100 Concepts Anatomy
100 Concepts Anatomy
100 Concepts Anatomy
Dear students, you can use this presentation like a guide during your
preparing for GA exams.
It does NOT cover all material of the Gross Anatomy course.
To complete GA material you should work with ALL professors
presentations.
Good Luck and All the best!
Dr. Mavrych
8 cervical SN (above)
12 thoracic SN
5 lumbar SN (below body)
5 Sacral SNs
1 coccygeal SN
PLL
l
l
ALL
6*
10*
Conus medullaris
Cauda Equina w/ FT
dura matter 7
subdural spac
subd
space 8
Arachnoid matter 9
2. Herniated IV disc
l
3
4
Kyphosis is an exaggeration of
the thoracic curvature that may
occur in elderly persons as a result
of osteoporosis (multiply
compression fracture of vertebral
bodies) or disk degeneration.
l
Lordosis is an exaggeration of the
lumbar curvature that may be
temporary and occurs as a result
of pregnancy, spondylolisthesis
or potbelly.
Leg lengths:
l
Scoliosis is a complex lateral
short bone:
deviation, or torsion, that is
Coxa Vara
caused by poliomyelitis, a leglength discrepancy, or hip disease. <100deg
Long bone:
Coxa Valga
Dr. Mavrych, MD, PhD, DSc [email protected]
>130deg
Degenerative osteoarthritis:
Spondylosis: immobility or fusion of vertebral joints
Spondylolysis: degeneration of articulating part of vertebrae
Spondylolisthesis: forward displacement of vertebrae
l
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Scaphoid fracture
Boxers fracture
Brawler's Fracture
Right humerus
Subscapular ns
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Tennis elbow
(Lateral epicondylitis)
l
l
1.
2.
3.
4.
Golfers elbow
(Medial epicondylitis)
l
l
1.
2.
3.
4.
the hand
8. Arterial anastomoses
around the scapula
Medial epicondylitis is
inflammation of the common
flexor tendon of the wrist
where it originates on the
medial epicondyle of the
humerus.
Origins of following muscles
may be affected:
Pronator Teres Pronates forearm
Flexor Carpi Radialis Flexes and abducts wrist
(Median n)
Palmaris Longus flexes wrist
Flexor Carpi Ulnaris flexes and adducts Wrist
Ulnar n
Blockage of the
Subclavian or Axillary
artery can be bypassed
by anastomoses
between branches of
the Thyrocervical and
Subscapular arteries:
l
Transverse cervical
off thyrocervical trunk
l
Suprascapular
l
Subscapular
l
Circumflex scapular
off subscapular
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9. Cubital fossa
1.
2.
3.
LATERAL
MEDIAL l
1.
2.
3.
l
l
structures protected
Biceps Brachii m (flex and supinate forearm)
l Not accompanied by nerves
O: Longhead supraglenoid tubercle, Shorthead
coracoid process)
I: to Radial
TuberosityMD, PhD, DSc [email protected]
Dr. Mavrych,
Venous blood is darker/purpleish and flows passively
Arterial blood is cherry red and has a pulse
Cubital Tunnel Syndrome: Compression of ulnar epicondylar groove via tendon of Flexor
Carpi Ulnaris, Ulnar n is compressed: Claw hand and weakened adduction of wrist
PIP FDS
DID
DIP - FDP
MCPs- Lumbricals
Metacarpal phalangeal joint
(Erb-Duchenne palsy)
adducted shoulder
extended elbow
Axillary C5-C6
Musculocutaenous C5-7
Median C6-T1
Dr. Mavrych, MD, PhD, DSc [email protected]
hand
paralysis (open extended hand), ulnar and
Dr. Mavrych, MD, PhD,Full
DSc
[email protected]
median n damage, thumb is extended bc radial n still good
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Injury to musculocutaneous
nerve
Median n lesion: Ape hand/benediction with lateral 3 digits are extended, wrist is extended
Ulnar n lesion: Claw hand with medial 2 digits extended
Dr. Mavrych, MD, PhD, DSc [email protected]
Dr. Mavrych, MD, PhD, DSc [email protected]
Radial n lesion: Drop Wrist with flexion of the wrist
Cutaneous innervation
reality, in case of superficial branch of
of the hand Inradial
nerve lesion it will be skin deficit
A catheter can also be passed through a peripheral vein (femoral vein) into IVC, the
R atrium,
R ventricle,
pulm trunk and pulm arteries. Intracardiac pressures, blood
Dr. Mavrych,
MD, PhD,
DSc [email protected]
samples, and visualization of great vessels using Xray
Avascular necrosis
of femoral head
A common fracture in
elderly women with
osteoporosis is fracture of
the femoral neck.
Fractures of the femoral
neck cause shortness and
lateral rotation of the lower
limb. Coxa Vara <100deg
Fractures of the femoral
neck often disrupt the blood
supply to the head of the
femur.
