Histology and Anatomy Exam 3
G-protein-linked receptor
A plasma membrane receptor that works with the help of a G-protein. have *7 transmembrane domains* (cytoplasmic loops) *N-terminus is always extracellular* Ex of G-proteins : SAR(ER)/ARF(golgi) (both are monomeric) there are also heterotrimeric GTP binding proteins with Alpha, beta, and gamma subunits already attached to the plasma membrane via the protein *alpha binds GTP/GDP Beta and gamma are always together* if it is in GDP form then it is inactive how do you make it active? have to EXCHANGE the GDP for GTP, (not phosphorylate like ADP/ATP) it is exchanged by a GEP (Guanine-nucleotide Exchange Protein) when the hetrotrimeric GTP-binding protein is activated (has GTP) then the alpha subunit separates from the beta/gamma subunit and they are BOTH active where is the GEP? the receptor is the GEP
*ligand effect depends on the receptor*
Acetylcholine + ?= cardiac muscle=relaxation skeletal muscle=contraction salivary glands=secretion signal may vary depending on cell type
what is the timeline for tissue ischemia?
Body's natural time frame for hypoxia or anoxia is 6-12 hours before you have to worry about permanent damage I would always err on the side of 4 hours You're pushing your luck at 8 hours, and you've kind of missed the boat by 12 hours.
what kind of pain does Choledocholithiasis cause?
Choledocholithiasis is when a gall stone is trapped in the common bile duct *causes colicky pain*
What are chylomicrons?
Chylomicrons are tiny fatty droplets wrapped in proteincoats packaged by enterocytes
gastrocolic ligament
Connects greater curvature and transverse colon Contains gastroepiploic arteries Part of greater omentum
where is the common hepatic duct?
E on the diagram its where the left and right hepatic ducts join to form one then they drain into the common bile duct
that are the 3 leafs of the thoracolumbar fascia?
E:anterior thoracolumbar fascia (has the lateral transverse abdominus and internal oblique inserting here too) F:middle thoracolumbar G:posterior thoracolumbar Psoas facisa is not part of the thoracolumbar fascia anterior is over the quadratus middle is behind the quadratus and over the erector spinae posterior is behind the erector spinae A:psoas B:quadratus C:erector spinae D:latissimus dorsi
Marginal artery of Drummond
Formed by anastomosis of various branches of the superior and inferior Mesenteric arteries It lies in the mesentery close to the colon and is important anastomosis if one of these arteries is blocked
What is a HIDA scan?
Hepatobilliar iminodiacetid acid scan Like ERCP, but from the other way, injection of the radiotracer in the vein Radiotracer is excreted through biliary tree and shows up to the blockage (Tc99m Technetium labeled iminodiacetic acid)
explain the lacteal zippering experiment.
High VEGF-A turned those button-like junctions in lacteals into zipper-like junctions chylomicron passage was impaired and there wasn't any fat absorption by the mice
What is the porta hepatis?
Hilum of liver (transverse hepatic fissure) contains components of hepatic artery, hepatic ducts and portal vein (porta hepatis = doorway to the liver)
where does the ovarian vein drain?
IVC so CA from the uterus could inflame the paraaortic/paracaval lymph nodes
Urachal fistula
If the allantois does not obliterate, lumen remains patent so urine will then leak through through the umbilicus (urachus becomes the median umbilical fold) can also get urachal cyst and urachal sinus
What does aldosterone do?
Increases reabsorption of sodium and increases secretion of potassium net result of aldosterone is the increase of reabsorption of sodium by the principal cells. This increases sodium concentration in the blood, which in turn increases blood volume and blood pressure.
What is an omphalocele?
Intestines protrude out of umbilicus *covered by peritoneum of the umbilical cord* problem with rotation
what is mucositis?
Irritation, inflammation, and/or ulceration of the mucosa painful can be a side effect of radiation/chemo
trigone of urinary bladder and it's clinical significance?
Is a triangular area on the inside of the bladder mesoderm that was pulled in from the mesonephric duct this area is a common site of bladder CA
What is secretin and what does it do?
It is a hormone that is released when *chyme arrives in the duodenum and is too acidic.* *It secretes Bicarbonate (HCO3-), which is basic* *acts on the pancreas*
pelvic kidney?
Kidney that fails to ascend and remains in the pelvis usually still viable without complications blood flow adjusts appropriately
where is the pyloris in relation to the spine?
L1
what innervates the cremasteric reflex?
L1 and L2
where is the lumbar splanchnic?
L1-L2 they are sympathetic synapses with the inferior mesenteric ganglion to become post-synaptic contributes to the hypogastric plexus
where is the bifurcation of the abdominal aorta?
L4
where is the bifurcation of the aorta and the umbilicus?
L4
what causes ovulation?
LH Surge
leydig cells
LH from anterior pituitary> triggers release of testosterone from the leydig cells anterior pituitary produces FSH, which binds to the sertoli cells in seminiferous tubules and produces androgen binding protein which aids in testosterone concentration and promotes spermatogenesis too much FSH can cause the sertoli cells to secrete inhibin which is a negative feedback component to inhibit FSH has foamy appearance because of the lipids leydig cells have macrophages around them the marcophages also affect the development of leydig cells, without them you dont have leydig cells
is abdominal cavity the same as peritoneal cavity?
NO peritoneal cavity is IN the abdominal cavity
do serous cells have a demilune?
NO this is artifact with conventional fixation with rapid freezing the true shape is preserved and the serous cells are actually pyramidal and side by side with mucous cells
the the stratum basalis undergo ischemia and shedding?
NO, it maintains regular blood flow and even has an *arteriovenous anastamosis*
Does the portal vein have valves?
No
Is the ovary and fimbria covered by peritoneum?
No, it is intraperitoneal, this allows the egg to be released and be fertilzed
does the esophagus have a serosa?
No, it has an adventitia; it attaches to the surrounding structures.
what kind of secretions are the major salivary glands?
Parotid: serous (eosinophilic with round nuclei) Submandibular: mixed (mostly serous) (round and flattened nuclei) Sublingual: mixed (mostly mucous) (round and flattened nuclei, much paler staining b/c of mucous)
important organelles of the liver?
RER makes proteins SER *detoxifies toxins and produces hormones and lipids* *once you expose the liver to a toxin the SER grows and it's detoxifying power inceases for other toxins*
saltatory conduction
Rapid transmission of a nerve impulse along an axon, resulting from the action potential jumping from one node of Ranvier to another, skipping the myelin-sheathed regions of membrane.
Rb regulation
Rb is a tumor supressor gene binds to transcription factors and prevents them from working when Rb is phosphorylated, transcription factors are released and they can transcribe gene amino acid mutation: when there is a change from serine to aspartic acid, the aspartic acid is negatively changed just like a phosphate so it thinks that it has been phosphorylated and you have unregulated transcription because the Rb is off of the transcription factor
what is the vasa recta?
Rect = Straight, Vasa = Vessels Long vessels parallel to long loops of Henle
path of sperm?
SEVEn UP -seminiferous tubes -epididymis -vas deferens -ejaculatory duct -urethra -penis made in the seminiferous tubules, which have germinal epithelium stored in the epididymis and get their motility here secreted into the vas deferns that goes over the bladder and into the seminal vesicle where it gets more fluid and has prostaglandins and fructose after the prostate it becomes the ejaculatory duct then to the urethra and penis
how do STDs spread into the peritoneum?
STD leaks into the peritoneal cavity because the ovary and fimbria are intraperitoneal and stuff can leak into the peritoneal cavity
what are the layers of the abdominal wall from superficial to deep? (7 layers)
Skin Superficial Fascia (Camper's Fascia) Deep Fascia (Scarpa's Fascia) (each layer of muscle has its own surrounding fascia) 3 layers of muscle Transversalis Fascia (deepest layer of deep fascia) (comes from other tendons) Extraperitoneal Fat Parietal Peritoneum
what are medullary rays?
Striation in the renal pyramids within the medulla continuations of straight tubules from the cortex to the medulla contains only straight tubules
what are the major dermatomes (4)?
T2 - angle of louis T4- nipple line T10- umbilicus T12- pubis
where is the SNS from the celiac ganglion?
T6-T9
which dermatome usually feels pain of appendicitis?
T8
What is Calot's triangle?
The area bordered by: 1. Cystic duct 2. Common hepatic duct 3. Cystic artery
what is the pelvic pain line?
The course of visceral afferent fibers from organs in the pelvis, in general, depends on the organ's position relative to the pelvic pain line. Corresponds to the inferior limit of peritoneum, except for the GIT when it is midway along sigmoid colon. Above pelvic pain line, visceral pain afferents travels with sympathetic nerves back to T1-L2 spinal cord, eg, heart->T1-5; midgut->T10; ureter->T10/11-L1 *Below pelvic pain line, visceral pain travels with parasympathetic nerves to S2-4 spinal cord, eg, lower bladder, cervix, prostate*
what is the arcuate line?
The discontinuance of the posterior sheath of the rectus, about 3/4 of the way down because the transversus abdominis goes to the anterior sheath instead of posterior past this point is transversalis fascia demarcates the lower limit of the posterior layer of the rectus sheath goes from the linea semilunaris to the linea alba in both compartments (Right and left)
mural granulosa cells
The granulosa cells that make up the wall of the Graafian follicle
what attaches to the lesser omentum?
The hepatoduodenal ligament and hepatogastric ligament this is ventral mesentery
tertiary anchoring villus
The mesodermal core differentiates into blood and blood vessels.
What is intussusception?
The telescoping of one part of the intestinal tract into another because one part of the intestine is dyskinetic, can be caused by an inflamed lymph node usually in smaller children *usually the terminal ileum into the cecum (RLQ)* can be reduced with a barium enema which works with hydrostatic pressure, if unsuccessful then surgery
3 narrowest spots of the kidney where you get stones
UPJ ureto-pelvic junction (where the renal pelvis meets the ureter) distal ureter where it crosses the pelvic brim UVJ ureto-vesiculo junction (where the ureter meets the bladder
What is the fornix of the vagina?
Ventral recess formed by the cervix projecting into the vagina
what happens to the oocytes in puberty?
a cohort of oocytes get larger but remain in Meiosis 1
what is a spigelian hernia?
a defect where the linea semilunaris meets the arcuate line can be difficult to diagnose, frequently presents as a SBO usually Dx by CT
Peritoneal lavage
a diagnostic test in which rinse solution is inserted and then removed from the peritoneal cavity to detect traumatic damage
what composes the outer capsule of the kidney?
a fibrous capsule, dense irregular connective tissue with myofibroblasts (cell that is in between a fibroblast and a smooth muscle cell, for contraction)
what is a mesentery?
a fold of mesothelium that has blood vessels it is a reflection of the visceral and parietal mesothelium
appearance of ampulla vs isthmus ?
a lot of folds in ampulla
what is the appendix?
a lymphoid organ that has the plan of the large intestine with crypts but it doesn't absorb it is highly invested with lymphatic tissue
what is a kupffer cell?
a macrophage that sits in the space of disse that phagocytoses old RBCs to bilirubin (it can tell which ones are old and which are new) increased bilirubin =jaundice
synaptic signaling
a nerve cell releases neurotransmitter molecules into a synapse, stimulating the target cell type of paracrine signaling
What is an ERCP (endoscopic retrograde cholangiopancreatography)?
a scope down the esophagus, into the duodenum, then retrograde through the major papilla to view the common bile duct and pancreatic duct high incidence of pancreatitis after an ERCP
what is a calyx and what lines them?
a series of cups in the kidneys that capture filtrate lined with *transitional epithelium* theres a major and minor calyx
What is the ileocecal valve?
a sphincter that controls the flow of material from the ileum into the cecum
hypospadias
abnormal congenital opening of the male urethra can open in the glans (glanular), scrotom(penoscrotal), or middle of the penile shaft (penile)
what is a congenital diaphragmatic hernia?
absent pleuroperitoneal fold causes intestine and other viscera pass into the thorax. Common on the left, not really on the right because the liver is there and it doesn't herniate as easily if there was a diaphragmatic herniation on the right the fetus would not be viable because the lungs wouldnt develop
what is the purpose of the small intestine?
absorption minimal digestion (just protein breakdown) villi increase the surface area for more effective absorption
parenchymal cells of the pancreas?
acini/alveoli that are pyramid shaped with apices projecting towards the lumen, there are gap junctions btwn the acinar cells *have a centroacinar cell* in the middle of the duct to help it contract secrete serous fluid produce enzymes for transport basophilic cytoplasm A: acinar cells B: centroacinar C: intercalated duct
where is the pelvic transverse plane?
across the junction of the cervix going into the vagina
what proteins are associated with microvilli?
actin and myosin villin at the tip fimbrin connects the actin bundles
What is Murphy's sign?
acute pain and *inspiratory arrest* elicited by palpation of the RUQ during inspiration indicates peritoneal irritation of the gallbladder = *cholecystitis*
congenital adrenal hyperplasia
adrenal gland is overdeveloped overproduction of testosterone in a pt with XX karotype presents with male appearance, fused labia, minimal breast growth
when does an embryo become a fetus?
after 8 weeks
what triggers bile to be released?
after a meal bile is released from the GB > cystic duct> common bile duct >duodenum CCK cholecystokinen is released from the duodenum after a meal this triggers the contraction of the bile, expelling bile into the duodenum
what is the corpus luteum?
after ovulation the left over follicle becomes the corpus luteum: mural granulosa and theca interna change and start secreting little estrogen, MOSTLY PROGESTERONE degenerates after 9-11 days without pregnancy into *corpus albicans* this is the follicular phase
how long does the mature graafian cell spend in meiosis 2?
after the LH surge the mature/graafian cell goes into meiosis 2 and only spends about 12-24 hours in this stage before it is ovulated
are splanchnics pre or post-ganglionic?
all are pre-ganglionic most are sympathetic except the pelvic splanchnic which is parasympathetic
High urorectal fistula
all colonic contacts empty into the urinary system less common in females because the uterus is in the way
classes of lipoproteins?
all of these lipoproteins transport lipids, since lips are not soluble in blood, the protein coat acts as a container and makes them soluble in order from most dense to least dense: HDL "good cholesterol" IDL (intermediate) LDL "bad cholesterol" VLDL (very low) chylomicrons (produced by enterocytes, not the liver)
which aponeuroses form the linea alba?
all three muscles the external oblique, internal oblique, and transversus abdominis
what is the foramen of winslow (epiploic foramen)?
allows communication between the greater peritoneal sac and the lesser peritoneal sac. It is located immediately posterior to the free margin of the lesser omentum, i.e. hepatoduodenal ligament (contains portal triad)
what is the basis of in-vitro fertilization?
allows follicles to mature and extract good oocytes with : clear, moderately granulate cytoplasm small perivitelline space intact polar body colorless zona pellucida - worst 0 average 1 best
are the transitions of the GI tract gradual or abrupt?
always abrupt
where did the spleen develop?
always in the dorsal mesentery
primordial follicle
always near the germinal epithelium of the ovary
types of cell surface molecules
amino acids peptided proteins lipids light hydrophilic so have to be interact on cell surface
where does amniotic fluid come from?
amniotic membrane developing lungs MOSTLY from *urination from the fetus* the developing kidneys produce some urine
What is the watershed area?
an area that doesn't have direct blood supply, it has blood supply from 2 different areas hypoperfusion can lead to ischemic bowel ex. splenic flexure
what is the metanephric system?
an unsegmented mesoderm near the tail that will develop into the kidneys it stays where it is and the tail just grows and moves away, so the kidney does not really travel up the entire embryo
labia majora
analogous to the scrotum b/c it has hair and skin covering keratinized stratified squamous epithelium
suprarenal glands
another name for the adrenal glands right is more pyramidal left is more semilunar *the suprarenal glands are within the renal fascia but they are separated by fascia* this means that you can do a nephrectomy without removing the suprarenal glands
prolactin and oxytocin in the mammary glands
anterior pituitary > prolactin > formation of milk product (lipid and protein) posterior pituitary > oxytocin > triggers contraction of myoepithelial cells found around the acinar units and ducts
where does the ureter cross the internal iliac?
anteriorly to the bifrucation of the iliac to internal and external branches
false vs true pelvis
anything above the pelvic brim is false (psoas, illiacus) anything below the pelvic brim is ture (levator ani)
characteristics of the mammary glands?
appendage of the skin, largest skin apocrine gland and merocrine (modified sweat gland) lobules contain acinous cells LOBES secrete milk into a common lactiferous duct, that collect in the lactiferous sinus, and are secreted through the nipple each lobe consists of lobules, they drain into a common duct
what is the oral cavity proper?
area between the teeth up to the tonsillar pillars
what causes esophageal atresia?
around 7 weeks, the lumen of the esophagus has stratified ciliated columnar (in adults we know its strat. squamous) and the lumen closes up, then recanalizes (reopens), and the cells differentiate if there is no recanalization, then the infant will have projectile vomiting with feedings the fetus is still viable because during development it not eating
blood supply to the testicles
arterial blood comes directly from the aorta into the gonadal vessels *venous drainage is different* right testicle drains into the IVC left testicle drains into the left renal vein this can cause complications in the left testicle if there is obstruction of the venous drainage of the left testicle it can over heat because the pimpiniform vessels (cooling system) are dilated and arent draining = *varicocele* this heat can cause a decrease in sperm count, affecting fertility
culdoscentesis?
aspiration of the fluid in the rectouterine pouch of douglas needle goes into the fornix, not somatic pain, just visceral, uncomfortable but can be tolerated in an emergency clear=cyst fluid if it's blood and you leave it out: not clotted blood= ruptured ectopic because blood is old and defibrinated from the sloughing around clotted blood=fresh blood from punctured vessel
where does the esophagus cross the diaphragm?
at T10 through the esophageal hiatus (T8= IVC, T10=esophagus, T12= aorta)
labioscrotal swelling
at around 6 weeks the skin differentiates into labia or scrotum so at this point it is starting to differentiate into male or female
where is a stimulated visceral afferent going to be felt?
