Term
the mediastinum
- is the space in the __ found between the ___
- the mediastinum is divided into two parts: __ and __
- the __ mediastinum is divided even further into 3 parts: __, __, __ |
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Definition
- thorax; pleural sacs of the lungs
- superior; inferior
- inferior; anterior; middle; posterior |
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Term
superior mediastinum
- the superior mediastinum includes those structures located above the __, which is the junction of the __ with the body of the sternum. This is located at __ vertebral level.
- the sternal angle marks where the __ articulates with the sternum, the bifurcation of the __ into the __, and where the great vessels enter or exit the ___. |
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Definition
- sternal angle; manubrium; T4/T5
- second rib; trachea; right and left primary brochi; heart |
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Term
the contents of the superior mediastinum are generally organized into three groups:
- the __ primarily includes veins, as well as the thymus
- the __ is a majority of arteries
- __ consists of the visceral structures of the superior mediastinum |
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Definition
retrosternal structures, intermediate structures, prevertebral structures
- retrosternal structures
- intermediate structures
- prevertebral structures |
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Term
- retrosternal structures:
- intermediate structures:
- prevertebral structures: |
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Definition
- thymus; left brachiocephalic vein, superior portion of superior vena cava
- aortic arch, brachiocephalic truck, left common carotid artery, left subclavian artery
- trachea, esophagus, thoracic duct, left recurrent laryngeal nerve |
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Term
neurovasculature of the superior mediastinum
- the right and left recurrent laryngeal nerves arise from the branch of the __. These nerves provide sensory and motor innervation to the __.
- the __ follows a much shorter and oblique course after looping around the __. Therefore, it is not found within the __, but rather in the __
- the __ follows a somewhat longer path, looping under the __ |
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Definition
- vagus nerve; larynx (voicebox)
- right recurrent laryngeal nerve; subclavian artery; superior mediastinum; root of the neck
- left recurrent laryngeal nerve; arch of the aorta |
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Term
| remember the vagus nerves provide __ to organs in the thorax and most of the abdomdn |
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Definition
| parasympathetic innervation |
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Term
inferior mediastinum
- the anterior mediastinum contains only __ and a few vessels
- the middle mediastinum contains the __ and the __
- the posterior mediastinum runs parallel to the __, and contains numerous visceral structures such as the __, __, and __ |
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Definition
- fat, connective tissue
- heart; pericardial sac
- vertebral column; esophagus; trachea; thoracic duct |
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Term
middle mediastinum
- the most notable structure of the middle mediastinum is the __ and its associated vessels. |
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Definition
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Term
structures of the posterior mediastinum
- the structures in the posterior mediastinum can be remembered by:
- the __ is also found in this region, following the esophagus as it descends towards the abdomen. note that the __ has a __ and __ found on each respective side of the esophagus |
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Definition
- DATES: Descending aorta, Azygous/hemiazygous/accessory hemiazygous veins, Thoracic duct, Esophagus, Symphathetic trunk/ganglia
- vagus nerve; vagus nerve; right; left branch |
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Term
vasculature of the posterior mediastinum
- the __ and the __ both collect venous blood from intercostal veins before they each empty into the __ |
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Definition
| - accessory hemiazygos; hemiazygos veins; azygos vein |
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Term
thoracic cavity
- the thoracic cavity is an anatomical region found in the upper portion of what's known as the __. in general, the trunk refers to all structures found from just below the neck and above the upper boundary of the pelvis.
- the truck encases the __ and __
- the truck helps the body with __ and __
- connected to the truck via the vertebral column are a series of bones known as the __. these collectively form a barrier that surrounds the __, known as the __. the ribs are connected to each other by muscles that assist with __. finally, the thoracic skeleton is enclosed with __ that connects the terminal end of each rib to the sternum |
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Definition
- trunk
- thorax; abdomen
- stability; flexibility
- ribs; thorax; thoracic cavity; respiration; costal cartilage |
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Term
thoracic cavity
- the thoracic skeleton protects __ and __ organs, the most notable of which are:
- the thoracic skeleton also provides __ to the region, which resists __ generated by the lung during inspiration
-- during inspiration, the pressure in the lungs __ and air rushes in, __ the lungs. the __ maintains its shape and merely moves up and down during this process
- in addition, the point of attachment for muscles of the upper limbs are also found in the region of the __.
- altogether, the thoracic skeleton consists of __ thoracic vertebrae, __ pairs of ribs, and the __ |
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Definition
- thoracic; abdominal; lungs; heart; kidneys; liver; spleen; vasculature
- rigidity; negative pressure
-- decreases; expanding; rib cage
- thorax
- 12; 12; sternum |
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Term
| regions explored in the thoracic cavity are as follows: |
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Definition
| mammary glands; muscles of the thoracic wall; ribs; vasculature; innervation; lymphatics |
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Term
Mammary glands
- in females, the mammary glands are situated over the __ and the __ muscles, one on either side of the sternum. beneath the skin, they are primarily composed of __, which gives the breasts their shape
- the mammary glands are in fact modified __ glands, each consisting of the following components:
1. the __ which is made of __, is arranged in a circular pattern. The smooth muscle allows for the nipples to become __. The surface is fissured and contains the terminal end of the __, which contain milk.
2. __ are __ that resemble small bumps often found around the nipple. they secrete __ during pregnancy, which helps to lubricate and protect the nipple while lactating.
3. the __ is the darker pigmented area of the breast. They contain the nipple as well as the areolar glands. |
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Definition
- pectoralis major; serratus anterior; adipose (fatty) tissue
- sweat
1. nipple; smooth muscle; erect; lactiferous ducts
2. areolar glands; sebacceous glands; oil
3. areola |
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Term
mammary gland
- the mammary glands rest on the __ which separates the fatty tissue of the gland from the underlying musculature and bone.
-- there is a thin area between the gland and deep fascia that doesn't contain any __. this allows the gland to ___.
- the mammary gland is firmly attached to the overlying skin by the __
- milk secreting cells are arranged into groups of alveoli at the end of ___, aka ___
- the __ lead to the __ which expand during puberty and __ is deposited around them
- before the lactiferous ducts open at the surface of the nipple, there is an area of swelling that is used to store milk prior to it being released. These areas are known as ___ |
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Definition
- deep investing fascia of the pectoralis major
-- fat; move smoothly over the muscle
- suspensory ligaments
- lactiferous ducts; lactiferous or mammary glands
- lactigerous glands; lactiferous ducts; fat
- lactiferous sinus |
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Term
pectoralis major
- makes up the bulk of the musculature of the __ in males, and lies immediately posterior to the __ in females
- the pec major primarily functions in keeping the __ connected to the __
- this muscle is also primarily responsible for the movement of the shoulder joint in 4 different ways:
1. __ of the humerus
2. __ of the humerus
3. __ of the humerus
4. aids in the process of __ |
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Definition
- chest; breasts
- upper limb; trunk
1. flexion
2. adduction
3. internal rotation
4. inspiration |
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Term
pectoralis minor
- located in the upper part of chest, deep to pec major, it is attached to the __ which is a small hook-like structure on the lateral edge of the superior and anterior portion of the scapula, and is attached distally to ___
- pectoralis minor has two functions:
1. pulls __ downward by pulling on the __, therefore rotating the __ __
2. assists in __ by pulling on the __
- remember that the pec minor was an important landmark in defining the __ of the __ |
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Definition
- coracoid process; ribs 3,4, and 5
1. scapula; coracoid process; glenoid fossa; inferiorly
2. respiration; ribs
- 2nd division; axillary artery |
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Term
innervation of pec major and minor
- the pec major and minor muscles have 2 nerves that innervate them, both of which branch off the __:
1. __ only innervates the pec major
2. __ innervates both pec major and pec minor |
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Definition
- brachial plexus
1. lateral pectoral nerve
2. medial pectoral nerve |
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Term
serratus anterior
- this muscle attached to the anterior portion of the medial border of the __
- has two different actions
1. __ and __ of the scapula
2. also assists in ___ |
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Definition
- scapula
1. upward rotation; protraction
2. respiration |
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Term
typical rib
- there are a total of __ ribs
-- ribs ___ are considered true ribs and connect to the __ via the __
-- ribs __ are false ribs and attach to the ribs above from the ___
-- ribs __ are floating ribs, and __
- only ribs __ are considered typical ribs.
-- this is because __ and __
- each rib consists of __, __, __, __ |
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Definition
- 12
-- 1-7; sternum; costal notches
-- 8-10; costal cartilage
-- 11-12; do not have any attachments
- 2-10
-- rib 1 is atypical in shape; ribs 11 and 12 are floating
- head, neck, tubercle, and shaft |
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Term
typical rib
- there are 3 main parts of each rib, which are associated with how the ribs connect with the __, and then travel around to join the __
1. the first part of each rib, the __, articulates with the body of the vertebrae to which each rib attaches
- next, the __ articulates with the __ of the same vertebrae
- finally, the __ articulates anteriorly with the __ via __ |
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Definition
- vertebrae; sternum
1. head
- tubercle; transverse process
- terminal part of the shaft; sternum; costal cartilage |
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Term
muscles of the thoracic wall
- the muscles of the thoracic wall are found between the ribs and function to __.
- from superficial to deep, they are __, __, __
- the external intercostal muscles are replaced anteriorly by the __. The internal intercostal muscles are replaced posteriorly by the __ |
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Definition
- elevate the ribs during respiration
- external intercostals; internal intercostals; innermost intercostals
- external intercostal membrane; internal intercostal membrane |
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Term
The thoracic wall
- the external intercostal muscles have a __ orientatoin
- the internal intercostal muscles run in the __ direction as they extend from the __ around to the angle of the ribs where they become a membrane
- note that the membrane of the external intercostal muscles is close to the __, while the membrane of the internal intercostal muscles is close to the ___ |
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Definition
- hands in pocket
- opposite; sternum
- sternum; vertebrae posteriorly |
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Term
three types of innermost intercostals
- the innermost intercostals can be broken down into 3 muscles linked by a membrane: __, __, __ |
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Definition
| - transversus thoracis; innermost intercostals; subcostals |
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Term
three types of innermost intercostals
- transversus thoracis: attach to the back of the __ and __. they may skip up to __ before reattaching
- innermost intercostals: similar in direction to the __, but are separated from this muscle by an __. they can be found along the __
- subcostals: easy to identify because they cross __ before attaching to __, and are found __ near the angle of the rib. |
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Definition
- sternum; xiphoid process; two ribs
- internal intercostals; intercostal neurovascular bundle; mid-axillary line
- one rib; another; posteriorly |
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Term
the thoracic wall
1. external intercostal muscles: __ ribs (__); supports __; stabilizes __
2. internal intercostal muscles: __ ribs (__); supports __; stabilizes __
3. innermost intercostal muscles: __ ribs (__) |
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Definition
1. raises (inspiration); intercostal spaces; chest wall
2. lowers (expiration); intercostal spaces; chest wall
3. raises (inspiration) |
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Term
arterial supply to the posterior thoracic wall
- the __ travels around the posterior and lateral sides of the thorax, and then anastomoses (communicates) with the __ anteriorly
- the anterior intercostal artery arises from a different arterial source, the __, which branches from the __
- note that there is __ and __ on each side of the thorax |
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Definition
- posterior intercostal artery; anterior intercostal artery
- internal thoracic artery; subclavian artery
- arterial; nerve supply |
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Term
components of the intercostal space
- there are intercostal vessels and an intercostal nerve located under each rib, this is referred to as the __ which protects the __ from the top to bottom, leaving the __ the least protected.
- the neurovascular bundle is comprised of 3 components: |
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Definition
- costal groove; neurovascular bundle; intercostal nerve
- Vein, Artery, Nerve (VAN) |
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Term
thoracic aorta
- the __ is the largest vessel that leaves the heart. it arises from the __, and supplies the ___ and __ with blood
- the __ is a continuation of the ascending aorta. at this point, blood supply to the heart itself has branched so the aorta arch supplies blood to the __
- following the aortic arch is the __ in the region of the thorax. this portion supplies the __, __, __, and the __ below the __
-- the __ passes through the __ of the diaphragm and becomes the __ in the abdomen |
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Definition
- ascending aorta; left ventricle of the heart; heart; entire body
- aortic arch; rest of the body
- descending aorta or thoracic aorta; thoracic wall; lungs; posterior mediastinum; body; diaphragm
- thoracic aorta; aortic hiatus; abdominal aorta |
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Term
venous drainage of the thoracic walls
- venous drainage of the thoracic walls is __ and __. this system is known as the __, which drains each side __ but the 2 halves join in a pattern resembling __
- the __ forms on the right side and drains the thoracic and posterior abdominal walls. The __ on the right side drain directly to the __.