At present time the best way
in case of femoral neck
fracture is hip replacement.
Transcervical fracture
disrupts blood supply to
the head of the femur via
retinacular arteries (from
medial circumflex femoral
artery) and may cause
avascular necrosis of the
femoral head if blood
supply through the ligament
to the head is inadequate.
Fractures of neck and head of femur will disrupt the cruciate anastamosis that includes the medial circumflex
femoral a & ascending and transverse lateral circumflex femoral aa with Retinacular branches that anastamose
with the acetabular branch of obturator a within Ligamentum Teres
Dr. Mavrych, MD, PhD, DSc [email protected]
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congenital dislocations are more common in females > males
l
l
Weakened hip
extension and knee
flexion
Footdrop (lack of
dorsiflexion)
Flail foot (lack of
both dorsiflexion and
plantar flexion)
Cause of injury:
caused by
improperly placed
gluteal injections
but may result from
posterior hip
dislocation
Gluteal injections should be done with palm over
& Piriformis syndrome: Trucker's
who sit all day piriformis m
greater trochanter, pinky on ASIS and middle finger on
Dr. Mavrych,
MD, PhD,
DSc [email protected]
compress n, numbness and tingling
mid axillary
line, thumb
point posteriorly,
the V between
to the affected side.
middle and ring finger is site of injection.
l
Superior gluteal
nerve injury
Normal
Right
superior
gluteal nerve
injury
tearing off
Injury of obturator
nerve Waddleing Gait (lateral leg swing/drag)
l
Hamstrings muscles:
1. Biceps femoris (long head)
2. Semitendinosus
3. Semimembranosus
l
Action: extension of hip
joint and flexion of knee
joint
l
Nerve supply Tibial
nerve (short head of
biceps femoris is supplied
by the common fibular
nerve)
Dr. Pseudohamstrings:
Mavrych, MD, PhD,Adductor
DSc [email protected]
Magnus (obturator & tibal ns), Biceps femoris ms (tibial &
common peroneal ns)
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Femoral hernia
Inguinal lig.
l
l
l
l
l
l
From lateral to
medial side:
Iliopsoas muscle
Femoral nerve w/ circumflexes &
Femoral arteryperforating br
Femoral vein & great saphenous v br
Femoral canal
Deep inguinal lymph nodes
l
1.
2.
3.
FN
FA
FV
Sartorius m
Loop of bowel gets pulled downward into femoral canal, aberrant obturator a off
Dr. Mavrych,external
MD, PhD,
[email protected]
iliacDSc
would
cross bowel and becomes vulnerable
Laceration of the Femoral a can be compensated by the perforating branch of femoral a
and the lateral superior genicular a that anastamoses with the descending lateral
femoral circumflex a.
Femoral v ligation can be compensated via the great saphenous v
Rupture of the
cruciate ligaments
l
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Prepatellar bursa
Suprapatellar bursa
articularis
genu m
Potts fracture
l
l
l
It is fracture-dislocations of
the ankle joint
Reason - forced eversion
(abduction) of the foot
The Deltoid ligament
avulses the medial
malleolus and after that
fibula fractures at a
higher level
Pott's fracture
l
l
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l
l
l
21. Breast:
Carcinoma of the Breast
l
Lymphatic drainage
of the breast
Carcinomas of the
breast are malignant
tumors, usually
adenocarcinomas
arising from the
epithelial cells of the
lactiferous ducts in the
mammary gland
lobules
1. It enlarges, attaches
to suspensory
(Coopers) ligaments,
and produces
shortening of the
ligaments, causing
depression or dimpling
of the overlying skin.
75%
25%
It is important because
of its role in the
metastasis of cancer
cells.
Most lymph (> 75%),
especially from the
lateral breast
quadrants, drains to
the axillary lymph
nodes, initially to the
anterior (pectoral)
nodes for the most
part.
Most of the remaining
lymph, particularly from
the medial breast
quadrants, drains to the
parasternal lymph
nodes or to the
opposite breast.
Lymph from
breast->Interpectoral
"Rotter's" lymph nodes -> axillary lymph nodes->
Dr. Mavrych,
MD, PhD,
DSc [email protected]
clavicular nodes-> R lymphatic duct or L Thoracic duct -> subclavian vs >brachiocephalic vs -> SVC-> heart
Rotter's nodes are a way breast cancer can metastasize by bypassing axillary nodes
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Mastectomy
Breast infection
l
Diaphragm:
Paralysis of half and ruptures
C3, 4, 5 keeps the Diaphragm alive!
Paradoxical
movement: dome of
diaphragm of injured
side pushed superiorly
by abdominal viscera
during inspiration
Flail Chest: One or more broken ribs in two separate places instead of descending
upon inspiration the broken area will sink in as chest wall moves out
upon expiration the broken area will push out as chest wall moves in
Dangerous bc lungs can be punctured
Dr. Mavrych, MD, PhD, DSc [email protected]
l
Most vulnerable
structures intercostal
nerve and posterior
intercostal artery
because they are not
covering by ribs.
