Sign up Log in. Web icon An illustration of a computer application window Wayback Machine Texts icon An illustration of an open book. Books Video icon An illustration of two cells of a film strip. Video Audio icon An illustration of an audio speaker. Audio Software icon An illustration of a 3. Software Images icon An illustration of two photographs.
Images Donate icon An illustration of a heart shape Donate Ellipses icon An illustration of text ellipses. Associates normal anatomy with an application of that knowledge in a clinical setting. Offers a strong selection of imaging to show you what is happening three-dimensionally in the human body, the way you see it in practice. Provides clinically applicable information right from the start, to mirror the way that most anatomy courses are now taught. Netter, MD.
If you like the post please share it with your medical friends and family and here are some more related posts that you might like. Please bear in mind that we do not own copyrights to these books. We highly encourage our visitors to purchase original books from respected publishers. Left brachiocephalic vein is twice as long as the right runs obliquely down and behind the manubrium crosses the roots of the three major branches of the aorta receives lymph from the thoracic duct e.
Aorta Ascending begins at the aortic orifice ascends to the 2nd right sternocostal joint Arch Begins at the 2nd right sternocostal joint and arches superiorly and to the left Anterior to the right pulmonary artery and bifurcation of the trachea Passes over the root of the right lung Ends at the body of the T4 vertebra Descending thoracic begins at the body of T4 vertebra descends on the left side of the bodies of T vertebrae, posterior to the root of the left lung and the pericardium enters the abdomen through the aortic hiatus at the T12 vertebral body has a number of branches: bronchial pericardial twigs superior phrenic 1 pair esophageal 2 posterior intercostal 9 pairs subcostal 1 pair f.
Vascular supply arterial: esophageal branches of the thoracic aorta venous: azygos, hemiazygos and accessory azygos veins h. Azygos venous system Drains blood from the back and thoracoabdominal walls Is highly variable Is composed of an unpaired azygos vein and its main tributary, the hemiazygos vein.
Phrenic nerves Supply motor and sensory fibers to the diaphragm Enter the superior mediastinum between the subclavian artery and brachiocephalic vein on either side Pass anterior to the roots of the lungs, unlike the vagus nerve The right phrenic nerve descends on the right side of the inferior vena cava to the diaphragm The left phrenic nerve crosses the arch of the aorta descends anterior to the root of the left lung and along the pericardium over the left atrium and ventricle pierces the diaphragm to the left of the pericardium 1.
Surgery, injury, or disease affecting the contents of superior mediastinum can damage either or both recurrent laryngeal nerves, reducing the voice to a hoarse whisper. The left recurrent laryngeal nerve passes beneath the arch of the aorta and ascends to the neck between the trachea and the esophagus.
Bronchogenic or esophageal carcinoma or an aneurysm of the arch of the aorta can thus affect this nerve. Chylothorax Surgical procedures involving the posterior mediastinum can injure the thoracic duct, which is hard to identify because it has a thin wall and is usually colorless. Injury to the thoracic duct can lead to leakage of lymph into the thoracic cavity at a volume of up to mL per hour.
Lymph is called chyle when it is carrying chylomicrons fat droplets from the digestion of food in the gastrointestinal system. If lymph from the thoracic duct enters the pleural cavity, the resulting condition is called a chylothorax and may require removal by thoracocentesis.
Mnemonics Memory Aids To remember the spinal nerve contributions to the phrenic nerve: C3,4,5 keeps the diaphragm alive T8-Site at which inferior vena cava pierces the diaphragm TSite at which esophagus pierces the diaphragm TSite at which aorta pierces the diaphragm Memory Aids SAT for major contents of the superior mediastinum : Superior vena cava, Arch of aorta, and Trachea Turkeys Blow Eggs: Trachea lies Behind the Esophagus page page Memory Aids Relationship of Thoracic Duct to Esophagus and Azygos Vein "The duck lies between two gooses.