at the associated section on the spinal level you're going to get a general signal that something is going on but there is no map for visceral pain
hard palate vs soft palate
at the roof of the mouth hard palate is attached to bone soft palate is NOT fixed to bone, has skeletal muscle deep to it
What is the falciform ligament?
attaches liver to anterior abdominal wall and diaphragm, *part of VENTRAL mesentery* it sits between the right and left anatomical lobes of the liver
Gubernaculum
attaches testes to scrotum
what is attached to the greater omentum?
attaches to the greater curvature of the stomach the transverse colon is attached to the greater omentum posteriorly the middle of the duodenum is not in the greater omentum, it is retroperitoneal
what is the innervation of the GB?
autonomic afferents travel back with sympathetic this causes diffuse pain with gall stones the pain is diffuse until the GB becomes inflamed and it touches the abdominal wall, the pain is now localized because you have somatic pain (starts diffuse then localizes when it touches the abd wall)
why are there occluding junctions around the lumen of the pancreatic intercalated ducts?
b/c these secretions are so strong, they will start to digest the pancreatic tissue itself if it leaked out
What is the glomerulus?
ball of capillaries, interacts with the bowman's capsule afferent arteriole in efferent arteriole out also called the vascular pole
what is a splenic artery aneurysm
ballooning of the splenic artery presents with LUQ pain once over 2 cm in diameter, even if their not symptomatic, they are prone to spontaneous rupture and surgery is advised
how do you treat internal hemorrhoids?
band ligation because they don't feel pain, just discomfort external hemorrhoids are treated under anesthesia by the removal of the veins in the external rectal venous plexus
what is an internal hernia?
bands of scar tissue are blocking the intestine, or it will make a bridge and a piece of intestine will get underneath the bridge and it gets trapped there
what is a superficial nephron?
barley has a loop of henle mostly in the cortex and and in the outer medulla
why should the portal triad be renamed to quadrad?
because in addition to the bile duct, hepatic artery, and portal vein, there are lymph vessels in it
relation between the ureter and the uterus?
because in females, the bladder is anterior to the uterus, the ureter comes in posteriorly under the fallopian tubes and through the cardinal ligament VERY CLOSE TO THE UTERINE ARTERY, can be ligated during hysterectomy
why does the tubule get thin and the PCT loose brush border when it gets straight ?
because most of the absorption has been done and it does not need such complexity
which perineum is more supportive, male or female?
because of the vagina, the female perineum isn't as strong as the male's bad b/c it is more susceptible to prolapse good because childbirth needs expansion
explain the significance of the location of the mesenteric vessels?
because the superior mesenteric vessels are sandwiched between the uncinate process if there is an arterial aneurysm then it can compress the 3rd part of the duodenum or the SMA depending on where it is if there is a change in the angle of the superior mesenteric artery then there can be a change in the 3rd part of the duodenum since the left renal vein is directly behind the SMA, it can easily be occluded causing nutcraker syndrome where the left testicle swells (since it drains into the left renal, unlike the right testicle that goes to the IVC)
why do the mitochondria in the PCT have folds around them?
because when stuff goes into the cell it is being put into the folds and they "bleed out" into the capillary
fate of urethral and labioscrotal folds in the female
becomes the: glans clitoris labia majora labia minora vaginal orifice
where is the greater peritoneal sac?
behind the greater omentum from the transverse colon to the rectouterine (female)/rectovesicular(male) pouch
where is the lesser sac?
behind the lesser omentum only has one door which is the *epiploic foramen f Winslow*
where does fluid from a SMA hemorrhage go?
behind the pancreas into the lesser sac, through the epiploic foramen of winslow, into the hepatorenal recess (pouch of morrison)
what are fordyce granules?
benign ectopic *sebaceous glands* in the submucosa
what is black hairy tongue?
benign hyperkeratosis of the filiform papillae staining from foods/bacteria/yeast/tobacco can be caused by poor oral hygiene, excessive coffee/dry mouth (xerostomia)/ and other things
what is oral linea alba ?
benign hyperkeratosis due to friction from grinding teeth (bruxing) like a callous
where is the superficial perineal pouch?
between colles' fascia and the perineal membrane the glans clitoris projects out of the superficial pouch
Lobe vs. Lobule
between lobes is dense CT between lobules within a lobe is dense CT in lobules is *loose CT* each lobe consists of lobules, they drain into a common duct
What is the perivitelline space?
between the oocyte and the zona pellucida
where can blood and urine from a peritoneal injury track up the abdominal wall?
between the scarpa's fascia and anterior rectus sheath
what is the oral vestibule?
between the teeth and lips/cheeks
where is the perineal membrane?
between the two ischiopubic rami covers the muscles of the *deep pouch/deep perineal space*
superficial transverse muscle
bigger in females than in males because females are keeping the perineal contents together in males contents are not as mobile
components of bile canaliculi?
bile canaliculi are composed of actin and myosin and tight junctions btwn hepatocytes
what happens when the sperm penetrates the zona pellucida?
binds to plasma membrane oolema calcium induced cortical granulocyte release this depolarizes the zona pellucida so it can't be fertilized by more than one sperm
explain the blood flow and oxygen consumption of the liver
blood comes in from the hepatic artery and the portal vein 70-80% of the blood FLOW is via portal vein 20-30% of the blood FLOW is via hepatic artery the oxygen comes 50/50 from the portal vein and hepatic artery
explain the portal system?
blood from the GI system goes into the portal vein, filters through the liver, then eventually ends up in the IVC
treatment of splenic injury
blood supply to the spleen: splenic artery and short gastrics so if there is a splenic injury then you can block the splenic artery with a coil and wait for it to resolve , still gets blood short short gastrics
is the erection somatic or autonomic?
both autonomic from pelvic splanchnic parasympathetic that relaxes everything somatic is pudendal
is the inferior hypogastric plexus parasympathetic or sympathetic?
both meaning it is also both pre and post synaptic
what is the difference between the ligamentum teres and ligamentum venosum?
both are embryonic remnants that reside within the falciform ligament ligamentum teres used to be an umbilical vein and its on the bottom ligamentum venosum used to be the ductus venosum and is superior
orthokeratinized vs parakeratined ?
both are found in the masticatory mucosa in orthokeratinized, the keratin cells do not have a nucleus in parakeratinized, the keratin cells do retain their nuclei not really clear why
what differentiates the bile duct from the bile ductule?
both have just cholangiocytes but the bile duct is surrounded by CT bile canuliculi have actin to help it maintain it's shape
where would a tumor on the uterus, right between the fallopian tube and the uterine artery drain?
both the ovarian and uterine veins, which would cause metachronus spread of CA to the aortic and internal iliac nodes
is the pancreas exocrine or endocrine?
both! exocrine: secretes bile into the duodenum for digestion endocrine: secretes insulin, glucagon, and somatostatin (inhibits insulin and glucagon)
what gives blood supply to the 3 lateral abdominal muscles?
branches of the 10th and 11th intercostals and superior epigastric artery
what does amylase do?
breakdown of carbohydrates
what are the main characteristics of the PCT?
brush border (microvilli) on apical side *cuboidal epithelium* plenty of mitochondria large surface area on basolateral portion to release things into the peritubular capillaries centrally/basally located nuclei hard to differentiate cell borders a lot of mitochondria on the basal surface because thats where transport out of the cell is happening back into systemic circulation (peritubular capillaries) little passive movement, including water. the water is transported in balance with the other molecules to maintain the osmolar balance *have aquaporins*
ischiocavernosus muscle and bulbospongious muscle
bulbospongious muscle wraps around the vaginal opening on top of the bulb of the vestibule
how do you fix portal hypertension
by creating a shunt into systemic circulation (IVC), bypassing the liver, lowering the pressure in the portal system can be splenic to IVC splenic to renal etc..
Hepatorenal recess
can be site of fluid accumulation when supine aka Morrisons pouch
what happens if the uterus is retroflexed?
can cause more compression of the IVC or aorta during pregnancy can also cause a more difficult vaginal delivery
what happens when the levator ani gets weak?
can cause uterine/bladder prolapse and stress incontinence this is because the angle is not maintained in the puborectalis
shear stress of blood flow
can trigger the release of NO nitrous oxide from the endothelial cells into blood=inhibits clotting in the tissue of the vessel=vasodilation
what is the course of the nephron?
capillary (cortex)> bowman's capsule (cortex) > PCT (cortex) > thin loop of henle (medulla)> thick ascending limb (medulla) > DCT (Cortex)
what is cascade/amplification/crosstalk(synergism)
cascade- domino effect amplification- produces a greater response crosstalk(synergism)-simultaneous dual activation
where are the caudate and quadrate lobes?
caudate = superior quadrate= inferior (c before q, c on top of q)
is the superior mesenteric, inferior mesenteric, and celiac trunk in the foregut, hindgut or midgut?
celiac trunk is in the foregut (T12) superior mesenteric is in the midgut (L1) inferior mesenteric is hindgut (L3)
what are the components of the podocyte?
cell body primary process secondary process (pedicles)
discordonant human sexual phenotype
cell receptors: no cell receptors on cells that are supposed to be differentiating into sex (in)sensitivity- cell isnt receptive to the factors hormonal responses - too much of a normal hormone
autocrine signaling?
cell releases a signal that feedsback onto itself
What are podocytes?
cells in the Bowman's capsule in the kidneys that completely surround capillaries of the glomerulus by creating a network special type of epithelial cell with *cuboidal structure* that surrounds the glomerular capillary as visceral layer and interdigitate into the sheath
what are enteroendocrine cells?
cells that produce hormones that get into the blood stream. Unlike the chief cells, which are exocrine cells and putting their secretions out into the gland and then the stomach (stains white)
how does blood leave the liver?
central veins in lobules > hepatic veins > IVC
the phases of pancreatic secretion
cephalic, gastric, intestinal cephalic= vagal efferent triggers acetylcholine release Intestinal phase= decrease of pH and increase of nutrients leads to the release of secretin and CCK *secretin acts on the ductal cels to release bicarb and alkaline juice CCK acts on the acinar cells for zymogen release of digestive enzymes* these secretions are all from the basal/lateral sides of the cells ***secretin increases cAMP so it works in the adenylyl cyclase/PKA cascade CCK increases the release of Ca* so it woks in the phospholipase C/IP3/Ca cascade*** no myoepithelium to squeeze out the juices so it relies on the flow of bicarb that drives it all into the duodenum Secretin in the presence of CCK has a greater response
what are the three main cell types of the stomach?
chief cells parietal cells enteroendocrine cells
Cholera toxin
cholera hijacking the signaling pathway by injecting toxin into the enterocyte, modifying the G-protein so it is always in the "on" state (alpha GTP state) simulation of pathway without regulation, leads to excessive Cl loss and water follows by osmotic effect, this causes massive diarrhea> dehydration
effect of chyme on the pancreas and GB? (cascade)
chyme > duodenal mucosa > CCK and Secretin (both via blood) CCK> pancreas and GB --------------- CCK(released through blood) CCK +GB= muscularis contraction releasing bile CCK+pancreas= secretion of enzyme rich fluid that digests food vagal stimulation+pancreas=secretion of enzyme rich fluid that digests food ------------ Secretin(through blood)> pancreas> copious flow of alkaline juice to neutralize acid in the duodenum
what are the two epithelial cell types of the uterine/fallopian tube?
ciliated simple columnar to move the egg towards the uterus non-cilliated peg cells with flat nuclei that provide nourishment to the oocyte
explain the casuse of esophageal varices and caput medusae
cirrhosis and fibrosis of the liver (usually in alcoholics) block the venous return from the portal system causing back flow in the portal circulation because there aren't any valves (portal hypertension) this causes bleeding because there is enlargement of the veins (caput medusae= umbilical veins) (esophageal varices= lower esophagus) (internal hemorrhoids= rectal anastamosis)
classical lobule of the liver vs portal lobule?
classical lobule is *endocrine*, has a hexagonal shape portal lobule is *exocrine* and does bile secretion formed by a triangle of *3 central veins *with a portal triad in the center liver acinus is from one central vein to another and it is divided into 3 zones
botox?
cleaves the SNARE protein, preventing release of vesicles form the presynaptic cell
complications of a vasectomy?
clipping the gonadal artery or vein when sperm gets trapped inside the body it can create anti-sperm antibodies which can lead to other autoimmune diseases like uveitis, arthritis, etc. loss of a testicle
What is fibrinogen?
clotting protein in blood elongated asymmetric molecule with + charge, RBCs have - charge. if you have more fibrinogen in the blood the RBCs can get closer to each other and form a roulcaux and they can sediment faster produced by the liver
what two areas have a very close ectoderm and endoderm, so that mesoderm doesn't enter?
colacal membrane buccopharyngeal membrane
what gives an apple core appearance to the colon on XR with Barium enema?
colon/rectal CA
where does the common hepatic artery go when it branches off of the celiac trunk?
common hepatic> hepatic proper and gastrodudenal hepatic proper> right gastric artery> cystic/right hepatic/left hepatic gastroduodenal > supraduodenal and right epiploic (right gastroomental)
what is Mondor's disease?
complaint: cord-like painful structure under skin Pathology: disease of the superficial fascia (fat, CT, and blood vessels) *thrombosis/thrombophlebitis of the thoracoepigastric vein* benign Dz mostly affecting women who wear tight underwire bras, the underwire acts as a tourniquet and compresses the vein causing a clot. This prevents blood from flowing back into the axillary vein Treatment: remove underwire, warm compress and NSAIDs throacoepigastric vein> lateral thoracic vein> axillary vein
what kinds of glands to the major salivary glands have?
compound tubuloacinar has a salivon subunit several acinus units drain into intercalated ducts > striated ducts > excretory duct
what are haustra?
constricted sections fecal material moves down by the contraction of the haustra
what are myoepithelial cells?
contain: actin, myosin, desmin, and keratin contractile desmosomal connections to withhold stresses, found between basal lamina and basement membrane (associated with sweat glands and mammary glands) (flat appearing)
dartos fascia
contains smooth muscle which wrinkles the scrotal sac
how can you identify a secondary follicle?
continual production of granulosa cells with multiple cavities of fluid build up hyalauron rich
are the two layers of peritoneum during embryologic development continuous or discontinuous?
continuous, they are reflections and come together at the dorsal mesentery around the gut tube
what does the bulbospongiosus muscle do?
contracts during ejaculation also contracts after urination to expel urine left in the urethra
erectile tissue of penis
corpus cavernosum x2 and corpus spongiosum inside the corpus spongiosum that surrounds the urethra there is a spongy urethra helicine arteries fill it with blood
function/innervation of the suprarenal glands?
cortex :corticosteroids from pituitary medulla: neuronal cells (preganglionic from celiac ganglion=sympathetic, synapse in the medulla) *epi and norepi* SYMPATHETIC INNERVATION ONLY, no parasympathetic innervation of the suprarenal glands
which way does the small intestine rotate?
counter-clockwise for a total of 270 degrees if it doesnt rotate this way then you get situs inversus (not life threatening)
what is the obturator foramen and what covers it?
covered by obturator membrane the obturator internus attaches here
obturator internus muscle
covers the obturator foramen and attaches to the femur
Where does the PSNS originate?
craniosacral= CN X and pelvic splanchnic which are preganglionic and synapse intramurally (within the organ) CN X= *foregut and midgut* *pelvic* splanchnic = sacral *S2-S4 hindgut* *S*acral splanchinc is *S*ympathetic ans is a branch off the lumbar sympathetic trunk all splanchnics are sympathetic except the pelvic splanchnic which comes off of S2-S4
what motion does the external oblique do?
crunch and squeeze
epithelium of cholangiocytes?
cuboidal they also have actin and myosin for peristalsis
purpose of amniotic fluid
cushion/protection movement
Cysts of Morgagni
cysts on the fimbria benign and common
what controls the blood pH?
dark/intercalated cells in the collecting duct
menses phase?
day 1-4 (4 days) breakdown of glands withdrawal of hormones menses (ischemic stage)
post-ovulation phase?
day 14-28 (15 days) secretory stage progesterone coiled glands "corkscrew configuration" luteal, after the egg is released you have a corpus luteal that secretes progesterone
pre-ovulation phase?
day 5-14 (10 days) proliferation stage estrogenic follicular phase straight glands how long does the follicle live ? 10 days, this controls the cycle
What is gangrene?
decay of dead tissue
do you increase or decrease tone to cause an erection?
decrease tone
what are the two subdivisions of the Scarpa's Deep Fascia as it descends the abdominal wall?
deep membranous/Scarpa's Fascia > superficial perineal/ Colles Fascia > onto penis as Dartos Fascia
what is corpus albicans?
degenerated corpus luteum occurs 9-11 days after ovulation without pregnancy (very hard to see in slides)
what composes the submucosa?
dense irregular CT (contains blood vessels, lymphatic vessels, nerves, and occasionally glands (esophagus and duodenum))
summary of the innervation of the bladder and sphincter
detruser=parasympathetic triggers contraction (pelvic splanchnic) internal sphincter= sympathetic triggers relaxation (L1/L2) external sphincter= somatic (pudendal)
what would you feel if the gall stone is causing the pancreatic duct to back up as well?
diffuse epigastric pain, RUQ + LUQ) because it is affecting a greater area and more afferents are being involved
where can you find the inferior mesenteric artery?
directly above the bifurcation of the aorta slightly to the left
what is the pectinate/dentate line?
divides the anus from recum
what is the intersphincteric groove?
division between non-keratinized and keratinized squamous epithelium keratinized is most exterior
what signifies visceral pain?
does not shift with position difficult or impossible to localize on PE ex. cramps and colic non-specific pain
kidney ascent?
doesn't really ascend, the embryo and tail just grows away during this "ascent" blood vessels form, as it rises even more the kidney gets new vasculature and the old ones fall off
what happens if the pancreatic juices leak into the abdominal cavity after trauma?
dont have to worry about it damaging the intestines because it is just pro-enzyme, needs to be activated by the acid in the stomach
do the pancreas and spleen grow into the ventral or dorsal mesentery?