- the __ and __ form the left side of the system
-- normally the __ drains into the __ between vertebra __, while the __ drains into the __ around __
- the upper 3 or 4 interspaces are drained by the __ |
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Definition
- indirect; segmental; azygous system: seperately; H
- azygous vein; posterior intercostal veins; azygous vein
- accessory hemiazygous vein; hemiazygous vein
- hemiazygous vein; azygous vein; T8-T10; accessory hemiazygous vein; azygous vein; T7
- superior intercostal veins |
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Term
lymphatic drainage
- lymph is formed at the __, then percolates between cells to take up wastes and is collected by the lymphatic system.
- it is important to understand that there are 2 routes for drainage back to the heart: the __ and __ drain into the junction of the __ and the __ on their respective sides
- the __ drains lymph from the right upper limb, right side of the head and neck, and also the right side of the thorax. this makes up about __ of the body
- the __ empties the remaining 3/4 of the body. lymph from the abdomen and the lower limbs are collected at the __, located just under the diaphragm. this is where the __ begins |
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Definition
- post-capillary venules
- right lymphatic duct; thoracic duct; internal jugular vein; subclavian veins
- right lymphatic duct; 1/4
- thoracic duct; cisterna chyli; thoracic duct |
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Term
the __ is a skeletal muscle that extends across the bottom of the rib cage and seperates the thoracic cavity from the abdominal cavity. it is innervated b the __ from the __
- there are two distinct asymmetric domes that can be seen when viewing the muscle, the __ and __ dome. the diaphragm is important for __. __ occurs by contracting or flattening the diaphragm. this enlarges the thoracic cavity which creates suction and allows air to be drawn into the lungs. when the diaphragm relaxes (assumes dome-like position again), the air is __ |
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Definition
diaphragm; phrenic nerve (c3, c4, c5); cervical plexus
- right; left; respiration; inspiration; exhaled |
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Term
the diaphragm
- along with the two asymmetric domes, there are __ that pierce the diaphragm to permit the passage of structures between the thoracic and abdominal cavities.
- the 3 most notable large apertures are named for the structures that pass through them, they are __, __, and __
- a possible way to remember the order of the apertures is to think of the vertebra that they begin at:
- also the __ continues through the esophageal aperture in the diaphragm to innervate organs in the abdomen |
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Definition
- apertures
- caval, esophageal, aortic apertures or hiatus
- vena cava = 8 letters = T8; esophageal = 10 letters = t10; aortic hiatus = 12 letters = t12
- vagus nerve |
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Term
the heart
-the __ refers to a group of structures found middle mass between the lungs, the structures within this region are bound to one another by connective tissue that attaches to the central compartment of the ___
- the heart is located within the __ of the __
- the mediastinum is bordered by one __ on both lateral sides, the remaining boundaries are formed by the __ posteriorly and the __ anteriorly |
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Definition
- mediastinum; thorax
- middle portion; inferior mediastinum
- lung; vertebrae; sternum |
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Term
structures of the heart
- the heart is a __ muscular organ that is commonly found in animals that have closed circulatory systems, although variation in structure between species is widespread. the heart primarily functions is __ throughout a network of blood vessels, propelling it through both __ and __ circulation.
- the structure of the heart, as well as the presence of self-excitable cells in this organ, allows the cardiac muscles of this organ to perpetually __ and __ (although not all at once)
- note that the __ is a roughly quadrilateral where the __ enter/exit the heart |
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Definition
- myogenic; pumping blood; systemic (to the body); pulmonary
- contract; relax
- base of the heart; great vessels (aorta/pulmonary trunk) |
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Term
Structure of the heart
- The ___ refers to the most inferior point of this organ where the ___ taper down and meet. Notice in this anterior view of the heart, the apex is oriented downward, anteriorly, and to the left. As the heart contracts (first the upper then the lower chambers), the pulse of muscular contraction travels ___ through the heart.
-By palpating near the sternum, you can feel the pulsation resulting from each individual contraction of the heart. As we will discuss later, contraction of the heart occurs in a wave-like manner, first contracting both atria, then both ventricles, finally terminating at the heart’s apex. The point when the pulsation reaches the apex can be palpated in the ___, and is known as the ___. |
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Definition
- apex of the heart; ventricles; inferiorly
- left 5th intercostal space; apex beat |
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Term
the heart
- The heart is itself divided into __ chambers: 2 upper chambers known as the right and left __, and 2 lower chambers, the right and left ___. Before we examine these chambers individually, we will discuss the 3 common layers of tissue that make up the walls of these chambers. Note that these layers are not clearly identifiable in this illustration.
- The outermost layer is the __, which is the same as the visceral layer of serous pericardium. Deep to the __ is what’s known as the ___. This middle layer is arranged into a helix of __, and appears similar to the wringing of a wet towel when the ventricles are contracted.
- Finally, the ___ is a thin internal layer of the heart’s muscular walls, and is composed of ___ layers |
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Definition
- 4; atria; ventricles
- epicardium; epicardium; myocardium; cardiac muscle
- endocardium; endothelial connective tissue |
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Term
chambers of the heart
- The atria are separated from the ventricles by an ___, or ___ (a groove that contains the __), which encircles the external surface of the heart and serves as the distinction between the upper and lower ___.
- The ventricles are also separated, this time by two additional grooves on the heart’s external surface, known as the ___. |
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Definition
- atrioventricular groove; cornary sulcus; coronary sinus; chambers
- anterior and posterior interventricular grooves |
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Term
chambers of the heart
-The ___ receives deoxygenated blood from the __ and __ and the __. The internal structure of this chamber includes a rough part muscular wall containing ___, which are muscular fibers raised in parallel ridges.
- Externally, there is an ear-like muscular pouch attached to the right atrium, called the __, seen on the image to the left as it wraps around to the origin of the ___. Another notable feature is the opening of the ___, seen on the internal wall of the right atrium in the illustration to the right. The ___ empties deoxygenated blood from the heart itself into the right atrium. |
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Definition
- right atrium; superior; inferior vena cava; coronary sinus; musculi pectinati
- right auricle;ascending aorta; coronary sinus; coronary sinus |
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Term
Chambers of the heart
- The right __ receives blood from the right __ during contraction of the atria, during which time the ventricles remain __ while they fill with blood. The right __ then pumps to the __ (via the __) to allow deoxygenated blood to release carbon dioxide and obtain oxygen prior to returning to the heart. Within this chamber, string-like cords attach to the cusps of the ___. These cords, known as __, attach to the conical-shaped ___.
- Another important feature are the muscular ridges on the right ventricle wall, the ___, which is an interwoven muscle network. |
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Definition
- ventricle; atrium; relaxed; ventricle; lungs; (pulmonary trunk); tricuspid valve; chordae tendinae; papillary muscles
- trabeculae carneae |
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Term
chambers of the heart
-The left atrium composes the __ and __ portion of the heart. Newly oxygenated blood from the lungs enters the left __ via the ___.
- there is a long, finger-like extension of the muscle protruding from the __, called the ___. The walls of this chamber are smooth, except for the presence of ___ in the ___ only. |
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Definition
- posterior; superior; atrium; 4 pulmonary veins
- left atrium; left auricle; musculi pectinati; left auricle |
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Term
chambers of the heart
-The left ventricle is the chamber that forms most of the ___, and has __ that are twice as thick as those found in the right ventricle. The additional muscle tissue allows the left ventricle to __ more forcefully than the right, which is necessary to propel blood throughout __.
-Similar to what we saw in the right ventricle, the larger left chamber also has ___ attached to the cusps of the ___ and to the conical __ that project up form the floor of the ventricle. Also note that ___ cover most of the internal wall of the left ventricle. |
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Definition
- apex of the heart; muscular walls; contract; systemic circulation
- chordae tendinae; bicuspid (mitral) valve; papillary muscles; trabeculae carneae |
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Term
characteristics specific to atria
- __, __, __
- __ |
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Definition
-muscular pouches, the auricles, attached to chamber walls anteriorly
-pectinate muscles |
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Term
characteristics specific to ventricles
- __
- __
- __ |
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Definition
-papillary muscles (muscles that pull valves closed)
-chordae tendinae (string-like cords attached to cusps of the valves)
-trabeculae carnae (interwoven muscular network) found lining their walls |
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Term
valves of the heart
-In order to maintain the one-way flow of blood through the heart, a set of valves known as the ___, separate both atria from their respective ventricles. The ___ between the left atrium and ventricle has two cusps (flaps), while the ___ between the right atrium and ventricle has three cusps
-When the atria contract and pressure within them ___, the AV valves are pushed __, and blood inside the atria passes through them into the corresponding ventricle. When the atria relax, atrial pressure __ and the AV valves __, preventing back flow.
- Once the AV valves are closed, the ventricles __ and ventricular pressure __, keeping these valves shut while blood in the ventricles is pushed out into either the __ or __. |
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Definition
- atrioventricular valves (AV); bicuspid (mitral) valve; tricuspid valve
- increases; open; decreases; close
- contract; increases; pulmonary arteries; aorta |
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Term
AV valves
- The tricuspid valve is a three-cusped valve on the __ side of the heart, found between the __ and __, that prevents blood that enters the __ from flowing backwards into the atrium.
-The bicuspid valve is a two-cusped valve between the __ and __, that similarly functions in preventing backflow between these two chambers. |
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Definition
- right; right atrium; ventricle; right ventricle
- left atrium; ventricle |
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Term
valves of the heart
- The AV valves are structured in such a way as to only allow a __ passage of blood, which is the primary purpose of the AV valves. Increased pressure in the __ causes blood to be pushed through these valves and into their respective __. However, the presence of __ attached to the __ keeps the AV valves shut during the increased pressure in the lower chambers during ventricular contraction. |
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Definition
| - one-way; atria; ventricles; chordae tendinae; papillary muscles |
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Term
valves of the heart
- The ___ are located at the base of the __ when exiting the right ventricle, as well as the origin of the the __ where it exits the left ventricle. These valves regulate blood passing into these two large arteries during the changes in pressure that occur in one complete contraction of the heart.
-The valves permit blood to be __ (by pressure exerted during __ contraction) into these arteries, while also preventing this same blood from flowing back into the __ once they relax. Note that the semilunar valves do not have attached __ |
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Definition
- semilunar valves; pulmonary trunk (pulmonary valves); aorta (aortic valves)
- pushed; ( ventricular); ventricles; chordae tendinae |
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Term
- The arterial supply to the heart muscle is provided by the network of vessels known as the __ (which can be found both externally along the hearts __, and deep to the __). The first of these vessels is the __, which branches off the __ above the __ of the aortic valve. During __ (ventricular relaxation), blood __ near the now closed aortic valve, some of which moves into the right and left coronary arteries.
-The RCA primarily supplies the __ of the __ . The RCA bifurcates into two terminal branches, the __ (not visible on this view, visible on next slide), and the __. |
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Definition
- coronary arteries; (surface; myocardium); right coronary artery (RCA); aorta; right cusp; diastole; pools
- cardiac muscle; right ventricle; posterior interventricular artery; marginal artery |
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Term
coronary arteries
-The ___ is also a branch of the __ originating above the left cusp of the aortic valve. The LCA is a short artery, running only a few millimeters before bifurcating into the __ (aka-__) and the __.
The circumflex artery curves to the left within the __, then turns __, anastomosing with the continuation of the RCA in the __.
The LAD travels between the __ and the __ before descending along the __. At the apex, it joins the ___, forming an anastomosis.
- To summarize, the RCA and circumflex branch of the LCA form an __, as do the __ and __ |
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Definition
- left coronary artery (LCA); aorta; anterior interventricular; (left anterior descending, LAD); circumflex arteries
- coronary sulcus; posteriorly; atrioventricular groove
- pulmonary arter; left auricle; anterior interventricular sulcus; posterior interventricular artery
- anastomoses; anterior; posterior interventricular arteries |
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Term
- __ is a vital connective tissue designed with the primary goal of delivering nutrients and oxygen to cells, while also removing metabolic waste products from those cells and transporting them out of the body (ie-carbon dioxide). Over the next few slides, we will follow the one-way course blood takes through the circulatory system, beginning (and ending) with deoxygenated blood that has returned from __, having released its __ and gained __ and __.