Is the largest cavity in the body and is continuous with the pelvic cavity. Lined with parietal peritoneum, a serous membrane Bounded superiorly by the diaphragm Has a concave dome Spleen, liver, part of the stomach, and part of the kidneys lies under the dome and are protected by the lower ribs and costal cartilages.
Lower extent lies in the greater pelvis Between the ala or wings of the ilia Ileum, cecum, and sigmoid colon thus partly protected Anterior and lateral walls composed of muscle Viscera in these areas are more likely to be damaged by blunt force and penetrating injuries. Posterior wall comprised of vertebral column, the lower ribs, and associated muscles Protect the abdominal contents. All the rest of the organs are peritoneal Lie within the peritoneal cavity Covered by a layer of visceral peritoneum Visceral peritoneum is continuous with the parietal peritoneum lining the cavity via a mesentery.
These planes create nine abdominal regions: Right and left hypochondriac regions, superiorly on either side Right and left lumbar flank regions, centrally on either side Right and left inguinal groin regions, inferiorly on either side Epigastric region superiorly and centrally Umbilical region, with the umbilicus as its center Hypogastric or suprapubic region, inferiorly and centrally Descriptive quadrants and regions are essential in clinical practice Each area represents certain visceral structures Allow correlation of pain and referred pain from these areas to specific organs.
Appendicitis: inflammation of the appendix. Pain first presents in the epigastric region, moves to the umbilical region and then localizes in the right lower quadrant. Rupture of the appendix leads to peritonitis inflammation of the peritoneum. This presents with severe pain, fever, and abdominal rigidity. Muscle-splitting incision of McBurney : used to access the appendix.
Each muscle layer is split in the direction of the fiber orientation. The incision must not go too far laterally or the ascending branch of the deep circumflex iliac artery may be severed. Clinical Points Grey-Turner's sign Local right flank redness or bruising ecchymosis Indicates a retroperitoneal hemorrhage Usually takes 24 to 48 hours to appear Can be predictive of severe hemorrhagic pancreatitis, abdominal injury, or metastatic cancer page page Clinical Points Cullen's sign Discoloration ecchymosis around the umbilicus Aresult of peritoneal hemorrhage Mnemonics Memory Aids Causes for abdominal expansion protuberance : Remember the five Fs: Fat Feces Fetus Flatus Fluid.
Transversalis fascia endoabdominal fascia Athin membranous sheet lining most of the abdominal wall Lies deep to the transversus muscles and the linea alba Endoabdominal fat separates the transversalis fascia from the parietal peritoneum Muscles Functions Protect the viscera Help maintain posture Can compress the abdominal contents, thus raising intra-abdominal pressure, such as in sneezing, coughing, defecating, micturating, lifting, and childbirth Four paired muscles make up the anterolateral abdominal wall Three flat muscles Asingle vertical muscle.
Three flat muscles include The external abdominal oblique a. Largest and most superficial b. Fibers run inferiorly and medially and end in aponeurosis that contributes to the rectus sheath. Inferior border of its aponeurosis forms the inguinal ligament, where it thickens and folds back on itself d. Innervated segmentally by T6-T12 spinal nerves and subcostal nerve The internal abdominal oblique a.
Athin muscular layer b. Fibers run inferiorly and laterally and end in an aponeurosis that contributes to the rectus sheath c. Innervated segmentally by the ventral rami of T6-T12 spinal nerves The transversus abdominis a.
Innermost of the three flat muscles b. Fibers run transversely and medially and end in an aponeurosis that contributes to the rectus sheath. Innervated segmentally by the ventral rami of T6-T12 spinal nerves Linea alba a. Tendinous raphe running vertically in the midline b. Formed by the union of the aponeuroses of the flat muscles on either side c. Largely avascular d. Nerves and vessels are transversely oriented and segmental Nerves Thoracoabdominal nerves Anterior cutaneous branches of the ventral primary rami of T7-T11 a.