dorsal
dorsal and ventral surface of the tongue
dorsal portion of the tongue is where the taste buds are ventral portion of the tongue is the underside touching the floor of the mouth
Anomalies of the ureter
double ureter ectopic ureter that go somewhere other than the bladder
ex. of voltage and ligand gated channels
down presynaptic axon, you get depolarization (voltage gated) that opens up neighboring channels allowing calcium channels to open and trigger exocytosis then the neurotransmitter (ligand) binds to the receptor on the post synaptic cell which would be a ligand gated channel
what is allantois?
duct that drains the fetal bladder into the yolk sac
ductus deferens and spermatocord
ductus deferens passes through spermatocord spermatocord has blood vessels and nerves deferens ends at the ampulla which is thicker, it is joined by the seminal vesicle that is very thick
hystersalpingogram?
dye study, usually for fertility studies make sure uterine cavity is patent dye ends up spilling into peritoneal cavity because the end of the fallopian tube is intraperitoneal
why are surgical incisions made at the line alba?
easier to sew together
epithelium of the efferent duct/epididymis/vas deferens
efferent duct has columnar epithelium with cilia to help movement of sperm and microvili for absorption of fluid epididymis: stratified columnar, steriocilia which are elongated microvili ductus deferns: a lot of muscle, short columnar epithelium the columnar epithelium get shorter as they pass from the efferent duct (longest) to the epididymis (shorter) and then the ductus deferens (shortest)
what are the maturation steps of an ovocyte?
egg maturation ovulation fertilization cell division implantation
what is referred rebound?
eliciting peritoneal irritation in the appropriate quadrant by doing something else in a different part of the abdomen when you let go of the abdominal wall
what are the 2 phases of ejaculation?
emission and expulsion
endo vs ectocervix?
endo and ecto cervix endocervix is a continuation of the fundus of the uterus, *simple columnar epithlial lining* ectocervix is the outer portion which has *stratified squamous*
cysts in cervix?
endocervix has a lot of glands that can get clogged, leading to cysts
islets of langerhans?
endocrine patches dispersed around the pancreas very vascular + fenestrated alpha= glucagon (on the periphery) Beta=insulin (in the middle) Delta= somatostatin F= pancreatic peptide (not really understood)
3 layers of the uterus?
endometrium (simple columnar) myometrium (smooth muscle) perimetrium
what are the three layers of the uterus?
endometrium = lining (mucosa) myometrium= middle (smooth muscle) perimetrium= outer (serosa)
what type of epithelium do sinusoids have ?
endothelium (simple squamous) since it is in contact with blood both fenstrated and discontinuous (discontinuous lacks a basement membrane)
what is the purpose of the bulb of the vestibule?
engorges with blood and swells sphincteric action
varicocele
enlarged veins of the spermatic cord usually it presents with a lower left testicle because the cremasteric muscle is lowering it to help it cool off feels like a bag of worms where are these structures? inside the internal spermatic fascia
what is the path of blood when it enters the kidney?
enters through an *afferent arteriole* > *fenestrated capillary (glomerulus)*> comes in contact with the bowman's capsule> then exits through the *efferent capillary* blood pressure pushes the blood into the proximal convoluted tubule
what are papilla/rete pegs?
epithelial extensions that decrease mobility the deeper the projections the less mobility there is like over bone
what are the 3 layers of the mucosa in the GI tract?
epithelium lamina propria (LCT with glands, and lymph tissue, the LP is between glands too) muscularis mucosae (smooth muscle)
what is a perforated ulcer?
erosion of the stomach wall causing acid and free air to leak into the peritoneum leading to peritonitis and stimulation of all of the dermatomes people present with a semi-rigid abdomen and can usually pinpoint the time it occurred
what will the foregut become?
esophagus thyroid lung buds stomach
where can submucosal glands be found in the GI tract?
esophagus and duodenum have submucosal glands anyplace else has mucosal glands
what drives the proliferative stage?
estrogen secreted by the graafian follicle secretes estrogen for 10 days
where is the ligand released from
ex. ligand released from enteroendocrine cells (CCK, secretin, etc) they get released on the basal side into the blood through fenestrated capillaries
how is the ovary exocrine and endocrine?
exocrine b/c it releases an egg endocrine b/c it releases hormones (progesterone and estrogen)
What is the Duct of Bellini?
exocrine gland that collects fluid coming through filtrate *thousands of nephrons feed their filtrate into a single collecting duct,* there are many of them it's the last transit through the hyperosmolar gradient fluid recapture which regulates our blood volume/BP
what are the divisions of the cervix from out to in?
external OS > cervical canal > internal OS
what are the three abdominal muscle layers?
external oblique internal oblique transversus abdominus (not including rectus abdominis)
inguinal ligament
external oblique ends as a free edge inferior, from iliac crest (ASIS) to pubic tubercle
what are the three sections of the external sphincter?
external sphincter is skeletal muscle under voluntary control (somatic) *formed by the levator ani* from external to internal it goes subcutaneous external sphincter superficial deep
What is gastroschisis?
extrusion of abdominal contents through abdominal folds; not covered by peritoneum problem with the abdominal wall
what is the potter's sequence?
facial compression because it cant lift head away from heart buldge growth deficiency pulmonary hypoplasia=lungs cant expand or grow breech position b/c it can't move around limb position defects
what does saliva do?
facilitates tasting of food initiated food digestion with enzymes assists swallowing by clumping it together, forming a bolus immunological lubricates and cleans oral cavity (maintains pH, assists in talking, and helps teeth) diagnostic tool
retroprostatic facia (denovillier's)
fascia between the prostate and rectum that is composed of transversalis fascia
what is loose endopelvic fascia?
fat layer between visceral and parietal layers fat + CT acts as packing
clitoris
female erectile tissue between the labia analagous to glans penis phallus remnant covered by *prepuce* (clitoral hood) 3 parts: angle, body, glands body is *paired corpora cavernosa* like in males which can get erect 2 crus underneath that attaches it to the ischiopubic rami
male vs female pelvis
female pelvis has a flared ilium
what kind of capillary is in the kidney?
fenestrated because you don't want barriers to diffusion
what are the 2 types of leydig cells?
fetal leydig- promotes mesonephric (wolffian) duct , stimulates the development of epididymis, seminal vesicles, and vas deferens adult leydig- kicks in during puberty initiates spermatogenesis, masculinizing the brain, mediates male sex behavior
why is there a lot of fibronectin in the endometrial wall?
fibronectin is usually found in places with a lot of regeneration it helps the endometrium regenerate
what is a tunica albuginea?
fibrous capsule that surrounds the ovary *dense irregular CT*
what are the divisions of the muscularis externa in the esophagus?
first 1/3- skeletal (voluntary control) second 2/3- mixed skeletal and smooth last third 3/3- smooth only
Iliacus
flexes thigh
Hydrocele vs Mass
fluid transluminates mass does not
what is an intracellular canaliculus and what cell is it found on?
folds in the membrane of the *parietal cell* to increase surface area, this way enough HCl can be secreted
What are rugae?
folds in the stomach (accommodates expansion of the stomach)
what are plicae?
folds/pleats in the small intestine with mutliple villi on them increases surface area
what are atritic follicles?
follicles that have undergone apoptosis
what drives the follicular and luteal stages?
follicular= mature/graafian follicle (estrogen) luteal= corpus luteum (progesterone)
arcuate artery of the kidney?
form arches around the medullary pyramids but inside the cortex,
foliate papillae
form ridges on posterior lateral edge *deep clefts contain taste buds on the lateral walls* papillary projections have lymphatics and serous (von Ebner's glands) glands/ducts that empty into the clefts
Lumbar (Petit's) Triangle
formed by external oblique and latissiumus dorsi, internal oblique peaks through in this area muscular coverage is not complete similar to triangle of auscultation common uncommon location for a hernia
prepuce?
forskin circumcision is removal of the foreskin
what are the crypts of lieberkhun?
found in the intestine straight tubular glands with simple columnar epithelium formed by the villi that dip down into the lamina propria and make glands There is continuity between the surface epithelium of the villi and surface epithelium of the glands
Antimesenteric border
free edge
nerves of the inguinal canal
from L1 ilioinginal nerve is somatic afferent to cremaster efferent is the genito branch of the genitofemoral when the cremasteric nerve is stimulated the genitofemoral nerve acts on the cremasteric muscle cremasteric muscle is skeletal muscle (because it comes off of the internal oblique)
psoas major
from lumbar vertebrae, transverse process > under the inguinal ligament to the lesser trochanter flexes hip
development of the stomach?
from the foregut starts as a closed tube that flattens and rotates clockwise holes form in the dorsal mesogastrium so it can turn the posterior side bulges out, causing the stomach to rotate so the bulge is on the left this rotation is what crates the lesser and greater curvature
where do the glomerulus, mesonephric, and paramesonephric ducts develop from and their purpose?
from the intermediate mesoderm paramesonephric duct will become the urinary bladder mesonephric duct will be a gondal structure
Quadratus Lumborum
from the medial part of 12th rib to the medial iliac crest also attached to the transverse process of the vertebrae
ureteric bud?
from the mesonephric duct a uterine bud will protrude into the metanephric blastema (developing mesodermal kidney) it starts to branch and become the renal pelvis and collecting tubules
how does the prostate grow?
from urethral outpouchings
salivon
functional unit of salivary gland has both serous and mucous cells in the *pyramidal* acinus, an *isotonic* (to plasma)solution is formed it then travels through intercalated duct (conduit) (low cuboidal)> striated duct (makes it hypotonic)(columnar)> then excretory duct (stratified cuboidal/columnar) secretion is regulated by nervous system
what are the parts of the gallbladder?
fundus, body, neck, cystic duct cystic duct drains into the bile duct
sections of the bladder
fundus/base is posterior inferolateral is right underneath the pubic symphysis internal smooth muscle sphincter external skeletal muscle sphincter detrusor muscle is smooth muscle
doe gall bladder have a submucosa? where do zymogen granules, released from the pancreas get activated?
gall bladder doesnt have submucosa zymogen granules go to the duodenum and are activated in the glycocalyx
main functions of the ovary?
gametogenesis- maturation of the egg steroidogenesis- hormones
how do the granulosa cells and oocytes communicate?
gap junctions this also keeps it arrested in M1
where are the gastrosplenic and splenorenal ligaments?
gastrosplenic- stomach to spleen splenorenal- spleen to the left kidney
when do females develop their oocytes?
germ cells populate in 3rd month of gestation born with all oocytes prior to birth, they will be *arrested in Meiosis 1* M2- Meiosis 2
what composes the capsule of the ovary?
germinal epithelium - simple cuboidal that overlays tunica albuginea - dense irregular CT
characteristics of the uterine glands?
glands are: vascular straight when first formed coiled appearance when secreting nutrients
what are the effects of estrogen?
glycogen accumulation in the vaginal lining changes viscosity of the cervix proliferation of uterine lining stimulates cilia to move
how do you know youve transitioned from thick descending to thin descending?
go from cuboidal to squamous cells
what is the tendinous arch of the levator ani
goes from pubic tubercle to ischial spine
from late spermatid to mature spermatozoon
golgi produces an acrosomal vesicle (like a lysosome) that is like a cap on the nucleus then the nucleus flattens with the help of mircotubules called Manchette cells centrioles form nucleation sites for flagella formation (microtubules 9+2) the cytoplasm enlarges and mitochondria proliferate and line the axonime to produce ATP for movement after this development it is a *mature spermatozoon* has head, neck, and tail middle piece of the neck has mitochondria has keratin fibers on the tail except for the very last end piece the principal piece is the majority of the tail that moves have dyenin for motor function the mature spermatozoon have OLFACTORY cells to help them travel to the egg also has progesterone receptors *flagella movement is Calcium dependent, odorants stimulate the olfactory cells in the sperm>triggering calcium release> triggering flagella movement*
extreme DSD (disorder of sexual development)
gonads and sex chromosomes are extremely discordant XX chromosomes presents with male genitals
what is peridontium?
gums and bone holding teeth together
how do you treat pancreatitis?
gut rest (NPO) (cuts down on acid secretion) H2 blockers (blocks the production/release of hydrogen in the stomach)
What is the broad ligament of the uterus?
has 3 segments, it is mesentary mesometrium (covers uterus) mesosalpinx (covers fallopian tube) mesovarium (covers the ovary like a book) fallopian tube is at the upper free edge of the broad ligament
structure of the pancreas?
has a very thin CT capsule that divides it into lobules *septa* has ducts, blood vessels, and nerves
blood supply to the adrenal glands
has multiple arterial branches superior suprarenal: from inferior phrenic Middle suprarenal: directly from the aorta inferior suprarenal: from the renal artery --------- Venous: left suprarenal vein goes directly into left renal vein (during left nephrectomy you have to ligate the renal vein distal to the insertion of the suprarenal vein so you dont compromise the gland) right suprarenal goes into the IVC
ureter
has smooth muscle and blood vessels sympathetic efferents and afferents flow is unidirectional via peristalsis blood supply comes from whatever is adjacent (gonadal, iliacs, etc) vasculature and nerves come into the ureter medially, so during surgery you can only reflect the ureter medially, NOT LATERALLY to not compromise these structures
what is the function of the mural granulosa cells?
have FSH receptors
what are theca internal cells?
have LH receptors *vascular* communication with pituitary
sertoli cells
have a pyramid shape pointing to the lumen and have a distinct nucleus, looks like an eye, they produce stuff to nourish the cell
where can you find minor salivary glands?
have short ducts submucosa found almost everywhere except the alveolar lining, hard palate, and gingiva (with exceptions) lingual labial palatine tonsils buccal molar
which artery fills the corpus cavernosum?
helicine artery
what makes up the portal triad?
hepatic artery (in) portal vein (in) bile duct (out)
what is the role of hepatocytes and insulin?
hepatocytes absorb the glucose which triggers the release of insulin form the pancreas to convert glucose into glycogen (negative feedback loop) insulin also promotes the uptake of amino acid proteins that enter hepatocytes, these proteins help form blood proteins like albumin, fibrinogen, prothrombin, and lipoproteins made in RER and secreted by the golgi
hepatocyte organization?
hepatocytes are organized into plates that radiate outwards from the central vein spaces between the plates are *sinusoids* which have *fenestrated capillaries*that are grouped into *sieve plates* *hepatocytes perform both exocrine and endocrine functions*
terminal hepatocytes?
hepatocytes close to the portal canal
what is on the apical and basolateral sides of the hepatocytes?
hepatocytes pour their plasma proteins onto the apical side the bile pigments and salts are poured out on the basal lateral side bile canaliculi are formed by tight junctions between hepatocytes between adjacent the basal lateral side, the lumens collect to form bile canaliculi and then the bile duct
Where is the hepatoduodenal ligament and the hepatogastric ligament?
hepatoduodenal: It is the right edge of lesser omentum containing portal triad hepatogastric- forms the lesser omentum with the hepatoduodenal ligament, extends from the fissure of the ligamentum venosum and porta hepatis to the lesser curvature of the stomach.
renal hilum/pelvis/sinus?
hilum is the plane where everything comes in and out pelvis is the collection of urine before becoming the ureter sinus is the hollow space where fat collects within the kidney 5: renal pelvis 4: renal sinus
what separates the rectus abdominis horizontally and where does it attach?
horizontal intersections separate the rectus abdnominis, known as *tendinous intersections* these attach to the *anterior rectus sheath only*, no posterior attachment
what is an indirect hernia?
if a hernia is lateral to the inferior epigastric artery (through the inguinal canal) it is an indirect hernia where Do My Intestines Leave (Direct =Medial Indirect=Lateral)
why is there a blood testes barrier?
if blood comes in contact with the sperm it will identify it as FB and kill it this is b/c the immune system is already formed by the time puberty starts
how can you tell if the mature/graafian cell is in meiosis 1 or 2 ?
if it still has a nucleus, then it is in meiosis 1 once the nucleus is phosphorylated and broken down it is in meiosis 2, very hard to tell on H&E
visceral afferents from sympathetic and parasympathetic NS.
if visceral afferent is sympathetic, then Sx will be referred pain to the dermatome if visceral afferent is parasympathetic, then Sx will be vagal like lightheadedness, slowed heart rate, cold/clammy, and need to poop
nerves of the male genitals
ilioinguinal is somatic afferent genito (of genitofemoral) is cremasteric somatic efferent testicular visceral afferents= T7 scrotum somatic afferent= pudendal (sacral)
two ways to numb for an episiotomy?
ilioinguinal nerve block (in the groin ) or pudendal nerve block (right near the ischial spine)
what is ligamentous endopelvic fascia?
important support structure prevents prolapse between the bladder/uterus/rectum *forms the tendinous arch of pelvic fascia that runs from the pubic bone to the sacrum, named by the region it is in*
effect of fibrosis of the liver?
in Dz like cirrhosis you can get fibrosis so the contractile activity shuts down and you can get hepatic HTN/portal HTN
where is the medial fold and what does it contain?
in between the median and lateral folds (lateral to the median fold/ medial to the lateral fold) contains obliterated umbilical artery coming up from internal iliac artery
where is the cremasteric nerve?
in between the transversus abdominis and internal oblique afferent: ilioinguinal nerve efferent: genitofemoral nerve (muscle contraction) (I Am Gonna Eat/ Ilioinguinal =afferent Genito= efferent )
what runs through the inguinal ring?
in males the ductus defferens (spermatocord), gonadal (testicular) artery, genito branch of genitofemoral nerve, and ilioinguinal nerve in females its the round ligament of the uterus, genito branch of genitofemoral nerve, and ilioinguinal nerve
what are the parts of the tongue?
in order from posterior to anterior terminal sulcus- divides the tasting part of the tongue from the lingual tonsils circumvallate papillae- round domes on the back of the tongue foliate papillae- ridges on the lateral posterior tongue filiform papillae- most numerous fungiform papillae- mushroom like appearance, they are redder/pinker and dispersed among the fungiform papillae
what is a *balbiani body?