Phrenic nerve
Diaphragmatic ruptures
l
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P-A projection
Cardiac Shadow
Right 2 ICS
PSL
Left 2 ICS
PSL
Left 4 ICS
PSL
Left 5 ICS
MCL
A heart murmur is heard downstream
l
l
VALVE
ANAT.
AUSCULTATION SITE
Dr. Mavrych,
MD,
PhD,LOCATION
DSc [email protected]
P
3rd CC
2nd LT ICS
A
3rd ICS
2nd RT ICS
M
4th CC
cardiac apex (5th Lt ICS MCL)
T
4th ICS
Rt inferior most ST (5th RT ICS)
(3344)
(2255)
regurgitation
Dr. Mavrych, MD, PhD, DSc [email protected]
Stenosis
Aortic Systole (HOOT Dub)
Pulm Systole (HOOT Dub)
Tricuspid Diastole (Lub hoot)
Mitral Diastole (Lub hoot)
Regurgiation
Aortic Diastole (Lub hoot)
Pulm Diastole (Lub hoot)
Tricuspid Systole (hoot Dub)
Mitral Systole (hoot Dub)
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"Widow Maker"
Branches:
1. Anterior (descending)
interventricular artery most
common place of MI descends in the
anterior interventricular sulcus and
provides branches to the (1) anterior
heard wall, (2) anterior 2/3 of IV
septum, (3) bundle of His, and (4)
Great cardiac vein
apex of the heart.
2. Circumflex artery winds around the
left margin of the heart in the
atrioventricular groove to anastomose
with the right coronary artery
posteriorly; supplies the left atrium
and left ventricle
SA node RCA
AV node RCA
AV bundle (and
moderator band)- LCA
mo
When
l
a MI occurs, a coronary bypass
graft can be completed using the
internal thoracic artery (used to be Great
saphenous v)
Great cardiac v, middle cardiac v, small cardiac v, L marginal v drain into Coronary Sinus which empties in Triangle of Koch at RA
Ventricular Septal
Defect (VSD)
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Right lung:
10 bronchopulmonary segments
Superior lobe:
1. Apical
2. Anterior
3. Posterior
Middle lobe:
4. Lateral
5. Medial
Inferior lobe:
6. Superior
7. Anterior basal
8. Posterior basal
9. Lateral basal
10. Medial basal
1
3
2
6
10
9
1
l
2
l
9
6
Left lung:
9 bronchopulmonary segments
Superior lobe:
1. Apicoposterior
2. Anterior
3. Superior lingularsurrounds cardiac notch
4. Inferior lingular
Inferior lobe:
5. Superior
6. Anterior basal
7. Posterior basal
8. Lateral basal
9. Medial basal
Pneumonia is an inflammation
of the lung, caused by an
infection or chemical injury to the
lungs.
Three common causes are
bacteria, viruses and fungi.
Symptoms: cough, chest pain,
fever, and difficulty in breathing.
Chest x-rays: areas of opacity
(seen as white) of the lung
parenchyma and enlargement of
bronchomediastinal lymph
nodes (mediastinal widening).
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Bronchogenic Carcinoma
Bronchogenic carcinoma
may lead to:
1
l
l
Qs about Auscultation
and penetrated wounds
Bronchogenic carcinoma
may lead to:
3. Superior vena cava
syndrome, which causes
dilation of the head and
neck veins, facial swelling,
and cyanosis Blue Face & arm
4. Dysphagia as a result of
esophageal obstruction
5. Hoarseness as a result of
recurrent laryngeal nerve
involvement
6. Paralysis of the
diaphragm as a result of
phrenic nerve involvement
3
6
2. Costodiaphragmatic Recess is
deepest place in pleural cavity, around
the chest wall, there are two rib
interspaces separating the inferior
limit of parietal pleural reflections from
the inferior border of the lungs and
visceral pleura:
Midclavicular line - between ribs 6-8
Midaxillary line - between ribs 8-10
Paravertebral line between ribs 10-12
1.
2.
3.
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31. Mediastinum
Superior
p
mediastinum
Improperly done
sternal puncture
may affect
structures related
to the posterior
surface of the
manubrium
sternum:
l In upper part
Left
brachiocephalic
vein
l In lower part
Aortic arch
Azygous vein and ascending
aortic arches
Trachea and Pulmonary artery
bifurcations
esophagus and thoracic duct
change directions (cross over)
l
Cervicothoracic Stellate Gangion down to T11 and Subcostal sympathetic ganglion comprise the thoracic
Ribs 1-2 down to transverse thoracic
sympathetic trunk
Dr. muscles
Mavrych,ofMD,
DSc [email protected]
PhD,(T2)/Plane
DSc [email protected]
of ludwig/angle of louis
Innervate
the PhD,
ribs, abdominal
wall, pulmonary and cardiac plexus, and esophageal plexus Dr. Mavrych, MD,plane
Vagus CNX assists plexus of thorax for vocal cords and swallowing, and gives off recurrent laryngeal and
superior external laryngeal to the larynx muscles
Thoracic duct
RL
RI
LH
LL
LI
of abdominal
Camper's Fascia, Scarpa's Fascia, Galludets Fascia (superficial
Ext oblique),
Oblique
\\//, (deep ext oblique, superficial int oblique),
Dr. Layers
Mavrych,
MD, PhD, wall:
DSc Skin,
[email protected]
Dr. Mavrych,
MD,Ext
PhD,
DSc m
[email protected]
Inter Oblique m //\\, (deep int oblique, superficial transversalis ab), Transversalis abdominus m, deep TA fascia, Extraperitoneal fat, parietal peritoneum
.