T7-T9 supply skin above the umbilicus b. T10 supplies skin around the umbilicus c. Subcostal nerves T12 supply skin below umbilicus e. Iliohypogastric and ilioinguinal nerves terminal branches of L1 supplies skin below umbilicus Vascular supply Arteries Anterior and collateral branches of posterior intercostal arteries Branches of the internal thoracic arteries a. Superior epigastric b. Musculophrenic Inferior epigastric from external iliac Branches of the femoral artery a. Superficial epigastric b.
Superficial circumflex iliac Veins Venous drainage is via venae comitantes veins corresponding to the arteries listed Blood drains away from the umbilicus Venous drainage to the caval system Lymphatics Superficial lymphatics above the umbilicus lymph drains to the axillary nodes Superficial lymphatics below the umbilicus drain to the superficial inguinal nodes Deep lymphatics a. Accompany deep veins b. Gives off inferior epigastric and deep circumflex arteries b. Exits under the inguinal ligament as the femoral artery c.
Its tributaries follow branches of aorta Exceptions: a. Left gonadal vein drains to left renal vein b. Ventral primary rami of T12 b. Arise in the thorax c.
Run inferiorly on surface of quadratus lumborum d. Supply external abdominal oblique and skin of anterolateral abdominal wall Lumbar nerves a.
Dorsal and ventral primary rami of lumbar spinal nerves b. Dorsal rami supply muscles and skin of back c. Ventral rami pass into substance of psoas major muscle and form lumbar plexus Nerves of lumbar plexus Ilioinguinal and iliohypogastric nerves L1 a.
Enter abdomen posterior to medial arcuate ligament b. Pierce transverse abdominus near anterior superior iliac spine ASIS c. Emerges from anterior surface of psoas muscle b. Runs inferiorly deep to fascia c. Emerges from lateral aspect of psoas muscle b. Runs inferiorly on iliacus c. Emerges from medial border of psoas b. Descends through pelvis to obturator canal c. Supplies muscles and skin of medial thigh Femoral nerve L2-L4 a. Emerges from lateral border of psoas b.
Innervates iliacus c. Passes beneath inguinal ligament on surface of iliopsoas muscle d. Descends over ala of sacrum into pelvis b. Joins in formation of sacral plexus Autonomic nerves Thoracic splanchnic nerves a. Convey presynaptic sympathetic fibers to celiac, superior mesenteric, and aorticorenal sympathetic ganglia Lumbar splanchnic nerves a.
Rise of abdominal sympathetic trunks b. Three to four in number c. Convey presynaptic sympathetic fibers to inferior mesenteric, intermesenteric, and superior hypogastric plexuses Prevertebral sympathetic ganglia a. Celiac b. Superior mesenteric c. Inferior mesenteric d. Aorticorenal Parasympathetic fibers a. Preganglionic b. Contain preganglionic sympathetic and parasympathetic fibers, postganglionic sympathetic fibers, sympathetic ganglia prevertebral , and visceral afferent fibers b.
Some named for major blood vessels periarterial : celiac, superior mesenteric, inferior mesenteric, intermesenteric, aorticorenal c. Located 1. Direct inguinal hernias protrude through the layers of the wall in Hesselbach's the inguinal triangle, medial to the epigastric vessels. The hernial sac consists of peritoneum containing a portion of a viscus usually small or large bowel Indirect hernias which leave the abdomen lateral to the epigastric vessels, entering the inguinal canal through its deep ring.
The hernial sac consists of peritoneum containing a portion of a viscus usually small or large bowel and is covered by the layers covering the spermatic cord. The hernia may continue through the superficial ring and into the scrotum. Clinical Points Psoas Abscess Usually caused by the spread of lumbar vertebral tuberculosis to the psoas sheath.
