Clinical Anatomy Lecture
The brain interprets painful sensory inputs from phrenic nerve as arising from _______________
the portions of the body served by C3-5 which is the neck and shoulder going down arm (ex. heart attack, gallbladder attack)
inguinal hernia
the protrusion of a small loop of bowel through a weak place in the lower abdominal wall or groin -farm more common in men due to vas deferens -less so in women because there is a pocket, but no canal for protrusion
During respiration how do the ribs move?
the ribs to the sides bend upward and the sternum raises away from the body to increase volume in lungs
ora serrata
the serrated boundary between the ciliary muscle (pars plana) and the retina
vagus nerve
the tenth cranial nerve that innervates digestive organs, heart and other areas
on the right side of body where aortic arch is resorbed during development, what happens to the vagus loop?
the vagus loop slips up to the next highest branch which is continuance of brachiocephalic to right subclavian artery
chordae tendineae
thin bands of fibrous tissue that attach to the valves in the heart and prevent them from inverting
Episclera (outer layer)
thin layer of vascularized connective tissue from limbus back to optic nerve sheath
sympathetic nerves can only exit through ________________________.
thoracic and lumbar outflow
Vascular supply of thoracic wall
thoracic aorta, posterior intercostal arteries travel along the costal grooves at each level --> branches into lateral cutaneous branch and a continuation of main artery --> main artery then becomes internal mammary artery at midline --> splits into anterior perforating branch
per-
through
perforation
through
The blood exits the eye how
through 1/4 vortex veins
Alveoli
tiny sacs of lung tissue specialized for the movement of gases between air and blood
ad-
toward the midline (eso-); could be both eyes moving in
branching of airways
trachea--> 2 mainstem bronchus(primary bronchi) --> Lobar bronchi(secondary bronchi) 3 right and 2 left --> Segmental bronchi (tertiary)
If you needed an emergency airway what would be done?
tracheostomy; insert a tube to allow air flow just above jugular notch @ 2-4 tracheal ring
Lymphatic vessels do what
transport lymph, including absorbed lipids from peripheral tissues to the veins of the cardiovascular system
what type of cut is this?
transverse cut
trigone of bladder
triangular region at the base of the urinary bladder between the openings of the two ureters and the urethra -this area is very sensitive to expansion and once hits a certain point, bladder signals brain it needs to empty
medullary pyramids
triangular shaped tissue inside kidney; composed of collecting tubules for the urine that is formed in the kidney
ureters
tubes that transport urine from the kidneys to the bladder. pass retroperitoneally, and become sub-peritoneal to reach the bladder
seminal vesicles
two small glands that secrete a fluid rich in sugar that nourishes and helps sperm move
Iris mammillations
unilateral; elevations same color as iris with systems of ridges connecting the dots
superior palpebra
upper eyelid
apex of the lung
uppermost portion of the lung(cupola), when lung expands the apex of lung rises above the first rib and into the root of neck
The projection of the visual world on the retina is ____________.
upside down
As the prostate enlarges it compresses the ___________ and makes it harder to ________urine.
urethra; void
tricuspid valve
valve between the right atrium and the right ventricle
peritoneum protrudes toward the front of the abdomen in order to allow for
vascular supply (aorta and inferior vena cavae) to reach the small intestine
VAN
veins, arteries, nerves from top to bottom running in the costal groove. Safest point of entry is directly above a rib
Sympathetics directly innervate the ___________________ and regulate force of contraction.
ventricular wall
irregular bones
vertebrae and facial bones
artery
vessel that carries blood away from the heart
internal thoracic artery and vein
vessels that run vertically on internal surface of thoracic wall. Can be diverted to use in cornary artery bypass
plica semilunaris (half-moon fold)
vestigial nictitating membrane (third eyelid) in medial canthus
The firmest attachments of the vitreous body to the wall of the eye is a ring that overlies the ora seratta, called the _____________.
vitreous base
Larynx
voice box; passageway for air moving from pharynx to trachea; contains vocal cords (adam's apple)
Pharynx
where GI and respiratory system share the same tube; the membrane-lined cavity behind the nose and mouth, connecting them to the esophagus
esophageal hiatus
where the esophagus passes through the diaphragm at T10
Poliosis
whitening of lashes
Trachea
windpipe that is formed by horse-shoe shaped cartilage and is closed in at the back by muscle and the esophagus running behind it
vermiform appendix
worm-like projection of lymphatic tissue hanging off the cecum with no digestive function; may help to resist infection
intravenous pyelogram (IVP)
x-rays of the urinary tract taken after iodine is injected into the bloodstream and as the contrast passes through the kidney, revealing obstruction, evidence of trauma, etc.
slide 13 of heart powerpoint
yikes
All lymphoid aggregates are hyperactive in what people?
young individuals
Spleen
An organ that is part of the lymphatic system; it produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. -also governs immune response in the eye
Pancreas
An organs in the abdominal cavity with two roles. The first is an exocrine role: to produce digestive enzymes and bicarbonate, which are delivered to the small intestine via the pancreatic duct. The second is an endocrine role: to secrete insulin and glucagon into the bloodstream to help regulate blood glucose levels.
In the area between the Lens, Ciliary body, and the iris there are 5 specific areas:
Anterior Packet, Posterior Packet, Hyaloid zonules, Equatorial zonules, Cannal of Hannover(area between ant. and post packets), and Canal of Petit (area between post packet and hyaloid zonules)
frontal plane
Divides the body into front and back portions.
Innervation of the body wall through spinal nerves, including parietal pleura
Dorsal (sensory); Ventral (motor)
retinotopic projection
Each part of retina is projected onto specific part of thalamus & visual cortex
Attachment of the Anterior Vitreous Face is composed of rings termed from outer to inner?
Equator of lens ---> Egger's line ---> Wieger's ligament ---> Berger's space
Trunk Muscles (Anterior)
External(lifts ribs)and internal intercostals(depresses ribs), pectoralis minor(lifts ribs)
All skeletal muscle is voluntary, and all smooth muscle is involuntary. (T or F)
False; accommodation happens voluntarily, but is driven by ciliary smooth muscle. eyelids can close involuntarily even though it is skeletal muscle
medications typically used to treat BPH (enlarged prostate) can cause what issues in eyes?