- Deoxygenated blood returns to the heart via the __ and __. Blood collects in the __ during its relaxation that occurs between atrial contractions.
- When the atria next contract, deoxygenated blood is pushed through the one-way __ into the right __. Since the ventricles are relaxed while atria contract, pressure is __ in the __, and this pressure is what pushes blood between these 2 chambers.
The blood then travels into the __ and to the __ where it becomes oxygenated |
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Definition
- blood; systemic circulation; oxygen; co2; metabolic wastes
- superior; inferior vena cava; right atrium
- av valves; atrium; higher; atria
- pulmonary trunk; lungs |
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Term
- Blood returning from the lungs via the __ is newly oxygenated, and these veins empty it into the __. Once this chamber contracts, higher atrial pressure pushes it through the opened __ into the __. These valves soon shut when the atrium relaxes, preventing the same blood from rushing back into the atrium.
- After a brief delay the __ contract. The left ventricle, with its thicker __, exerts enough pressure to propel the blood through the __ and into the __.
-The aorta has thicker __ in its vessel walls, and is __ enough to accommodate the large volume of ventricular blood being pumped through with each heartbeat. From the __, oxygenated blood is spread through the entire body via the network of arteries known as __. Once depleted of oxygen, the blood is collected by __ (in capillary beds), and eventually reaches the __ or __, restarting the process. |
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Definition
-pulmonary veins; left atrium; av valves; left ventricle
- ventricles; muscular walls; one way aortic valves; aorta
- smooth muscle; elastic; aorta; systemic circulation; veins; ivc; svc |
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Term
fetal circulation: shunts
-Oxygenated, nutrient-rich blood from the mother’s placenta enters into fetal circulation via the __. Unlike adult circulation, however, prenatal blood is __ around certain structures that are still developing. Fetal blood is bypassed via __, which are openings or vessels through which blood can skip portions of fetal circulation.
-One of these shunts is the __, which connects the __ with the __. It allows some blood to bypass __, since the lungs are not yet functional during gestation. Following birth, the __ no longer functions as a blood vessel, but instead becomes a small __ known as the ___. It is closely related to the __, which loops around the aortic arch just posterior to this ligament. |
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Definition
- umbilical vein; redirected; shunts
- ductus arteriosus; pulmonary artery; aortic arch; pulmonary circulation; ductus arteriosus; ligament; ligamentum arteriosum; left recurrent laryngeal nerve |
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Term
fetal circulation
-Another important fetal shunt is the __, which is an opening between the two atria that acts as a right-to-left shunt.
-In the image of fetal circulation on the upper right, the red and blue dashed lines illustrate the flow of both oxygenated (from __) and deoxygenated blood (from the fetus) entering the right atrium via the IVC, from which it passes from the right atrium through the __ into the left atrium. Blood will then flow from the left atrium to the left ventricle and be pumped out through the aorta to the rest of the body. This allows blood to bypass __ during fetal development, sparing the developing lungs from receiving the full amount of pulmonary blood supply. This opening typically __ following birth once pulmonary pressure decreases causing left atrial pressure to ___ that in the right atria (preventing bloodflow through the opening). |
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Definition
- foramen ovale
- (umbilical vein); foramen ovale; pulmonary circulation; closes; exceed |
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Term
conduction system of the heart
-Contraction of the cardiac muscle is modulated by the __. This system of specialized __ cells generates and conducts excitatory impulses in the heart. The conduction system contains two __, both located in the __. We will discuss these nodes and the key roles each plays in regulating heart beat via the conduction system.
-The __ is the impulse generating specialized tissue found in the right atrium. The specialized cells of this node are near the entrance of the __. This node is known as the __, because while all heart cells can generate impulse, the __ does so more rapidly and thus overrides impulses from other regions of the heart. Therefore its overriding impulses determine the rate of it is responsible for the rest of the __ activity of the heart and is why we most commonly see a heart rate between 60-100 beats per minute.
-The __ serves as an electrical connection between the atria and ventricles. The __ is found between the atria and ventricles in an area known as the __, which is between the right and left atria near the opening of the __. |
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Definition
- cardiac conduction system;; myocardial; nodes; atria
- sinoatrial (SA) node; superior vena cava; pacemaker; sa node; electrical
- atrioventricular (AV) node; av node; interatrial septum; coronary sinus |
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Term
conduction system of the heart
-While we’ve just discussed the sinoatrial (SA) node, there are some additional features of this region of specialized cells that are worth noting. The role of the SA node in generating impulses that begin each contraction of the heart gives it the title of __ of the heart.
-The SA node receives both __ (from spinal nerves __) and __ innervation (from vagus nerve __). This dual innervation makes the node sensitive to antagonistic pairs of autonomic stimuli.
-SYM stimulation causes increases __ activity, which increases __ as well as the __ of the heart (which occurs via __ innervation of atria/ventricles). Stimulation from __ fibers of CN X decreases the __ impulse generation rate, decreasing __ only. |
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Definition
-pacemaker
- sympathetic; (T1-T4); parasympathetic; (CN X);
- sa node; heart rate; force of contraction; (sympathetic); parasympathetic; sa node; heart rate |
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Term
conduction system of the heart
- atrioventricular bundle aka __ aka __
-Comprised primarily of specialized, self-excitable cells (__) known as __, the atrioventricular (AV) node is located near the inferior aspect of the __, near the opening of the __.
-As a part of the cardiac conduction system that coordinates the contraction of __, the __ node serves as a waypoint where the impulse generated by the __ node is very briefly delayed. This delay is vital, ensuring that the __ have time to completely contract prior to __ contraction. This allows the atria to pump the blood they contain fully into their respective ventricles. |
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Definition
- av bundle; bundle of his
- (cardiomyocytes); purkinje fibers; interatrial septum; coronary sinus
- myocytes; av; sa; atria; ventricular |
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Term
conduction system: impulse pathway
- __ initiates impulse > conducted to walls of __ > __ contract > impulse enters the __ > then to __ and __ > __ contract > __ contract |
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Definition
| - sa node; atria; atria; av node; av bundle; bundle branches; papillary muscles; ventricles |
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Term
autonomic innervation: sym innervation
-__ from __ spinal cord levels send fibers to synapse with corresponding __ found in the __ and __ sympathetic ganglia.
The three __ along with the __ branches contribute to the cardiac plexus.
Note that sympathetic nervous stimulation acts to increase __, such as during a “fight-or-flight” response to threatening external stimuli. |
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Definition
- preganglionic sym fibers; T1-T6; postganglionic sym neurons; cervical; upper thoracic
- cervical nerves; thoracic cardiac
- heart rate |
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Term
autonomic innervation: pym innervation
-__ (highlighted in blue), reach the heart via cardiac branches of the __.
They synapse on the __ near the __ (in ganglia in the wall of the organ) and along the __.
Parasympathetic nervous stimulation has an antagonistic effect to that of __. For example, PYM stimulation acts to decrease __. |
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Definition
- preganglionic pym neurons; vagus nerve (CN X)
- postsynaptic neurons; sa node; coronary arteries
- sym stimulation; heart rate |
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Term
intro to the lungs
-The __ exist as a pair of respiratory organs that occupy much of the thoracic cavity. Essential for all air-breathing animals, the lungs primarily function in transporting __ from the external environment into the bloodstream, while simultaneously transferring __ (waste product) in the blood out into the atmosphere.
Seen to the right as a pair of conically shaped organs, healthy lungs appear __ in color, and are soft, spongy, and inherently elastic in order to accommodate for perpetual changes in the volume of air they contain.
The lungs are both contained within a __, with each of these cavities being separated by the __. Each lung is divided into __, which differ between the two lungs. Note from this illustration that the __ is larger, and contains __. The __, smaller lung has __ lobes, and contains a large groove known as the __ |
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Definition
- lungs; oxygen; carbon dioxide
- pink
- pleural cavity; mediastinum; lobes; right; three lobes; left; two; cardiac notch |
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Term
| -The paired __ contain the left and right lungs. They are completely separated from each other by the mediastinum, and are under __. The pleura that is intimately associated with the external surface of the lungs is known as the __. Note that each __ of the lung (which we will discuss soon) is surrounded by its own layer of __. The outer layer of pleura is found on the __ (i.e. lining the rib cage), and is referred to as the __. One layer of parietal pleura surrounds each __. |
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Definition
| - pleural cavities; negative atmospheric pressure; visceral pleura; lobe; visceral pleura; body wall; parietal pleura; individual lung |
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Term
pleural cavity
-The __ lines the inside of the thoracic wall, and is held in place against the inner surface of the thorax by a layer of __ (not shown). This fascia acts like an adhesive between the __ and the __. However, parietal pleura can be organized into distinct divisions depending on the part of the wall of the thoracic cavity it is found. In the image to the right, the anterior thoracic cage and the right lung has been removed so we can see the posterior wall of the cavity.
-__ lines the posterior surface of the thoracic (rib) cage. The __ is found lining the mediastinal mass, while the floor of the pleural cavity is formed by the __, which covers the diaphragms surface.
-__ covers the apex of the lungs within the thoracic inlet, and is found lining the inside of a thickened membrane called the __. |
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Definition
- parietal pleura; endothoracic fascia; muscle wall; parietal pleura;
- costal pleura; mediastinal pleura; diaphragmatic pleura
- cervical pleura (cupola); suprapleural membrane |
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Term
external structures of the lungs
-One distinct difference between the two lungs is the number of structural divisions found in each organ. These segments are known as __ of the lung, and are marked by visible separations between segment of lung tissue, which are known as __. The right lung exhibits __ lobes, while the left has only __. The __ and __ fissures divide the right lung into three lobes, known as the right __, __, and __ lobes. The left lung lacks a __, and exhibits an __ that divides the left lung into two lobes, called the left __ and __ lobes. |
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Definition
| - lobes; fissures; 3; 2; oblique; horizontal; superior; middle; inferior; horizontal; oblique fissure; superior; inferior |
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Term
features of the lung
-While there are key differences between them, the right and left lungs do share several common structural features.
-The first notable common structure is found at the most superior point of each lung. This point is known as the __, and the tissue here actually extends into the __.
-Found on the mediastinal surface of each of the two lungs is a region called the __, which refers to the point at which the structures of the __ enter/exit the pleural cavities. The hilum of the right lung is indicated by the bracket and is a depression on the medial side of the lung. Notice the cross sections of multiple __ and __ structures that pass through this narrow passageway. This is the only point through which __ and __ structures can either enter or exit the lungs.
A __ is exhibited at each root. This ligament is in fact the reflection of __ off the thoracic wall and on onto the surface of the lung. |
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Definition
-
- apex of the lung; root of the neck
- hilum; root of the lung; blood vessels; nervous system; neurovascular; lymphatic
- pulmonary ligament; parietal pleura |
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Term
-The __ bifurcates at the __ (at approximately the level of __) into two main __, each of which goes on to enter its own respective lung. However, these two bronchi are not identical.
-The __ is shorter, wider, and is essentially a continuation of the trachea. The __, however, is longer, narrower, and takes a horizontal turn away from the trachea on its way to the left lung. |
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Definition
- trachea; sternal angle; (T4/5); bronchi
- right main bronchus; left main bronchus |
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Term
bronchial tree
-The respiratory complex, known as the __ due to its extensive branching, is formed by the following progressively narrower continuations from the primary main bronchi:
-Each lung is supplied by a __
Each primary bronchi then branches to a __, which supplies a __.
A __ of the lungs is supplied by an individual __. |
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Definition
- bronchial tree
- primary (1 degree main) bronchus
- secondary bronchus; lobe of the lung
- bronchopulmonary segment (BPS); tertiary (3 degree) bronchus |
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Term
-Each of the __ supplies air to one specific portion of the lung. These distinct regions are known as the __. In addition to their own tertiary bronchi, each BPS is supplied with its own __ and __, making each segment self-sufficient and independent from the rest.
