Advanced Anatomy Exam 2

Features of the lungs you may not see in the right lung

lingula

cardiac notch

renal pelvis leads to...

ureter

Geriatrics lose what?

glandular tissues as hormone levels decline

Parasympathetic and sympathetic pathways....

These types of ANS fibers merge on the airways as the pulmonary plexus

What nerves supply the intercostal muscles?

Intercostal nerves (T1-T11)

Right coronary artery

marginal artery (small vein)

posterior interventricular artery (middle vein)

The right atrium has...

entrances:

superior and inferior vena cava

coronary sinus (not a "great vessel")

exits:

tricuspid valve

Anatomy of an AV valve...

"lives " in the ventricle

There is also an affect force of the heart during conduction

...

Superior and posterior

are more complex

fascial layers of the anterior/lateral abdominal wall

Skin

superficial fascia

camper's fascia

scarpa's fascia

muscles and fascia

transversalis fascia

extrapertitoneal fat

parietal peritoneum

Abdominal regions of gut tube:

1) stomach, 2) small intestine, and 3) large intestine

retroperitoneal

were never in the cavity

Only the urogential organs are truly retroperitoneal

Retroperitoneal organs are located behind (posterior to) the peritoneum and are only partially covered by parietal peritoneum, usually on their anterior surface.

These organs are not suspended by mesenteries and are more fixed in place compared to intraperitoneal organs.

What major vessel off the abdominal aorta supplies the foregut?

Celiac trunk and artery

pylorus

distal region of the stomach, opening to the duodenum

round ligament of the liver (ligamentum teres)

was the umbilical vein; its continuatio was the ductus venosus that becomes ligamentum venosum

Gallstones

Small crystals that form from bile in the gallbladder.

Diaphragm with a central tendon (T8)

Which nerves supply it?

What spinal cord levels?

What three major hiatuses?

phrenic nerves

C3, C4, C5

IVF hiatus

Aortic hiatus (T12)

Esophageal hiatus (T10)

Ureters enter.... forming...

posterior-inferior aspect of bladder forming "physiologic sphincter"; not a true muscular sphincter (full bladder "sits down" on ureter)

important because kidneys are sterile

Three parts of the sternum?

manubrium, sternal body, xiphoid process

Which # rib articulates at the sternal angle?

2

Which ribs have their own costal cartilage attaching them to the sternum (hint relates to true ribs)?

Seven ribs have their own cartilaginous attachment to the sternum, called true ribs

in most older people, the rib cartilage turned to...

bone

The sternal angle is an important surface landmark

Rib two attachment

beginning and end of aortic arch

bifurcation of the trachea

same plane as T4-T5 IV disc

what rib feature articulates with the body of a thoracic vertebra?

Superior and Inferior Articular Facets

what rib feature joins with the transverse process of a thoracic vertebra ?

Transverse Process Facet

What defines a true rib?

own cartilaginous attachment to the sternum

How many pairs?

7

Floating ribs are what?

a subdivision of false ribs

How many pairs of false ribs?

5

How would you define false ribs?

The false ribs include rib pairs 8-12. borrow or use the cartilage of rib 7

The floating ribs (11-12) are the last two pairs of false ribs, but unlike the other false ribs, they do not attach to the cartilage of the preceding ribs on the anterior side. Instead, they attach posteriorly to the thoracic vertebrae and "float" without attaching to the costal cartilage

Rib head attaches where?

to costal facets (or demifaces for mid-ribs) of the thoracic vertebra of the same number (and the vertebra above, if attaching to demifacets between ribs)

Rib tubercle attaches where?

The transverse process of the thoracic vertebra of the same number

Uppermost and lowermost ribs attach where?

a single vertebra (of the same number)

Superficial thoracic muscles are upper limb muscles supplied by what?

brachial plexus

Deep thoracic muscles move what? Innervated by what?

move=chest wall

innervated by intercostal nerves (ventral rami of thoracic spinal nerves)

What is deeper, the pectoralis major or minor?

pectoralis minor

pectoralis major movement

humerus

pectoralis minor movement

scapula

Pectoralis major and minor are both supplied by what?

brachial plexus, since upper limb muscles

External intercostals are between what?

between ribs

membranous anteriorly (so internal intercostal can be seen through them)

intercostal muscle layers

external, internal, innermost

van is between internal and innermost (2 and 3)

Layer one of .....

The external intercostal has fibers that go "down and in" (membranous anteriorly as it approaches the sternum)

"hands in pocket"

muscle laterally, but as the approach tothe sternum becomes membranous

Layer two of...

internal intercostal has fibers that go perpendicular to external, so "down and out" (membranous posteriorly as it approaches spine)

"hands up"

muscle medially, but as it approaches laterally, it turns to membranous

"membranous" means what?

that there are areas in the layer lacking in muscle fibers

Layer three of..

innermost complex is transvers thoracics anteriorly, innermost intercostal laterally, and subcostal muscles posteriorly (all supplied by intercostal nerves)

subcostals on the inside of ribcage span...

innermosts intercostals and span more than two ribs (part of the innermost complex)

Levator costarum is where?

outside of the ribcage, and goes from the transverse processes to the ribs

What muscles are posterior to the ribcage?