Flomax meds --> can cause floppy iris syndrome which causes issues for cataract surgery
Y sutures
Formed during embryogenesis, early lens fibers join together along 2 Y-shaped lines. The front Y is upright and the posterior Y is upside down
main causes of nausea
GI problems, concussion, brain tumor, heart attack, ear infection(pressure on tympanic membrane), emotions, angle closure
The kidneys are surrounded by what?
Gerota's fascia in addition to a strong, but thin capsule
Thymus
Gland in the thoracic cavity above the heart where T lymphocytes mature. -secretes thymosin
Lung cancer near its apex can interrupt the sympathetic chain giving what syndrome?
Horner's Syndrome: ptosis (ipsilateral lid droop), miosis (one pupil smaller than other), anhydrosis(no sweat on one side of face)
Hilus of lung contains
Identify
trichiasis
Ingrowing eyelashes
walls of small intestine
Inner circular layer and outer longitudinal layer(with plica circulares), villi projections
The lens continues growing throughout adult life. As it enlarges, it can push the _______ forward and narrow the outflow angle.
Iris
How does aqueous humor exit the anterior chamber?
It flows down the dome of the back of the cornea and travels through the trabecular meshwork and out through the Schlemm's canal (SC)
proximal interphalangeal joint (PIP)
Joint between the proximal and middle phalanges (involved in rheumatoid arthritis)
Kidney gets rid of ________ soluble compounds. Liver gets rid of ____________ soluble compounds.
Kidney --> water soluble Liver --> fat soluble
GI system pathway
Oral cavity --> oropharynx --> esophagus --> stomach--> duodenum --> jujunem --> ileum --> ileocecal junction --> cecum --> ascending colon --> right colic flexure --> transverse colon --> Left colic flexure(splenic) --> descending colon --> sigmoid colon --> rectum --> anus
Endocrine renal functions
Produce and release 3 hormones: 1. Renin (regulation of blood pressure) 2. Erythropoietin (stimulate RBC formation) 3. 1,25 dihydroxycholecalciferol (convert vit D to active form for calcium absorption)
Hernia
Protrusion of an organ through the wall of the cavity that normally contains it
Epicapsular stars
Remnants of the anterior vascular tunic on the anterior lens. Appear as little brown starfish deposits on the lens. No vision loss or threats to vision
Path of urine through kidney
Renal artery Glomerulus Bowman's capsule Renal tubules Calyx Renal Pelvis Ureter Bladder Urethra
hyoid bone
U-shaped bone at the base of the tongue that supports the tongue and its muscles.
The ring of attachment to the back of the lens is called ___________________.
Wieger's ligament and its peripheral edge is called the Egger's line
Collarette of the iris
a circular layer midway through iris
vitreous
a clear, avascular viscoelastic gel. volume of 4-5 mL. It progressively liquifies with age. Eye can still function without a vitreous
histology of liver
- Hepatocytes arranged in lobules (hexagon shaped) - Sinusoids in between hepatocytes are blood-filled spaces - Kupffer cells phagocytize microbes & foreign matter -Portal triad
regulatory kidney functions
-Filters waste from the blood like urea, water, salt and proteins. -maintain stable fluid volume and ion composition -regulation of acid-base (pH) in conjunction with lungs
pupillary margin
-Free edge of the iris -Rests on the crystalline lens
3 holes in the diaphragm
-aortic hiatus T12 -esophageal hiatus T10(accompanied by CN10 vagus) -foramen vena cava T8
phrenic nerve (C3-C5)
-arises from ventral rami of C3,4,5 -descends along pericardium to innervate diaphragm and return sensory info -irritation of phrenic nerve causes hiccups
movement of blood and bile between plates of liver cells
-blood enters through hepatic arterioles and portal venules and travels toward central canal through sinusoids of each lobule -bile is formed in bile canaliculi and travels down a bile canal away from center of lobule into a bile duct
anatomy of vertebrae
-body -arch -transverse processes -spinous processes -vertebral foramen -superior + inferior articular surfaces -facets
autonomic nerves innervate 3 kinds of tissues?
-cardiac muscle -smooth muscle (around ducts, blood vessels) -glands and secretory epithelia
issues with recurrent laryngeals could present as
-hoarse or nasal voice -pt coughs when they swallow
The walls of the large intestine contain
-inner circular layer continuous, outer layer longitudinal smooth muscle (tenia coli) 3 strips -internal folds called plica semilunaris that form haustra -tabs of brown fat on edge of tenia coli called appendices epiploicae
Sensory innervation by CN 10
-innervates skin of external acoustic meatus, tympanic membrane, internal surfaces of laryngopharynx and larynx. -visceral sensation to heart and abdominal viscera -sensory fibers to meninges
adrenal (suprarenal) glands - master of stress
-paired, pyramid-shaped organs atop the kidneys -Structurally and functionally, they are two glands in one -richly vascularized, endocrine ouputs into venous system
peritoneum purpose
-provide support and insulation, especially for hollow viscera -provide lubrication for the outer surfaces of organs -provide a continuous connective tissue pathway for vessels and nerves to reach all points of GI tube
Constrictions of ureter are located at
-ureteropelvic junction of the renal pelvis and ureter -prominens of sacrum -point of crossing between ductus deferencs or broad ligament of uterus -at its opening in lateral angle of trigone area of the bladder -during oblique passage through the bladder
issues with soft palate
-uvular displacement -should have symmetrical soft palate elevation
Blood supply of eye breakdown
1-CRA 2-Posterior ciliary arteries ----> breaks into 2 long posterior ciliary arteries and 10-20 short posterior ciliary arteries 7- anterior ciliary arteries (whose blood supply comes from rectus muscles)
3 locations of normally palpable nodes
1. Cervical 2. Axillary 3. Inguinal
Portal hypertension can cause what 4 things
1. Esophageal Varicosities- permanently dilated veins 2. Hemorrhoids 3. Ascites- fluid in the abdomen due to leaky venous vessels 4. Caput medussae- dilated veins that get tangled and go to umbilicus
3 types of hernias
1. Hiatal (stomach in thorax) 2. Inguinal (near reproductive area) 3. Umbilical (belly button)
Portal-Systemic Anastomoses (circulation) 3 sites
1. Lower 1/3 of esophagus 2. Paraumbilical area 3. Upper end of anal canal
3 parts of deglutition
1. Voluntary -bolus of food moved by tongue from oral cavity to pharynx 2. Pharyngeal- reflex--> upper esophageal sphincter relaxes, elevated pharynx opens esophagus, food pushed into esophagus (very short phase bc no breathing during) 3. Esophageal- reflex--> epiglottis is tipped posteriorly, larynx elevated to prevent food passing into larynx
Release of bile from gallbladder
1. When fat-containing chyme enters the duodenum, I cells release CCK into the blood 2. CCK causes contraction of the gallbladder and relaxes the sphincter of Oddi 3. Contraction of gallbladder is spasmodic. bile does not flow evenly. 4. It spurts out and enters the 2nd part of the duodenum via the ampulla of Vater
hyaloid membrane (vitreous face)
a collagenous shell that surrounds the gel of the vitreous. which attaches it to the macula, optic nerve, posterior surface of the lens and lightly to the retina. (The portion of the vitreous face stretched behind the lens and not directly attached is called the anterior vitreous face)
transverse section (cross section)
a cut along a horizontal plane, dividing the body or organ into superior and inferior parts
Greater omentum
a fatty sheet that hangs like an apron over the abdominal viscera, attaches from bottom of stomach and drapes down over coils of small intestine and returns to attach to the transverse colon -contains brown fat as insulation
mesentery
a fused double layer of the parietal peritoneum that connects small intestines (jejunum and ileum) to posterior wall -line of attachment from beneath stomach to ileocecal junction
falciform ligament
a ligament that attaches part of the liver to the diaphragm and the abdominal wall
cecum
a pouch connected to the junction of the small and large intestines.