-The independent nature of these lung structures means that should one or more __ become diseased, they can be surgically removed without impairing the function of nearby segments. The area occupied by each bronchopulmonary segment can be traced on the surface of each lung. |
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Definition
- tertiary bronchi; bronchopulmonary segments; pulmonary artery/vein; bronchial artery
- BPS |
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Term
vasculature of bps segment
-As we just mentioned, each broncho-pulmonary segment is supplied by their own distinct __. In addition to this, each BPS is supplied with blood by two arteries, one carrying __ blood while the other supplies __ blood. The __ carries deoxygenated blood from the right ventricle, eventually ending up in each __ to travel to __ where it receives oxygen. The __ then carries this newly oxygenated blood back to the heart’s left atrium. Notice the pattern of the pulmonary vein. It is used by clinicians to find the boundaries of a BPS during resection of the lung due to tumors.
-Distinct from pulmonary circulation, the __ carries oxygenated blood to the __ of the lung’s bronchopulmonary segments. This is emphasized on the next slide. |
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Definition
-tertiary bronchus; deoxygenated; oxygenated; pulmonary artery; bps; alveoli; pulmonary vein
- bronchial artery; tissues |
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Term
neurovasculature
-The tissues that make up the lung must receive their own supply of oxygenated blood in order to survive. Oxygen and nutrients reach the lungs via the ___.
-Found in the __, the bronchial arteries initially arise directly from the __. The vessel that arises from the aorta will itself subsequently branch out into a network of distinct, individual blood vessels known as the bronchial arteries, each of which travels through the __ of the bronchial tree on their way to supply their own __ (one bronchial artery supplies each BPS) |
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Definition
- brochial arteries
- adventitia of the airways; aorta; respiratory tracts; bps |
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Term
innervation of the lungs
-The structures of the lungs, including bronchioles, are supplied with __ and __ fibers from the __ and __. These are two distinct nerve plexi, one of which is found anterior to the __ of each lung, with the other being posterior to the __. The __ tissues found in the bronchioles, blood vessels, and mucous membranes in this region are all innervated by fibers that arise from these plexi.
-Innervation to the smooth muscle tissues found in the bronchial tree are responsible for orchestrating the necessary relaxation and constriction of __, which is a integral part of respiration. __ (which is provided by branches from the right and left vagus nerves) causes the smooth muscle of the bronchioles to __. Stimulation from sympathetic nerve fibers, on the other hand, will cause those same smooth muscle tissues in the bronchioles to __. This antagonistic relationship between the actions that result from stimulation of PYM and SYM fibers is the basis for our ability to both inhale and exhale the air we breath. |
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Definition
- sympathetic; parasympathetic; anterior; posterior pulmonary plexuses; root; root; smooth muscle
- bronchioles; parasympathetic innervation; constrict; relax (dilate) |
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Term
lymphatics of the pleural cavity
-A superficial __ lies just under the __. A __ follows the bronchial tree. They both meet at the __ of the lung, where they drain into the __ group of nodes at the root of the lung.
Lymphatic drainage of the lungs begins at their __. Lymph is drained out of the individual __, passing through a network of vessels that are found along the bronchial tree (as well as superficially just under the visceral pleura). The fluid from these drainage networks joins at each lungs __ before it passes through the __ of the lung.
Note the series of nodes found along either lateral side of the trachea. These are the __, which act to collect the lymph fluid exiting the roots of each lung and return it to __ blood flow. From the paratracheal nodes, lymph travels through the right & left __ trunks, from which it empties into either the __ before joining the __. |
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Definition
- lymphatic plexus; visceral pleura; deep plexus; hilus; bronchopulmonary;smallest functional unit; bps; hilus; root
- paratracheal nodes; venous; bronchomediastinal; thoracic or right lymphatic duct; subclavian vein |
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Term
The abdomen
-Area of Concentration-the abdomen is the region of the body found between the __ and the __. The abdomen stretches from the __ to the __ at the __.
-The space contained above the pelvic inlet and under the thoracic diaphragm is termed the __, bounded by the anterior __ and the __ posteriorly. |
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Definition
- thorax; pelvis; thoracic diaphragm; pelvis; pelvis brim
- abdominal cavity; abdominal wall; peritoneal lining |
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Term
layers of the abdominal wall
- The anterior abdominal wall can be organized from its most superficial to the most deep layers. These layers are listed to the right. |
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Definition
epidermis
dermis
fascia
-camper's fascia
-scarpa's fascia
muscles
- rectus abdominis
- external oblique
- internal oblique
- transversus abdominis
fascia transversalis
peritoneum |
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Term
anterior abdominal wall - skin
-The outer skin layer of the anterior abdominal wall is comprised of an __ and __ layer. All nervous endings and vasculature to supply blood to this skin layer reside in the __.
-Directly underneath the __ lies a layer of __, which is a sheet or band of connective tissue. The fascia here is comprised of a __ outer and a __ inner layer, as seen in the right side of this diagram. The lower portion containing the fascia is collectively known as the __. This is NOT considered part of the __. |
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Definition
- epidermal (outer); dermis; dermis
- dermis; fascia; fatty; membraneous; hypodermis; skin |
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Term
Fascia
-__ is a layer of fibrous tissue that permeates the body. A __ is a type of connective tissue that encases muscles or muscle groups, nerves, and blood vessels
-In the abdomen, the fascia found directly underneath the __ of the abdomen is known as the __ and it consists of a __ and __ layer. The outer fatty fascial layer is known as __. this is largely __ in texture and has a mesh-like structure. It contains various amounts of adipose tissue throughout, so it is considered the fatty layer of the superficial fascia.
-Directly underneath Camper’s fascia is the membranous layer of the hypodermis known as __. this is deep to the Camper’s fascia and superficial to the __ of the anterior abdominal wall. Scarpa’s fascia is similar in appearance to a pair of tight-fitting “biker shorts”. It is considered the __ layer of the superficial fascia in the abdomen. Underneath Scarpa’s fascia is the __, which envelops the abdominal muscles. Deep investing fascia is found throughout the body as it invests individual muscles and forms compartments between muscle groups. It is not part of the __. |
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Definition
- fascia; fascia
- epidermis/dermis; hypodermis; fatty; membranous; camper's fascia; areolar
- scarpa's fascia; external oblique muscle; membranous; deep investing fascia; hypodermis |
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Term
-Directly inferior to Scarpa’s fascia and the deep investing fascia is the __. Known as an __, the rectus sheath is a layer of __ that join to encase the underlying rectus abdominis muscles, and it can be divided into the __ and __.
-Another notable structure is the __, a noticeable line which bisects the abdomen into two equal hemispheres.
- an __ is a flat, broad sheet-like tendon providing for a wide area of attachment of a muscle |
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Definition
- rectus sheath; aponeurosis; tendons; anterior; posterior sheath
- linea alba
- aponeurosis |
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Term
| -Although the muscles of the anterior abdominal wall will be discussed shortly, it is helpful in understanding the rectus sheath to note the location of the ___, as the rectus sheath encases these vertically oriented muscles both anteriorly and posteriorly. Notice how the rectus abdominis runs longitudinally from the thorax to the pelvis, completely wrapped by the rectus sheath. The white colored lines segmenting the rectus abdominis are known as ___, and are part of the rectus sheath. |
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Definition
| rectus abdominis; tendinous intersections |
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Term
anterior abdominal wall - muscles
-The muscles that comprise the anterior abdominal wall function primarily to __ the organs (viscera) found within the abdominal cavity and in rotation of the trunk. These muscles are found between the __ and the __ just above the pelvis.
-The most superficial of these muscles is the __. It’s fibers run __ and are oriented in an inferior and medial direction (__ orientation), and the anterior tendons of this muscle merge to from the __ (part of the rectus sheath). This muscle acts to pull the __ and compress the __, thus increasing pressure within the cavity.
- the __ muscles can be seen deep to the rectus sheath |
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Definition
- compress; thorax; inguinal ligament
- external oblique muscle; diagonally; (hands in pocket); external oblique aponeurosis; chest downward; abdominal cavity
- rectus abdominis |
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Term
anterior abdominal wall - muscles
-With the external oblique removed in this diagram, it is easier to see the __, which is directly underneath the external oblique. It’s fibers run opposite to those of the external oblique and are oriented in a __ and medial fashion.
-The internal oblique acts both as an antagonist to the __ by reducing __ during exhalation, as well as by rotating and bending the __ sideways by acting along with the external oblique muscles. Also visible is the rectus abdominis (right side only) spanning between the costal cartilage of ribs __ down to the pubic symphysis and crest.
-The white line running longitudinally between the ribs and the pelvis, where the internal oblique’s __ joins the __, is known as the __, and is also referred to as the __.
-The white line running longitudinally between the ribs and the pelvis, where the internal oblique’s aponuerosis joins the rectus sheath, is known as the internal oblique aponeurosis, and is also referred to as the semilunar line. |
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Definition
- internal oblique muscle; superior
- diaphragm; chest volume; trunk; 5-7
- aponeurosis; rectus sheath; internal oblique aponeurosis; semilunar line |
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Term
| -With the internal oblique removed, you can now see the __ muscle, whose fibers are oriented laterally. This muscle functions in compression of the __, for instance while coughing, during inhalation of a deep breath, and when excreting waste. |
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Definition
| transversus abdominis; abdominal cavity |
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Term
summary: obliques
- The abdominal obliques are made up of two different muscles: the __ obliques and __ obliques.
-Together, the obliques perform a variety of different functions including flexing/bending the __ forward and sideways, rotating the __ to both the right and left, and helping to provide __ to the hips and lower back.
-A cross-section of the anterior abdominal wall on the next slide will allow us to more clearly see the __ muscles that are encased in the rectus sheath. |
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Definition
- internal; external
- torso; torso; stability
- rectus abdominis |
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Term
-One the lateral side of each of the paired __, the __ from both of the obliques, as well as from __ join to form either the anterior or posterior __. From top to bottom these are the external, internal, and transversus __, respectively.
-This portion of a cross-sectional view of the anterior abdominal wall allows you to see the joining of the __ from the three anterior abdominal wall muscles (they join near the lateral edge of __) as they fuse to form the two layers (anterior and posterior) of the __.
-We will discuss in more detail the rectus sheath’s formation by moving from the lateral wall medially towards the __.
-Notice how the tendons from the __, contributing to part of both the anterior and the posterior __. |
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Definition
- rectus abdominis muscles; aponeurosis; transversus abdominis; rectus sheath; abdominis aponeuroses
- aponeuroses; (rectus abdominis); rectus sheath
- linea alba
- internal oblique bifurcate; rectus sheaths |
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Term
-Running horizontally across the anterior abdominal wall is a demarcation line known as the __.
-The __ is an important point of transition in the layout of the __. Superior to the arcuate line, the __ splits to envelope the __ muscle, so it contributes __.
-Inferior to the arcuate line, the __ and __ merge and also pass over the anterior surface of the __, so that the anterior rectus sheath is composed of the __ of the __, __, and __. Below the arcuate line, there is no __, it is only a thin layer known as __.
-The arcuate line typically exists approximately 1/3 of the distance from the __ to the __ |
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Definition
- arcuate line
- arcuate line; rectus sheath; internal oblique aponeurosis; rectus abdominis muscle; both to the anterior and posterior rectus sheath
- internal oblique; transversus abdominis aponeurosis; rectus muscle; three aponeurosis; external oblique; internal oblique; transversus abdominis muscles; posterior sheath; transversalis fascia
- umbilicus; pubic crest |
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Term
rectus sheath- superior to arcuate line
-Understanding the rectus sheath requires knowing which structures are involved in its formation. The sheath is in fact a joining of layers of the __ extending from the __ and __ and from the __.
-Above the arcuate line, the __ splits to merge with the __, forming the __.
-The remaining half of the __ moves posteriorly to join the __, forming the __. |
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Definition
- aponeuroses; external; internal obliques; transversus abdominis muscles
- internal oblique aponeurosis; external oblique aponeurosis; anterior rectus sheath
- internal oblique aponeurosis; transverse abdominis aponeurosis; posterior rectus sheath |
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Term
rectus sheath layers and arcuate line
- The aponeuroses extending from the __ and __ and the __ contribute to the formation of the __ or __. These three aponeuroses remain separate from each other until they reach the __. From these lateral edges, each of these 3 __ merge together, wrapping __ both in front and back, forming the anterior or posterior rectus sheath.
-To review, above the arcuate line, the __ contributes to __. The branch behind rectus abdominis joins to contribute to the __, while the front branch helps form the __.