in the *primordial follicle* collection of golgi and ER organelles- dispersed when oocyte matures
what happens in the very beginning stages of GI tract formation
in the beginning there are two little spots where the foregut and hindgut are forming as the brain keeps growing, it causes the embryo (buccopharyngeal and cloacal membranes) to fold over and now it looks like a mushroom with the amniotic cavity on top and yolk sac at the bottom, starts to form the mid gut by the end of the first month
what is the difference between the mucous glands of the cardia and the pyloris?
in the cardia the mucous glands are shorter and in the pyloris they are longer the surface mucous secreting cells are NOT goblet cells
what type gland shape is in the fundus and stomach, compared to the cardia and pyloris?
in the cardia they are short in the fundus/body they are *intermediate in length* in the pyloris they are longer
where do you feel pancreatitis pain?
in the epigastric region and back because that is where the celiac ganglia is SNS from celiac ganglion at T6-T9 so referred pain is in this area
where is Alcock's canal and what does it contain?
in the ischianal fossa pudendal nerve, artery, and vein
where does the foregut end?
in the middle of the second part of the duodenum, where the cystic duct and pancreatic duct enter the duodenum at the *ampulla of Vater*
where are the anterior two thirds of the tongue?
in the oral cavity proper
where is the root of the tongue?
in the oropharynx
where are minor salivary glands found?
in the submucosa
where is the deep inguinal ring?
in the transversalis fascia
what can lead to decreased or absence of amniotic fluid?
in utero rupture= loss of fluid renal agenesis=decreased production
episiotomy
incision into the vulva because the space is not wide enough and the perineum might tear surgical incision is made to create a controlled incision and not a rugged tear that might damage the muscle *prevents tearing into the rectum*
what effect does tone have on the erection?
increased tone =increased contraction of the blood vessels and muscle = flaccidity decreased tone= relaxation of the blood vessels and muscles=erection
what gives the rectus abdominis blood supply?
inferior epigastric artery and superior epigastric artery that is a branch from the internal thoracic artery
which vessel is more likely to clot, superior/inferior mesenteric artery?
inferior mesenteric artery especially in the elderly
where is the prostate?
inferior to the bladder anterior to the rectum can feel prostate through the rectum
epididymitis
inflammation of the epididymis infection vs chemical infectious=chlamydia + STDs chemical= urine can retrograde into that space this can happen from strenous activity like holding breath while lifting weights
what makes the striated duct appear striated?
infoldings of the plasma membrane elongated mitochondria this is where the secretion is modified and made more *hypotonic* by absorbing sodium and secreting potassium and bicarbonate
what is a barium study?
ingestion of barium allows you to identify parts of the stomach
what is the most common hernia?
inguinal hernias (femoral hernias are more common in women)
what are the two sections of the internal sphincter?
inner circular outer longitudinal both smooth muscle/involuntary
how is insulin made?
insulin is stored as crystals when it is made it has a signal peptide *pre-pro-insulin* when signal peptide is cleaved in the RER it becomes *pro-insulin* *connecting peptide (C-protein)* (connects A and B chain) is cleaved by the golgi = insulin A+B chain that is connected by 3 di-sulfide chains unknown function of the connecting/ C-peptide
paracrine
interacts with receptors near by
what innervates the umbilicus?
intercostal nerve T10 (T2 is angle of louis, T4 is the nipple line)
fungiform papillae
interdispersed among the filiform papillae *they have taste buds on dorsal side* thin layer of keratin on stratified squamous primary and secondary CT Papillae, one large primary papillae that splits into secondary smaller papillae highly vascular which makes them appear redder
what is interleukin-6?
interleukin-6 (IL-6) is why there is a fever, it is produced by damaged cells and reaches the liver leading to increased fibrinogen synthesis IL-6 is not produced by the liver, it is produced by damaged cells elsewhere it is the predominant cytokine that reaches the brain to produce fever
what do the theca interna and granulosa cells produce?
interna theca cells produce the androgens granulosa cells produce the aromatase
what are the two anal sphincters?
internal anal sphincter (smooth muscle) external anal sphincter (skeletal muscle under voluntary control)
what is the difference between the sensation of internal and external hemorrhoids?
internal hemorrohoids are submucosal and only have visceral afferents that don't feel pain external hemorrhoids are subcutaneous which have somatic innervation and do feel pain
where does the uterine vein drain?
internal iliac veins so CA would involve the internal iliac nodes
what is the difference between the internal and external venous plexuses?
internal is above the pectinate line and submocosal external is below and subcutaneous
What are enterocytes?
intestinal absorptive cells on villi and bring stuff into the villi they are the main cells of the GI system have many microvilli and mitochondria
where do enteroendocrine cells secrete hormone?
into the capillaries of the lamina propria the hormone can act locally or distantly it is part of the humoral regulatory system of the body, it's an endocrine organ
where do the arterial branches of the kidney deposit?
into the cortex this is the most vascular part as well
where to the pits of the stomach lead?
into the lamina propria where they empty into glands
intramural vs extramural glands?
intramural glands are in the submucosa and mucosa extramural glands are outside organs like liver, GB, pancreas, and salivary glands
what category of peritoneum is the sigmoid colon?
intraperitoneal
what happens to the tenia coli as it approaches the rectum?
it becomes circumferential from sigmoid to rectum
does ischemia in the intestine cause somatic pain?
it can cause severe visceral pain but not somatic in the beginning stages *somatic pain is usually produced when there is an inflammatory process, if the tissue is ischemic, then it is unable to get inflamed. inflammation requires blood supply* if someone has ischemic bowel they usually present writhing around in pain, c/o diffuse non-specific pain, without any point tenderness on exam
why does the ureter enter the bladder obliquely?
it creates a valve that prevents the backflow of urine
is a mature/ Graafian follicle a primary or secondary *oocyte*?
it depends on where it is in the cycle relative to the *LH surge* before the LH surge its a primary oocyte in meiosis 1 after the LH surge it is a secondary oocyte in Meiosis 2
what is the purpose of the glycocalyx in the nephron?
it has enzymes to digest larger molecules that slipped through the filtration unit like large peptides the fenestra has a glycocalyx that is negatively charged in order to repel negative molecules
what is intrinsic factor and where does it act?
it is a glycoprotein secreted in the stomach by parietal cells to promote absorption of B12 it acts in the *ileum*, a distant part of the small intestine and B12 is absorbed there
clinical use for connecting protein (C-protein)?
it is a good marker for the function of B cells that are producing insulin if there is C-protein then it means insulin is being produced and cleaved because the removal of c-protein converts pro-insulin to insulin
What is a sphincter?
it is a muscle aggregate with many fascicles A circular muscle that constricts or dilates to regulate the passage of materials through an opening
what is the significance of the paraduodenal fossa?
it is created by the peritoneum and the small intestine can get stuck here, creating hernias
rectus abdominis
it is deep to the anterior layer of the rectus sheath edges are bound by *linea semilunaris* horizontal intersections separate the rectus abdnominis, known as *tendinous intersections* pairs are separated by linea alba extends from xiphoid/anterior ribs 5-7 to the pubis *anterior rectus sheath is complete and the posterior is not, posterior ends at the arcuate line, about 1/4 uncovered posteriorly*
What is the myenteric plexus (Auerbach's plexus)?
it is located in the *muscularis externa* and has *both parasympathetic and sympathetic* innervation contribute to peristalsis distributed throughout the GI tract
what makes up the celiac trunk and where is it? draw out the blood supply to the stomach
it is on the anterior abdominal aorta at *T12*, supplies blood to the foregut left gastric splenic common hepatic because the supply to the stomach has a lot of anastamoses, if one source is compromised, the stomach will still be perfused
What is CRP (C-reactive protein)?
it is produced by the liver during an acute phase
is the sacral splanchnic parasympathetic or sympathetic?
it is sympathetic and comes off of the sympathetic chain at S1 S2 and becomes the sacral splanchnic don't confuse parasympathetic pelvic splanchnic which comes off of the sacrum with the sacral splanchnic
what is the inguinal canal and what are the components?
it is the canal formed by the testicle/round ligament as it pushes out of the body through the abdominal wall starts with the deep inguinal ring in the transversalis fascia then the transversus abdominis> internal oblique> external oblique aponeurosis> and ends with the superficial inguinal ring in the aponeurosis of the external oblique (all openings in the abdominal wall for the inguinal canal are staggered, this adds reinforcement)
what is the thick descending limb of the nephron?
it is the straight portion of the PCT that is going into the loop of henle thick descending is in the cortex absorbs the last bits of glucose that passed through
how are the follicles selected to be dominant or undergo artresia?
it is unclear
is the transportation of bile passive or active?
it requires energy int he form of ATP to move bile into the canaliculi there is microperistalsis in the liver which pushes the bile through the canaliculi
is the kidney solid?
it's kind of hollow in the inside like a boxing glove
what are the two different types of skin in the anal canal?
its all stratified squamous but the most outer portion is keratinized, like skin whole thing is *anoderm* non-keratinized portion is *pecten*
difference between illeum and jejunum, can you tell them apart by looking at them?
jejunum has more blood vessels and is more muscular then ileum the jejunum also has straighter and longer blood vessels than the ileum can't really tell them apart by just looking at them, jejunum is maybe more pink than the ileum and the vasculature is different if you hold the mesentery up to the light
what is the cardinal ligament
junction between cervix and uterus has uterine artery and vein *suspends and supports the cervix/vagina* can get looser after childbirth leading to prolapse underneath is the ureter
how to shut down a signaling event?
just reverse the events reverse phosphorylation cAMP hydrolysis GTP hydrolysis
what is in the peritoneal cavity and what is an intraperitoneal structure?
just some juice for lubrication, like the pleural cavity just a potential space the gut is suspended by mesentery, intraperitoneal structure is suspended by mesentery into the peritoneal cavity, not in the cavity, but free to move around, covered by visceral peritoneum
filiform papillae
keratinized stratified squamous conical projections aimed posteriorly most numerus NO taste buds, only mechanical
what part of the mesoderm do the kidneys grow?
kidneys come from the intermediate mesoderm on the lateral plate (not the bladder) nephrons and collecting tubules come from different parts of the embryo
consequence of Abx greater than one week?
kills the gut floura which interferes with Vitamin K Vit. K is essential in blood clotting, this can inhibit the body's ability to coagulate causing bruising and bleeding
what do the kinases do?
kinase donates gamma phosphate of ATP onto the hydroxyl group of the residues via *covalent modification* this can cause a lot of changes like activation/deactivation/etc depending on what is being phosphorylated
what is pernicious anemia?
lack of B12 leading to anemia B12 is important in blood cell development
what is an ileus?
lack of peristalsis can lead to obstruction and filling of the bowel with gas
what structures are associated with villi?
lacteals smooth muscle capillaries IELs (intraepithelial lymphocytes) plasma cells goblet cells enterocytes microvilli actin, myosin, villin, fimbrin in microvilli
where is the terminal ileum?
last part of the ileum that connects to the cecum in the RLQ the cecum here is there the appendix is
where is the deep inguinal ring in relation to the inferior epigastric artery/vein?
lateral (the inguinal ring is superior to the inguinal ligament)
what is the white line of toldt?
lateral to the ascending and descending colon anchors the intestine down, pericolic gutter in surgery have to cut down the while tine of toldt in order to mobilize the intestine because there are many important structures on the medial side of the intestine that you can risk injuring like the ureter
what is germinal epithelium
layer of epithelial cells on the ovary *cuboidal mesothelium*
What is situs inversus?
left-right reversal of organ placement can be complete or partial can still lead a normal life
what is the most common abdominal tumor? Are abdominal tumors common?
leiomyosarcoma they usually are not common but can cause bleeding and obstruction
lesser omentum vs greater omentum?
lesser omentum attaches to the lesser curvature of the stomach and it is VENTRAL mesentery the greater omentum attaches to the greater curvature of the stomach and it is DORSAL mesentery
name the signaling cascades that involve adenylyl cyclase and phospholipase C
ligand + receptor> G-protein activation>activation of the effector protein adenylyk cyclase> production of second messenger cAMP> activation of the late effector PKA ligand + receptor> G-protein activation>activation of the effector protein *phospholipase C which HYDROLYZES phosphatidylinositol converting it into IP3 via HYDROLYSIS*> production of second messenger *IP3 or Diaglycerol*> activation of the late effector Calcium release/protein kinase c IP3 (inositol triphosphate)> calcium release from smooth ER dialgycerol>PKC *Phospholipase C hydrolyzes PI converting it into IP3*
what is cell signaling
ligand(agonist) interacts with intracellular receptors leading to: secretion transcription apoptosis contraction/relaxation degradation....etc... cell signaling relies on a combination of factors and signals
what types of cells make up the collecting duct in the kidney?
light cell/principal cell- salt, controlled by aldosterone (more common) (think light=Lite=electrolyte) dark cell/ intercalated cell- but bicarb or acid into the blood to adjust pH (less common) (only found in the cortex) *this causes the collecting ducts to have a characteristic appearance where you can tell the difference between light and dark cells)
what binds the edges of the rectus abdominis?
linea semilunaris
cell of Ito?
lipocyte that stores vitamin A converts to myofibroblast when injured to produce fibrosis and collagen
what is appendices epiplocia?
little pieces of fat hanging off of the intestine has blood supply all the way to the tip if it twists this can die and produce an inflammatory response
characteristics of the mammary glands
lobule contains duct and acinar units acinar units contain epithelial cells producing milk product surrounded by myoepithlial cells that helps secrete the milk RESTING mammary glands will have more ducts than glands, because the acinar units will proliferate when lactating
What is Meissner's (submucosal) plexus ?
located in the *submucosa of the small intestine* and has *parasympathetic* innervation only moves the villi
What is the distal tubule?
located in the cortex *regulates salt and pH of blood*
What is the Loop of Henle?
located in the medulla *creates the hyperosmolar gradient of the medulla*
what is the portal-systemic anastamosis?
located on the esophagus from left gastric vein, azygos, and portal vein also on the periumbulical veins if you have obstruction of the liver (ex. cirrhosis or portal HTN) , the anastamosis of the esophagus can engorge and bleed
what are magenstrasse?
longitudinal folds of the stomach on the side of the lesser curvature they create a highway for liquids to bypass the rest of the stomach into the duodenum
where are the lungs and liver developing?
lung and liver are developing from the foregut liver is partially coming from the endoderm
what are lacteals?
lymphatic capillary within the villi that *absorb fats*
where is the urinary system derived from?
mainly the MESODERM
what gives blood supply to the pancreas?
mainly the splenic artery splenic > dorsal pancreatic artery *blood from celiac trunk (superior) and superior mesenteric (inferior)* gastroduodenal > anterior/posterior superior pancreaticduodenal arteries superior mesenteric artery > anterior/posterior inferior pancreaticduodenal arteries there is anastamosis between the superior and inferior arteries anteriorly and posteriorly
proliferating celomic epithelium
makes trabeculae for the primordial germ cells to settle they make a cord of epithelial cells already have sex chromosomes
What is a leiomyosarcoma?
malignant tumor of smooth muscle
what defines a late primary follicle?
many layers of granulosa cells
placenta
maternal blood comes in and circulates around the tertiary villi
where is the inguinal (Hesselbach's) triangle relative to the inferior epigastric artery/vein?
medial
where is are the inferior epigastric vessels relative to the inguinal canal?
medially
What are the 3 umbilical folds?
median fold medial fold lateral fold they are folds between the parietal peritoneum and and transversalis fascia
causes of dry mouth (xerostomia)?
medications radiation therapy salivary gland CA autoimmune disease (Sjogren's) and many more...
contact-dependent signaling
membrane-bound signals bind to receptors on adjacent cells
what interrupts the menstrual cycle?
menses and lactation
two mechanisms of secretion of milk
merocrine =protein made in vesicles, exocytosis of just the protein apocrine= lipids made in cytoplasm, secreted with a bit of plasma membrane and cytoplasm (*ONLY FOUND IN MAMMARY GLANDS*)
development of the female reproductive ducts
mesonephric (wolffian) duct becomes the proper ligament of the ovary and the round ligament of the ovary paramesonephric (mullerian) duct becomes the fallopian tube the two paramesonephric ducts also come together to form the uterus/vagina the paramesonephric duct also forms a tubercle that forms the *uterovaginal plate* when the paramesonephric ducts joined to create the uterus the septum between the two disappears, if it doesnt then you can get two uteruses and/or two vaginas
what is a brush border in the PCT?
microvilli to reabsorb things like glucose and proteins brush border is found all along the *proximal* tubular system
internal oblique
middle muscle runs anteriorly and *superiorly* inferior borders of ribs 10-12 thoraco lumbar fascia to linea alba the fibers forms right angles with the external oblique fibers change directionality inferiorly so it looks like external oblique in the lower abdomen it forms the *cremaster muscle*
two ways to cut for an episiotomy?
midline -cut through perineal body but not into sphincter -easy to close -more comfortable postop -*higher risk, might cut rectal sphincter) -more cosmetic mediolateral -risk cutting the bulboospomgiosus muscle, more painful -*less risk of cutting rectal sphincter* -less cosmetic
what makes the major and minor papilla in embryonic development?
minor= dorsal pancreatic duct major= ventral pancreatic duct + bile duct which empties into the second part of the duodenum
turner syndrome
missing an X chromosome, only X instead of XX. short stature, coarctation of the aorta, infertility, webbed neck
where is the deep perineal pouch?
more important than the superficial pouch contains muscles
what are the characteristics of the light/primary cells?
most common cell in the collecting duct salt regulation controlled by aldosterone and ADH has one primary cilia on it aldosterone acts on the cell to control salt ADH acts on aquaporin2 in the cortex and medulla
where is the lateral fold and what does it contain?
most lateral fold contains he inferior epigastric artery and vein least prominent and most variable fold
where is most of the blood in the kidney and why?
most of it is in the cortex if you had a lot of blood/ blood vessels in the medulla you would loose the hyperosmolar gradient
where do all three abdominal muscles end?