Pericardium
a serosa with 3 layers that surrounds the heart
pleura
a serosal, double-layered membrane surrounding each lung that secretes lubricating fluid
vein
a vessel that carries blood toward the heart
supra
above
pericardial effusion
accumulation of fluid in the pericardial cavity that compresses the heart
To ensure that atria and ventricles do not contract together, they are electrically insulates from each other by the __________________.
cardiac skeleton
movement of blood through the liver
1. arterial blood from hepatic artery and venous blood returning from the GI system via the portal vein, enter the liver from below via the porta hepatis 2. Passes through liver lobules and collect in central veins 3. central veins converge on hepatic veins that leave the top of the liver 4. hepatic vein joins IVC
what are the 3 layers of the eye?
1. corneo-scleral coat - fibrous tunic 2. vascular coat- uvea 3. neural coat - retina
Main areas of lymphoid aggregates
1. palatine tonsils 2. Pharyngeal tonsils 3. Lingual tonsils
male urethra 3 parts
1. prostate gland 2. urogenital diaphragm 3. corpus spongiosum
What are the 3 primary functions of the lymphatic system?
1. serve as highway connecting the primary lymphoid tissues for defense against pathogens 2. Balance starlings equilibrium- by picking up and cleaning interstitial fluids 3. provide initial conduit for transport of absorbed lipids and fat-soluble vitamins from GI system
what are the three sympathetic pathways?
1. stays on same level, 2. goes up or down in levels before synapsing, 3. stays on same level, but passes to one of very few remote ganglia to synapse
3 layers around the heart from inner to outer
1. visceral layer of serous pericardium 2. parietal layer of serous pericardium 3. fibrous pericardium
what size is the normal adult prostate?
1.5 inches diameter, positioned just beneath the bladder
Horizontal diamater of the optic disc is ___________.
1.5 mm
What rib does the spleen lie along?
10th rib
As we get older and arteriosclerosis thickens the wall of the CRA, the ratio of CRA to CRV becomes _________.
1:1
3 Sections of Duodenum
1st 2nd- receives common bile duct from liver, gallbladder and pancrea at ampulla of Vater closed by the sphincter of Oddi 3rd
ANS has how many motor neurons
2 (preganglionic and postganglionic)
Parasympathetic long pre ganglion motor neurons release __________ as well as the short post ganglion motor neurons.
Acetocholine (cholinergic)
Sympathetic pre ganglionic neuron releases ________ and long post ganglionic neuron releases ______
Achetocholine; norepinephrine
Liver functions
Responsible for: The metabolism of fats, proteins, and carbohydrates. Excretion of bilirubin, cholesterol, hormones, and drugs. Enzyme activation. Storage of glycogen, vitamins, and minerals. Synthesis of plasma proteins, such as albumin, and clotting factors. Blood detoxification and purification. Bile production and secretion.
Above the diaphragm, right side of lymphatic system drains to the ______________ , and left to the _____________.
Right to right; left to left
List all retroperitoneal organs
S- supra renal glands A- aorta D- duodenum 2nd and 3rd parts P- pancreas U- ureters C- colon (ascending and descending) K- kidneys E- eosophagus R- Rectum
Nodal system of the heart
SA node, AV node, bundle of his, bundle branches, purkinje fibers
Sympathetic nervous system has short ___________ and long ______________ motor neurons.
Short preganglionic, and long post ganglionic
Skeletal muscle innervation is termed the __________ system.
Somatic
Sphincter of Oddi
controls the amount of bile into the small intestine
Hypothalamus
coordinates autonomic functions in both limbs by sensing changes and stimulating either parasympathetic or sympathetic system to function
What is the first place served by the aorta?
coronary arteries to keep the heart going
conjunctiva
cover anterior 1/3 and then reflects onto the inside surface of the lids (starts at limbus)
parasympathetic nerves can only exit through ___________________.
cranial and sacral outflow
longitudinal section
cut through the long axis of an organ
oblique section
cuts made diagonally, results in an elliptical shape (thinnest section of this cut is same as regular cut thickness)
Mucus traps
debris and bacteria which is swallowed. Hairs on the mucosal surface also trigger the sneeze reflex.
urogenital diaphragm
deep transverse perineal, urethrae sphincter
interventricular groove (sulcus)
demarcation line that separates the left and right ventricles
dentate processes vs oral bays
dentate processes -- extensions of the peripheral retina into the pars plana oral bays -- pars plana extensions between the dentate processes this is only a feature of the nasal side of the eye
duodenal ulcers usually occur where? why?