The sheath becomes thickened and pus accumulates beneath it Pus tracks inferiorly within the sheath, deep to the inguinal ligament, surfacing in the superior part of the thigh. Should pus track to the adjacent iliac fascia, a recess may form-the iliacosubfascial fossa. The large bowel can become trapped in this fossa, with resulting severe pain.
Involvement of parietal peritoneum leads to well-localized, sharp abdominal pain with tenderness on palpation. Ascites Accumulation of fluid in the peritoneal cavity May form secondary to peritonitis or a variety of other pathological conditions Abdomen may become grossly distended as many liters of fluid accumulate Paracentesis may be undertaken both for diagnostic purposes and for draining the ascitic fluid.
Usually performed under local anaesthesia. Thick, circular middle layer of muscularis externa b. Controls passage of chime into duodenum c. The right arm of the H is formed by the inferior vena cava and the gall bladder. The left arm is formed by the fissure for the ligamentum teres hepatis and the fissure for the ligamentum venosum. Clinical points page page Gallstones cholelithiasis Stone-like deposits are commonly seen in the gallbladder If they obstruct the cystic duct, can cause pain in the right upper quadrant RUQ , especially after consumption of a fatty meal.
Pain typically comes and goes biliary colic and may be associated with nausea and vomiting. Secondary inflammation of the gallbladder leads to constant pain, and is often the trigger to seeking medical attention. If the gallstones pass further down, they may obstruct the biliary system causing jaundice, or the pancreatic duct causing pancreatitis.
Splenic rupture Spleen is the most commonly damaged abdominal organ, despite being protected by the ribcage. Trauma causing rib fracture or sudden increases in intra-abdominal pressure such as being impaled against a steering wheel in a road traffic accident may result in rupture of the spleen. Bleeding is typically profuse owing to its thin capsule and soft parenchyma. Subphrenic abscess Subphrenic recess is a common site for pus to accumulate.
Right-sided abscesses are more common owing to the incidence of perforation of an inflamed appendix. Pus usually tracks into the hepatorenal recess in the supine position, and is best drained inferior to the 12th rib avoiding puncture of the pleura. Left gastroepiploic: supplies left side of greater curvature of stomach, anastomoses with right gastroepiploic b.
Short gastric arteries: supply fundus of stomach Common hepatic artery Extends retroperitoneally to the right to reach hepatoduodenal ligament Divides into gastroduodenal and proper hepatic arteries Gastroduodenal artery branches: a. Superior pancreaticoduodenal supplying the head of pancreas and proximal duodenum b. Right gastroepiploic artery supplying right side of greater curvature of stomach Proper hepatic branches: a.
Right gastric artery to right portion of lesser curvature of stomach c. Cystic artery usually from the right hepatic artery supplies the gallbladder and cystic duct Superior mesenteric artery SMA Arises at L1 Supplies the gut from the second part of duodenum as far as the distal one third of the transverse colon Major branches include: Inferior pancreaticoduodenal a. Supplies duodenum distal to entry of bile duct , pancreas, and spleen b. Anastomosis with superior pancreaticoduodenal Jejunal and ileal branches a.
Form anastomotic loops arterial arcades Fewer large loops in jejunum Many shorter loops in ileum b. Loops give off vasa recta straight arteries Longer in jejunum Shorter in ileum Ileocolic artery: a. Supplies caecum and some of the ascending colon b. Resistance to portal blood flow may occur due to intrahepatic obstruction fibrosis of the liver from cirrhosis Resistance may also occur as a result of posthepatic obstruction such as heart failure or Budd-Chiari syndrome or prehepatic obstruction.
Each plexus has sympathetic and parasympathetic input, both with motor and sensory divisions. Motor control governs glandular secretion, smooth muscle activity, and vascular tone.
Afferent nerves mediate distension of organs and tension on mesenteries. Embryologically, the kidneys develop in the pelvis and ascend to their abdominal position. In doing so, they acquire successively more superior vessels from the aorta and IVC, whereas inferior vessels degenerate.