most of the muscles end at the mid-clavicular line and the aponeurosis continues to the midline this is because the rectus abdominis is at the midline and it doesn't communicate with these muscles
external oblique
most superficial muscle attaches to posterior ribs and comes anteriorly and *inferiorly* at the mid-clavicular line the muscle ends and the aponeurosis (tendon) begins, *the aponeurosis from all muscles join anteriorly to create the linea alba* external surface of 5th-12th ribs to linea alba interdigitates with the serratus anterior ends as a free edge inferior, from iliac crest (ASIS) to pubic tubercle = *inguinal ligament *
what innervates the stomach?
mostly parasympathetic from the anterior vagus to trigger release of acids and movement of the stomach parasympathetic is pre-ganglionic, meaning the ganglia are in the walls of the stomach sympathetic- celiac ganglion > post ganglionic, come from splanchnic T6-T9, reaches prevertebral ganglion, the celiac ganglion para and sympathetic innervation is along the blood vessels afferents come back with SNS efferents, this is why reflux feels like MI anterior vagus gives off gastric branch which innervates the the intestines until the distal transverse colon *(all pre-ganglionic)*
complication of undescended testicle
much higher incidence of CA Cryptochordism- when the testicle doesnt descend and it is arrected in the peritoneum
structure of the GB?
mucosa (columnar epithelium and a vascular lamina propria) muscularis externa adventitia near liver, serosa in free sides DOES NOT HAVE A SUBMUCOSA
oral labial mucosa?
mucosa lining the lips
what lines the oral cavity?
mucosa which is a soft tissue lining the oral cavity
what is the function of the crypts in the large intestine?
mucous production (goblet cells) water absorption, dehydration of the fecal material
what are the main types of cells in the cardia and pyloris, and why?
mucous secreting cells for protection in the cardia it lubricates the entrance for food to enter in the pyloris, it protects the duodenum from being digested by the stomach juices
what is involuntary guarding
muscles spasm and patient has pain upon palpation of the abdomen
what is the muscular organization of the large intestine?
muscularis muocosae 2 layers in the muscularis externa 1. inner circular layer 2. outer longitudinal layer arranged into *3 tenia coli* all smooth muscle
where is the apex of the kidney?
near the medulla
where are the inferior epigastric vessels in the pelvis?
near the round ligament attachment round ligament is lateral to the inferior epigastric vessels that are in the abdominal wall round ligament can be removed in surgical repair of inguinal hernia because it does not support that much, males have to be more careful because the spermatocord is there
What is the pronephros and mesonephros?
nephron and kidney first develops in the pronephros then the mesonephros, they contain non-functional nephric units between the gonad and the mesonephric duct they do not become the kidneys in the end, the pronephros is *vestigial* and disappears the mesonephric partly disappears and partly becomes integrated into the gonadal structures
components of a taste bud?
neruoepithelial (sensory) cells that are elongated with microvilli extending through taste pore, synapse at the base with afferent sensory neurons of cranial nerves taste pore is a whole in the surface tongue epithelium supporting cell has a similar profile to the neuroepithelial cell *except it doesn't synapse* basal cells are progenitor cells for the neuroep and support cells
are there aquapoins in the ascending thin limb?
no
do blood and bile flow in the same direction?
no blood goes into the liver towards the central vein while bile flows in the opposite direction
why cant you transport water in the ascending thin limb?
no aquaporins this is the site of passive *salt* movement because salt is leaving and water is not, the filtrate is becoming isoosmolar
White line of Toldt
no blood vessels when things leak in the peritoneal cavity they can go into the paracolic gutter, and the edge is the white line of toldt
how can you identify a late primary follicle?
no fluid and multiple layers of granulosa cells= late primary follicle no theca cells at this point
renal agenesis?
no kidneys not viable
lower urinary tract obstruction?
no outlet for urine = swelling of the abdomen + no amniotic fluid
is the alveolar mucosa the same as the gums/gingiva?
no, the alveolar mucosa is higher up while the gingiva/gums are the outlines of the teeth
does the intestine feel pain?
no, it feels distention where do you feel that distention? visceral afferent and referred kind of pain if there is distention you can have discomfort without irritation/point tenderness
does any processing occur in the ureter?
no, just a tube out for waste
does the colon have villi?
no, just crypts
does the central vein of the liver have valves or smooth muscle like the rest of the veins?
no, just endothelium
does the pain shift when it progresses from visceral to somatic pain?
no, the body thinks it has shifted but its because the brain is averaging the input and trying to make sense of it visceral pain is global somatic pain is localized to the dermatome this occurs when the inflamed organ (viscus) physically irritates the abdominal wall or the irritated organ touches the peritoneum
are all hepatocytes the same?
no, they all have different functions there is functional differentiation of the hepatocytes based on their location in the lobule the peri-portal hepatocytes are near highly oxygenated blood peri-central hepatocytes have much less oxygen
are primordial cells dependent on ganadotropin?
no, they are independent
labia minora
non-keratinized stratified squamous also skin, not mucosa thinner skin which is why it's pinker, can see more blood vessels
is the organization of the kidney linear or non-linear?
non-linear
Pirifomis Muscle
not part of levator ani goes from sacrum through greater sciatic foramen
adenylyl cyclase cascade
now that the g-protein is active, it attaches to adenylyl cyclase, making it active adenylyl cyclase is the effector protein, sits in the plasma membrane it takes ATP and turns it into a cyclic form *cAMP* (cyclic adenine MONO phosphate), it removes 2 phosphate groups cAMP is the second messenger which will now bind to another protein, the cAMP dependent protein kinase (PKA) the PKA is activated by cAMP because it has two regulatory domains and 2 catalytic domains. when inactive the regulatory domains block the active site on the catalytic domains when cAMP binds the PKA, the regulatory domains break off of the catalytic domains and their active site is now free and can phosphorylate proteins (*kinase is an enzyme that catalyzes the transfer of a phosphate group from ATP to a specified molecule)
what becomes the ligament of teres (round ligament of the liver)?
obliterated left umbilical vein that becomes the free edge of the falciform ligament
what is the path of the internal pudendal artery?
off of the internal iliac > greater sciatic foramen > through the lesser sciatic foramen > ischioanal fossa >perineal region *same as the nerve*
what is the lesser sac and lesser omentum?
omentum is the sheet of fatty CT from the liver to the stomach (hepatoduodenal and hepatogastric ligaments) sac is deep to the lesser omentum, formed by space between peritoneum on stomach and pancreas (just a potential space)
where can you find specialized mucosa?
on the dorsal surface of the tongue
where is the gallbladder?
on the inferior surface of the liver, close to the 1st part of the duodenum and hepatic flexure of the colon
where do the theca cells reside?
on the outer portion of the follicle, outside of the basal lamina
Where are portal triads located?
on the periphery of the hepatic lobules (hepatic artery, (Initial portion) bile duct, portal vein)
where is the bare area of the liver more extensive?
on the right
do gallstones cause pain?
only when they leave the gall bladder, like kidney stones
duodenal hematoma
onset after trauma vomiting after eating fluid collection between muscular and mucosal layer tx with decompression of the stomach and wait for it to resolve, if it doesnt then you have to drain the hematoma
how can you tell its a Matrure/Graafian cell?
oocyte is bound to one area via *cumulous oophorus* cells, like a peninsula , a subset of the cumulus oophorus form the *corona radiata*that surrounds the of of the cell also mural granulosa cells that surround the inside of the follicle, under the basal lamina *ALL OF THEM ARE GRANULOSA CELLS* mural granulosa cells of the mature follicle will SECRETE ESTROGEN very large follicle highly mature oocyte
what is being ovulated?
oocyte, polar body, and granulosa cells (corona radiata to increase surface area) the follicle stays in the ovary
external uretheral orifice
opening of the urethra on TOP of 2 smaller paraurethral ducts
What is oral candidiasis/oral thrush?
opportunistic yeast infection (fungal) usually seen in immunocompromised patients
how is the muscle arranged in the ureter and bladder?
opposite of the GI tract *inner longitudinal outer circular* occasionally a third layer of longitudinal also has FUSIFORM VESICLES that are plasma membrane folds that make expandable plates (GI= inner circular and outer longitudinal )
what is the path of the food bolus? name all sections
oral cavity > esophagus > stomach > duodenum > jejunum > ileum > cecum (where appendix is) > ascending colon > transverse colon > descending colon > sigmoid colon > rectum > anal canal
what are the three types of oral mucosa and what is it ?
oral mucosa is the soft tissue lining of the oral cavity it serves as a barrier to pathogens, withstands mechanical stresses, provides sensation, and secretes saliva via the minor salivary glands lining mucosa- most oral surfaces masticatory mucosa- hard palate and gingiva (has more stresses) specialized mucosa- dorsum of the tongue (has taste buds)
how is the kidney organized?
outer cortex inner medulla pyramidal lobes (8-18 per kidney)
seminiferous tubule structure?
outline of myoid cells to help contract germinal epithelium lamina propria has myoid cells that are like smooth muscle cells (in other species, not really in humans) inside you have spermatocytes developing spermatogonia (stem cell)>primary spermatocyte (large nuclei, can see chromosomes in Meiosis 1)> secondary spermatocyte (after meiosis 2 very short span, cant see them)>early spermatid> late spermatid (needle shaped) mature towards the lumen very long prophase (primary spermatocyte) shortest phase is the M2, (secondary spermatocyte) spermatogonia in the basal compartment has to pass through a tight junction into the luminal compartment, it involves the formation and deformation of the tight junctions so it is like a revolving door epithelial cells here create fluid to help carry away the sperm
what is the difference between the the ovarian medulla and ovarian cortex?
ovarian medulla - CT with vasculature ovarian cortex- contains follicles, allows oocyte to mature
what are the parts of the fallopian tube?
ovary > fimbria > infundibulum (from fibria to the suspensory ligament) > ampulla > isthmus > uterine ostium
what is the path of the ovulated oocyte/ sections of the fallopian tube ?
ovary > fimbriae > infundibulum > ampulla > isthmus > interstitial part gets more muscular closer to the uterus
does the uterine artery go over or under the ureter?
over /anterior
Psoas minor muscle
over the psoas major, only goes to the pelvic brim
what is rebound pain
pain when you lift your hands after palpation indicates inflammation of the peritoneum= peritonitis
cooling mechanisms of the testicle
pampiniform plexus cremasteric muscle that raises and lowers the testicle
pampiniform venous plexus
pampiniform plexus are veins that surround the artery to cool it off
pancreatic vs parotid ducts/cells?
pancreas +centroacinar -striated ducts -myoepithelial cells parotid gland -centroacinar +striated ducts +myoepithelial cells
what are the endoderm derivatives?
pancreas and liver
are the stomach, pancreas, and small intestines intra or retro peritoneal?
pancreas is retroperitoneal stomach and small intestines are intraperitoneal
what is a whipple surgery?
pancreaticoduodenectomy an operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. used to treat pancreatic CA
what are somites and what formed them?
paraxial mesoderm forms somites =little packages of mesoderm when it gets to the 31 somite stage (31 segments) it is well along in development
what is the urachus?
part of *allantoic* duct between bladder and umbilicus *median umbilical ligament*
what are aquaporins and where are they found along the nephron?
passive water channels found in proximal convoluted tubule, straight proximal tubule, and descending *thin* loop of henle water follows solutes out, maintaining osmolarity
what is PID?
pelvic inflammatory disease chandelier's sign/ CMT (cervical motion tenderness) infection spreads the uterus, fallopian tubes, and out to the peritoneal cavity
how is clitoral erection autonomic and somatic?
pelvic splanchnic/parasympathetic relaxes the smooth muscle pudendal somatic contracts the ishiocavernosus muscle
fate of urethral and labioscrotal folds in the male
penis urethral fold on the *inferior surface* urethral groove scrotal folds (*abdominal skin,just like the labia majora*) the urethral and scrotal folds then zipper up into the *urethral and scrotal raphe* which is a seam the two scrotums were sewn together
hepatic blood supply
peripheral portal canals in central veins out portal system is a link of capillary beds 80% of blood in is the deoxygenated blood of the portal vein 20% is oxygenated blood of the hepatic artery proper liver isnt usually well oxygenated
what are the layers over the uterus?
peritoneum> visceral layer of membranous fascia> uterus
development of the testis
persistence of the cords creates *rete testis* the tunica albuginea develops "white coat" thick white capsule the sex cords become horseshoe shaped the paramesonephric (mullerian) duct disappears and becomes a prostatic urticle (not functional) testicle travels from the retroperitoneum through the inguinal ring, to the outside of the body wolffian duct (mesonephric duct) becomes the seminal vesicle/ductus deferens/epididymis
phenotype vs karotype
phenotype=physical presentation karotype= chromosomal
phosphorylation of Rb (retinoblastoma protein)
phosphorylation of Rb (retinoblastoma protein) results in the activation of transcription factors
Effects of phosphorylation
phosphorylation of myosin light chain=smooth muscle contraction phosphorylation of a channel=activation ex. Parietal cell =release of H+ and intrinsic factor phosphorylation of Rb= makes Rb inactive so it separates from the transcription factor, can cause unregulated cell transcription nuclear lamin phosphorylation = *disassembly* of the nuclear envelope
what allows the esophagus to stay open while passing through the diaphragm?
phrenoesophageal ligament with the upper ascending limb and lower descending limb, the ligaments prevent regurgitation and the subhiatal fat ring, helps esophagus distend
types of ligands/agonists
physical stimuli like light mechanical like shear stress chemical like acetylcholice, NO gas, proteins cell associated -tethered to the cell surface or ECM hydrophilic ligands interact with cell surface receptors (peptides) hyprophobic ligands like lipids can freely pass through the plasma membrane and interact with intracellular receptors (steroids, not as rapid)
what are anal columns?
pleats in the anus created by the narrow sphincter
what will you find if you open the duodenum?
plica circularis
what do you have to consider in patients with upper abdominal pain, that is unrelated to the abdomen?
pneumonia this is because the lungs are sitting on the diaphragm, stimulating visceral afferents usually this is caused by the middle lobe of the right lung because it is most anterior, presents as RUQ pain
what are the 4 peritoneal signs?
point tenderness involuntary guarding rebound pain referred rebound pain (voluntary guarding is not a peritoneal sign)
how does the blood in the liver make it to the central vein?
portal canal> sinusoids> central vein
how are the capillaries connected in the kidney and what type of epithelium is it?
portal capillary system endothelial tissue (blood vessels always have endothelium)
What is the hepatoduodenal ligament?
portal triad bile duct on right hepatic artery proper on left portal vein in the back
where are the 5 locations for portal-systemic anasatamosis?
portal vein lower esophagus umbilicus posterior colon rectum
is ovary anterior or posterior to the fallopian tube?
posterior
what secretes ADH
posterior pituitary gland
are the sympathetic fibers in the GI tract pre or post ganglionic?
postganglionic efferents and afferents
renal papilla
pours urine into the minor calix> major calyx> pelvis>ureter it is the the renal pyramids of the medulla
is the splanchnic pre or post ganglionic?
pre-ganglionic, they synapse at a plexus which then becomes post-synaptic (multiple splanchnic nerves) celiac plexus has a ganglion that is post-ganglionic (T5-T9) (Foregut) superior mesenteric plexus (T10-T12) (midgut) inferior mesenteric plexus (hind gut) starts half way through sigmoid colon (T12/L1-L2/L3)
what is the leading cause of bowel obstructions?
previous surgery because bands of scar tissue are blocking the intestine, or it will make a bridge and a piece of intestine will get underneath the bridge and it gets trapped there, this is an *internal hernia*
what are granulosa cells?
primary follicle with cuboidal cells zona pellucida (special ECM material, like a shell for protection, generated by oocyte and granulosa cells) stromal network starts developing has cortical granules
what is primary vs secondary oocyte?
primary is Meiosis 1 secondary is Meiosis 2
what are primordial follicles?
primary oocytes epithelium is flat pre-granulosa cells /follicular cells, sits under the germinal epithelium resting in quiescent pool most numerous *balbiani body*- collection of golgi and ER organelles- dispersed when oocyte matures has a basement membrane speparating stroma independent of ganadotropin a cohort of cells are chosen at random
what is the difference between primary and secondary retroperitoneal?
primary retro was always in the retroperitoneal space like the bladder and kidneys secondary retro means it was once in the intraperitoneal cavity with mesentery but then became retro. like the pancreas, ascending/descending colon and lost the mesentery
whats is the most common follicle type?
primordial
what are the follicular stages?
primordial (pre-granulosa cell) primary (granulosa cell) late primary secondary follicle (with theca cells) (early antral) late secondary (with antral) Matrure/Graafian follicle (has cumulus cell) all are *primary oocytes including the Graafian cell until the LH surge when it becomes the secondary oocyte 12-24 hours before ovulation
what are the 4 stages of *follicle* maturation?
primordial follicle (pre-gransulosa cell) > primary follicle (puberty) (Granulsa cell) > secondary follicle (LH) (grows and forms an antral cavity, STILL MEIOSIS 1) Mature/Graafian Follicle (meiosis 1 or 2 depending on the LH surge)
autosomal dominant polycystic kidney disease?
problem with golgi trafficking
functions of the liver?
processing and storage of absorbed nutrients (carbs, fats, proteins) neutralizes and eliminates toxic substances endocrine: secretes blood proteins (albumin, prothrombin, fibrinogen, and lipoproteins) exocrine: secretes bile , phospholipids, cholesterol, and bilirubin
path of bile?
produced by hepatocytes > bile canaliculi > canal of herring (lined by hepatocytes, stem cells, and cholangiocytes) (*C of H has both H and C so its both cholangio and hepatocytes*) > intrahepatic bile ductule (lined by cholangiocytes only)> (all ducts here on out are just cholangiocytes) bile duct proper> cystic duct> GB > common bile duct> duodenum
zona reticularis in the suprarenal cortex?
produces androgens: male hormones =testosterone closest to the medulla
what does the pancreatic intercalated duct do?
produces fluid portion of the secretions this also washes them out of the lumen
what is mesenteric lymphadenitis?
prominent area of lymph node tissue in mesentery to the terminal ileum and cecum can present like appendicitis can get inflamed because of strep or other illness
prostaglandins?
