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