Arcuate line is where lateral abdominal ms tendons merge with Rectus abdominus (linea semilunaris), Above arcuate line int oblique superficial fascia is above rectus abdominus (3 layers
of fascia), Below arcuate line ALL fascias above rectus abdominis (6 layers) typically inferior to umbilicus
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33. Herniations
Hernia consist of 3 parts:
PortalMD,
Caval
anastamosis
of paraumbilical veins off hepatic portal v with superficial
Dr. Mavrych,
PhD,
DSc [email protected]
epigastric veins (Caput Medusae- swiggly veins on belly button)
Important SUPERFICIAL
ARTERIES ((supply
supply skin)
skin are:
1.
Superficial epigastric
from femoral a
2.
Superficial circumflex iliac
T5-T11
T12
L1
Dr. Mavrych, MD, PhD, DSc [email protected]
aponerocis of internal
oblique fascia and
tranversalis fascia
TIE ICE
Transversalis Fascia becomes Internal Spermatic Fascia
Dr. Mavrych, MD, PhD, DSc [email protected]
Internal Oblique m & Fascia becomes Cremasteric m & Fascia
External Oblique fascia becomes External Spermatic Fascia
Surrounds the Spermatic cord within the inguinal canal:
3 as: cremasteric (inferior epigastric), ductus deferans (internal iliac-inferior vesicle),
gonadal a (aorta)
3 ns: genital br (motor genitofemoral), ANS, ilioinguinal
3 others: Pampiniform plexus (IVC and Lrenal), Ductus Deferens, Lymphatics
Process Vaginalis/Gubernaculum
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Consist of 2 ligaments:
l hepatogastric
l hepatoduodenal
Contents :
l Right & Left gastric
vessels
l Connective and fatty
tissue
and Portal triad:
l Bile duct
l Portal vein
l Proper hepatic artery
Posteriorly: IVC
Superiorly: Caudate
lobe of the liver.
Culdocentesis
In women only!
l
l
Rectouterine pouch
(pouch of Douglas):
deeper point of
peritoneal space in
vertical position of the
female body between the
rectum and the cervix of
uterus.
It is space of the pelvic
abscess location.
Vesicouterine pouch
Culdocentesis is
aspiration of fluid from
the cul-de-sac of
Douglas (rectouterine
pouch) by a needle
puncture of the
posterior vaginal
fornix near the midline
between the uterosacral
ligaments
Because the
rectouterine pouch is
the lowest portion of
the female peritoneal
cavity, it can collect
inflammatory fluid
(pelvic abscess).
Males have a vesicorectal pouch, fluid can accumulate in these peritoneal areas if there is a pelvic abscess.
Dr. Mavrych, MD,
PhD, DSc
[email protected]
Dr.kidney
Mavrych,
Morrison's
pouch
is where fluid accumulates if the person is lying down (between
and MD,
liver)PhD, DSc [email protected]
FOREGUT
MIDGUT
HINDGUT
Esophagus
Transverse colon
Duodenum (2nd, 3rd,
(distal 1/3)
Stomach
4th
Descending colon
Duodenum (1st and
parts)
Sigmoid colon
2nd parts)
Jejunum
Rectum (anal canal
Ileum
Liver
above pectinate line)
Cecum (with
Pancreas
Appendix)
Biliary apparatus
IMV to splenic v to
Ascending colon
Gallbladder
hepatic portal v to liver
1st part duodenum is
Transverse colon
to IVC
suspended by greater
(proximal 2/3)
SMV joins splenic v to
omentum and hepato
form hepatic portal v
2nd part of duodenum is
duodenal lig
where Spincter of Oddi/
Ampula of Vader/major
papilla of the Wirsung major
Dr. Mavrych, MD, PhD,
DSc [email protected]
Pancreatic
duct empties
along with the common bile
duct
MIDGUT
HINDGUT
Artery: CA
Artery: SMA
Artery: IMA
Parasympathetic
innervation: vagus
nerves, CNX
Parasympathetic
innervation: vagus
nerves, CNX
Parasympathetic
innervation: pelvic
splanchnic nerves, S2-S4
Sympathetic
innervation:
Preganglionics: greater
splanchnic nerves, T5-T9
Postganglionics:
celiac ganglion
Sympathetic
innervation:
Preganglionics: lesser
splanchnic nerves, T10T11
Postganglionics:
superior mesenteric
ganglion
Sympathetic
innervation:
Preganglionics: lumbar
splanchnic nerves, L1-L2
Postganglionics: inferior
mesenteric ganglion
Sensory Innervation:
DRG T5-T9
Sensory Innervation:
DRG T10-T11
Sensory Innervation:
DRG L1-L2
Referred Pain:
Epigastrium
Referred Pain:
Umbilical
Referred Pain:
Hypogastrium
Dr. Mavrych,
DSc [email protected]
Retroperitoneal
Organs: MD,
SAD PhD,
PUCKER
Suprarenal glands, Aorta, Duodenum (2-3rd), Pancreas, Ureters, Colon, Kidneys, Esophagus, Rectum
DPC are secondary retroperitoneal
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Colon
l
2.
