notes from note packet up to abdominal organs of digestion
dorsal mesenteries
mesoesophagus-becomes part of diaphragm
mesogaster- becomes ligaments
mesentry-> mesentery proper
mesocolon- transverse and sigmoid
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
ductal system of breasr
glands form lobules
lobules form lobes (15-25)
lactiferous-sinsuses(ampullae)
-each have individual opening to nipple
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
thorax communication
neck=superior thoracic aperature(inlet)
ab=inferior thoracic aperature(outlet)
pectoral=anterior chest wall-attachment for mm
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)
intrinsic muscles of inspiration
external and internal intercostal
transverse thoracis, subcostalis, innermost intercostal, levator costorum
N: intercostal Nn
thoracic vasculatrue
neurovascular bundle: post intercostal A/V/N
-posterior intercostal
-internal thoracic-anterior intercostals, superior epigastric
-highest intercostal- from costocervical trunk
forced inspiration
addition of extrinsic respiratory mm
pec major/minor
SCM, scalenes (Runner's Posture)
costal vs diaphragmatic
costal: female, thin
diaphragmatic: male, heavy, children, elderly
other factors: age, sex, body type, profession, health, clothing
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 lines of reflection
-anterior border rt and left
left side-cardiac notch
-inferior at rib 12
-posterior at cupula to T12
lung root (radix) structures
main stem bronchi
pulmonary artery
pulmonary veins
bronchial lymphatics
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)
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
pericardial reflections
oblique sinus-post to heart
transverse sinus-behind ascending aorta and pulm trunk
rt coronary supplies
atrium
SA node
post 1/3 of interventricular septum
AV node
rt branch of AV bundle
anastomoses w circumflex
anterior interventricular supplies
ant lft&rt ventricle
ant 2/3 pf interventricular septum
lft AV bundle (of His)
anastomoses with PIA
least cardiac (thesbian) (venae cordis minimae)
drain endocardium
and innermost myocardium
drain mostly to rt atria and ventricle
-valveless, very tiny
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
Atrioventricular valves (AV)
rt-tricuspid(ant, post, septal cusps)
lft-bicuspid/mitrial (ant/post cusps)
heart sounds
2nd intercostal interspace
-Rt-pulm semilunar
-Lft-aortic semilunar
5th intercostal space
-rt-tricuspid
-lft(mid-clav(apex of heart))- bicuspid
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]
regions
R/L hypochondriac
R/L lumbar/flank/lateral
R/L inguinal/ilian
epigastric
umbilical
pubic/hypogastric
L hypochondriac
Stomach
Liver (tip)
Small Intestine
Transverse Colon
Descending Colon
Pancreas
Left Kidney
Spleen
R inguinal
Small Intestine
Appendix
Cecum & Ascending Colon
Female -
Right Ovary
Right Fallopian Tube
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
cleavage line (Langer's)
direction of fibers
incisions should be made with these lines for best healing
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
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
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
inguinal canal boundaries
anterior-external oblique aponeurosis
superior-falx inguinalis(conjoined tendon)
inferior-inguinal ligament and lat crus
posterior-transveralis fascia
rectus sheath/arcuate line
above umbilicus
-posterior layer: tranversalis abdominis, internal oblique
below umbilicus: terminal edge of posterior layer
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
ab wall layers
skin
subcutaneous fat
ext obl
int obl
trans ab
trans fascia
extra peritoneal fat
peritoneum
scrotum wall layers
skin
dartos fascia/muscle
external spermatic fascia
cremasteric m
--
internal spermatic fascia
extra peritoneal fat
tunica vaginalis
dorsal mesentery
-gastrolienal(splenic): short gasric A/V, gastroepiploic A/V
-lieno(spleno)renal: splenic A/V, tail of pancreas
greater omentum
-from greater curvature of stomach
-connects to transverse colon
-4 layers thick
-inferior recess