-Below the arcuate line, however, the aponeuroses from __ join together, forming __ only. Therefore there is NO __ sheath below the arcuate line |
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Definition
- external; internal oblique; transverse abdominis; anterior; posterior rectus sheath; lateral edges of each rectus abdominis muscle; tendons; rectus abdominis
- internal oblique aponeurosis; both sheaths; posterior sheath; anterior rectus sheath
- all 3 abdominal muscles; an anterior rectus sheath only; posterior rectus sheath |
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Term
-The structure that separates the transversalis abdominis muscle from the anterior surface of the abdominal cavity is known as the __. Deep to the __ is the ___, which lines the abdominal cavity.
-The __ is a very thin, aponeurotic membrane which borders between the inner surface of the __ and the __ or lining of the abdominal cavity. Below the arcuate line, this __ is located __ to the transverus abdominis and rectus abdominis muscles, as there is no posterior sheath. |
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Definition
- transversalis fascia; transversalis fascia; peritoneum
- transversalis fascia; transversalis abdominis/rectus abdominis muscles; peritoneum; transversalis fascia; deep |
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Term
-The __ is a tubular passageway in the __ that serves as the passage for the __ and __ in men and the __ in women. The canal is larger and more prominent in men as the testes must descend from their superior location in the abdomen to the scrotum just before birth. In both sexes, the __ (seen in the next few slides) passes through the canal. Sitting just above the __, the canal is directed inferiorly and anteriorly as it travels from the lateral sides of the body inwards.
-The superior “roof” of the canal is comprised of portions of the __ and __. The anterior wall is formed by the __. The inferior “floor” of the canal is primarily formed by the __ (which is a thickened free edge of the __), and the posterior wall is mostly an extension of ___ and __. |
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Definition
- inguinal canal; anterior abdominal wall; testes; spermatic cord; round ligament; ilioguinal nerve; iguinal ligament
- internal oblique; trasversus abdominis muscles; external oblique aponeurosis; inguinal ligament; (external abdominal oblique aponeurosis); transversalis fascia; parietal peritoneum |
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Term
-By taking another look at a coronal section of the __ canal of a male, we can more clearly see how this passageway is in fact a true canal, encasing the structures that travel through it. While both men and women have an inguinal canal, we are using images of the male canal since it is more prominent in men and structures are more visible.
-The presence of the canal can lead to certain conditions that require medical attention. One of these conditions is the occurrence of __, wherein segments of __ protrude through weak points in the inguinal region of the __. |
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Definition
- inguinal canal
- inguinal hernias; small intestine; lower anterior abdominal wall |
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Term
vasculature of the anterior abdomen
-The integument (skin) and muscles of the anterior abdominal wall are supplied with blood from several key arteries. The most important arteries supplying the anterior abdominal wall are the __ and __.
- The __ arises from the __, which branches direclty from the __. The __ arises from the __.
-At approximately the umbilical region of the anterior abdomen, both the superior and inferior epigastric arteries form an anastomoses with one another.
-At approximately the umbilical region of the anterior abdomen, both the superior and inferior epigastric arteries form an anastomoses with one another.
- At approximately the __ region of the __, both the __ and __ form an anastomoses with one another. |
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Definition
- superior; inferior epigastric arteries
- superior epigastric artery; internal thoracic artery; subclavian; inferior epigastric artery; external iliac artery
- umbilical region; anterior abdomen; superior; inferior epigastric artery |
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Term
- The __ is defined as a serous membrane, which is a smooth membrane whose cells secrete serous fluid (a very effective lubricant).
-The peritoneum both encloses and supports the ___, and it also acts as a __ for the blood vessels, lymphatic vessels, and nerves of the abdomen.
- the __ should be differentiated from the __ (or __). the portion of the abdomen enclosed by the peritoneum is referred to as the __. Other structures found in the abdominal cavity, such as the kidneys, are located behind the peritoneal cavity and are therefore referred to as __. |
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Definition
- peritoneum
- abdominal organs; conduit
- abdominal cavity; peritoneal cavity; (intraperitoneal space); peritoneal cavity; retroperitoneal |
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Term
peritoneum
-The peritoneum is composed of two layers, the __ and the __. __ is not visible on these picture, as it is a one-cell layer thick covering on the viscera (organs).
-The __ is the most superficial of the two peritoneal layers, and its anterior portion is found just deep to the __. |
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Definition
- parietal peritoneum; visceral peritoneum; visceral peritoneum
- parietal peritoneum; transversalis fascia |
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Term
-By examining a midsagittal section through the male abdominal cavity, we can see how the __ lines the entire abdominal cavity. In the image to the left, both __ (found lining the inner surface of the abdominal wall) and __ (which covers the external surface of abdominal viscera) are colored red.
- __: joining of two visceral peritoneum layers
- The diagram below illustrates how both layers of peritoneum are associated with ___, and how they join to form __ that support these organs. For example, if the tubular inner structure in this image was a segment of small intestine, it would be completely covered by visceral peritoneum, except at one point where the 2 visceral peritoneum layers join and reflect back on itself (becoming parietal peritoneum). The resulting junction of these layers forms a mesentery. Arteries, veins, and nerves utilize ___ as conduits through which they can reach their target organ |
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Definition
- peritoneum; parietal peritoneum; visceral peritoneum
- mesentery
- abdominal viscera; mesentaries; mesentaries |
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Term
-Once inside of the peritoneal cavity, the most notable structure is the __. This is a layered sheet of __ that blankets the anterior surface of the intestines and other abdominal organs. The __ is also often referred to as appearing similar to a __.
- Just behind the greater omentum lie the __, which are covered by and intimately-associated with a layer of __. Unlike __, __ is so thin and attached to the external surface of the abdominal organs that it cannot be removed. It has a glassy appearance. There is a small amount of __ between the parietal and visceral layers of peritoneum so this helps to maintain a friction-less environment for the abdominal organs to move past each other (i.e. 20ft of small intestine must move around during digestion). |
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Definition
- greater omentum; peritoneum; greater omentum; fatty apron
- abdominal organs; visceral peritoneum; parietal peritoneum; visceral peritoneum; fluid |
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Term
abdominal organs - stomach
-As food is ingested, it is moved via __ down the __ where it enters the __ through the __. Note that the __ enters the abdominal cavity by piercing the __ at the __ vertebral level, through an opening that’s known as the __.
- the __ hangs from the lower curved edge of the stomach |
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Definition
peristalsis; esophagus; stomach; esophageal sphincter; inferior portion of the esophagus; diaphragm; T10; esophageal hiatus
- greater omentum |
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Term
-The stomach is divided into four distinct sections: the __, __, __, and __. The smaller picture below shows an isolated stomach, and each of the four sections of the stomach. The cross-section of the stomach clearly shows the structures known as __, which are longitudinal folds in the muscular lining of the stomach.
-Two additional structures to be noted are the __ and the __. The greater curvature runs along the __ edge of the stomach, while the lesser curvature runs on the __ edge between the __ and the __ (where food exits the stomach and enters the small intestines). |
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Definition
- cardia; fundus; body; pylorus; rugae
- greater curvature; lesser curvature; lateral; medial; esophagus; pyloric sphincter |
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Term
-The muscles lining the stomach churn food into a mash-like substance (now called __) through __ action. Once the __ has been properly processed, it then exits the stomach through the __ and enters the first section of the small intestines, called the __.
-The __ is the shortest portion of the small intestine, approximately 10-12 inches long, and is also the site where most __ occurs.
-The duodenum, which is noticeably _ shaped, is the section of the small intestines where __ from the __ and __ enter and are incorporated into the digestive process. The dashed line (---) indicates the __ junction. |
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Definition
- chyme; peristaltic; chyme; pyloric sphincter; duodenum
- duodenum; chemical digestion
- C; bile secretions; gallbladder; pancreatic secretions; gasroduodenal junction |
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Term
-The __ are the portion of the digestive tract that spans from the stomach to the large intestine. Much of the __ and __ of food occurs here.
-An important feature of the small intestine is the __. The __ of the small intestine is a double layer of __ that suspends the __ and __ (portions of the small intestine discussed on the next slide) from the posterior wall of the abdomen.
-In the picture on the right, the __ is visible as an interconnected double layer of peritoneum. This image shows the peritoneal cavity in a midsagittal section in order to see how the intestines are suspended in the abdominal cavity by the __. |
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Definition
- small intestines; digestion; absorption
- mesentery; mesentery; peritoneum; jejunum; ileum
- mesentary; mesenteries |
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Term
-The small intestine is divided into __ anatomical sections, each of which is a distinct portion involving different aspects of digestion. __ occurs here, involving __ from various accessory organs, such as the __ and __, to be discussed later.
-The three portions of the small intestine (beginning after the stomach and ending at the __ of the large intestine) are known as the __ (shown on previous slides), the __, and the __.
-As a __ of food passes through the duodenum, it then enters the ileum. While the distinction between the _-shaped duodenum and the jejunum is __ recognizable, the jejunum and ileum are __, and are less easily discernable .
-After passing through the ileum, a bolus of food then exits the small intestine via the __, which is the anatomical boundary between the __ and __ (the __ being the last portion of small intestines and the __ the beginning of the large intestines). |
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Definition
- 3; chemical digestion; secretions; pancreas; gallbladder
- (cecum); duodenum; jejunum; ileum
- bolus; C; easily; continuous
- ileocecal valve; small; large intestine; (ileum; cecum) |
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Term
-The internal surface of the __ is a mucous membrane comprised of projections known as __. __ in the jejunum are noticeably __ than those found in the duodenum and ileum. These serve to increase __, thereby facilitating __ of nutrients from food.
-Surface area is further increased by __ projections that cover the __. Absorption of nutrients such as amino acids, small peptides, vitamins and most glucose occur in the __.
-Another important structure found in the jejunum are __, which are large valvular flaps projecting into the __. These are permanent structures in that they do not change upon __ of the jejunum as do folds in the stomach. As their name implies, circular folds extend around the whole surface of the jejunum. |
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Definition
- jejunum; villi; villi; longer; surface area; absorption
- microvilli; villi; jejunum
- circular folds; lumen of the small intestine; stretching |
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Term
-The __ is approximately 2-4 meters long, varying widely among individuals. Similar to the jejunum, the inner surface of the ileum also has __. __, and the even smaller __ that cover them are also present in the ileum, giving it a very large __ for more effective nutrient absorption.
-Additionally, the ileum has structures known as __, which are lymphatic nodules. These __ contain high concentrations of __ and other immune cells.
-The main functions of the ileum are to continue the __ that were __ as food that traveled down the duodenum and jejunum. The absorption of __ and __ are also important functions of the ileum. |
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Definition
- ileum; circular folds; villi; microvilli; surface area
- peyer's patches; peyer's patches; lymphocytes
- absorption of nutrients; missed; vitamin B12; bile salts |
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Term
- As a bolus of food travels toward the end of the ileum, it reaches the __, a large pouch-like structure that is considered the beginning of the portion of the __ known as the __.
-The Ileum is separated from the cecum by the __, which is a __ that prevents colonic contents from moving back into the __ after they enter the __.
-It is important to mention that the __ is typically located within the __ and is therefore referred to as __, while the ascending colon to which it is attached is __. |
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Definition
- cecum; large intestine; ascending colon
- ileocecal valve (ICV); sphincter muscle; ileum; ascending colon
- cecum; peritoneal cavity; intraperitoneal; retroperitoneal |
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Term
- Once food has traveled from the small intestine (exiting via the __) and has entered the __, it has officially entered the large Intestine, beginning in the __.
- The ascending colon it passes upward from its junction with the cecum to the inferior surface of the __, on the anatomical right of the __.
- At the point where the ascending colon reaches the underside of the __, it is lodged in a shallow depression called the __. Here the colon twists anteriorly and to the left, forming the __ or __.
- Another important structure is the __, which hangs from the junction of the __ and __. The appendix is a blind-ended tube averaging 11cm long, and is considered to be a vestigial organ (one that has lost its original function over evolutionary time). Inflammation of the appendix leads to __, causing sharp pain and often requiring emergency surgical removal. |
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Definition
- (ileocecal valve); cecum; ascending colon
- right lobe of the liver; gallbladder
- liver; colic impression; hepatic fixture; right colic fixture
- vermiform appendix; ileum; cecum; appendicitis |
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Term
-After the right colic flexure, the large intestine then travels horizontally from right to left in the portion known as the __. This is the __ and most __ of the large intestine.