in the first part of duodenum because it is constantly exposed to acidic substances prior to being neutralized in 2nd part
Differences between adult kidney and child kidney
infant kidney is lobular, adult kidney is smooth and bigger
Filariasis
infection of the blood and tissues of healthy individuals by worm embryos or filariae. Usually situates blocking lymphatic vessels in leg calling swelling
Inferior limit of thorax
inferior edge of T12, line connecting inferior edge of rib 12 w/ inferior costal margin
posterior uveitis
inflammation of the choroid
intermediate uveitis
inflammation of the ciliary body and choroid
Anterior uveitis
inflammation of the iris and ciliary body
uveitis
inflammation of the uvea causing swelling and irritation
renal pelvis (of kidney)
inner collecting tube
medial canthus
inner corner of the eye where the upper and lower eyelids meet
parasympathetic functions of vagus
innervates smooth muscle of trachea, bronchi and all of the GI tract and related organs up to the left colic flexure -also balances sympathetic input to SA node of heart to govern heart rate
When we direct a colleague to find something we have seen in the retina we describe it as X disc diameters, and Y disc diameters away along the Z o'clock meridian.
oof
Sclera
opaque, fibrous exoskeleton of the eye to which EOM's are attached to move the eye
All arterial vessels arise from the _______________________.
ophthalmic artery
retroperitoneal organs
organs beneath peritoneum, strapped to posterior abdominal wall
constrictions in the ureter serve as ____________ to retard urinary reflux.
pseudovalves
Sympathetics of Eye
pupil: dilates (mydriasis) lens: slight relaxation for far vision similar to pathway 3, pre-ganglionics begin in C8-T2 area and enter chain at their level and pass up the chain to superior cervical ganglion and synapse. sending post-ganglionic sympathetics as plexus around blood supply
Lymphatics of breast
radioactive material or dye is used to find primary or "sentinel nodes". If tumor is found, it is removed and then there is radiation
How does blood flow through kidneys?
receive renal artery from retroperitoneal aorta and return blood to retroperitoneal inferior vena cavae
lymphatic system functions
recovery of excess tissue fluid, detection of pathogens, production of immune cells, defense against disease
Portal systemic anastomoses serve as a
relief valve, ensuring that venous blood has some pathway to get back to the heart
Hilus of kidney contains
renal artery, renal vein, renal nerves, lymphatics, and renal pelvis
Identify parts of kidney
renal cortex, renal medulla, renal sinus, renal pyramid, renal column, renal capsule, renal artery, renal vein, segmental arteries, ureter
Urinary system is entirely
retroperitoneal
urinary system is entirely _______________
retroperitoneal or subperitoneal in pelvis
Circulation of blood through the heart
right atrium, right ventricle, pulmonary artery, lungs, left atrium, left ventricle, aorta, rest of body, vena cavae, right atrium
juxta
right next to
what outflow of nerves serves the GI system?
sacral outflow and the splanchnic nerves of the parasympathetic
what type of cut is this photo?
sagittal
Brushfield spots
salt and pepper speckling on the iris associated with Down Syndrome
Crypts of Fuchs
the holes in the anterior border layer, give iris its individuality and color, and allow aqueous to enter stroma from the anterior chamber.
visceral pleura
the inner layer of pleura that surrounds each lung (not innervated)
pupillary margin of iris (pupillary frill or ruff)
the innermost layer of iris
As the ribs are raised and the diaphragm descends, volume is added to the intrapleural spaces, making _________
the negative pressure greater and expanding the lung.
optic nerve
the nerve that carries neural impulses from the eye to the brain; is a tract of the brain and is contained in the 3 layers of the brain :dura mater, arachnoid, and pia mater
Thoracic inlet picture
identify
identify head, nack, body, and tail of pancreas
identify
label female pelvic cavity
identify
pulmonary lymph nodes
in the angles of bifurcation of branching lobar bronchi
emmetropic eye
no refractive error
BPH (benign prostatic hyperplasia)
noncancerous enlargement of the prostate with age
Kunkman-Wolffian
normal people
In an MRI bones appear how?
not bright
Contralateral
on the opposite side of the body from another structure
Ipsilateral
on the same side of the body
epi
on the surface of
Fluid in the lymphatic system is
only going in one direction due to valves
Short posterior ciliary arteries break into 3 clusters termed:
2 called distal SPCAs( which cross the sclera and become the choroid) and 1 called paraoptic SPCAs(serve the optic nerve head)
Penis is made of 3 elements
2 erectile corpora cavernosa, 1 corpus spongiosum which has the urethra in the middle
Aqueous humor is secreted at a rate of _________. Therefore the aqueous in the AC and PC turns over every _____________ min if IOP stable.
2-3mL/ min production; turnover every 90-100 min
Axial length of eye
24mm
Anterior chamber has how much liquid in it at one time?
250-350 mL
for each mm greater or lesser than 24 mm, the shift in refractive error will be how many diopters?
3 diopters
Lungs lobes
3 right, 2 left (each lobe served by a lobar/secondary bronchus)
what cranial nerves innervate the extraocular muscles?
3, 4, 6
what are the four cranial nerves used by the parasympathetic nervous system?
3, 7, 9, 10 (go down spinal cord and emerge at sacral levels 3 and 4)
How many spinal nerves are there?
31 pairs 8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal
Oral cavity consists of how many teeth?
32
Vortex veins
4 on the back of the eye that drain blood from eye
Posterior chamber has how much volume at one time?
50 mL
portal triad of liver lobule
6 sets of these vessels per lobule which contain: -bile duct -portal venule -portal arteriole also: branch of autonomics and lymphatic vessel
How many nodules does a person have?
600-700
prostate gland
A gland in males that contributes to the seminal fluid and contracts to add force to ejaculation
Gallbladder
A muscular sac attached to the liver that secretes bile and stores it until needed for digestion
Gallbladder
A muscular sac attached to the liver that secretes bile and stores it until needed for digestion; also resorbs water and ions
eustachian tube (auditory tube)
A narrow tube between the middle ear and the throat that serves to equalize pressure on both sides of the eardrum
Pouch of Douglas (Rectouterine Pouch)
A peritoneal recess extending between the rectum and the uterus.