3.
l
Appendices epiploic
Sacculations
(haustrations)
Taeniae coli
The taeniae coli meet
together at the base of
the appendix where they
form a complete
longitudinal muscle coat
for the appendix.
1.
It is seen in infants
and the mortality rate is
high because of left
lung hypoplasia.
39. Meckel's
diverticulum
Outpouch of intestines into rectum
Hernia of stomach or
intestine through a
posterolateral defect
in diaphragm
(foramen of
Bochadalek).
1
3
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Mc Burney's point
It is a point at the
junction between the
lateral 1/3 and
medial 2/3 of a line
joining the right
anterior superior iliac
spine with the
umbilicus.
McBurney's point lies 2/3 from umbilicus to ASIS OR 1/3 from ASIS to umbilicus
Dr. Mavrych, MD, PhD, DSc [email protected]
Dr. Mavrych, MD, PhD, DSc [email protected]
42. Volvulus
l
l
l
l
l
3
2
l
l
l
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1st off Celiac Trunk
4
3
1
2
l
2
1
l
l
Gastroduodenal artery
2
l
Splenic artery
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5
1
3
6
2
4
SMA Branches:
l (1) Inferior
pancreaticoduodenal
arteries
l (2)Jejunal and
(3)
Ileal branches
l (4) Ileocolic artery
l Ascending branch
l Anterior cecal artery
l Posterior cecal artery
l (5) Appendicular
artery
l (6) Right colic artery
l (7) Middle colic artery
Mesenteric ischemia
l
IMA Branches:
l (1) Left colic artery
l (2) Sigmoid arteries
l (3) Superior rectal artery
Biliary system
Sphincter of Oddi
Ampula of Vader
Amp
Tumor in the head of the pancreas can block the duct and cause jaundice
Dr. Mavrych, MD, PhD, DSc [email protected]
Blockage of the cystic or common bile duct via gall stones can cause gall bladder rupture w/ refered
pain to the shoulder (C3-5 phrenic n), and backflow of pancreatic enzymes that digest the pancreas
and the spleen via splenic artery branches
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Cholelithiasis (gallstones)
l
2
l
Gall stone
the cystic
will cause backflow to the gall bladder (burst)
Dr. Mavrych,
MD,inPhD,
DScduct
[email protected]
Gallstones
l
BUT NOT jaundice bc Common bile duct is still releasing bile properly to the stomach
Portal hypertension is a
common clinical condition, and
for this reason portal-systemic
anastomoses should be
remembered.
l
l
l
Dr.
Diverting blood from portal venous system to the systemic venous system by creating a
communication between the hepatic portal vein and the IVC.
Mavrych,
MD,
PhD,
DSc [email protected]
Side to side
shunts
connecting
the portal system to the IVC, End to side connection with
separation and connection of end and head of portal caval system to IVC. And typical
splenorenal central shunt all allow portion of blood to IVC to decrease flow to liver.
Esophageal anastomosis
l
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Rectal anastomosis
Umbilical anastomosis
l
Superior Rectal vein (IMV) anastomoses with middle and inferior rectal vs (internal iliac v &
Dr. Mavrych,
PhD,v)DSc
internalMD,
pudendal
[email protected]
portal hypertension Rectal varices (Hemorrhoids)
Internal hemorrhoids are painless superior to pectinate line at internal rectal venous plexus.
External hemorrhoids are painful due to blockage of external rectal venous plexus, where
Nociceptors (pain) are located.
48. Pancreas:
Head and uncinate process
l
2nd part of
duodenum
Dr. Mavrych,
MD, PhD,
[email protected]
pancreas
and theDSc
spleen
via splenic artery.
3
1
Posterior to the
neck of the
pancreas is the site
of formation of the
PORTAL VEIN.
VEIN
(1)Splenic vein
joins with (2)
superior
mesenteric vein to
form (3) portal vein.
1
3
2
2
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Annular Pancreas
l
l
1.
2.