-The transverse colon is attached to the posterior abdominal wall by the __, which is a broad fold of the __. The vessels that supply the transverse colon are contained between the layers of the __. The superior surface of the transverse colon is in close proximity to the liver, gallbladder, and the greater curvature of the stomach as it runs horizontally toward the spleen. The inferior surface is associated with the __.
-Upon reaching the lower end of the spleen, the transverse colon curves sharply on itself going from a horizontal to a downward orientation. This point of curvature is known as the __ (or __). |
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Definition
- transverse colon; longest; mobile
- transverse mesocolon; peritoneum; transverse mesocolon; small intestines
- splenic flexure; (left colic flexure) |
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Term
-From the ending of the transverse colon at the splenic flexure, the portion of the large intestine that passes downward is known as the __.
-Beginning along the lateral border of the left kidney, the __ travels vertically downwards towards the __ (not to be confused with __). Here it ends by joining seamlessly with the __ which is “S” shaped (discussed more later).
-The descending colon is covered by __ on its anterior surface and its medial and lateral sides, and is therefore considered to be __, while the transverse and sigmoid colon are both __. |
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Definition
- descending colon
- descending colon; crest of the ilium ; (ileum); sigmoid colon
- peritoneum; retroperitoneal; intraperitoneal |
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Term
-A notable characteristic of the large intestine are three separate, longitudinal bands of smooth muscle which are located on the outside of the ascending, transverse, descending, and sigmoid colons. These visible ribbon-like bands of smooth muscle are known as the __. The three bands begin at the __, where they diverge and travel along their respective sides of the entire large intestine, converging together at the transition between the __ and the __.
-Since the __ are collectively shorter than the length of the large intestine, the colon becomes bunched into a series of consecutive pouches, clearly seen running the entire length of the large intestine. These pouches, known as __, give the colon its segmented appearance.
-As digested food fills each __, it distends their tissues triggering it to contract, pushing its contents along to the next __. Patients suffering from __ often exhibit a loss of visible haustra |
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Definition
- taenia coli; appendix; sigmoid colon; rectum
- taenia coli; haustra
- haustra; haustra; ulcerative colitis |
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Term
-Another series of structures visible along the large intestine are the __ (commonly referred to as __). These are small hanging pouches of the __, each filled with __ as they taper off of the __.
-Epiploic Appendages are mostly associated with the __ and __. Their exact function is __.
-Although uncommon, these appendages can sometimes become inflamed, a condition known as __, which is often mistaken for acute appendicitis. Although painful, symptoms typically disappear within a week. |
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Definition
- epiploc appendages; (fatty tags); peritoneum; fat; taenia coli
- transverse; sigmoid; unknown
- epiploic appendagitis |
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Term
-The __ is the last portion of the large intestine before its connects to the __ and __. The sigmoid colon is found in what is called the __, which is a portion of the cavity surrounded by the skeleton of the pelvis. It forms a loop that lies in the pelvis with relative freedom of movement, occasionally changing position into the abdominal cavity.
-As the S in its name implies, the __ is distinctly S-shaped. It begins at the __ of the __, then passes transversely across the front of the __ to the right side of the __. It then curves on itself, turning downward where it joins with the __.
-The __ is the final portion of the large intestine. It is a straight segment of colon approximately 12 cm long, with a similar diameter as the sigmoid colon in its beginning, while it tapers incrementally smaller towards its termination, forming the __, which is the sight where __ are stored until they are eliminated via the __ and the __. |
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Definition
- sigmoid colon; rectum; anus; false pelvis
- sigmoid colon; superior aperture; lesser pelvis; sacrum; pelvis; rectum
- rectum; rectal ampulla; feces; anal canal; anus |
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Term
| Now that we have examined the structures composing the alimentary canal, we will begin to move into a discussion of the other abdominal organs that participate in digestion. These are commonly referred to as the __, and they include the __, __, __, and the __. These illustrations show each accessory organ in an isolated view. We will discuss each organ individually, illustrating their structure and respective contribution to digestion. |
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Definition
| accessory organs; liver; gallbladder; pancreas; spleen |
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Term
- The __ is a large reddish brown organ, and is relatively triangular in shape. It is the __ abdominal organ, and is the __ organ of the body (second only to the integument). The liver is located just below the __ in the right upper quadrant of the abdominal cavity (to the right of the stomach).
-The __ is a vital organ involved in a wide range of functions, such as detoxification, protein synthesis, hormone production, and glycogen storage. The liver also plays an essential role in digestion by producing __, which is an alkaline compound that aids in the __ (breakdown) of __. It is this contribution that classifies the liver as an accessory organ to digestion |
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Definition
- liver; largest; second largest; diaphragm
- liver; bile; emulsification; lipids |
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Term
- Except for a patch where the liver connects to the __ (known as the __), the liver is entirely covered by __. The __ folds back on itself to form the __, as well as the __ and __.
-The liver is divided into _ anatomical lobes. The __ ligament divides the liver into the __ lobe and __ lobe, easily visible on it’s anterior surface.
-If the liver is flipped over (as in the bottom illustration) you can see two additional lobes between the right and left. These are the __ lobe and the __ lobe. The __ lobe is associated with the inferior vena cava (IVC), while the __ is found relative to the gallbladder.
-The caudate and quadrate lobes are separated by the __ (also known as the __). This is a short, deep fissure that runs transversely along the underside of the __. The __ and the __ enter here, and the __ exits through the fissure. |
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Definition
- diaphragm; (bare area of the liver); visceral peritoneum; peritoneum; falciform ligament; right; left triangular ligaments
- 4; falciform ligament; right; left
- caudate; quadrate; caudate; quadrate
- transverse fissure; (porta hepatis); right lobe; hepatic portal vein; hepatic artery proper; common hepatic duct |
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Term
-The liver is almost completely covered by __, except for a triangular shaped portion on its superior surface. This portion is known as the __. It is bounded by the __.
-The bare area is the site of attachment between the __ and the __, where __ tissue connects the two to each other.
-The bare area is clinically significant since it is a site where __ can spread from the abdominal cavity into the __. |
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Definition
- peritoneum; bare area of the liver; coronary ligament
- liver; diaphragm; areolar tissue
- infection; thoracic cavity |
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Term
-The __ is a small organ that sits just below the liver. It is divided into 3 anatomical sections, the __, __, and the __.
-The path through which bile is secreted by the __ and then transported to the __ is known as the __. This can be seen as a series of connected __ that permeate the liver. The neck portion of the gallbladder tapers down to connect with the __ via the __, which then joins the __ to become the __.
-The gallbladder functions mainly as a __ for bile produced by the liver, which aids in the digestion of __. When fat enters the digestive tract, it stimulates the secretion of the __. In response to __ the gallbladder releases its store of bile into the duodenum. The bile, which was originally produced by the liver and only stored and concentrated in the gallbladder, helps emulsify fats in the digesting food. |
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Definition
- gallbladder; fundus; body; neck
- liver; duodenum; billary tree; tubules; billary tree; cystic duct; common hepatic duct; common bile duct
- storage vesicle; lipids; peptide hormone cholecyctikinin (CCK); CCK |
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Term
-The liver and the gallbladder both contribute to an intricate system known as the __, which is a key contributor to the digestive process. The branch-like ducts that make up this system is why it is often referred to as the biliary “tree”. More specifically, the biliary tree is the common term for the path by which __ is secreted by the __ and then transported to the __.
-The many small branches that comprise the beginning of the biliary tract within the __ and __ lobes of the liver drain out of the liver to the __ and __, respectively.
-The __ and __ join to form the __. The __ is joined by the __ from the __ to form the __. The __ releases bile into the duodenum (the first portion of the small intestine). |
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Definition
- biliary tree; bile; liver; duodenum
- right; left; right; left hepatic ducts
- right; left hepatic ducts; common hepatic duct; common hepatic duct; cystic duct; gallbladder; common bile duct; bile duct |
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Term
-The __ is a glandular organ that serves many functions. It is involved in both the __ system and the __ system. As an endocrine gland, the pancreas produces several key hormones including __ and __. It also aids in digestion by secreting pancreatic juice, which contains digestive enzymes that assist in the absorption of nutrients and in the digestion occurring in the small intestine. These enzymes help break down carbohydrates, proteins, and lipids in the digesting food.
-The pancreas is divided into 3 main anatomical sections: the __, __, __, and the __. The head of the pancreas is the larger, rounded portion found nestled in the c-shaped concavity of the __. The neck is the more constricted section between the head the the body, which lies just behind the stomach. The tail is the left end of the pancreas, which lies in contact with the __ (as seen in the bottom illustration).
-Due to the passage of __ throughout the pancreas, pancreatic metastatic cancers easily spread throughout the body, and are considered one of the most deadly forms of cancer for this reason. |
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Definition
- pancreas; digestive; endocrine; insulin; glucagon
- head; neck; body; tail; duodenum; spleen
- lymphatic vessels |
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Term
-The __ is an organ found in the left upper quadrant of the abdomen. It is in contact with the tail of the pancreas, and lies beneath the __ to the __. It is supplied by the __. With the large amount of blood traveling through the spleen, a rupture of the splenic artery could cause patients to bleed out quickly.
-The spleen plays an important role involving __, as well as contributing to the __. Older erythrocytes are removed by the spleen, where it metabolizes __ into its globin and heme constituents. For this reason the spleen is sometimes referred to as an __.
__ is produced from the heme portion of the recycled hemoglobin harvested from old red blood cells, and is subsequently transported to the __for removal. __ is what causes the yellow color of urine and the yellow discoloration of the skin in patients suffering from jaundice. If the spleen requires surgical removal, either due to rupture, infection, etc., the body can continue functioning almost as normal. However, removal of the spleen can leave patients more at risk for infection by bacteria, and may reduce responsiveness to some vaccines. |
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Definition
- spleen; 9th; 12th thoracic ribs; splenic artery
- erythrocytes; immune system; hemoglobin; erythrocyte graveyard
- bilirubin; liver; bilirubin |
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Term
-The abdominal aorta enters the abdomen through a passageway in the __ known as the __. After entering the abdomen, the aorta travels vertically downward until the level of the __ vertebra, where it bifurcates into its terminal branches, the __, which go on to supply the lower limbs. Before bifurcating, the abdominal aorta gives off the __, and three major unpaired trunks that supply the organs of the digestive system.
-These three major arteries given off by the abdominal aorta include the (1) __, the (2) __, and the (3) __
-Together, these 3 arteries supply the organs of the __, including small and large intestines, as well as the accessory organs such as the liver and pancreas. We will discuss each major branch in more detail, and learn about the key branches that each gives off in the abdomen. |
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Definition
- diaphragm; aortic aperture; L4; common iliac arteries; renal arteries
- 1. celiac trunk 2. superior mesenteric artery 3. inferior mesenteric artery
- alimentary canal |
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Term
-Arterial blood supply to the abdomen is accomplished primarily by three branches off of the abdominal aorta. Moving down the aorta from the diaphragm, the first major branch we encounter is known as the __.
-The __ branches anteriorly from the abdominal aorta at the level of the __ vertebra, which is almost immediately after the aorta penetrates the diaphragm to enter the abdomen. Overall, the celiac trunk supplies blood to the structures of the __, which consists of the esophagus (distal half only), liver, stomach, gallbladder, and the superior portions of both the duodenum and pancreas.
-Shortly after it branches from the aorta, the celiac trunk itself splits into 3 distinct branches, which we will discuss in the following slides. These branches include the __, the __, and the __. |
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Definition
- celiac trunk
- celiac trunk; L1; foregut
- left gastric artery; common hepatic artery; splenic artery |
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Term
BRANCHES of THE CELIAC TRUNK
-Beginning with the __, we can see that this vessel gives off two branches that supply the stomach. Just above the pyloric sphincter, the __ branches off the common hepatic, followed shortly by the __. The __ travels behind the pylorus before giving rise to the __.