Failure of degeneration of any of these vessels may result either in branches to the poles of the kidney, or in accessory vessels at the hilum. Furthermore, the renal arteries are not infrequently divided prior to their arrival at the hilum. Clinical Points Nephrolithiasis kidney stones Renal caliculi stones may be found anywhere between the renal calices and urinary bladder Astone in the ureter can cause significant distension This results in colicky pain radiating from loin to groin as ureteric contractions try to move the stone distally In the past, an intravenous urogram pyelogram was the imaging tool to determine a filling defect in the ureter More recently, a computed tomography CT scan has become the tool of choice, because patients may have an allergic response to the dye used in the urogram.
Management is usually conservative waiting for the stone to pass , but may be surgical or involve lithotripsy sonic disruption of the stone. Renal cysts Cysts are a common finding in the kidney. They may be solitary or multiple. Solitary cysts are usually of no clinical consequence. Multiple cysts may cause gross distortion and enlargement of the kidneys, culminating in renal failure.
Multiple cysts may be caused by adult polycystic kidney disease, because of an autosomal dominant gene. Acute Urinary Retention: The bladder, if distended, may be palpated and percussed up to the umbilicus. On examination, the bladder is dull to percussion and in acute urinary retention, the patient may also complain of tenderness on palpation in the suprapubic region. Supracristal Line: Auseful landmark when performing a lumbar puncture since it corresponds to the 4th lumbar vertebral body.
Lumbar puncture in adults is performed in the lateral decubitus position in the L4-L5 interspace. This movement is prevented by the sacrospinous and sacrotuberous ligaments. All of the ilia are less flared in men than in women, so the greater pelvis is deeper.
In a stable fracture, the pelvis remains stable and there is only one break-point in the pelvic ring with minimal hemorrhage. In an unstable fracture, the pelvis is unstable with two or more break-points in the pelvic ring with moderate to severe hemorrhage. Signs of a fractured pelvis include: pain in the groin, hip or lower back; difficulty walking; urethral, vaginal or rectal bleeding; scrotal hematoma; and shock as a result of concealed hemorrhage contained bleeding into the pelvic cavity Afracture can be confirmed on x-ray and is seen as a break in continuity of the pelvic ring.
Decubitus Ulcers Also called pressure sores Can be a partial- or full-thickness loss of skin, underlying connective tissue and can extend into muscle, bone, tendons, and joint capsules. Two thirds of pressure sores occur in patients older than 70 years Results from prolonged pressure on an area of skin, connective tissue and muscle from a mattress, wheelchair seat, or bed rail.
Commonly occur in those with poor mobility, bed-bound, poor nutrition, and incontinence. Innervated by fibers from adjacent autonomic plexuses Urinary Bladder General structure Lies posterior to pubic bones and pubic symphysis When empty is tetrahedron in shape and lies entirely within true pelvic cavity; spherical when full and may reach as high as umbilicus When empty has a base posterior surface and a superior and two inferolateral surfaces.
Sympathetic fibers via hypogastric plexus to bladder neck relaxes bladder neck internal urethral sphincter and prevents retrograde ejaculation during micturition in males page page Clinical Points Fractures of the Pelvis and Bladder Injury The bladder lies immediately posterior to the pubic symphysis and fractures of the pubis can be complicated by rupture of the bladder.
The rupture can result in the extravasation of urine intraperitoneally if the peritoneum is torn Urinary Tract Infections UTIs As a result of a shorter urethra, women are more susceptible to UTIs Commonly occurs in women following sexual intercourse Pathogen is commonly Escherichia coli Infection may lead to urethritis, cystitis, or pyelonephritis inflammation of urethra, bladder, and kidneys, respectively.