3.
l
l
l
3
1
2
(1) Superior
pancreaticoduodenal arteries - Off Common
Hepatic a of
branches of gastroduodenal
Celiac trunk
artery.
(2) Inferior pancreaticoduodenal
arteries - branches of SMA
This region is important for
collateral circulation because
there are anastomoses between
these branches of the CA and
SMA.
pancreas:
Pancreatic branches of the (3) Off celiac trunk
Splenic artery.
49. Spleen:
RUPTURE
Rapture of the Spleen
l
l
l
Prenatally the spleen is primary source for hematopoiesis, post birth it is site of RBC
Dr. Mavrych, MD, PhD, DSc [email protected]
sequester, destruction, and filtration, it produces lymphoctyes and immune
surveillance, it recycles iron and globin. (Not vital organ)
The spleen has gastric, colic, renal, and costal impressions. It contains many
lymphatic nodules, red pulp (blood sinuses) and white pulp (germinal centers).
50. Kidney:
Dimensions and position
l
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Anterior relations
of the right kidney
APICAL
Pouch of Morison
ANTEROSUPERIOR
L2
ANTEROINFERIOR
Anterior relations
of the left kidney
1. Right suprarenal gland pyramidal
2. 2nd part of the
duodenum
3. Right lobe of the liver
4. Right colic flexure ascending colon to
5. Small intestine
transverse colon
Short renal v and Long renal a
INFERIOR
1.
2.
3.
4.
Perinephric abscess
Pus around the kidney within the perinephric/renal fascia
51. Nephrolithiasis
l
3 constrictions of ureter:
1
l
l
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Staghorn calculi
3
2
l
1
4
53. Varicocele
l
l
It is enlargement of the
pampiniform plexus that
produces a wormlike scrotal
mass and enlargement of the
spermatic cord. Varicocele
may be reason of low sperm
count.
Varicocele formation is usually
on the left side and may
disappear in supine position
of the body.
Varicocele may indicate
kidney disease or may signal
a retro peritoneal malignancy
obstructing the testicular
vein.
Pampiniform plexus
54. Hydrocele
l
the left.
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55. Hemorrhoids:
Venous drainage from rectum
l
External hemorrhoids
Internal hemorrhoids
2
2
2
2. Internal hemorrhoids
are dilated tributaries of the
superior rectal veins
(SRV) ABOVE THE
PECTINATE LINE and are
not painful because the
mucosa is supplied by
visceral afferent fibers.
Internal hemorrhoids
frequently develop in
chronic alcoholics
because of liver cirrhosis
and portal hypertension
syndrome.
Urine leaks
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3
1
58. Cystocele
(hernia of bladder)
Sup
Suprapubic
aspiration:
l Urine can be removed from
the bladder without penetrating
the peritoneum by inserting a
needle JUST ABOVE the
pubic symphysis.
l The needle passes
successively through skin,
superficial and deep layers of
superficial fascia, linea alba,
transversalis fascia,
extraperitoneal connective
tissue, and wall of the bladder.
Prostatectomy
A prostatectomy may be performed
through a suprapubic [1] or
perineal [2] incision or
transurethrally [3].
l Because of damage to nerves in
1
the capsule of the prostate and
around the urethra (cavernosus
nerves) can cause impotence
(erectaile dysfunction) and/or
urinary incontinence.
l Pelvic splanchnic nerves may be
3
injured in case of intensive
dissection of pelvic lymph nodes
Transurethral
(prostatic cancer ectomy) and as
resection of the
th
result autonomic innervation of
prostate = TURP
TUR
derivate of hindgut may be
allows preservation of affected.
neurovasculature
l
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1. Internal urethral
sphincter is made of
smooth muscles in the
neck of the bladder
and has sympathetic
innervation
2. External urethral
sphincter has skeletal
muscle fibers and
surrounds the
membranous part of
urethra, supplied by
the perineal branch of
the pudendal nerve
The 1st and 2nd parts of the urethra are urogenital endoderm and the external urethra meatus is ectoderm
The ductus deferens is intermediate mesoderm of the remaining mesonephric duct/tubules
Dr. Mavrych, MD, PhD, DSc [email protected]
Dr. Mavrych, MD, PhD, DSc [email protected]
Muscle of the bladder is Detrusor m, the urinary trigone is where the
entrance of the 2 ureters and exit of bladder meet. Internal urethral
sphincters are involuntary.
1
2
Dr. Mavrych,CREMASTERIC
MD, PhD, DSc [email protected]
REFLEX: Genitofemoral
Dr. Mavrych,
PhD, DSc
[email protected]
nerve L1-2, Genital branch:
withinMD,
inguinal
canal
with the cremasteric m and fascia acts as
motor division to pull testis up. Femoral branch is the sensory division of the reflex that is stimulated by touch and temperature
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Micturition reflex
Facilitating emptying:
l Parasympathetic fibers (pelvic
splanchnic nn.) stimulate
DETRUSOR MUSCLE [1]
contraction and involuntary relax
internal sphincter [2].
l Somatic motor fibers (pudendal
nerve) cause voluntary
relaxation of external [3] urethral
sphincter.