-Branching from the celiac trunk, the __ runs along the superior portion of the lesser curvature of the stomach, and along the way it meets to form an anastomosis with the __
-The __ branches from the splenic artery (seen posterior to the stomach), traveling from left to right just below the greater curvature of the stomach. Along its route, the __ forms an anastomosis with the __. Together, these anastamoses (circled in black) serve as safeguards for maintaing blood flow in case one of these vessels becomes blocked or compromised due to trauma. |
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Definition
- common hepatic artery; gastroduodenal artery; right gastric artery; gastroduodenal; right gastroepiploic artery
- left gastric artery; right gastric artery
- left gastroepiploic artery; left gastroepiploic; right gastroepiploic |
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Term
-The second major branch off the abdominal aorta is the __. Originating just below the celiac trunk, the superior mesenteric a. primarily supplies the structures of the __, including the distal half of the duodenum, the jejunum, ileum, cecum and appendix, as well as the ascending and transverse colons. The __ branch off the superior mesenteric’s convex side, and supply portions of the jejunum and ileum.
-Also branching off the superior mesenteric are the __, which travels towards the ascending colon, the __, which supplies the transverse colon, and the __ artery, which supplies the last section of the ileum, the cecum, and the appendix. These 3 branches anastomose with each other to form a __ that travels along the inner border of the colon (discussed later). |
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Definition
- superior mesenteric artery; midgut; intestinal arteries
- right colic artery; middle colic artery; ileocolic artery; "marginal artery" |
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Term
-The third major branch off the abdominal aorta that supplies the abdomen is the __
-The primary role of the inferior mesenteric artery is to supply the __ from the __ to the upper part of the rectum. This includes the descending colon, the sigmoid colon, and part of the rectum, all supplied by this artery.
-The inferior mesenteric artery has three main branches, including the __, the __, and the __.
-The branches of the inferior mesenteric artery also contributes to the __. |
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Definition
- inferior mesenteric artery
- large intestine; splenic fixture
- left colic artery; sigmoid branches; superior rectal artery
- marginal artery |
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Term
-The __ is a vessel that provides an anastamoses between the __ and the __. It serves as a backup pathway for bloodflow to reach the large intestine should a blockage form in the __.
-The marginal artery runs in the __ close to the bowel.
-If an ___ impacts the flow of blood through the inferior mesenteric artery, the marginal artery can usually compensate by providing oxygenated blood to those portions of the colon the inferior mesenteric artery supplied |
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Definition
- marginal artery; inferior mesenteric; superior mesenteric arteries; inferior mesenteric artery
- mesentery
- aoric aneuryism |
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Term
-The hepatic portal system is the system of veins that includes the ___ and its tributaries. This system is responsible for directing blood from parts of the __, __, and __ to capillary beds in the liver. Unwanted substances (such as toxins) that are digested and then absorbed into the bloodstream must be filtered by the liver before the blood continues to the heart. The portal system is what ensures that these undesirable substances are removed.
-The large veins that are considered major contributors to the hepatic portal system (although several smaller tributary veins also drain into this system) are the __, the __ vein, the __, and the __.
-The __ and the __ come together to form the hepatic portal vein, while the __ typically connects to the __, thereby contributing to the portal system.
-Generally speaking, the hepatic portal system provides venous drainage to those areas that are supplied arterially by the celiac trunk, the superior mesenteric artery, and the inferior mesenteric artery, all of which we have just discussed. |
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Definition
- hepatic portal vein; gi tract; pancreas; spleen
- hepatic portal vein; splenic vein; superior; inferior mesenteric vein
- superior mesenteric; splenic veins; inferior mesenteric; splenic vein |
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Term
| Below we can see images showing two spinal cord levels, with the sympathetic chain running vertically. Sympathetic innervation can be supplied via three scenarios. The first two show __ exiting the spinal column and traveling along the __. Scenario 3, however, shows that __ (going to smooth muscle/glands in the abdominal organs), which are pre-ganglionic SYM fibers, can bypass the SYM chain instead and travel to the __ ganglia via __. They then synapse with post-ganglionic SYM fibers in the collateral ganglia, which then travel along with the celiac, superior mesenteric, or inferior mesenteric arteries in order to reach their target organs |
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Definition
| - pre-ganglionic sym fibers; sympathetic (paravertebral) chain ganglion; visceral efferent fibers; collateral (prevertebral) ganglia; splanchnic nerves; |
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Term
-In the abdomen, sympathetic innervation is provided by a series of __, which are paired nerves that contribute to the innervation of the viscera, carrying autonomic (preganglionic sympathetic) fibers as well as visceral efferent (sensory) fibers. All of the following splanchnic nerves carry preganglionic sympathetic fibers, except the __, which carries only __
-The __ carries preganglionic sympathetic fibers into the abdominal cavity through the diaphragm, synapsing in the celiac ganglion. Postganglionic sympathetic fibers in the celiac ganglion then follow the celiac trunk and it’s branches to innervate blood vessels and their corresponding viscera. The __ carries preganglionic fibers to the aorticorenal ganglion, from which postganglionic sympathetics distribute with the superior mesenteric artery and its branches.
-The __ arise from the lumbar portion of the sympathetic trunk, sending preganglionic sympathetic fibers to synapse in the inferior mesenteric ganglion. Postganglionic fibers then travel to innervate smooth muscle and glands of the pelvic viscera and portions of the hindgut (such as descending colon, sigmoid colon, and rectum). |
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Definition
- splanchnic nerves; pelvic splanchnics; pre ganglionic pym fibers
-greater splanchnic nerve; lesser splanchnic nerve
- lumbar splanchnic nerves |
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Term
-Located along the anterior surface of the abdominal aorta is an extensive __. Although it is a continuation of the plexi seen in the thorax and pelvis, it is subdivided into components named for the vascular structure to which they are associated.
-The __ is found surrounding the celiac trunk, with a celiac ganglion on either side (note that each plexus is named for the artery it is near and that most plexi have one or more collateral ganglia associated with it.). Pre-ganglionic sympathetic fibers (which did not synapse in the sympathetic chain) reach the celiac plexus via splanchnic nerves. Pre-ganglionic parasympathetic fibers from the vagus nerve also travel to this plexus. Only pre-ganglionic sympathetic fibers that did not synapse in the sympathetic trunk (paravertebral) ganglia will synapse in these prevertebral/collateral ganglia; post-ganglionic fibers then continue toward their targets by traveling along the unpaired arteries branching off the abdominal aorta. Fibers from the vagus nerve do not synapse here, but instead travel on to synapse in the wall of their target organs.
-The s__ is found around the base of the superior mesenteric artery, and it receives sympathetic innervation from the thorax via the splanchnic nerves.
-The __ lies between the two mesenteric arteries. From this point downwards, the sympathetic input is provided by the lumbar splanchnic nerves (mentioned on previous slide). Thus, the __ receives preganglionic sympathetic fibers from the lumbar splanchnic nerves. |
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Definition
- prevertebral autonomic plexus
- celiac plexus
- superior mesenteric plexus
- intermesenteric plexus; inferior mesenteric plexus |
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Term
-Innervation of the abdomen (sympathetic and parasympathetic fibers) will “hitch a ride” on the arteries that supply the __. For example, the celiac trunk supplies blood to the liver, pancreas, stomach, and spleen. So preganglionic sympathetic fibers traveling in the greater splanchnic nerve for example, will synapse with postganglionic sympathetic fibers in the celiac ganglion (a collateral ganglion) and then the postganglionic sympathetic fibers will ride out with the branches of the celiac artery to reach the target organ.
-Preganglionic parasympathetic fibers will pass through the __ without synapsing and “hitch a ride” with the arteries as well. These fibers will synapse with postganglionic parasympathetic fibers in a ganglia located in the wall of the target organ (intramural ganglia). |
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Definition
- hitch a ride
- celiac ganglion |
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Term
-Parasympathetic (PYM) nerve fibers arise from the CNS as the __ spinal nerves (the __), and cranial nerves __. They consist of a very long preganglionic axon with a cell body located in the CNS, and a short post-ganglionic axon usually embedded in their target organ. In this image, preganglionic fibers are seen in blue (post-ganglionics aren’t shown).
-PYM innervation of the abdomen is provided by the __. this travels down to the __, innervating portions of the organs seen here. Fibers from CN X distribute through the celiac and superior mesenteric plexi. The inferior mesenteric plexus, however, receives PYM input from the __, which arise from the ventral rami of the spinal nerves __ to innervate the hindgut. These pelvic splanchnics travel to the inferior hypogastric plexi on their respective sides, located bilaterally on the walls of the rectum, and up to the inferior mesenteric ganglion to distribute with the branches of the inferior mesenteric |
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Definition
- S2, S3, S4; (pelvic splanchnic nerves); 3,7,9,10
- vagus nerve (cnX); splenic flexure; pelvic splanchnic nerves; S2-S4 |
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Term
-The lymph nodes that provide drainage for the superficial portions of the abdominal wall are found in the __, as well as in the region that is immediately anterior to the __ of the abdominal muscles.
-An important dividing point in the direction of lymphatic drainage in the abdomen is the __. Lymphatic drainage in those portions of the abdomen that are superior to the umbilicus is directed towards the __, where it eventually drains into the __. Below the umbilicus, lymphatic drainage is oriented towards the __. |
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Definition
- superficial fascia; deep investing fascia
- umbilicus; thorax; axillary lymph nodes; superficial inguinal lymph nodes |
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Term
-In this image, green lines indicate the direction of lymph drainage as the fluid passes through lymphatic vessels. Notable groups of nodes (which are numbered in the image) that receive lymph from abdominal viscera include the __, __, and the __ groups of lymph nodes.
-From these groups, intestinal trunks drain lymph out of the abdomen before they ultimately terminate in the ___, which is a large lymphatic sac where lymph from this region is collected.
-Finally, the __ drains fluid away from the cisterna chyli by draining upward along the aorta and out of the abdomen to eventually join the venous drainage at the junction of the __ and __. |
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Definition
- celiac; superior mesenteric; inferior mesenteric
- cisterna chyli
- thoracic duct; internal jugular; subclavian veins |
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Term
-The __ is a serous membrane that forms the lining of the abdominal cavity. In addition, it covers the exterior surfaces of most abdominal organs, and serves as both support for these organs and as a conduit for the blood vessels, lymph vessels, and nerves that supply them.
-__ refers specifically to the outer of the two layers of peritoneum (the inner being the __, which intimately covers the surface of abdominal organs). The parietal peritoneum that covers the posterior abdominal wall is colored red, with noticeable patches not being covered where the superior surface (“bare area”) of the liver is located, as well as the locations of the ascending and descending colons.
-In this illustration, the contents of the peritoneal cavity have been removed, allowing us to see the anterior surface of the posterior abdominal wall as it is covered in __. The structures located on the posterior abdominal wall are located behind the peritoneum, and are therefore referred to as being __. We will discuss these structures, beginning with the peritoneum, then covering the musculature, organs, vasculature, innervation, and finally the lymphatics of this region of the abdomen. |
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Definition
- peritoneum
- parietal peritoneum; (visceral peritoneum)
- parietal peritoneum; retroperitoneal |
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Term
-The musculature of the posterior abdominal wall is primarily composed of three muscles, the __, the __, and the __, all of which are paired muscles (one on each side of the spinal column).
The __ is a flat muscle immediately lateral to the upper portion of the psoas. It travels from the 12th rib and the tips of the lumbar transverse processes to the __ between L5 and the iliac crest. It functions in stabilizing the __ during inspiration, and helps laterally flex the trunk.
-The __ is a long, fusiform muscle that attaches to the __ of the lumbar vertebrae, then passes under the inguinal ligament (along with the iliacus) towards a tendinous attachment on the lesser trochanter of the femur. It acts as a flexor of the __.
-The __ muscle is also a flexor of the __. It arises from the internal aspect of the ala of the iliac bone, then travels under the inguinal ligament with the psoas major to attach on the lesser trochanter of the femur. |
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Definition
- psoas major; quadratus lumborum; iliacus; quadratus lumborum; iliolumbar ligament; 12th rib
- psoas major; transverse process; thigh
- iliacus; thigh |
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Term
| The urinary system is the organ system that produces, stores, and eliminates urine. It includes two __, two __, the __, and the __. Differences in the anatomy exist between the urinary systems of males and females, primarily in the location of the __ and structure of the __. We will discuss these differences, as well as the anatomy and basic functions of each of the four components of the urinary system. |
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Definition
| urinary system; kidneys; ureters; bladder; urethra; bladder; urethra |
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Term
-The primary organs of the urinary system are the __. There are two kidneys, one on either lateral side of the vertebral column. The presence of the liver typically causes the __ kidney to be slightly lower than the __. Both kidneys sit just below the diaphragm, with the right kidney being posterior to the liver and the left being posterior to the spleen. Resting just on top of each kidney sits an __, which we will discuss later.