Bile
A substance produced by the liver that breaks up fat particles, stored in gallbladder
The variations in the depth of the Anterior Chamber can cause the angles to be open, narrow, or closed
As a person ages the lens becomes stiffer and pushes the iris forward and causes the angles to narrow
lymph nodes
Bean-shaped filters that cluster along the lymphatic vessels of the body. They function as a cleanser of lymph as wells as a site of T and B cell activation. All fluid and cells deemed "clean" leave lymph nodes through efferent channel at the HILUS of the node.
bile production pathway
Bile is produced in the liver and drained by right and left hepatic ducts into the common hepatic duct. Bile flows from the common hepatic duct through the cystic duct into the gallbladder for storage and concentration. When a fatty meal is eaten, bile is expelled from the gallbladder through the cystic duct into the common bile duct. The common bile duct empties bile into the duodenum to facilitate the breakdown of lipids into fatty acids suitable for absorption
In clinical testing of vagus nerve which nerves are usually tested together? (testing in the form of oral cavity tongue depressor)
CN 9(sensory) and 10(motor)
Mean Arterial Pressure (MAP)
CO x PR (cardiac output x peripheral resistance)
Which is typically larger out of the CRA(central retinal artery) or CRV(central retinal vein)?
CRV is bigger by a ration of 3:2
Biliary tree anatomy
Common hepatic duct joins the cystic duct to form the common bile duct Common bile duct empties into the duodenum
zonular fibers
Connects ciliary body with the lens Allows for adjustment and focusing of the lens
Parasympathetic nervous system begins where?
Cranio-Sacral Outflow!!! CN3 in brain stem (Edgar Westphalia nucleus); CN7; CN9; and CN10 vagus Sacral outputs S2-S4
tear film
Creates a smooth refractive surface to the front of the cornea, maintains a moist environment, and carries oxygen to the eye (First optical surface of the eye) 0.5 mm thick
Hilus of each kidney is roughly at junction of ___________ along transpyloric plane.
L1-L2
which cranial nerves innervate each extraocular muscle specifically?
LR6 (SO4)3; lateral rectus =6, superior oblique=4, rest are 3
Diaphragm
Large, flat muscle at the bottom of the chest cavity that helps with breathing. Higher in front than back
Lymphatic drainage of the breast
Lateral 2/3 of breast --> axillary nodes in armpit Medial 1/3 of breast --> drains to mediastinal nodes
Below the diaphragm, both sides drain ____________.
Left; to the cisterna chyli and thoracic duct
semilunar valves (SL)
Located between the two ventricular chambers and the large arteries that carry blood away from the heart, both have 3 cusps(leaflets)
parasympathetic nervous system has long _________ and short _________ motor neurons.
Long pre and short post/ terminal ganglion
Kupffer cells
Macrophages in the liver. Perform fast phagocytosis -line of immune response and cleaning blood
The LPCAs and the ACAs join a vascular circle called the
Major circle of the iris, which runs in the ciliary body. from the MACI, vessels serve the iris and ciliary body
vascular layer (uvea)
Middle pigmented layer Three regions: choroid, ciliary body, and iris (very vascularized)
opposition
Movement of the thumb to touch the fingertips
Voluntary skeletal muscle is _____ served by the ANS.
NOT
The diaphragm is innervated by what?
Phrenic nerves: C 3,4,5
The optic nerve is a tract of the brain, therefore it is surrounded by these 3 layers.
Pia mater, Arachnoid, and then Dura mater on the outside. The subdural space also has CSF fluid in it
carina
Point at which the trachea bifurcates (divides) into the left and right mainstem bronchi.
axial skeleton
Portion of the skeletal system that consists of the skull, rib cage, and vertebral column (74 bones)
pathway of sympathetic neurons
Preganglionic sympathetic motor neurons come out the lateral ventral root —- ventral ramus — white rami communicans— chain ganglion (paravertebral ganglia) —3 options 1. Synapses at chain ganglion —goes through gray rami communicans —with spinal nerves to target 2. Goes up or down a level through chain ganglia —synapses there and goes through gray rami communicans —- with spinal nerves to target (or does it's own thing as a sphlanchnic nerve) 3. Goes forward in front of aorta and vertebrae and synapses at that ganglia — called pre aortic, prevertebral, or collateral ganglia
The ANS is split into what 2 branches?
Sympathetic and parasympathetic (enteric)
Sympathetic branches of ANS are located where?
T1-L2 (Thoraco-Lumbar Outflow)
Innervation of taste buds, tongue sensation, and tongue movement
Taste buds 7 and 9 Tongue sensation 8 Tongue movement 12
Spiral of Tillaux
The insertion pattern of the rectus muscles is called the..... (SLIM) measuring limbus to point of insertion
Superior, middle, and inferior meatus
The lateral walls off the nasal septum that create three irregular passages in the nasal cavity are called
lid margin
The lower most edge of the upper lid or upper most edge of the lower lid which contains the opening of the meibomian glands. It is the location of the junction of the skin and mucous membranes (mucocutaneous junction)
Which kidney is lower and why?
The right kidney is lower in the abdominal cavity because of the amount of space the liver occupies. During development kidneys rise, and right hits the liver so it ends up lower
lacrimal punctum
The very small circular opening of the lacrimal duct on the margin of each eyelid near the medial canthus
coronary arteries and veins
These are the vessels located on and in the actual myocardium or heart muscle. They supply and drain the myocardium of blood, respectively.
What do wings of bone (conchae or turbinates) do? (superior, middle, and inferior concha)
They are covered in vascularized and innervated mucosa that warms, humidifies and cleans incoming air of particulates
ligamentum arteriosum
This structure is a remnant of a fetal vessel that connected the pulmonary trunk and the aorta.
Pharynx is divided into
Three parts : nasopharynx , oropharynx, and laryngopharynx.
What are the numberings of the different types of ribs?