prostaglandins are thought to act on the female reproductive system named prostaglandins b/c they were first identified in the prostate but they are more common in the seminal vesicle PSA prostate specific antigen enzyme that reduces the viscosity of the semen so the sperm can swim freely-important in prostate CA detection b/c it is normally not in the blood
where are you if you see brush border?
proximal tubule
levator ani muscle
puborectalis/puboanalis closest to the anus, most central muscle, goes along with the pubococcygeus -from pubic around the anus, drags the angle forwards pubococcygeus has a gap where the coccyx is. -from pubis to coccyx iliococcygeus -from tendinous arch to the other tendinous arch forms the pelvic floor
is the pudendal nerve autonomic or somatic?
pudendal nerve is somatic
characteristics of the acinar cells?
pyramidal cells wide base and apex toward lumen have spherical secretory granules near lumen (in the apical cytoplasm) *serous cells*- secrete zymogen granules which have inactive proteins) *mucous cells*- secrete mucinogen granules (heavily glycosylated) *joined to adjacent cells via junctional complexes* organelles are mostly in the basal region
what is the purpose of the colon?
reabsorption of water, converting chyme into stool reabsorbs sodium, potassium, maybe carbs produces and absorbs vitamin K intestinal floura
what happens in folliculogenesis?
reawakening of follicles, the granulosa cells proliferate, the oocyte size increases, and accumulation of fluid process: recruitment of primordial follicles, pre-antral follicle development, selection which will be dominant, and artresia/apoptosis of the ones that were not selected to be dominant
Three stages of signal transduction
reception, transduction, response
where would blood collect from a ruptured ectopic pregnancy?
rectouterine pouch (of Douglas)
where would blood from a ruptured ectopic pregnancy or fluid from a ruptured ovarian cyst go?
rectouterine space (pouch of douglas) the fluid then irritates the peritoneum
imperforate anus
rectum doesn't join the anus surgical correction
What is the rectum and anus?
rectum is the last portion of the colon, has glands the anal canal is stratified squamous epithelium and it leads to the exterior
helicine arteries
releases blood into vascular sinusoids of the corpus cavernosum and corpus spongiosum causing an erection afterwards NO nitrus oxide comes and acts as a vasodilator and it inhibits clotting
blood supply to the kidney?
renal artery and renal vein, both are directly attached to the aorta/IVC
5 alpha reductase?
requires 5 alpha reductase that converts testosterone into dihydrotestosterone, which causes external virilization cells have the alpha 5 reductase enzyme will change the testosterone and undergo the proper differentiation ex. when testosterone goes to the wolffian duct it differentiates into the internal structures when testosterone goes to the cloacal membrane, it begins the external differentiation without this enzyme, these structures wont masculinize
variations of the uterine position
reteroflexed and retroverted
Is the bladder intraperitoneal or retroperitoneal?
retroperitoneal
what is the bile duct structure
right and left hepatic ducts drain into the common hepatic duct cystic duct and common hepatic duct drain into the common bile duct *the bile duct is in the hepatoduodenal ligament* bile duct and pancreatic duct join to enter the ampulla of the bile duct and the secretions exit into the duodenum via the papilla when the sphincter of Oddi opens
where is the median fold and what does it contain?
right at the midline contains a remnant of the bladder called urachus, sometimes can remain patent and contain urine the urachus is usually not patent after birth remnant of allantosis
where is the superior mesenteric artery and vein?
runs anterior to the 3rd part of the duodenum, *it is sandwiched between the pancreas and duodenum which can cause problems, and the left renal vein runs right behind the SMA* (since the superior mesenteric is in the midgut (L1) ends at second part of duodenum) this means the superior mesenteric supplies the 3rd part of the duodenum (inferior mesenteric is hindgut (L3) celiac trunk is in the foregut (T12))
transversus abdominus
runs horizontally towards the midline
What is the fundus of the stomach?
same functionality as the stomach
what is a pap smear?
sampling of tissues of the cervix, usually the transformational zone
summary of the signals
second messengers and their associated terms cAMP=adenylyl cyclase/PKA IP3 (inositol triphosphate)=phosphaditylinositol /Ca+ (PI is usually on the inside of the cell) diaglycerol= phosphatidylinositol/PKC Ca+=calmodulin
what category of peritoneum are the ascending and descending colon?
secondary retroperitoneal
what does the body and fundus of the stomach do?
secretes acid, pepsin (enzyme)
thickening epithelium of the genital ridge
sends trabeculae into the gonadal ridge
what are the main residues that act in the phosphorylation/dephosphorylation cascade?
serine threonine tyrosine because they have hydroxyl groups in their side chain 2 main divisions of kinases.. those that activate serine/threonine and those that activate tyrosine this is because serine and threonine have similar structures, and tyrosine is very different there is technically 3 because there is a kinase that acts on all 3 residues, called dual specific
how do you fix a hernia?
sew in mesh
endocrine
signal is released in the blood
where is the signal protein and connecting protein cleaved from insulin?
signal protein is cleaved in the RER (pre-pro> pro-insulin) c-protien is cleaved in the golgi (pro> insulin)
what is the lining of the uterine/fallopian tube?
simple columnar cells with cilia, except for the non-ciliated peg cells with flat nuclei
what kind of epithelium lines the stomach?
simple columnar epithelium *with pits*
epithelium of the uterus?
simple columnar epithelium with invaginations forming the uterine glands that secretes nutrients to support a fertilized egg
what are the characteristics of the thin descending loop of henle?
simple squamous epithelium *it is in the medulla (hyperosmolar(* not actively transporting, just passive exchange not much transport =few mitochondria/organelles have *aquaporins* because the medulla is hyperosmolar water leaves the tubule into the capillaries, back into systemic circulation, this concentrates the filtrate in the tubule *water leaves, salt enters passively* squamous + aquaporin= thin descending loop of henle has vasa recta, not peritubular capillaries
what type of epithelium is in the bowmans capsule?
simple squamous in the parietal layer *podocytes* in the visceral layer also called the urinary pole
what are visceral afferents?
single neuron cell bodies in the dorsal root ganglion
is the levator ani skeletal or smooth muscle?
skeletal
layers of the male genitals
skin dartos fascia (continuous with scarpas and has smooth muscle at the scrotum) external oblique internal oblique (cremasteric muscle) transversalis fascia parietal tunica vaginalis cavity of the tunica (potential space) visceral tunica vaginalis tunica albugenia
what are the two types of hiatal hernias?
sliding hiatus hernia- weak phrenoesophageal ligament, hernia goes straight up paraesophageal hiatus hernia- fundus coming through the diaphragm on the side of the esophagus, can lead to trouble swallowing surgical repair can be congenital
what is a polar body?
small haploid cell that is in the oocyte but very small due to disproportionate distribution of cytoplasm haploid=only one copy of each chromosome, indicative of gametes because when fertilized the other gametes will make it become diploid
detrusor muscle
smooth muscle has both parasympathetic (pelvic splanchnic) and sympathetic innervation (L1 and L2) pudendal nerve goes to the external sphincter (somatic) parasympathetic innervation of the detruser makes the smooth muscle of the *detruser CONTRACT* internal sphincter is sympathetic innervation so that you dont pee or poop while in fight/flight mode
what are theca external cells?
smooth muscle to expel the oocyte stroma of CT and smooth muscle
what are fibroids/fibromas?
smooth muscle tumors of the uterus
why does the cumulus expand in size?
so it can be caught by the fimbrae and be led into the falloopian tube
how does bile get concentrated ?
sodium, chloride, and bicarb are secreted into the bile ACTIVELY then water flows down the concentration gradient PASSIVELY then water leaves
corpora amylacea
solidified aggregations of secretions accumulate with age may cause CA? diagnostic of the prostate
is the pudendal nerve autonomic or somatic?
somatic
What is the rectovesical pouch?
space between anterior rectum and posterior urinary bladder Inferior to it, the rectum is anteriorly related to the prostate gland and seminal vesicles.
What is the rectouterine pouch (of Douglas)?
space between the rectum and uterus
What is the vesicouterine pouch?
space between the uterus and the urinary bladder *anterior*
what is the periportal space (space of Mall)?
space btwn the terminal hepatocyte next to sinusoids and portal triad tissue fluid w/in the liver flow towards this space and the lymph vessels take it away
what is a follicle?
specialized unit in the ovary stromal cells + basement membrane + epithelial cells (specialized epithelial cells with basement membrane) + oocyte an essential niche
path of sperm through the prostate and prostate CA
sperm then passes through the seminal vesicles towards the prostate here the ejaculatory duct joins with the prostatory urethra prostate has 2 sets of glands, the mucosal/submucosal glands and the main glands on the periphery a tumor of the mucosal/submucosal glands is usually benign and presents with urinary obstruction tumor of the main glands are usually cancerous and dont usually obstruct early on, leading to late detection
spermatogenesis vs spermiogenesis
spermATOgenesis is the development of everything spermatogonia (stem cells) > spermatozoa spermIOgenesis is the development of spermatids into spermatozoa (no meiosis or mitosis here) very long prophase
what are the three components of the urethrovaginalis sphincter?
sphincter urethrae muscle sompressor urethrae muscle sphincter urethrovaginalis muscle
what does the transversus abdominis do?
stabilization
how are the small intestines developed?
starts with a primary intestinal loop that is supplied by the SMA (midgut) the loop has a cephalic (close to the head) and caudal limb (close to the tail) with a viteline duct at the tip the loop then rotates counter-clockwise along the axis of the SMA as the abdominal cavity gets bigger the guts leave the umbilicus and go into the abdominal cavity while they continue to rotate *total rotation of 270 degrees * then ascending and descending get plastered to the abdominal wall and become secondarily retroperitoneal
what are interglomerular mesangial cells?
stem cells (replace epithelial cells, endothelial cells, glomerular cells) phagocytosis (remove proteins that clog the filtration unit) supporting cells (create matrix to prevent leakage)
what type of hormones are estrogen and progesterone?
steroids have a lot of lipids which gives the call a foamy/adipose appearance in the corpus luteum
what is the effect of estrogen on the cilia?
stimulate motility of cilia and promotes cilia formation
how was the lesser sac formed in development?
stomach rotates, entraps the upper part of the peritoneal sac on right posteriorly
cholestasis?
stoppage of flow of bile just sits there
Epididymis
stores the sperm, this is also where sperm get their motility head> body > tail very coiled head is where the efferent ductules join to it
what type of epithelium and lamina propria is in the esophagus?
stratified squamous epithelium for protection and loose CT in the lamina propria no absorption or digestion here SUBMUCOSAL Glands
what are the layers of the oral mucosa?
stratified squamus epithelium (can be keratinized or not) basement membrane 2 layers of lamina propria: -papillary layer of LCT that has blood vessels and nerves -reticular layer od DCT submucosa (not always present) contains minor salivary glands
what is the epithelium of the vagina?
stratified, non-keratinizing, glycogen containing squamous epithelium NO GLANDS in the wall of the vagina all the lubrication is coming from the cervix
what is the stratum functionalis and stratum basalis layer of the endometrium?
stratum functionalis is the top 2 layers that are shed with menstruation and regrown stratum basalis is the bottom layer
salivary gland histology
striated ducts have a distinct appearance excretory ducts appear flattened and are surrounded by CT parotid glands have adipose tissue serous cells have round nuclei mucous cells have round flattened nuclei
what is a nephron?
structural and functional unit of the kidney
what innervates the pubis?
subcostal nerve T12
female gubernaculum?
subserosal fascia accumulation through deep and superficial ring *forms the ovarian ligament and round ligament of the uterus* *caudal gubernaculum/ round ligament extends to labia majora, degrades post-menopause*
Colle's fascia
superficial perineal fascia
what does the pudendal artery feed in the superficial and deep perineal pouches?
superior : posterior labial artery perineal artery in superficial pouch> labial arteries deep: artery to the bulb of the vestibule> vestibule and vagina branch of internal pudendal artery in deep pouch
What veins form the portal vein?
superior mesenteric vein inferior mesenteric vein + splenic
Where is the zona pellucida?
surrounding the actual small oocyte, not the follicle
What does the fimbriae do?
sweeps the egg into the fallopian tube, preventing it from going into the peritoneal cavity
hypogastric nerves?
sympathetic lumbar splanchnic> inferior mesenteric ganglion> superior hypogastric plexus> right and left hypogastric nerves> inferior hypogastric plexus *inferior hypogastric plexus joins with sacral splanchnic and pelvic splanchnic so it is both parasympathetic and sympathetic*
what are the 3 types of nerves in the intestine?
sympathetic post-ganglionic (visceral efferent) parasympathetic pre-ganglionic (visceral efferent) visceral afferent (usually comes up with sympathetic nerves regardless of origin)
what is the emission phase in male ejaculation?
sympathetic response via L1-L2: closure of the bladder neck and smooth muscle of the internal urethral sphincter, this prevents retrograde ejaculation parasympathetic response via S1-S4 (pelvic splanchnic): contract ductus deferens to move seminal fluid to the proximal urethra and secretion of seminal fluid from epithelial cells and accessory sex glands (prostate, seminal vesicles, and bulbourethral glands)
what is the expulsion phase of male ejaculation?
sympathetic response: hypogastric nerve triggers contraction of the urethral muscle parasympathetic response: via pudendal nerve, the bulbospongiosus muscle rhythmically contracts
cells of the male gonad
testis determining factor (TDF) of the Y chromosome - has an effect on the gonadal cells, causes cells to develop into sertoli sells sertoli cells produce: antimullerian hormone (AMH)(against the mullerian/paranephric duct that becomes the uterus in females) AMH triggers the development of Leydig cells leydig cells produce testosterone
what is the peritubular capillary network?
the *efferent capillary* twists around the nephron creating a network whatever is being transported out of the filtrate it being put back into the blood
what is ovulated?
the *secondary oocyte* arrested in Meiosis 2 with its's polar body (do not confuse secondary oocyte with secondary follicle)
what is the name of the bone that is holding the teeth?
the alveolar bone and it is covered by alveolar mucosa
where is the visceral peritoneum of the liver?
the anterior shiny surface of the liver that extends to the under surface of the diaphragm
what composes the rectus sheath?
the aponeurosis of the external oblique, internal oblique, and transversus abdominis external oblique is anterior internal oblique splits into front and back transversus abdominis is posterior
what gives blood supply to the appendix?
the appendicular artery that is a branch of the ileal artery, coming from the SMA
what makes the fore/mid/hind guts so specific?
the blood supply
how would RBCs be recycled if the spleen was damaged?
the body would rely on kupffer cells to take over
what is Glissons capsule?
the capsule of fibrous CT around the liver (since the visceral surface of the liver is shiny=glistens=Glissons)
what part of the stomach is closest to the esophageal-gastric junction?
the cardia of the stomach autonomic afference from the stomach can imitate symptoms of autonomic afference from the heart. so with a pt c/o L CP, gastritis is a DDx, b/c it can mimmic pain of angina
where does the collecting duct drain into?
the collecting ducts fuse to form the *ducts of Bellini* which release filtrate into the minor calyx once in the calyx the filtrate is considered urine
where are the follicles within the ovary?
the cortex region
where do the arcuate arteries in the kidneys enter?
the cortex, just after the medulla, so this is where most of the blood is
wheres the party happening in the kidney?
the cortical region
what drives the cyclical release of the ova?
the cyclical levels of hormones positive and negative feedback between the hypothalamus and pituitary
what gives blood supply to the gallbladder?
the cystic artery which is usually a branch from the hepatic artery proper
why are all the developing spermatids joined together?
the cytoplasmic bridges are there b/c it allows them to develop synchronously once they mature into spermatozoa the cytoplasmic ridges and residual bodies come off
what forms the diaphram?
the diaphragm is formed by the pleuroperitoneal folds, body wall (muscle), and septum transversum
what regulates what is filtrated through the podocytes?
the diaphragms its regulates the *Size* of what is filtered through platelets and RBCs can't pass through the diaphragm is negatively charged with repels negatively charged proteins (RBCs have negative charges) and only lets in positive or neutral molecules the fenestra has a glycocalyx that is negatively charged in order to repel negative molecules
what are the characteristics of the thick ascending limb/ straight distal tubule?
the distal tubule regulates *salt*/potassium composition *no aquaporins* NO BRUSH BORDER IN DISTAL TUBULE (no absorption, just salt transport) there is mitochondria, no difference in amount between proximal and distal tubule apical nucleus
what is the dominant follicle and how long does it live?
the dominant follicle is the egg that is maturing each cycle it lives for 10 days
what becomes the ligamentum venosum ?
the ductus venosus which is a shunt bypassing the liver forms the ligamentum venosum on the posterior liver
Mesenteric border
the edge attached to the fat, where blood vessels enter, weak spot
what is a phallus?
the embryonic genitalia can be female or male
what is the cardia of the stomach?
the entrance of the stomach where the esophagus meets the stomach
what is the major duodenal papilla?
the exit site of the bile and pancreatic ducts into the 2nd part of the duodenum it often has a hooded plica on top of it *papilla is the hole/nipple , sphincter of Oddi controls the flow, and the ampulla of vater is where the juices collect*
Space of Disse (perisinusoidal space)
the fenestrated capillaries have gaps that allows substances from blood plasma to travel from sinusoids into the space of disse (perisinal space) these substances interact with hepatocytes for transport hepatocytes can also secrete things into the space of disse to be put into the blood stream the space of disse is a two way street hepatocytes have microvilli that extend into the space of disse
what is a duodenal cap?
the first part of the duodenum
what is the proximal tubule?
the first part of the nephron, in the cortex since it's in the cortex, it is interacting with many blood vessels *it is capturing sugar, salt, and amino acids*
Where does the lesser omentum attach on the liver?
the fissure on the posterior liver, in between the left and right lobes
which portions of the gut have a dorsal mesentery?
the foregut only the rest only have a ventral mesentery
what causes RUQ pain in cholecystitis?
the fundus of the inflamed GB rubs against the abdominal wall
where does the gall bladder sit and does it have its own mesentery?
the gall bladder sits in the gall bladder fossa it sometimes has its own mesentery, typically not
what happens if protein gets through the filtration site?
the get processed by the PCT into amino acids to go back into the systemic circulation
why is there glycogen in the vaginal canal?