-As seen in this illustration, the kidneys are covered in __ (shown as a film over the organs), meaning they are __ in location, as are all structures of the posterior abdominal wall that we will learn about in this module.
-The kidneys have many important functions. They are essential in the urinary system, as well as in serving some homeostatic functions such as the regulation of electrolytes, the regulation of blood pressure by maintaining salt and water balance, and the maintenance of an acid-base balance in the body |
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Definition
- kidneys; right; left; adrenal gland (suprarenal gland)
- parietal peritoneum; retroperitoneal |
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Term
-The kidney is surrounded by tough fibrous tissue called the __ (not seen here, but surrounds the exterior surface of the kidney).
-The inner structure of the kidney can be divided into two layers, the superficial __ and the deep layer of __. The renal cortex forms a border around areas of the renal medulla, which is made up of __. The broad base of each pyramid faces the renal cortex and it’s apex points inward. Projections of renal cortex into the medulla, known as __, separate the individual renal pyramids |
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Definition
- renal capsule
- renal cortex; renal medulla; renal pyramids; renal columns |
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Term
-The tip of each renal pyramid is known as a __. As urine is formed in the renal pyramids, it drains centrally through the papillae, emptying first into the __ and then the __.
-The minor and major calyces are collecting areas for the urine, and then it is drained into the larger space of the __. The minor calyces collect all the urine produced in the renal pyramids, and channel it toward three or four major calyces, and eventually toward the renal pelvis. The renal pelvis is often described as the upper funnel- shaped portion of the __.
- The renal pelvis soon narrows to become the __, and the ureter from each kidney travels inferiorly to empty into the __. |
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Definition
- renal papilla; minor calyces; major calyces
- renal pelvis; ureter
- ureter; bladder |
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Term
-The __ are muscular tubes that propel urine from the kidneys to the __, measuring approximately 25-30 cm. The ureters arise from the renal pelvis on the medial side of each kidney and descend towards the bladder. The ureters pass anterior to the __. The bladder is a hollow, muscular, elastic organ that collects urine, storing it prior to the excretion of urine through the __. We will examine the bladder and the urethra in more detail during our discussion of the pelvis.
-The ureters cross the pelvic brim near the site of the bifurcation of the __ (marked by an X). This is a common site for the impaction of __ (the other common site is where the __ meets the __, indicated by the *). |
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Definition
- ureters; bladder; psoas major; urethra
- iliac arteries; kidney stones; (renal pelvis; ureter) |
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Term
-Located just superior to each kidney is an endocrine gland known as the __.
-Each of these two endocrine glands sit atop the kidneys, with the right adrenal gland being roughly __ and the left being more __ in shape. They are chiefly responsible for synthesizing hormones such as cortisol, epinephrine, and aldosterone, among others, which serve various functions such as regulating kidney function.
-The adrenal glands are __ in location and are surrounded by an __ and __. Each gland has two distinct layers (not pictured), the superficial __ and the deep __, both of which produce hormones. |
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Definition
- adrenal glands (suprarenal glands)
- triangular; semilunar
- retroperitoneal; adipose capsule; renal fascia; adrenal cortex; adrenal medulla |
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Term
-The __ is located at the center of each gland, being surrounded by the __. The cells of the medulla secrete the hormones __, __, and small amounts of __ in response to neural stimulation. These hormones are major contributors to the body’s __ response to environmental stressors. The hormones produced here are released directly into the bloodstream.
-The __ is situated along the perimeter of each adrenal gland. It’s primary function is mediating the body’s response to stress through the production of hormones such as __ and __. The cortex is also the secondary site for the synthesis of male sex hormones, or __ (the primary site being the testes). While the adrenal medulla has direct innervation that regulates its hormone synthesis, the adrenal cortex is regulated by __ that are secreted by the pituitary gland and the hypothalamus. |
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Definition
- adrenal medulla; adrenal cortex; epi; ne; dopamine; fight or flight
- adrenal cortex; cortisol; aldosterone; androgens; neuroendocrine hormones |
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Term
-Descending from the thoracic cavity is the __. Traveling down the posterior wall, this portion of the aorta lies just anterior to the vertebral column, following the curvature of the lumbar vertebrae. As it descends, it bifurcates into the __ and the __, which run along the medial border of the psoas muscles. A parallel pair of __ and __ ascend to merge into the __.
-The abdominal aorta lies slightly to the left of the midline of the body. It’s venous counterpart is the __, which travels parallel to the aorta on it’s right side. This vein carries de-oxygenated blood from the lower half of the body to the right atrium, entering at the lower right, posterior side of the heart.
-Shortly after entering the abdomen, the abdominal aorta branches off paired arteries which supply the kidneys and suprarenal glands. These are known at the __ and __, which we will discuss on the following slide. |
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Definition
- abdominal aorta; left; right common iliac arteries; left; right common iliac veins; inferior vena cava
- inferior vena cava
- left; right renal arteries |
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Term
-Both kidneys are supplied by a __. The renal arteries normally arise off the side of the abdominal aorta, immediately below the __. With the abdominal aorta being on the left side of the vertebral column, the __ is typically shorter than the __.
-Located parallel to the renal arteries are the __, which travel from the kidneys to merge with the ___. Since the inferior vena cava is located on the right side of the body’s midline, the __ must generally be longer in order to reach the left kidney.
-Since the filtration of blood by the kidneys is a vital body function, the renal arteries carry a large portion of the total blood flow to the kidneys. Renal arteries carry about __ of the cardiac output. Approximately __ of this is delivered to the cortex for filtration. |
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Definition
- renal artery; superior mesenteric; left renal artery; right
- renal veins; inferior vena cava; left renal vein
- 20%; 90% |
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Term
-The renal arteries arise at approximately the level of the L2 vertebrae. Each renal artery divides into an __ and __ branch.
-At the __, each renal artery divides into a number of branches to supply the __ of the kidney, referred to as the __ arteries.
-Each segmental artery then divides into a number of __ arteries that ascend in the renal columns (between the lobes of the kidney) to the corticomedullary junction. Here they branch into __ arteries that “arch” over the base of the renal pyramids |
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Definition
- L2; anterior; posterior branch
- hilus of the kidney; five segments; segmental arteries
- interlobar arteries; arcuate arteries |
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Term
-Before examining the innervation of the posterior wall, let’s review our discussion of abdominal innervation. In learning about autonomic innervation, we saw that sympathetic fibers travel from their respective spinal cord level from which they exit the spinal column toward the ___. To the right we can see a pre-ganglionic SYM fiber (purple line) as it travels from the spine to synapse with its post-ganglionic SYM fiber (orange line). The structures that allow these SYM fibers to bypass the sympathetic chain are known as __, which we will discuss in detail on the next slide.
-Note that viscera associated with the posterior abdominal wall receive autonomic innervation through __ and __ from the __.
-Equally important in the discussion of innervation of the posterior abdominal wall are nerves which provide somatomotor (to skeletal muscle) and somatosensory (to skin of body wall) innervation in this region. We will discuss the ___ which gives rise to nerves that supply motor and sensory innervation to the muscles and skin in this region. This is to be distinguished from the autonomic innervation of the viscera. |
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Definition
- abdominal nerve plexi; splanchnic nerves
- splanchnic nerves (preganglionic sympathetics); parasympathetics; vagus nerve
- lumbar plexus |
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Term
innervation of the post abdominal viscera
-In this image we can see several autonomic plexuses which contribute to the innervation of viscera of the posterior abdominal wall. Two notable structures are the __ and __, which can be found at the branching point of the __ artery off the abdominal aorta.
-As we mentioned on the last slide, __ allow SYM fibers to bypass the sympathetic chain on their way to autonomic plexi. One of these is the __ serves as a pathway through which preganglionic sympathetic fibers can pass through and synapse in the suprarenal and renal plexi.
-After leaving the suprarenal/renal plexuses, post-ganglionic SYM fibers can reach their target structures by accompanying the ___ as they travel from the aorta towards the kidneys. |
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Definition
- suprarenal; renal plexuses; renal artery
- splanchnic nerves; least splanchnic nerve
- renal arteries |
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Term
-In the posterior abdomen, pre-ganglionic SYM nerve fibers travel between the spinal column and their autonomic ganglion via a series of ___, which exist as paired nerves that contribute to the innervation of the viscera by carrying these autonomic fibers. Pre-ganglionic SYM fibers are found in all ___ (except for the ___).
-The splanchnic nerves that bring pre-ganglionic SYM fibers to the renal plexus are listed below:
-The __ nerve carries pre-ganglionic fibers to the __ (which is a part of the renal plexi), from which postganglionic sympathetic fibers distribute to the suprarenal gland, kidney, and proximal portions of the ureters.
-The __ nerve carries preganglionic fibers to the ___, from which postganglionic fibers can reach targets such as the renal arteries and the kidneys. |
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Definition
- splanchnic nerves; splanchnic nerves {except for the pelvis splanchnics)
- lesser splanchnic nerve; aorticorenal ganglion (renal plexi)
- least splanchnic nerve; aorticorenal ganglion |
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Term
-The lumbar plexus, which is formed by the union of the __, emerges along the posterior abdominal wall. It supplies innervation to the skin of the thigh and muscles of the anterior and medial compartments of the thigh. This plexus is anterior to the transverse processes of the lumbar vertebrae, and is embedded in the ___.
-There are 6 major nerves that compose the lumbar plexus. The superior branch of spinal nerve L1 is the ___. Exiting the spinal cord at T12-L1, it emerges from the psoas major muscle and crosses in front of the quadratus lumborum towards the iliac crest, running posterior to the kidneys. It then enters the posterior portion of the transversus abdominus muscle.
-The ___ nerve is a branch of the first lumbar nerve (L1). It branches from the first lumbar nerve along with the iliohypogastric nerve. Emerging from the psoas major muscle, it passes obliquely to perforate the transversus abdominus, then accompanies the spermatic cord as it travels through the inguinal canal to innervate the medial/upper thigh |
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Definition
- ventral rami of the first 4 spinal nerves; psoas major
- iliohypogastric nerve
- ilioinguinal |
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Term
-Exiting the spinal cord at L1-L2 is the ___, which emerges on top of the psoas muscle and descends on its anterior surface.
-The genitofemoral nerve branches into both a __ and __. The __ branch supplies the skin of the “femoral triangle”. In men, the __ branch enters the inguinal canal through the deep inguinal ring and travels within the spermatic cord, supplying the cremaster muscle and the scrotum.
-The ___ exits at L2-L3, where it then emerges from the lateral side of the psoas muscle and runs in front of the iliacus and behind the inguinal ligament. It innervates the skin of the anterior and lateral thigh. |
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Definition
- genitofemoral nerve
- genital; femoral branch; femoral branch; genital branch
- lateral femoral cutaneous nerve |
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Term
-The last two major nerves that comprise the lumbar plexus are the __ and the __.
-The ___ (L2-4) emerges from the lateral border of psoas major and descends between the psoas and iliacus muscles. It enters the femoral triangle deep to the inguinal ligament, where it divides into numerous branches. Here it innervates the skin of the thigh, the muscles of the anterior thigh, as well as the hip and knee joints.
-The ___ (L2-L4) descends along the medial border of psoas major. It runs forward on the lateral wall of the pelvis and enters the thigh through the obturator foramen. The obturator nerve innervates the adductor group of muscles in the thigh and the skin of the medial side of the thigh. |
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Definition
- femoral nerve; obturator nerve
- femoral nerve
- obturator nerve |
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Term
| __: Cutaneous innervation of the gluteal region and suprapubic area. |
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Definition
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Term
| __: Cutaneous innervation of the proximal medial thigh and scrotum/mons pubis |
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Definition
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Term
| __: Cutaneous innervation of the lateral side of the thigh. |
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Definition
| lateral femoral cutaneous nerve |
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Term
| __: Cutaneous innervation of genitalia and thigh; genital branch joins spermatic cord to innervate the cremaster muscle. |
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Definition
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Term
| __: Motor innervation to anterior region of the thigh. |
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Definition
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Term
| __: Motor innervation to medial side of the thigh. |
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Definition
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Term
| __: Contributes fibers to the sacral plexus. |
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Definition
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Term
| see drawing for the path of lymphatic drainage in posterior abdominal wall slide 24 |
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Definition
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