Inhibiting emptying:
l Sympathetic fibers (sacral
.) inhibit detrusor
splanchnic nn.)
muscle [1] and stimulate
internal sphincter [2].
66. Cryptorchism
l
Undescended testes
(cryptorchism) when the testes
fail to descend into the scrotum.
This normally occurs within 3
months after birth.
The undescended testes may be
found in the abdominal cavity or
in the inguinal canal.
If neglected, malignant
transformation may occur in the
undescended testis.
N.B. In case of cryptorchism,
spermatogenesis is arrested
and the spermatogenic tissue is
damaged leading to permanent
sterility in bilateral cases.
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Deep inguinal nodes-> superficial inguinal nodes-> internal & external iliac nodes-> lumbar nodes-> paraaortic nodes-> thoracic duct
Hysterectomy
l
Hysterosalpingography
of the uterus
Ampulla
l
Isthmus
l
Uterine part
l
Medial continuation of
infundibulum comprising
about half of uterine tube
Usual site of fertilization
Infundibulum
l
Funnel-shaped expansion
of lateral end, fringed with
fimbriae
Overlies ovary and
receives oocyte at
ovulation
The instillation of
viscous iodine
through the
external os [1] of
the uterine cervix
allows the lumen of
the cervical canal
[2],, the uterine
cavity [3],, and the
different parts of
the uterine tubes
[4] to be visualized
on X-ray.
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Posterior Division
1. Obturator
1. Iliolumbar
2. Umbilical
w/ superior
vesicle of bladder
3 Inferior gluteal
goes back up
2. Lateral sacral
to medial sacral a
3. Superior gluteal
4. Internal pudendal
alcock's canal
to medial sacral a
obturator canal
gluteus maximus
maxi
urachus
bladder
6. Middle rectal
7. Uterine (females)
coccygeus m
ductus deferens
genitals
Craniosyntosis-FGFR2 gene mt
Bean Bleed
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2
l
1
l
Septicemia leads to
meningitis and cavernous
sinus thrombosis, both of
which can cause neurological
damage and are lifethreatening. bacterial infection response
Facial v (cheeks)-> angular v (lateral nose)-> opthalmic v (super& inferior eye)-> Cavernous sinus (BRAIN)
Manifestations:
l unable to close lips and eyelids on affected side
l eye on affected side is not lubricated (dry eye)
l unable to whistle, blow a wind instrument, or chew effectively
l facial distortion due to contractions of unopposed contralateral facial
muscles
Lesion of CNVII at internal acoustic meatus causes no saliva/tears, hyperacoustics (stapedius m),
imbalance and distorted hearing (CNVIII)
Mavrych,
MD,ganglion
PhD, DSc
[email protected]
LesionDr.
past
geniculate
causes
hyperacoustics and Bell's
Lesion at chorda tympani causes no taste, no saliva from submandibular& sublingual glands
Lesion at stylomastoid foramen causes Bells
Infraorbital
foramen
CNV1:
sensory
to forehead,
sinuses, nose, dilator pupillae (SNS) and sensory
Dr. Mavrych,
MD, PhD,
DSc
[email protected]
blinking reflex, (VII is motor)
CNV2: sensory to cheeks, nose, upper mouth, tears (SNS/PNS)
CNV3: sensory to chin, lower mouth, ant 2/3 tongue (taste is VII), ears, scalp,
muscles of mastication
80. Epistaxis
l
Epistaxis (nosebleed)
most often occurs from
the anterior nasal septum
(Kiesselbach's area),
where branches of the
sphenopalatine,
anterior ethmoidal,
greater palatine, and
superior labial (from
facial) arteries converge.
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81. Sinusitis
Sphenoiditis
Ethmoiditis
l
Relationships of the
sphenoidal sinus are clinically
important ; because of potential
injury during pituitary
surgery and the possible
spread of infection.
Infection can reach the sinuses
through their ostia from the
nasal cavity or through their
floor from the nasopharynx.
Infection may erode the walls to
reach the cavernous sinuses,
pituitary gland, optic nerves,
or optic chiasma
83. Cheeks
l
1
2
3
l
All 4 muscles of
mastication are
innervated by V3:
1. Temporalis
elevation &
retraction
2. Masseter - Strong
elevation
3. Medial
closes jaw
pterygoid elevation
4. Lateral Only muscle to
pterygoid -open jaw/mouth
protrusion
Tensor veli palatini m prevents inhale of food and equalizes the air
Dr. Mavrych, MD, PhD,
DSc [email protected]
pressure
protect tympanic membrane
Tensor tympani dampens the sound from chewing
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Tonsillitis
l
Found between Faucel Pillars and become highly inflamed during infection
Tonsilectomy and adenoectomy can risk the tonsilar a and v.