True ribs: 1-7 False ribs: 8-10 Floating ribs:11-12
Esophagus
Tube connecting the mouth to the stomach, descends through mediastinum and crosses diaphragm at T10(joined by L and R vagus nerves CN 10)
catheter
Tube inserted into vessels or body cavities to permit injection or withdrawal of fluids or to keep a passage open; entered through femoral artery to go up to coronary arteries
Another issue with visual field where all nasal vision is lost is called binasal hemianopsia. which is caused by _________________.
can be caused by an aneurysm and swelling/overdilation of carotid artery pressing on outer lanes of optic chiasm
Exocrine functions of pancreas
acinar cells produce digestive enzymes and secrete them through pancreatic ducts
what kind of muscle in the colon?
all smooth muscle, except the anal sphincter which is striated-voluntary
Sectorial nevus
an area of pigmented cells in the iris
cisterna chyli
an enlarged pouch on the thoracic duct that serves as a storage area for lymph moving toward its point of entry into the venous system
navicular fossa
an enlargement of the distal end of the urethra in the area of the glans penis
omentum
an extension of the peritoneum attached to the stomach and connecting it with other abdominal organs
Issues with visual fields can be indicative of issues within the optic nerve, chiasm, or optic tracts. For example, bitemporal hemianopsia (losing all temporal vision on both eyes) is caused by ______________.
an issue with the optic chiasm where the wires cross, so each eye is only getting its own input (pituitary tumor)
labia majora meet anteriorly at the
anterior labial commissure, and posteriorly at the posterior labial commissure
how does blood flow through kidneys?
aorta--> renal arteries--> capillaries --> renal veins (left renal vein receives gonadal vein) --> inferior vena cavae
anterior pole
apex of the cornea
chylomicrons
are moved by central lacteals to the cisterna chyli and then up thoracic duct to enter venous system
porta hepatis
area of liver where the hepatic portal vein and hepatic artery enter; and the bile duct exits the liver
peri-, circum-
around
Anterior ciliary arteries
arrive from the rectus muscles at their insertions, 2 come out of each muscle, except only 1 at lateral rectus
where is the sclera the thinnest?
at the insertions of rectus muscles and thickest around optic nerve
a nerve signal gets distributed where?
at whatever level you synapse
Lesser omentum
attaches bottom of liver to upper part of stomach -Free edge has an epiploic foramen (foramen of winslow) whcih contains: hepatic artery, hepatic portal vein, and bile duct from liver
within the cranium, what branches of the vagus nerve arise?
auricular branches, which supply sensation to the posterior part of the external auditory and canal external ear (tympanic membrane)
ab-
away from midline (exo-); could be both eyes moving out
kidney disease commonly gives rise to ____________?
back pain, bc they are retroperitoneal
disc edema (papilledema)
can be caused by elevation of CSF pressure (potentially a brain tumor)
how do abdominal dermatomes compare with spinal levels?
bc the ribs and dermatomes tilt downward as they come forward they are not in sync; for example, T10 dermatome is actually where L3 and L4 vertebrae are in the back
infra
below
Rectouterine pouch (pouch of Douglas)
between uterus and rectum
what happens when sphincter of oddi is closed at the ampulla of vater?
bile will build up and go up the spiral valve into the gallbladder to be stored
Because the optic nerve head has no photoreceptors, it projects into the visual field as a ______________. Right, left, up and down are defined by position relative to the fovea in a visual field.
blind spot
hepatic portal system
blood goes through capillary beds in the walls of the gut to pick up nutrients, then passes through the hepatic portal vein before reaching the capillary beds in the liver to deliver the nutrients for metabolism/storage -pathway: heart-aorta- mesenteric artery - capillaries in wall of intestine - hepatic portal vein - liver sinusoids - hepatic veins - inferior vena cavae - heart
long bones
bones of the arms and legs; clavicle
appendicular skeleton
bones of the shoulder, pelvis, and upper and lower extremities (126 BONES)
short bones
bones of the wrist and ankles
limbus
border between cornea and sclera
Identify the 3 arteries that branch off the aortic arch.
brachiocephalic, Left common carotid, left subclavian
where are parasympathetic pre-ganglionic cell bodies located?
brainstem
when tonsils become enlarged they may interfere with __________
breathing
abdominal wall
bridging in midline are 2 vertical muscles (rectus abdominus) that are separated by a fibrous connection called the linea alba (white line)
Each lobe of lung is broken into
brochopulmonary segments, which all have there own segmented bronchus and vascular supply. This means one lobe can be removed and will not affect the function of others
medulla of adrenal gland produces (center of gland)
catecholamines --> epinephrine and norepinephrine
frontal sinus
cavity within the frontal bone
within the microvilli of the gut there are small lymphatic vessels called
central lacteals. when fats are absorbed they do not easily transport in a hydrophilic environment. They are thus packaged with a protein to become amphiphilic--> called chylomicrons
most of the iris and all of the ciliary body drain blood toward the
choroid
posterior pole of eye on optos photo
circle that contains the optic nerve head, the macula and largest veins, arteries, and nerves
Cornea
clear, avascular principal surface of the eye, covered by tear film
where is the position of ganglia in the sympathetic nervous system?
close to CNS
where is the position of ganglia in the parasympathetic nervous system?
close to target
Major and minor calyx
collect urine
lacrimal lake
collecting area of the tears at the medial angle of the eye
ganglion
collection of CNS neuron cell bodies outside of the CNS
ganglion
collection of nerve cell bodies in the peripheral nervous system
Near the posterior surface of the pancreas, runs the main pancreatic duct that receives an accessory duct before joining the __________________
common bile duct leading to the 2nd part of the duodenum via the ampulla of vater
CT
computed tomography; bones appear bright white
since bile elements cannot be reabsorbed, bile is _______________
concentrated
Nevi (iris)
congenital concentrations of normal pigmented cells (give the appearance of flat moss)
Persistent pupillary membrane (PPM)
congenital remnants of the prenatal pupillary vascular membrane that extend from the collarette region of the iris into the anterior chamber, to the cornea, or other areas of the iris, may appear as "web-like" strands stretching across the pupil.
Meridional plane
contains any oblique meridian and is perpendicular to coronal plane (infinite)
falciform ligament of liver
contains remnants of umbilical vein attached to umbilicus in its free edge
pleural cavity
contains the lungs, an air tight cavity (maintains a negative pressure, which keeps the lungs partially inflated, even in expiration)
Median Plane (midsagittal plane)
divides body into two equal parts (right and left)
Aorta development
during development, the right 4th aortic arch is resorbed. the LEFT 4th arch becomes the final aorta
The pancreas is both an ________ and _______ gland
endocrine and exocrine
Excretory kidney functions
ensure that water soluble substances present in excess or those that are potentially harmful are excreted in formed urine
Liver is all made up of what kind of tissue?
epithelial
space of disse
epithelial cells pick up O2 and nutrients and join hepatic vein --> inferior vena cavae
anatomical position
erect, feet forward, arms at side with palms facing forward, head facing forward
Myopia (nearsightedness)
eye longer
Hyperopia (farsightedness)
eye shorter
What areas of the body do not have lymphatics?