Symptoms include: dysuria, urgency, frequency, and occasionally hematuria Urinary Stress Incontinence Factors maintaining continence in the female are the external urethral sphincter striated muscle surrounding middle third of urethra and support of the bladder and urethra by the levator ani muscles Urinary stress incontinence is an involuntary loss of urine that occurs during coughing, sneezing, laughing, lifting, or exercise, because of the inability of these muscles to counter the increase in intra-abdominal pressure.
Following menopause the uterus and vagina undergo atrophy Because the upper two thirds of the vagina lie within the pelvic cavity, weakness of the pelvic floor muscles can lead to vaginal prolapse. The lumen of fallopian tubes communicates with the peritoneal cavity at its distal ovarian end. The ovary is covered only by a thin layer of mesothelium, an extension of the mesovarium, to permit ovulation of the mature ovum into the peritoneal cavity. Ectopic pregnancies are therefore possible within the peritoneum.
Fertilization of an ovum usually occurs within the fallopian tubes at the ampulla the widest part Ectopic pregnancies-implantation of a blastocyst other than in the uterine wall-can occur in the uterine tube tubal pregnancy-most common ectopic pregnancy , into the ovary ovarian pregnancy-rare or into the abdominal wall peritoneal pregnancy-very rare Blockage of the uterine tubes as the result of disease is a common cause of infertility Clinical Points Cervical Cancer Common between age 40 and 60 years Was the leading cause of death of women in the United States until , when detection of malignancies and premalignant conditions was made possible by the development of Pap Papanicolaou smears.
Site of urethral rupture determines where urine will extravasate The superficial perineal fascia is continuous with the deep membranous layer of the superficial fascia of the anterior abdominal wall. If there is disruption of the spongy urethra, urine may extravasate into the superficial perineal pouch and ascend up the anterior abdominal wall beneath the deep membranous layer.
It will not extend into the anal triangle, because the superficial perineal fascia is tacked down to the perineal membrane along its posterior margin. It will not extend into the thigh because the superficial perineal fascia is tacked down to superomedial fascia lata of the thigh.
Penile trauma is rare. Qual dos seguintes seios drena para o meato nasal superior? Seio esfenoidal B. Seio frontal E. O nervo etmoidal anterior inerva, ao menos em parte, o seio esfenoidal C. O seio esfenoidal drena para o recesso esfenoetmoidal D. O nervo alveolar superior posterior inerva, ao menos em parte, o seio maxilar E.
Separa a cavidade oral da nasal C. Apresenta cristas transversais laterais na mucosa denominadas pregas palatinas transversas Palatoglosso E. Lingual B. Hipoglosso D. Veia sublingual C. Tuba auditiva E. Nervo vago D. A e C apenas Ligamento vocal C. Membrana cricovocal E. Ligamento vestibular Nervo vago B.
Veia jugular interna D. Nervo hipoglosso B. Nervo lingual C. Ducto submandibular E. Ductos semicirculares E. Martelo Os seguintes vasos irrigam a orelha externa, exceto um. Maxila B. Lacrimal C. Etmoide D. Nasal E. Etmoide B. Asa maior do esfenoide C. Asa menor do esfenoide D. Frontal E. Lacrimal Dorso da sela turca C. Fissura orbital superior E. Nenhuma das anteriores Superolateral B. Inferomedial C. Superomedial E. Ramo comunicante cinzento B.
Ramo comunicante branco C. Ramo posterior D. Ramo anterior E. A e B apenas F. B e C apenas G. A e D apenas Todos os dentes inferiores B. Toda a gengiva lingual inferior D. Toda a mucosa alveolar lingual inferior Bloqueio do nervo alveolar inferior B.
Bloqueio Gow-Gates C. Bloqueio Akinosi D. Bloqueio do nervo mentual E. Bloqueio do nervo alveolar superior posterior Bloqueio do nervo nasopalatino C. Bloqueio do nervo infraorbital D. Bloqueio do nervo palatino maior E. Ramos anteriores de C5—T1 B. Ramos anteriores de C5—C7 C. Ramos anteriores de C8—T1 D.
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