.
Dr. Mavrych, MD, PhD,
DSc [email protected]
Dr. Mavrych, MD, PhD, DSc [email protected]
Pharyngeal,
Tubal, Palatine, Lingual Tonsils (Waldeyer's ring of lymph tissue)
90.
Blow-out fracture
No look down, no sensation to upper mouth and
bleeding from branch of external carotid a
l A blow-out fracture of the
orbital floor typically is not
involve the orbital rim and is
caused by blunt trauma to the
orbital contents (e.g., by a
handball). Content of orbital
cavity blow-out in maxillary
sinus.
l Blow-out fractures may damage:
1.
Inferior rectus muscle
2.
Infraorbital nerve (from
maxillary V2)
Branches of External Carotid Artery
3.
Infraorbital artery
Some = Superior Thyroid A.
(hemorrhaging).
Angry = Ascending Pharyngeal A.
Lady = Lingual A.
Found = Facial A.
Dr.Out
Mavrych,
MD,A.PhD, DSc [email protected]
= Occipital
P = Posterior Auricular A.
M = Maxillary A.
S = Superficial Temporal A.
Muscle
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
Superior oblique
Inferior oblique
Levator pulpebra superior
Action
Elevates and adducts
pupil
Depresses and adducts
pupil
Adducts pupil
Abducts pupil
Depresses and abducts
pupil
Elevates and abducts
pupil
Elevates upper eyelid
Innervation
CN III
CN III
CN III
CN VI
CN IV
CN III
CN III
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inferior oblique is
unopposed so eye looks
up and out
Dr. Mavrych, MD, PhD, DSc [email protected]
Perforation of the
Tympanic Membrane
May result from otitis media and is
one of several causes of middle ear
(conduction) deafness
l Causes: foreign bodies in external
acoustic meatus, excessive pressure
(as in diving), trauma
l Because chorda tympani directly
Pars flaccida relates to the posterior surface of the
tympanic membrane it may be
damaged and resulting in loss of
taste over anterior 2/3 of the tongue
Umbo
and secretion of the sublingual and
refracted cone of light
submandibular glands
l Minor perforation heal spontaneously;
pars tensa
large ones require surgical repair
l
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Anatomical relations
of tthe
o
e thyroid
t y o d gland
ga d
Hormones:
l The thyroid gland is the body's largest endocrine
gland. It produces thyroid hormone (T3 & T4),
which controls the rate of metabolism (increase
the temperature of the body), and calcitonin, a
hormone controlling calcium metabolism (reduce
decrease osteoclasts
blood calcium Ca2+).
l After total thyroidectomy may develop lower
temperature of the body and hypercalcemia.
l
1
l
Anterolateral
infrahyoid muscles
Posterolateral
COMMON CAROTID
ARTERY [1]
Medial larynx,
TRACHEA [2],
pharynx, esophagus,
cricothyroid muscle,
recurrent laryngeal
nerve [3]
Posterior
parathyroid glands
[4]
CS of the neck
Carotid Sheath
& CNX
Buccopharyngeal membrane
RETROPHARYNGEAL SPACE
Alar Fascia
DANGER ZONE
Prevertebral fascia
Variation of parathyroid
glands position
l
96. Larynx
3
1
2
1
2
Piriform recess at hyoid-> epiglottis is where small sharp objects get stuck
Zenker's
is outpouch of pharynx at inferior constrictor where food gets caught
Dr. Mavrych, MD,
PhD,Diverticulum
DSc [email protected]
in killians triangle and gets infected leading to hallitosis (bad breath)
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Cricothyrotomy
Transverse arytenoid (whisper), Thyroarytenoid (low pitch), vocalis (opera singer)- ADDUCTORS
Abductors
l Posterior cricoarytenoid
abducts vocal folds (the only
abductors of the vocal folds)
l It is innervated by recurrent
laryngeal nerve (CNX
vagus).
Most intrinsic ms of the larynx
Interruption of recurrent
laryngeal nerve results in
hoarseness because the
corresponding vocal fold
does not abduct and deviate
toward the midline.
A cricothyrotomy is an emergency
procedure that relieves an airway
obstruction (e.g. swallowed foreign
bodies or abnormal tissue growths).
A hollow needle is inserted into the
midline of the neck, just below the
thyroid cartilage (needle
cricothyrotomy).
More frequently, a small incision is made
in the skin over the Cricothyroid
membrane, and another one is made
through the membrane between the
cricoid and thyroid cartilage.. A tube
that enables breathing is inserted through
the incision.
Dr. BRACHIAL
Mavrych, MD, PLEXUS
PhD, DSc [email protected]
BRANCHES:
MARMU, LT, DS, SS, SC, LP, MP, AP, USS, TD, LSS, Mca, Mcf
CN XI
Good Luck!
Carotid Triangle of the Neck:
Posterior digastric, omohyoid, SCM
Contains: Internal jug v, common carotid, CNX