the glycogen makes the H&E stain appear pale pink one thought is that the glycogen feed bacteria/ferment in order to make an acidic environment which is protective
embryologic cousins?
the gonads and suprarenal glands develop at the same times neural crest cells aid in the development of the suprarenal cortex
what can delay the localizing signs of an inflammatory process, delaying diagnosis?
the greater omentum can wall off and contain inflammatory processes, preventing them from reaching the abdominal wall
what stimulates the emission of lubrication from the bartholin/greater vestibular glands?
the greater vestibular glands/bartholin is a *sympathetic response* from L1-L2 (lumbar splanchnic) which synapses at the inferior mesenteric ganglion then become post synaptic
liver anatomy
the hepatic artery proper divides into a left and right branch everything supplied by the left branch is the functional left lobe of the liver everything supplied by the right branch is the functional right lobe of the liver 4 functional on right 4 functional on left anatomic left lobe =/= functional left lobe there are 8 segments in the liver 4 lobes of the liver ( right, left, caudate, quadrate) this is significant for liver resections and partial transplants
why are the hepatic veins sessile?
the hepatic veins are sessile, meaning they don't have free existence, they are within the substance of the liver and they go directly into the IVC
what are the functional units of the liver?
the hexagonal lobules
what is the uncinate process of the pancreas?
the hook of the head of the pancreas that hooks posterior to the superior mesenteric vessels (the mesenteric vessels run anterior to the duodenum)
what drives the recapture of water in the kidneys?
the hyperosmotic gradient
what do you sit on?
the ischial tuberosity not on glutes
anorectal junction
the junction between the anus and rectum
what causes diverticulitis?
the lack of outer longitudinal muscle in the colon puts it at risk of sustained injury from sustained pressure (result of prolonged pressure) when you hold in feces and gas, the colon distends and gets weak, which creates pockets called diverticulosis if the pockets get inflamed= diverticulitis most common in the LLQ /sigmoid colon
what makes up the stomach bed?
the lesser sac and the structures behind the lesser sac parietal peritoneum covers the posterior most boundary of the posterior sac visceral covers the stomach, most anterior major structure is the pancreas
What is the uterosacral/rectouterine/sacrouterine ligament?
the ligament that supports the area between the uterus and rectum
what is the largest internal organ?
the liver at 1.5 kg
what causes umbilical herniation in the embryo?
the liver gets so big in development that it pushes the intestines into the umbilical cord
explain the growth of the liver and the coronary ligament
the liver grows very rapidly, spreading apart the layers of the ventral mesentery, generating a *bare area that sits under the diaphragm and is in direct contact with it* pushing through also causes a reflection in peritoneum called the *coronary ligament* it goes all around the bare area of the liver, front and back, at the edges it comes to a sharp edge, this called the *left and right triangular ligaments*
what are the lymphatics of the stomach and liver
the lymph nodes from the stomach and liver drain into the celiac nodes bare area of the liver goes into the diaphragm CA near the portal vein can end up as mets in the liver a lot of time CA from the GI system presents as mets in the liver
what is the difference of lymphatic drainage of the colon vs rectum and what clinical implications does this have?
the lymphatics and venous drainage of the colon goes almost exclusively to the portal system so mets go to the liver first in the case of rectal CA the drainage can go to either the portal system or directly into the IVC >lungs this means rectal CA can metastasize in the lungs first, bypassing the liver
explain the lymphatics of the stomach
the lymphatics follow veins like the rest of the body the stomach is a floppy area so the lymph nodes can expand without causing a mechanical issue lymph can go many ways, which is why gastric CA has a poor prognosis, same as pancreas
how can you differentiate between the female and male genital ducts?
the male cords are very elongated and have persisting *rete testis*which is like a mesh of tubules the female cords of the ovary move to the periphery
where are the thin portions of the nephron always found?
the medulla
what is the osmolarity of the cortex and medulla?
the medulla is hyperosmolar the cortex is iso-osmolar (goes from high osmolarity to low along the path)
where do hepatocytes develop from?
the mesoderm of the septum transversum it is controlled by Wnt2b in the mesoderm, if you knock this out the liver wont develop even if the biliary epithelium does
Is the duodenum intraperitoneal or retroperitoneal?
the middle part is secondarily retroperitoneal
buccal mucosa?
the mucosa over the cheeks
what does the free edge of the falciform ligament contain?
the obliterated umbilical vein called the round ligament (ligamentum teres hepatis)
which organs are primary retroperitoneal?
the ones related to urine/kidneys bladder kidney adrenal glands ureters
what is the effect of luteinizing hormone?
the oocyte completes Meiosis 1 and goes into Meiosis 2, arrested in Meiosis 2 now, becoming a secondary oocyte, and this is what is going to be ovulated with it's polar body usually only one egg is released per cycle
what are tenia coli?
the outer longitudinal layer of muscle of the large intestine it is arranged into 3 thick straps, that are equidistant around the circumference
what gives blood supply to the ovary?
the ovarian artery and veins which come directy from the aorta near the kidney into the ovary, it is accompanied by the suspensory ligaments
where is the generation of of estrogen and progesterone?
the ovary, at different times estrogen from mature graafian progesterone from corpus luteum
what causes the clitoral erection?
the paired corpora cavernosa smooth muscle in them relaxes via the sacral parasympathetic via the pelvic splanchnic the pudendal nerve that is somatic innervates the SKELETAL ischiocavernosus muscle when this contracts it adds to the erectile process
what is the pyloris?
the part leading into the small intestine (duodenum)
which hepatocytes are the stem cells?
the peri-central hepatocytes (near the central vein) are the ones that differentiate to replenish the hepatocytes this is why partial liver transplants work
explain the localization of pain
the peritoneum/ abdominal wall has somatic afferents when the inflammatory process touches the peritoneum, it localizes and activates the somatic afferents (intercostal nerve and it's dermatome)
what is the difference between the peritubular network and vasa recta?
the peritubular network surrounds the convoluted tubules the vasa recta surrounds the straight portions of the tubules and loop of henle takes stuff from the filtrate and puts it back in the blood
ballistic trauma
the permanent cavity is the trajectory of the bullet temporary cavity is the shock wave from the bullet faster bullet is more dangerous blunt tip on bullet creates more trauma- creates larger primary cavity therefore larger secondary cavity exit wound is larger than the entrance wound
what nerve innervates the pelvis?
the pudendal nerve (somatic=motor and sensory) originates in the sacrum S2-S4 exits via the greater sciatic foramen
what nerves innervated the vaginal area?
the pudendal nerve leaves Alcock's canal and becomes the perineal nerve and the dorsal nerve of the clitoris a lot of somatic nerves
where is the GEP?
the receptor is the GEP when the receptor binds a ligand, it changes the conformation leading to interaction with a/b/y in GDP form, leading to nucleotide exchange by *GPCR* (the GEP) now GTP comes on and alpha and b/y subunits separate and are both active so it doesnt need another factor to exchange it, once the ligand attaches it releases the GDP and there is a lot of GTP in the matrix that will come in
which kidney is lower and why?
the right kidney is lower because the liver is there and it has to acommodate right kidney is at the 12th rib/hilum L2 left kidney is at the 11th rib/hilum L1
what forms the central tendon of the diaphragm?
the septum transversum
how does urine in the ureter move into the bladder?
the smooth muscle allows it to have peristalsis
what happens if you take calcium inhibiting drugs?
the sperm are immotile and can lead to fertility problems
what is right behind the pancreas?
the splenic vein
what are some of the complications of a gall stone?
the stone can erode the wall into the duodenum= cystoduodenal fistula or into the transverse colon= cystocolic fistula it an also occlude the bile duct/pancreatic duct/ampulla of vater
what gives blood supply to the rectum?
the superior rectal artery that is a branch from the IMA, as well as branches directly off of the aorta (median sacral), and the mid rectal artery that is a branch from the internal iliac artery
what is the difference between the suspensory ligament of the ovary and the ligament of the ovary?
the suspensory ligament of the ovary comes in with the ovarian vessels from the top (the gonadal vessels from the aorta) and it attaches to the lateral edge of the ovary (HAS BLOOD VESSELS) the ligament of the ovary attaches the ovary to the uterus, prevents the ovary from flying away, causal gubernaculum remnant (NO BLOOD VESSSELS)
what forms the transmembranous pelvic fascia?
the transversalis fascia, it helps support pelvis, keeping things from falling out
what limits the stretching?
the tunica albugenia creates a pressure to maintain the erection this increases the intracorporal pressure
horse-shoe kidney?
the two inferior poles of the kidneys fuse and fail to separate *usually gets caught on the inferior mesenteric vessels* which prevents it from rising normally still viable and the person won't even know they have it
tunica vaginalis and tunica albuginea
the two tunics that surround the testes tunica vaginalis (thin) is on the outside and it comes through the peritoneum and descends with the testes through the inguinal canal, only covers the front part tunica albuginea (thick and white appearance) is the innermost tunic, covers the entire teste and divides it into lobules that hold seminiferous tubules and forms a mediastinum, contracts and squeezes sperm out seminiferous tubules have a blind end and a straight portion (tubuli recti) that leads into the rete testis
incorporation of the mesonephric ducts
the ureter stays at the same spot but the mesonephric duct moves lower because as the bladder grows, it is pulled down the mesonephric duct will become the gonadal vessels the mesonephric duct sort of loops over the ureter blue part becomes the trigone of the urinary bladder
what fills with blood in the penis?
the venous sinuses
what forms the uncinate process?
the ventral pancreas which becomes the head of the pancreas
what part of the pancreas gives rise to the uncinate process?
the ventral pancreatic duct in embryonic development ventral pancreas developed in ventral mesentery and dorsal developed in dorsal mesentery
What is Meckel's diverticulum?
the vitelline duct attached to the illeum after birth the ligament detaches if it doesnt the organs can get tethered to the abdominal wall at this point if the diverticulum doesnt close completely then feces can extrude from the umbilicus= vitelline fistula
what is the role of LH and how does the pathway involve FSH and ultimately the production of estrogen ?
theca interna + LH = androgen production . androgens go into the granulosa cells granulosa cells with+ FSH= aromatase enzyme that converts androgens into estrogen
Intervitelline sprouts
there are two vitelline veins where the septum transversus was the vitelline veins start to form sprouts that will be liver circulation right and left intervitelline sprouts will anastomose (the right and left umbilical veins will also fuse together starting at the umbilical cord, left one takes over ) *remember that veins in embryonic development are oxygenated*
what is the cycle of the seminiferous tubules?
there is a mosaic in humans, NO WAVE, there is a cycle there is a wave of seminiferous epithelium in the seminiferous that is divided into 6 stages that correlate with the sperm development
how does bile exit the gallbladder?
there is a spiral valve in the cystic duct that allows bile to accumulate, when CCK from the stomach is released (not nervous innervation), this triggers the GB to contract and release bile into the duodenum
where does the duodenum become the jejunum?
there isn't a histolological change but it's where the ligament of Treitz (suspensory ligament of the duodenum) is it comes down from the esophagus and anchors the junction
what triggers the release of blood proteins from the liver?
these blood proteins are constantly being released without trigger usually exocytosis is very regulated made in RER released by the golgi
bulbourethral glands (Cowper's glands)
they add mucous to the semen
are the ascending and descending colon intra or retroperitoneal?
they are *SECONDARILY retroperitoneal* b/c they used to be intraperitoneal but then became retroperitoneal
is the bladder, uterus, and rectum intra or retroperitoneal and what forms the parietal and visceral layer of the membranous pelvic fascia?
they are all retoperitoneal and covered by peritoneum *transversalis fascia goes underneath bladder and reflects up bladder, over bladder, and back down to pelvic floor, and then up and around the uterus and rectum the same way, this forms the parietal and visceral layer of the membranous pelvic fascia *
where do you find small intestinal diverticuli?
they are always on the mesenteric border because that is the weak point where the blood vessels are entering the mesenteric surface they poke into the mesentery these rarely cause a problem
What are chief cells and what do they secrete?
they are basophilic (blue staining) due to rER since its secreting a lot of protein (enzymes are proteins) have zymogen granules which are secretory vesicles *they secrete a proteolytic enzyme pepsinogen that is activated by acid in the stomach into pepsin* (B, dark staining)
what shape are the villi?
they are finger-like or they can be a little flatter: mitten-like
What is a juxtamedullary nephron?
they are near the cortex-medullary border has a very long loop of henle so it goes deep into the medulla
what are the characteristic of dark cells/intercalated cells?
they are the least common cell of the collecting duct but bicarb or acid into the blood to adjust pH
where do the veins of the stomach reside and where do they empty?
they follow the arteries of the stomach and drain into the *portal system* going to the liver, not the IVC
what happens when the primordial germ cells dont make it back to the genital ridge?
they form extragonadal teratomas unviable
what is the purpose of the anal sinuses?
they form valves so as stool comes out so that there's no stool left in the anus if stool is left over it can erode the tissue and create an abscess or fistula
what are the tonsillar pillars?
they have small muscles look like arches they are the boarder between oral cavity and pharynx behind the pillar are the palatine tonsils (aka Fauces)
what do the seminal vesicles do?
they make semen, fluid in which the sperm swim
what are paneth's cells?
they protect against overgrowth of bacteria in the gut they use *defensins* (glycoprotein) that acts like an Abx and *lysozyme* (an enzyme) lyses bacterial cell walls, killing bacteria *they have granules that are very eosinophilic (pink/red) staining)
what are parietal cells and what do they secrete?
they stain eosinophilic (pink) because of the intracellular canaliculus and mitochondria *they secrete hydrochloric acid (HCL) and intrinsic factor (glycoprotein), which is important for vitamin B12 absorption* has a lot of mitochondria b/c pumping out H+ ions requires a lot of energy (A, light staining)
what is the lining of the interface between the glomerulus and bowman's capsule?
thick, fused basal lamina/basement membrane (collagen IV) produced by the interdigitating podocyte and capillary endothelial cell, doesn't involve connective tissue fenestrated capillaries (pores), IT IS NOT DISCONTINUOUS, the basal lamina is continuous podocytes endothelium pedicles of the podocytes create filtration slits
development of the ovary
thickened epithelium degenerating medullary cords cortical cords on the periphery later the development of primary oocytes with surrounding follicular cells
arcuate ligaments
thickening of the fascia median: over the opening of the aorta medial: over psoas lateral: over quadratus lumborum
how to do surgery on the kidney?
through the back, on the lumbar region, LATERALLY, if you go posteriorly you risk injuring the iliohypogastric and ilioinguinal nerves if you go through the abdomen the pt will end up with a lot of adhesions have to go through 3 layers of abdominal muscle>pararenal fat> renal fascia>perirenal fat> renal capsule
where do the greater and lesser splanchnics enter the abdomen?
through the crus of the diaphragm
how do you get drunk, wouldn't the liver detox everything?
through the digestion the gut produces some alcohol via fermentation and it travels to the liver to be neutralized when you drink alcoholic beverages the liver cant keep up with the demand and you get inebriated
where does the ductus deferens go?
through the inguinal canal, over the pubic bone, over the bladder, medial to the ureters, through seminal vesicles (superior to prostate, posterior to bladder), into the prostate through the prostatic utricle, then into the urethra/penis
components of the acinar units in mammary glands?
tight junctions, *myoepithelial cells* (actin, desmin, keratin) (have flat nuclei around the acinar unit) luminal cells hemi-desmosomes basement membrane
androgen insensitivity syndrome
tissues are insensitive to the androgens ex. pt with XY chromosomes, cells are not sensitive to the testosterone and dont differentiate into male structures
what is the purpose of the anal glands?
to lubricate the canal as stool passes through
where does the pancreatic venous blood go?
to the portal vein, *which originates posterior to the pancreas at the junction between the splenic vein and superior mesenteric vein* the inferior mesenteric vein drains into the portal system via either splenic or superior mesenteric veins
where do the fats from the lacteals travel?
to the thoracic duct and eventually the blood stream
what are the two types of liver transplants?
total or partial
what type of epithelium is in the calyx?
transitional epithelium (has dome cells) the entire urinary tract has transitional epithelium
where are lymphoid aggregates usually found?
transitional regions
what is a nephrin?
transmembrane protein inside pedicle and forms zipper forming the filtration slit that helps prevent molecules like immunoglobulin, RBCs, platelets, and protein from going across
vas deferens (ductus deferens)
transports sperm from the epididymis
what is the inguinal (Hesselbach's) triangle
triangle on the parietal peritoneum formed by the 1) inguinal ligament (inferior) 2) lateral umbilical fold (inferior epigasric artery/vein) (lateral border) 3) lateral boarder of the rectus sheath (medial border)
is the bladder in the true or false pelvis?
true pelvis females: sits on the levator ani males: sits on the prostate then the levator ani
male erection?
tunica albuginea on outside of corpus cavernosum restricts blood from leaving and adds pressure Buck's fascia also assists corpora push against fascia to increase pressure smooth muscle trabeculae of the corpus cavernosum are relaxed (inhibited) by the parasympathetic NS from prostatic plexus which allows the blood to enter and engorge the penis (you know parasympathetic in this region is pelvic splanchnic) pudendal contracts the bulbospongiosus and ischiocavernosus some of the stimulation is reflex but majority is cognitive via the pudendal nerve, this creates memory so you can get erection without physical stimulation
what motion does the internal oblique do?
twist and reach
What is volvulus?
twisting of the bowel * has a characteristic bird's beak appearance on radiography with retrograde barium enema* sometimes the twist can be corrected with the barium enema or a rigid sigmoidoscope
testicular torsion
twisting of the testicle cuts off the blood supply to the testicle can be caused by a long or absent gubernaculum sudden onset of pain how to differentiate it? can feel difference between the orientation of the testicles absent cremasteric reflex on the affected side ductus deferens is inside the transversalis/spermatic fascia
how does the blood from the rectum drain in the veins?
two ways superior rectal vein> inferior mesenteric vein > portal system (superior rectum) also mid rectal/ internal+external plexus > internal iliac > common iliac> IVC (mid and distal rectum)
what is the pyloric antrum?