Serratus posterior superior and inferior

levator costarum

Innermost complex

-all muscles are bilateral

-Innermost intercostal do not reach very far anteriorly

The internal thoracic artery descending within the anterior thoracic wall supplies...

muscles and skin of the anterior thorax (as well as breast)

deep (posterior ) side with deeper anterior chest wall muscles

transversus thoracis muscle (starfish)

internal intercostal muscle

innermost intercostal muscle

Transverse thoracis is a member of the...

innermost complex of chest wall muscles

The innermost intercostal is only found where? member of what?

only found laterally

belongs to the innermost complex

What is the muscle of normal, quiet breathing?

diaphragm

The diaphragm forms what?

"floor" of thorax

The central tendon is its insertion (the diaphragm inserts on itself)

The central tendon of the diaphragm is a thin but strong aponeurosis located near the center of the diaphragm muscle, slightly anterior to the vault formed by the muscle. It is shaped like a trefoil leaf, consisting of three leaflets separated by slight indentations, with the right leaflet being the largest. The central tendon is composed of several planes of fibers that intersect at various angles, giving it additional strength. It connects the diaphragm to the fibrous pericardium and plays a crucial role in respiration by allowing the diaphragm to contract and expand the thoracic cavity during inspiration.

What supplies the diaphragm?

phrenic nerve from cervical plexus (C3-C5 cord levels)

Cervial (C1-C4)

Hiatuses (openings/gaps) in the diaphragm for what?

inferior vena cave

aorta

esophagus

Anterior axillary fold is what muscle?

pectoralis major

back fold is what muscle?

latissimus dorsi

Costal arch

from the rib cartilage

can feel when sucking in

Jugular/suprasternal notch of manubrium

feels deeper on us then actaully is because of the attachment to the clavicle.

Female breast is mostly what?

fat

Cooper ligaments are?

Supsensory ligaments

supportive and separate lobule of fat (adipose)

Glandular tissue leads to what

lactiferous ducts

Ducts lead to what?

nipple; multiple openings there

Nipple dermatome level

T4

The female breast extends from?

extends from rib 2-6

Both males and females have what?

glandular tissue, but milk is produced only during lactation

Major arteries of breast

internal thoracic artery

lateral thoracic artery

posterior intercostal artery

Why does the breast need a rich blood supply (hint: what is breast milk derived from)

blood plasma, blood stream

Milk is made of calcium from blood plasma, which is created from what we eat and drink, and then goes into our bloodstream

Why do clinicians need to understand lymphatic drainage pathways? (What can travel in the lymph besides infection?)

lymph=fluid

A vein-like system that sucks in extra fluid

Cancer can spread

and then goes into the cardiovascular system

Thoracic spinal nerves- dosal ramus has..

cutaneous branch (supplies the longitudinal middle third of the back skin)

thoracic spinal nerves- ventral ramus of thoracic nerve has...

intercostal nerve, and has both lateral and anterior cutaneous branches (supplies the remainder of the trunk skin)

Thoracic spinal nerves- each has

accompanied by the cutaneous artery and vein

What does cutaneous mean?

through the skin

Why aren't C6 through C8 represented in the dermatome map at left?

HELP oing into the axillary to form the brachial plexus

What area/body part skin do those spinal cord levels serve (by the brachial plexus)?

HELP

If a patient had a fractured spine and severe spinal cord damage at the T4 level of the cord, would they have any feeling in the chest?

Yes they would, anything above T4 level, which is crucial for the center of reflexes and brain

Where would their cutaneous sensation terminate if they had a complete transection of the cord? (Hint: what body structure marks the T4 dermatome level?)

then all spinal levels below that point would lose sensory input, because the communication to the brain is cut off.

What lies in the intercostal space from superior to inferior?

intercostal vein, artery, nerve

These run between the second and third layers of the intercostal muscle complex, or in other words

They run between the internal intercostal muscles and the innermost complex

posterior intercostal veins drain into

azygos system of veins

Azygos system of veins

superior vena cava

anterior intercostal veins (tiny) drain into

internal thoracic vein

posterior intercostal arteries come off....

thoracic aorta

anterior intercostal arteries (tiny) come off..

the internal thoracic artery

Serous Membranes

1. line body cavities not open to the environment

2. Cover the organs within those cavities

The serous membrane is made of two connected layers

Parietal is the lining part (1)

visceral the covering part (2)

What does in situ mean?

in the original or natural position or place

The pleural cavity contains what?

thin layer of serous fluid

How are the visceral and parietal layers connected

negative pressure

These layers are sliding together, which is allowed by serous fluid.

kind of "stuck together"

Lungs are not....

not actually in the cavity but rather surrounded by it

Humans have how many pleural cavities

Humans have two separate pleural cavities (our only serous membrane that is paired). If one cavity is breached, only that lung collapses, which is called a pneumo- thorax.

parietal pleural regions

cervical/cupula

costal

diaphrgamatic

mediastinal

Costadiaphramagitc recess

"Potential space"

not a real space until lungs are disrupted

right lung

three lobes

two fissures (horizontal fissure and oblique fissure)

left lung

two lobes

one fissure (oblique fissure)

Trachea

at Carina, an internal

splits into...

The two primary bronchi

The two primary bronchi then split into...

secondary bronchi, one for each lobe,

right lung: 3 lobes = 3 bronchi

left lung: 2 lobes= 2 bronchi