eye, brain, and testes (conjunctiva of eye and lids do)
palpebra
eyelid
palpebri
eyelids plural
Greater and lesser curvature of stomach
identify
duodenum
first part of the small intestine, begins at pyloric sphincter; wraps tightly around head and neck of pancreas
superior sulcus
fold above the eye lid
In the heart, every cell contracts everytime, but the ______ of contraction can vary.
force
caruncle
found in the medial canthus, it is a small fleshy mass containing sebacceous glands
all 3 of the vessels at the porta hepatis are carried in the ________________.
free edge of the lesser omentum
surgical approach to kidney
from the back to avoid breaking peritoneal cavity
The parts of the stomach include
fundus: top portion of stomach that goes above entrance rugae: folds on inside surface that help with digestion body: middle part pyloric region: bottom pyloric sphincter: connects stomach to duodenum
the pupil does what as a person ages?
gets smaller (unknown reason why)
adrenal cortex composed of 3 layers
glomerulosa fasciculata reticularis
zona fasciculata secretes
glucocorticoids (cortisol)
Vagus traverses the diaphragm by clinging to the esophagus and
going through the esophageal hiatus at T10
anatomy of ribs
head attaches to vertebrae, costal cartilage attaches front to sternum, costal groove runs along the inside wall and carries VAN
Mitral valve (bicuspid valve)
heart valve between the left atrium and the left ventricle
Vagus nerve innervates what organs?
heart, lungs, liver, gallbladder, pancreas, spleen, small intestine, large intestine up to left colic flexure
blood leaves the liver through
hepatic vein and then joins IVC
parenchyma of liver
hepatocytes (liver cells)
nasal cavity
hollow space behind the nose
transverse plane
horizontal division of the body into upper and lower portions
transpyloric plane
horizontal plane that passes through the pylorus, the duodenal junction, the neck of the pancreas, and the hilum of the kidneys -at L1 level
9 areas of the abdomen
hypochondriac--epigastric--hypochondriac -------------transpyloric plane-------------- lumbar----------umbilical-------------lumbar --------------transtubercular plane----------- iliac------------hypogastric---------------iliac
plica semilunaris colon
internal folds in large intestine
internal and external urethral sphincter
internal: smooth muscle external: skeletal muscle
penetration
into, but not through
bulbar conjunctiva attachment
is the most loosely attached to the sclera, massive allergic reactions can cause the bulbar conjunctiva to billow out beyond the margins of the eyelids
Papillary muscle contraction is
isometric; chordae tendinae holds valve still so it does not backblow
what is the surgical importance of the pars plana?
it is the safest point of surgical entry into the eye to work on the vitreous or the choroid/retina because it is the least vascularized portion of the eye-wall posterior to the lens.
distal interphalangeal joint (DIP)
joint between middle and distal phalanges
The vagus nerve exits the cranium via the ________________.
jugular foramen (goes with CN9 and 11 as well)
urinary pathway
kidneys--> ureter --> ureters --> urethra
stomach
large muscular sac that continues the mechanical and chemical digestion of food
How does the lymphatic drainage in the breast work?
lateral 2/3 drains primarily to axillary nodes (armpit), medial 1/3 drain to substernal nodes that are difficult to access......... Bonus: Tamoxafin-> med used instead of chemo for breast cancer, can harm retina
right recumbent position
laying down on right side, knees bent
Splanchnic parasympathetic from sacral levels take over at
left colic flexure and serve the rest of the GI system. -Also serves pelvic organs and urinary tract, including kidneys.
bronchopulmonary hilar lymph nodes
lie in the hilus of lung. can become so enlarged in some diseases like sarcoidosis that they are visible on x-ray (could be linked to uveitis)
Coronary groove (sulcus)
lies between the atria and ventricles and contains the coronary vessels and fat
parietal pleura
lines the walls of the thoracic cavity (innervated)
Tracheobronchial lymph nodes
located at the bifurcation of the trachea and also farther out on the bronchi
thymus gland
located in the mediastinal cavity beneath the manubrium of the sternum; it is where uncommitted lymphocytes become T-cells, secretes thymosin, gets smaller with age
LPCA
long posterior ciliary arteries
parasympathetics have these kind of ganglions
long pre-ganglionic and short post-ganglionic neurons
the circumference around the eye is always longer on the __________ side, than on the __________ side.
longer on the temporal side than the nasal side
The tenia coli of the large intestine are
longitudinal smooth muscle fibers
3 layers of stomach
longitudinal, circular, oblique (from outer to inner)
Madarosis
loss of eyelashes
inferior palpebra
lower eyelid
Lymphatic role in fluid balance and hydration
lymphatics pick up excess fluid that is left in areas in order to keep from swelling or edema in areas. Fluid that is picked up most go through testing and cleaning before being returned to circulation blood
MRI
magnetic resonance imaging; a grey scale picture that are always being viewed from below and have R and L switched
medulla of adrenal gland receives ______________
massive Pre-ganglionic sympathetic input
The ureters enter the bladder:
obliquely through its muscular wall
the vagus nerve originates from the
medulla of the brainstem--> then exits the skull via the jugular foramen
bulbar conjunctiva
membrane that covers white of eyes (not cornea) Small blood vessels found in this membrane; seen easily in "bloodshot" eyes
jejunum and ileum are surrounded by what
mesentery
zona glomerulosa secretes
mineralocorticoids (aldosterone)
Gross Anatomy of the Kidney, path of urine
minor calyces receive formed urine from apices of medullary pyramids --> minor calyces merge to form major calyces --> 3 major calyces coverge to form renal pelvis within the renal sinus --> the renal pelvis tapers down and ureter leave hilus
Lymph nodes do what
monitor and filter composition of lymph, immunologic response
inguinal canal and hernias
more common in men because of vas deferens where it connects to the abdominal wall. less common in women bc of the round ligament of the uterus
jejunum
mostly left side
ileum
mostly right side
Motor function of vagus
motor innervation to majority of muscles of pharynx, soft palate, and larynx
both parasympathetic and sympathetic divisions are _________ systems that work__________ to one another.
motor systems that work opposite (antagonists; one being stimulatory and the other being inhibitory)
During inspiration the diaphragm__________. It is innervated by what nerve?
