoracolumbar fascia, TP, inguinal ligament
I: rid 10-12, linea alba, pubic symphysis
N: intercostal T10-L1

transverse abdominis

O: Inner costal cartilages (5) 7-12, thoracolumbar fascia, iliac crest, lat ing lig
I: linea alba, aponeurosis, pubic crest, ing lig
N: intercostal T7-L1

rectus abdominis

in rectus sheath
O: costal cartilages 5-7. xiphoid p,
I: pubic crest
N: intercostal T5-12

pyramidalis

absent in 16-25% of pop
O: pub sym, pubis
I: linea alba
N: subcostal T12

abdominal blood supply

superior epigastric(internal thoracic) anastomoses w inferior epigastric(external iliac)
musculophrenic
intercostal 9-12
superficial epigastric(external iliac)
deep circumflex iliac

abdominal drainage

superficial: superficial and inferior epigastric
axillar via thoracic and thoracicepigastric
femoral via branches of great saphenous
hepatic portal via paraumbilical
deep: parallel deep arteries

superficial inguinal ring/external

triangular interruption in external oblique
transmits:
males-spermatic cord
females-round ligament

external oblique split into 2 crurs

lateral- into pucic tubercle
medial-into pubic symphysis
intercrural- strengthens apex

hernias

small- will bulge during coughing (valsalva fixation)
large-will be visually apparent

deep internal ring

interruption though transverse fascia, covered by peritoneum

inguinal canal boundaries

anterior-external oblique aponeurosis
superior-falx inguinalis(conjoined tendon)
inferior-inguinal ligament and lat crus
posterior-transveralis fascia

inguinal triangle

Hesselbach's
-linea semilunaris
-inguinal ligament
-inferior epigastric artery

direct hernia

through wall of inguinal canal

indirect hernia

in canal

anterior ab wall

parietal peritoneum
transversalis fascia
rectus sheath

rectus sheath/arcuate line

above umbilicus
-posterior layer: tranversalis abdominis, internal oblique
below umbilicus: terminal edge of posterior layer

umbilical folds/remnants

median-urachus
medial-umbilical A
lateral-inferior epigastric A/V

transversalis fascia

gives rise to deep inguinal ring

falciform ligament

remnant of ventral mesentery

spermatic cord

vas deferens
testicular artery
pampiniform plexus of veins
tunica vaginalis-peritoneum
cremasteric m-int obl
external spermatic fascia-fasca of ext obl
internal spermatic fascia- trans fasc

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