upstream from the pyloric sphincter and pyloric canal this region connects the body of the stomach to the pyloric canal
what is filtrate?
urine that leaves vis minor and major calyx into the ureter
What does the cloaca divide into?
urogenital sinus (anteriorly) and anal canal (posteriorly) the cloacal membrane used to be an area where there was *ectoderm and endoderm* were touching each other, with no mesoderm in between (along with the buccalpharyngeal membrane)
name all the vessels from the superior mesenteric and inferior mesenteric arteries
use netters FCs
what composes the muscularis externa and what is the muscle orientation?
usually 2 layers of smooth muscle but can be skeletal or mixed in the esophagus *inner circular and outer longitudinal*
what is trypsinogen?
usually in its inactive form when it enters the duct but it is activated by enterokinase the active trypsin, a strong enzyme that activates other proteases (enzymes that break down proteins) this is a safety feature
where are the glands in the GI system?
usually in the layer of the mucosa occasionally in the submucosa like in the esophagus and duodenum
what innervates the uterus/ovaries/vagina?
uterus: sympathetic: superior hypogastric plexus parasympathetic: pelvic splanchnic afferent: to lumbars ovaries: sympathetic:superior hypogastric plexus parasympathetic: pelvic splanchnic afferent: to lumbars vaginal canal: sympathetic: superior hypogastric plexus parasympathetic: pelvic splanchnic afferent: *pelvic splanchnic in sacrum * uterine and ovarian pain is felt in the lumbar region while vaginal pain is felt sacrally all parasympathetic is from pelvic splanchnic which originates in S2-S4 all sympathetic is from the lumbar region
relation between the ureter and vas deferens?
vas deferens hooks on top of the ureters
what is the effect of angiotensin II?
vasocontriction and release of aldosterone, increasing BP
effect of histamine?
vasodilation and vascular permeability acts on smooth muscle=vasodilation acts on endothelial cells=vascular permeability
does the liver grow in dorsal or ventral mesentery?
ventral
where does the liver develop?
ventral mesentery
where is the gonad?
very medial
vestibule vs orifice of the vagina
vestibule of the vagina is the wall of the opening orifice is the vaginal opening
how is cholesterol removed from blood?
via *clathrin mediated endocytosis* LDL can be hard to endocytose because of defective coated-pit-binding site so LDL just floats in the blood= *leading to vascular Dz* this is where HDL comes into play, the HDL can actually pick up LDL and transport it back to the liver to be released as bile
how are post synaptic sympathetic nerves distributed ?
via the blood vessels structures usually run together (VAN- vein artery nerve)
subphrenic recess
visceral surface of liver touching parietal peritoneum (not like the lungs where it was two layers of perietal pleura toughing)
What is the vitelline duct?
vitelline duct is part of the yolk stalk that attaches to the ileum through the umbilicus for nourishment
cardiac muscle excitation
voltage and ligand gated channels working together acion potential reaches the T-tubule dihydropyridine (voltage gated) receptors in the T-tubule depolarize and release ryanidine (ligand) which open the channels in the sarcoplasmic reticulum, which then releases calcium that will bind to troponin which will move tropomyosin from actin, so myosin can bind
how are nutrients absorbed in the small intestine?
water soluble things like proteins, sugars, peptides, and other nutrients are absorbed by the blood vessels fats are not water soluble and they are absorbed by lacteals
where is the ureter in relation to the gonadal vessels?
water under the bridge ureter under the gonadal vessels
what is the transformational zone of the cervix and what is the clinical significance?
when a pap smear is performed you want to get a sample from the transformation zone to test for HPV or cervical CA, this is where the HPV attaches migration of simple columnar and simple squamous , look at picture
what is the effect of CCK?
when food mixes with acid in the stomach and goes to the *first portion of the duodenum* it stimulates the release of CCK cholecystokinin (CCK) causes the gall bladder to contract and the sphincter of Oddi to open this causes bile to get pushed out of the gall bladder, down the cystic duct then common bile duct into the major papilla, and ultimately the duodenum
glucagon?
when glucose is low, glucagon goes up (glucagon when the glucose is gone) triggers the degradation of glycogen back into glucose
why does the lining shed?
when implantation does not occur , the hormones are REMOVED, this causes necrosis of the tissue, causing it to be excreted as menstrual blood and tissue
what is metachronus cancer?
when it metastasizes to two places at once ex. rectal CA can go to both the lungs and liver
what is global (non-localized pain)
when multiple splanchnics are involved
what is a direct hernia?
when the hernia is medial to the inferior epigastric artery (through the inguinal (Hesselbach's) triangle) it is a direct hernia where Do My Intestines Leave (Direct =Medial Indirect=Lateral)
what is oligohydraminos (primary anomaly) and what are the secondary anomalies that come with it?
when there is low or no amniotic fluid so baby can't move around can lead to : potter facies
phosphorylation of the parietal cell
when you eat, histamine is released and it triggers the G-protein linked receptor in the plasma membrane of the parietal cell it then releases cAMP, this activates the protein kinases (PKA) so it can phosphorylate things in the parietal cell it phosphorylates a channel that will increase the activity of the parietal cell=release of H+ protons and intrinsic factor if you block the proton channel, the intrinsic factor can still be released mechanism is G-protein activation>cAMP (second messenger) release from adenylyl cyclase (effector protein)> activation of PKA (late effector) so it can phosphorylate
what is the difference between a direct and indirect hernia?
where it pokes through the canal relative to the inferior epigastric artery
what is the anal canal?
where rectum meets the anus
anteflexed vs anteverted
where the body of the cervix meets the vagina is anteverted where the cervix meets the uterus it is anteflexed
what is the uterine ostium?
where the fallopian tube inserts into the uterus
what are the major and minor duodenal papilla?
where the pancreas drains into the duodenum the minor papilla from the dorsal pancreatic duct usually closes off the major papilla from the ventral bud is usually the functional one
what is the chorionic fondosum?
where the placenta is on the uterine lining *comes from extraembryonic tertiary mesoderm*
what is the left colic (splenic) flexure?
where the transverse colon and descending colon make a sharp bend (near the spleen)
primordial germ cells
will become sperm or egg influenced by surrounding factors develop in the mesoderm, but sequestered in the yolk sac until the gonads finish developing when the gonadal structure is complete they crawl back via amoeba movement (crawling) back via cloaca>hind gut>dorsal mesentery>retroperitoneal>genital ridge they are sent away so they dont get influenced by everything around the developing embryo
what consequence can pancreatitis have on the spleen?
with repeated and severe bouts of pancreatitis, the splenic vein can clot off, this leads to splenomegaly because the inflow is still coming but the outflow is blocked must monitor the platelet count of a patient with pancreatitis
what causes the menses?
withdrawal of hormones leading to the shedding of the superficial uterine lining
Is the IVC retroperitoneal?
yes primary retroperitoneal
can you get a dysfunctional gall bladder with no stones?
yes the gall bladder fills up but doesn't contract well enough *if it ejects less than 38% then your gall bladder is considered dysfunctional* it is a diskinetic GB if a pt has a diskinetic GB and pain with CCK, thats a reason to have a cholecystectomy
are there plasma cells in the mammary glands?
yes, IgA secreted by PLASMA CELLS that have a cartwheel appearance
can tumors cause hyper-coagulability?
yes, if you have tumors/CA you're more likely to get clots
can you still get trauma from a gun shot wound wearing a bulletproof vest?
yes, can still get internal contusions and ruptures
is the bullet sterile?
yes, it gets heated up enough to kill germs so sometimes retrieving the bullet can create more problems
Do hepatocytes have microvilli?
yes, on two sides !
what happens during the lateral folding (cannoli stage)?
you can see 2 dorsal aortas *the formation of a visceral mesothelium and parietal mesothelium* *visceral mesothelium will become the visceral peritoneum*
which zone would be most affected by a toxin?
zone 1
which liver acinus zone would be most affected in a time of hypoxia?
zone 3
buck's fascia?
#7
what is the reciprocal induction between the ureteric bud and the metanephric blastema?
(both are mesoderm derivatives) it means that they both influence each other to change using certain factors the ureteric bud becomes the collecting system the metanephric blastema becomes the kidney/excretory system and the epithelial changes
what does the left gastric artery supply?
(branch off of celiac trunk) goes to left lesser curvature and lower esophagus, anastamoses with right gastric
what does the splenic artery supply?
(branch off of celiac trunk) serpentine running left along upper pancreas (retroperitoneal), reaches splenorenal ligament and supplies spleen splits into short gastric and left gastroomental artery *from the splenic hilum* short gastric > fundus left gastroomental *epiploic*> supplies greater curvature, anastamoses with right epiploic
what does the common hepatic artery supply?
(branch off of celiac trunk) splits into hepatic proper > right gastric art. > right lesser curvature gastroduodenal art. > 1st part of the duodenum and right gastroomental art. *epiploic* > greater curvature right epiploic anastamoses with the left epiploic
what are the decidua layers of the uterus during pregnancy?
(deciduus means to fall off/shed) decidua capsularis: around the fetus decidua basalis: supporting connection to the fetus, where the blood supply is (anchor) decidua parietalis: not in contact with fetus, its between the basalis and the myometrium all of these layers shed after birth
Gallaudet's fascia
(deep fascia) ? same in men and females
what is the mesentery of the small intestine?
*2 layers of peritoneum with blood vessels* suspends the small intestine from the posterior wall the root of the mesentery is where the mesentery attaches to the posterior wall
What stimulates the release of aldosterone?
*Angiotensin II* renin > angiotensin I > ACE > angiotensin II > vasoconstriction/ aldosterone release from adrenal glands aldosterone= increase sodium reuptake =increase BP
how are proteins absorbed?
*active transport* proteins are very large, up to a couple 100 amino acids whole proteins are not transported into the enterocyte; they have to be chopped down into amino acids, which are transported into the enterocyte by specific transporter molecules Once it's inside the cell there are cytoplasmic peptidases, to break these down and you have amino acids Some small oligopeptides get transported directly into the capillaries through a molecule dedicated to that basic, neutral, acidic amino acids, and glycine, get put into the capillaries by special transporters
what does ADH regulate?
*aquaporin 2* (ADH regulated water channel), allows water to leave filtrate into the blood high ADH- a lot of water moving into the blood ( blood volume goes up) low ADH- more water in the filtrate to be excreted, (More urine=less blood volume ) acts on principal/light cells in the medulla
explain the orientation of the structures in the hepatoduodenal ligament (very important)
*bile duct is front and right hepatic artery proper is front and left portal vein is posterior*
characteristic of the collecting tubule on imaging?
*clearly defined cell borders*
What is Meckel's diverticulum?
*congenital anomaly from persistence of the vitelline (omphalomesenteric) duct, located in the terminal ileum* it is a yolk sac remnant can contain islets of stomach and pancreas that can bleed may mimic pain of appendicitis if it gets infected
is the greater omentum dorsal or ventral mesentery?
*dorsal mesentery* the root is DORSAL not ventral has an omental bursa that fuses between the stomach and duodenum after birth
cremaster muscle
*formed by the internal oblique in the lower abdomen* elevates testes to control temperature cremasteric reflex is associated with its function
what is the difference between internal and external thecal cells?
*internal* part of follicle, important in hormone communication *external* smooth muscle cells-involved in expulsion of the oocyte from the mature follicle
is the sphincter urethrae muscle (external sphincter) stronger in males or women? Is it smooth or skeletal muscle?
*it is somatic skeletal muscle* in women it needs to be stronger because it doesn't have the supportive structure of the penis
what is the origin of the portal vein?
*junction between the splenic vein and superior mesenteric vein. posterior to the pancreas* *the inferior mesenteric vein drains into the splenic vein, most of the time...* inferior mesenteric can also drain into the superior mesenteric or portal vein, does it's own thing
What is Hirschsprung's disease (congenital megacolon)?
*no neural crest cell migration into the colon* the aganglianosis starts at the rectum and goes proximally (affects the large intestine) the myenteric plexus lacks parasympathetic innervation so the colon can't contract and have peristalsis
what are renal corpuscles?
*only found in the CORTEX* they begin the interaction between vascular system and tubular system that will process the blood composed of the bowman's capsule + glomerulus
what autonomic nerves come from the sacral spinal cord?
*parasympathetic preganglionic PELVIC splanchnic nerves*
how are lipids absorbed?
*simple diffusion* fats are broken down into fatty acids, monoglycerides, and glycerol then they simply diffuse through the lipid bilayer they get resynthesized into triglycerides in the cell and RER transports them *impairments in this process can lead to atherosclerosis*
What is the macula densa?
*straight part of the distal tubule* comes back to the renal corpuscle, after this point it becomes the distal convoluted tubule, then collecting duct monitor the sodium concentration in the tubular fluid and regulate both the glomerular filtration rate and the release of renin from the juxtaglomerular cells *(modified smooth muscle)* near the vascular pole
What are Brunner's glands?
*submucosal glands* of the duodenum that secrete mucous specific to the duodenum, even tho the esophagus also has submucosal glands, they are not brunners glands
where can you find masticatory mucosa?
-hard palate -gingiva epithelium: ortho(keratinized) and parakeratinized stratified squamous this area has a lot of stressors features: -keratin layer, dead epithelial cells with an abundance of cross-linked keratin, no nuclei -granular cells with keratohyalin granules -numerous deep papillae/rete pegs which decrease mobility -no submucosa (the majority of the time) -attaches to bone
receptors display:
-specificity to ligand and cell (cell might not have a receptor to insulin b/c it doesnt need it) -saturability (can only bind so much and they get fully saturated) -signaling ability
where can you find lining mucosa?
-ventral surface of the tongue -floor of the mouth -soft palate -alveolar surface -labial and buccal mucosa this lining is found on most oral surfaces epithelium: non-keratinized stratified squamous Features: -mostly shallow papillae except on the alveolar surface (less mobility) -submucosa binds to skeletal muscle except the alveolar mucosa
how much is secreted from the kidney compared to what entered?
0.5%
what are the major functions of the urinary system?
1. exocrine (removal of waste) 2. endocrine (regulating RBCs through prostaglandins, vitamin D, etc) 3. regulation of body chemistry (BP, water and salt composition)
development of the male urethra
1. formation of urethral plate 2. transformation from plate to groove 3. from primary to secondary groove 4. enclosure of the urethra urethral plate *(ectoderm)* starts to thicken and form a hollow groove that travels to the center while it is a primary groove the inferior surface is closed, when it turns into a secondary groove the inferior surface is open and forms a urethral fold, which then closes up by the urethral raphe at this point the glans is sealed and has to make an intrusion into the skin to connect to the urethra, if it doesnt connect then you get the hypospadias ectodermal layer is the skin mesodermal layer is the middle endodermal layer is the urethra
3 types of membrane receptors
1. ion channel linked voltage gated and ligand gated 2. G-protein linked receptors 3. catalytic receptors
how long does a mature graafian cell last?
10 days
structure of the kidney
10x5x2.5 vein anterior artery superior and posterior ureter posterior *5 segments* based on the arterial branches (superior, inferior, antero-superior, antero-inferior)
how long is the rectum?
15 cm
what gives blood supply to the duodenum?
1st and 2nd parts are celiac trunk from 3rd part on is superior mesenteric artery
how many layers of fat surrounding the kidney?
2 the *PERIrenal* fat that is around the kidney and within the renal fascia the *PARArenal* fat that is outside the renal fascia, sandwiched between the posterior renal fascia and anterior thoracolumbar fascia this is for protection of the kidney
cloacal septation
2 folds (urogenital and anal septation) tourneux fold (higher) right and left rathke fold (lower) these two join folding a separation, if it doesn't you can have a urorectal fistula
liver regeneration
2 ways with *severe liver Dz the stem cells* can proliferate to generate more hepatocytes and cholangiocytes with liver *injury/lobectomy* the liver can regenerate without stem cells and the existing hepatocytes regenerate through hyperplasia
how long does it take primordial follicle to get to a graafian follicle?
2.5 cycles
how many arteries branch off the aorta to supply the gut?
3 celiac (foregut) superior mesenteric artery (midgut) inferior mesenteric artery (hindgut)
how many transverse folds (valves of houston) are in the rectum?
3 inferior (left) middle superior (left) 2 on left, 1 on right prevents stool from just dropping out
how many layers of muscle in the myometrium of the uterus?
3 *indistinct* layers
How many tenia coli are there?
3 bands along the large intestine
major salivary glands
3 paired extramural exocrine glands Parotid submandibular sublingual
what are the functional zones of the liver / acinus of Rappaport?
3 zones within a lobule zone 1 is closest to the portal triad and zone 3 is closest to the central vein Zone 1: has branches from the hepatic artery and is the most oxygen and nutrient rich Zone 2: has less O2 and nutrients Zone 3: closest to the central vein, has the least amount of O2 and nutrients
how many layers of muscle in the stomach?
3, this is the exception they are all smooth muscle inner oblique layer middle circular layer outer longitudinal layer
how many parts does the duodenum have?
4 1. Superior and backwards towards liver 2. Descending vertically in front of kidney 3. Horizontal around the head of the pancreas and in front of lumbar vertebrae 4. Ascending, juts out anteriorly around the head of the pancreas and continues to the jejunum (this is the transition from retro to intraperitoneal) parts 2 and 3 are secondarily retroperitoneal in adults whole thing used to be intraperitoneal in development
triple sex chromosomes
47 total chomosomes hint of Y chromosome, will be male XXX Female=mental retardation, fertile XYY Male=tall, poor impulse control "super male" XXY Male= Klinefelter syndrome, small testes, aspermatogenesis, tall and long limbs, make have gynecomastia
circumvallate papillae
8-12 on tongue have serous glands *taste buds on lateral borders like the foliate papillae*
is bile reused or synthesized de novo?
90% recirculated 10% de novo
where is the majority of the blood in the kidney circulated?
95% is in the cortex and the outer portion of the medulla a small fraction is towards the apical part
What is Crohn's disease?
A chronic inflammatory bowel disease that affects the lining of the digestive tract, mouth to anus