moves down; phrenic nerve
conjunctiva
mucous membrane lining the eyelids and covering the anterior portion of the sclera
Distichiasis
multiple rows of lashes (congenital)
trabeculae carneae
muscular ridges on the internal surface of the ventricles
Vagus is also known as the what?
nausea nerve
para-
near
kidney functional unit
nephron
will you see an eye in a mid-saggital cut?
no (cut would be between the eyes)
pathway of vagus nerve
originates in medulla of brainstem --> auricular branches arise while still in cranium -->main branch passes through jugular foramen --> goes through neck within the carotid sheath --> passing aorta on left and subclavian on right, gives off its recurrent laryngeal branches that go back up to neck to provide motor fibers for larynx, pharynx, and soft palate --> continues downward toward abdomen and innervates many other organs including GI system until left colic flexure
lateral canthus
outer corner of the eye where the upper and lower eyelids meet
renal cortex
outer region of the kidney
SA node
pacemaker of the heart; causes atrial contraction; receives both sympathetic and parasympathetic inputs that raise or lower heart rate
peritoneum layers
parietal: covering inside of abdominal wall visceral: covering the outside of organs
What 2 parts make up the ciliary body?
pars plicata (pleated, ciliary processes), pars plana (flat)
The portion of the anterior vitreous face within the ring of attachment is termed the ____________________, and the potential space between this and the posterior lens capsule is called the _____________________________.
patellar capsule; space of berger
How does urine move through the ureters?
peristaltic waves of contractions and gravity
additional lymphoid aggregates
peyer's patches in small intestine conjunctival follicles/crypts
Appesiotomy
placing a cut from vaginal orifice downward to make room for childbirth so it will not rip to anus
haustra
pouches in the wall of the large intestine that expand to accommodate the bulk of undigested materials
what nodes on head and neck are to be palpated in cases of red eye?
pre-auricular (in front of ears), retro-auricular (behind ears), sub-mandibular
sympathetics (thoraco-lumbar outflow)
pre-ganglionic cell bodies are located in spinal cord; leave the CNS with ventral roots through T1-L3
sympathetic flow in thoraco-lumbar region?
pre-ganglionic fibers originating from the intermediolateral column at each spinal level move into the ventral ramus and continue out to the white ramus communicantes. then they enter the paravertebral ganglion and can be transported up or down the chain
labia minora meet anteriorly at the
prepuce of clitoris, and posteriorly at the frenulum
Endocrine functions of pancreas
produce hormones (insulin and glucagon) that regulate carbohydrate metabolism from nest of cells called Islets of Langerhans
Where is aqueous humor produced and how does it flow?
produced in the ciliary body and flows through the pupil. Circulates in a convective flow driven by the temperature difference between the warm iris and cooler cornea.
Columns of Bertin (renal columns)
projections of cortical tissue between pyramids
pectinate muscles
prominent muscular ridges along the inner surface of the auricle and across the adjacent anterior atrial wall
which is stronger; pronation or supination?
pronation
Male urethra
prostatic urethra, membranous urethra, spongy urethra
parts of male urethra
prostatic urethra, membranous urethra, spongy urethra
Cilia (eyelashes)
protect the eye from foreign material (2 rows)
Hiatal hernia
protrusion of a part of the stomach upward through the opening in the diaphragm
Series of tubes in the testes
seminifeorus tubules --> straight ducts --> rete testis --> efferent ductule --> epididymis --> ductus deferens
pathway of sperm during ejaculation
seminiferous tubules in testes --> coveyed via efferent ductules to epidydimis--> through abdominal wall with vas (ductus deferens) which loop around ureters --> join the duct from the seminal vesicle--> ejaculatory duct through the prostate gland into urethra --> cowper's gland --> urethra continues through length of penis, dilating at the end with the navicular fossa
gag reflex testing
sensory 9 and motor 10
hard palate and soft palate
separate oral cavity from nasal cavity
costo-diaphragmatic recess
separation of parietal pleura from visceral pleura where the costal and diaphragmatic pleura meet
zona rectularis secretes
sex hormones, androgens
sympathetics have these kind of ganglions
short pre-ganglionic and long post-ganglionic neurons
sphenoid sinus
sinus above and behind the nose
glomeruli
site in kidney where filtration occurs
flat bones
skull, mandible, scapula, sternum, and ribs
appendices epiploicae
small fatty sacs attached to outer wall of large intestine
Ampulla of Vater
small opening in the duodenum in which the pancreatic and common bile duct enter to release secretions
parasympathetic response controls what
smooth muscle, cardiac muscle, and glands
uvula
soft tissue hanging from the middle of the soft palate
in a portal system, what happens?
something is picked up in the first set of capillaries and dropped off in second set
vesicouterine pouch
space between bladder and uterus
Mediastinum
space between the lungs which contains the heart, major vessels, trachea and esophagus, vagus and phrenic nerves and the thymus gland beneath the sternum
renal sinus
space within kidney that is adjacent to renal medulla, contains calyces and renal pelvis. contains brown fat
What is the largest lymphatic organ?
spleen
sympathetic nervous system to head and neck are composed of______
stellate (inferior cervical) ganglion, middle cervical ganglion, and superior cervical ganglion (none of which have a white or gray ramus communicans
Dermatomes
strip of body served by one spinal nerve or cranial nerve (radiating pain along dermatome) ex. herpes zoster
thoracic inlet
superior edge of T1, superior edge of rib 1, and superior edge of manubrium
At ovulation, the fimbria _________ to move closer to the ovary to optimize capture of the ovum
swell
What are the 2 divisions of the ANS?
sympathetic and parasympathetic
Special sensory of vagus
taste sensation to epiglottis and base of tongue
deglutition
the act of swallowing
Peau d'orange
the appearance of the capsule of the lens because it has a leathery/orange peel appearance.
fornix
the blind pocket created by the fold in between the bulbar conjunctiva and the palpebral conjunctiva
posterior pole of eye
the center of the posterior curvature of the eyeball
sympathetic nervous system
the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations
parasympathetic nervous system
the division of the autonomic nervous system that calms the body, conserving its energy
portal hypertension
the elevation of blood pressure within the portal venous system due to liver disease -blood gets backed up going to liver in the portal vein and must take an alternate route
ileocecal junction
the end of the small intestine where the ileum joins the cecum of the large intestine where mesentery attaches to body wall. controlled by ileocecal valve
