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
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
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
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]
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
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
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