Thoracic & Abdominal Anatomy

Last updated 20.09.12

 

Index

 

-  Bones

-  Joints

-  Movements & ROM

-  Muscles

-  Fascia

-  Trigger Points

-  Arterial Supply

-  Venous Drainage

-  Lymphatic Drainage

-  Innervation

-  Cutaneous Innervation

-  Organs

-  Dermatomes

-  Reflexes

-  Regional Anatomy

-  Surface Anatomy

-  Acupuncture

 

 

 

 

Bones of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

-  Sternum

-  Ribs

-  Vertebrae

-  Sacruum

-  Cocyx

 

 

 

Sternnum

 

-  Manubrium - jugular notch, clavicular notch

-  Body of Sternum - sternal angle

-  Xiphoid Process - which originally cartilage but calcifies eventually after birth

 

 

Ribs

 

Features

-  Twelve ribs, head, tubercule, neck, costal groove (intercostal artery, intercostal vein and intercostal nerve inferiorly), ribs pass forward and down,

-  True Ribs (1st – 7th) - attached to the sternum by individual costal cartilages

-  1st Rib

-  Atypical, attaches T1 only, anteriorly attaches to top of manubrium, scalene tubercule for  anterior scalene muscle, subclavian vein, subclavian artery and brachial plexus lie ontop of

-  2nd Rib

-  Attaches T1 & T2, attaches to manubrosternal joint (sternal angle), tuberocity for the serratus anterior muscle

-  Typical Ribs (3rd – 9th) - heads connect to two vertebrae, corresponding thoracic vertebrae and superior vertebrae, two articular facets,

-  3rd Rib - attaches T2 & T3

-  4th Rib - attaches T3 & T4

-  5th Rib - attaches T4 & T5

-  6ht Rib - attaches T5 & T6, attaches to xiphosternal joint

-  7th Rib - attaches T6 & T7

-  False Ribs (8th -12th) – 8th-10th ribs are connected to the costal cartillages above them to join sternum via 7th costal cartilage

-  8th Rib –

-  9th Rib –

-  10th Rib - attaches T10 only

-  Floating Ribs (11th – 12th) - only connected to vertebrae, no anterior attachment, no cartilage attachment to sternum, are not connected to transverse processes

-  11th Rib - attaches T11 only

-  12th Rib - attaches T12 only

 

 

 

Vertebrae

 

Features

-  24 vertabrae (» 33 including sacral & coxygeal), contain vertebral canal which contains the spinal cord, secondary curves are due to intervertebral discs, primary curves are due to the shape of the vertebral bodies

 

Cervical

-  7 vertebrae, secondary curve (arches anteriorly), transverse formaina in transverse processes transmit vertebral artery (except C7), vertebral vein and autonomic nerve, possibly bifid spinous processes, smallest body, have anterior tubercule and posterior tubercule

-  C1 (atlas) - attaches superiorly to occipital bone of skull

-  Pons posticus – bony process forming a partial or complete bridge from the spinous process to the vertebral body, creates the arcuate foramen which transmits the vertebral artery, contradindicates cervical manipulation

-  C2 (axis) - dens (odontoid process)

-  Os odontoidium – agenesis or hypoplasia of odontoid process, accompanied by hyperplasia of anterior tubercule in accommodation, contraindicates cervical manipulation

-  C3

-  C4

-  C5

-  C6

-  C7 

-  Transverse foramina does not transmit vertebral artery, is identifiable as the most superior vertebrae with a large spinous process that does not move with head rotation (it is the only cervical vertebrae that does not).

-  Cervical ribs (transitional vertebrae) – a rib of C7 joins 1st rib anterio-laterally, may manifest with thoracic outlet syndrome

 

Thoracic

-  12 vertebrae, primary curve (arches posteriorly)

-  T1 - attaches to 1st rib

-  T2 - attaches to 1st and 2nd rib

-  T3 - attaches to 2nd and 3rd rib

-  T4 - attaches to 3rd and 4th rib

-  T5 - attaches to 4th and 5th rib

-  T6 - attaches to 5th and 6th rib

-  T7 - attaches to 6th and 7th rib

-  T8 - attaches to 7th and 8th rib

-  T9 - attaches to 8th and 9th rib

-  T10 - attaches to 10th rib

-  T11 - attaches to 11th rib

-  T12 - attaches to 12th rib

 

Lumbar

-  Five vertabrae, secondary curve (arches anteriorly), largest body

-  L1 

-  L2

-  L3

-  L4

-  L5 - attaches inferiorly to sacrum 

 

 

 

Saccrum

 

-  5 vertebrae fused to form one bone, attaches superiorly to L5 and inferiorly to coccyx, primary curve (arches posteriorly), Sacral Foramina, Lateral Sacral Crest, Median Sacral Crest, Apex, Ala

 

 

 

Coccyx

 

-  4-5 vertebrae fused to form one bone, “tail”, attaches superiorly to saccrum

 

 

 

 

Joints of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

-  Manubrosternal Joint

-  Xiphisternal Joint

-  Costovertebral Joint

-  Sternocostal Joint

-  Intervertebral Joints

-  Lumbosacral Joint

 

 

 

 

 

Movements & ROM of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

-  Descriptions

-  Flexion

-  Extension

-  Abduction

-  Adduction

-  Closed packed position

-  Neutral position

 

 

 

 

 

Muscles of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

-  Thoracic Wall

-  External Intercostals

-  Internal Intercostals

-  Subcostalis

-  Transversus Thoracis

-  Transversus Abdominus

-  Posterior Abdominal Wall

-  Quadratus Lumborum

-  Psoas Minor

-  Iliopsoas

-  Psoas Major

-  Iliacus

-  Rectus Sheath

-  Rectus Abdominus

-  Transverse Oblique

-  Internal Oblique

-  External Oblique

-  Pyramidial

-  Levator Costarum

-  Cremaster

-  Erector Spinae

-  Iliocostalis

-  Cervicis

-  Thoracis

-  Lumborum

-  Longissimus

-  Capitis

-  Cervicis

-  Thoracis

-  Spinalis

-  Capitis

-  Cervicis

-  Thoracis

-  Transversospinal

-  Semispinalis

-  Capitis

-  Cervicis

-  Thoracis

-  Multifidus

-  Long Rotatores

-  Deep Back

-  Short Rotatores

-  Interspinalis

-  Intertransversari

-  Longus Coli

-  Longus Capitus

-  Rectus Capitis Anterior

-  Rectus Capitus Lateralis

-  Latissimus Dorsi

-  Diaphragm

-  Pelvis

-  Iliopsoas

-  Illiacus

-  Psoas Major

-  Psoas Minor

-  Quadratus Lumborum

-  Urogenital Diaphragm

-  Deep Transverse Perineal

-  Sphincter Urethrae

 

 

 

MUSCLES OF THE THORACIC WALL

 

External Intercostal Muscle

fibers runs to form a “V”, 11 pairs

Origin: inferior border of upper rib

Insertion: superior border of lower rib

Action: elevates ribs during respiration, depresses ribs in forced respiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Internal Intercostal Muscle

fibers run perpendicular to external intercostal muscle to form a “L”, 11 pairs

Origin: superior border of lower rib

Insertion: inferior border of upper rib

Action: depresses ribs during respiration, elevates ribs in forced expiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Innermost Intercostals Muscle

11 pairs

Origin: superior border of lower rib

Insertion: inferior border of upper rib

Action: assists in respiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Subcostalis Muscle

Origin: inner surface of each rib near angle

Insertion: medially two or three ribs below

Action: depresses ribs in expiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Transversus Thoracis Muscle

Origin: inner surface of lower sternum

Insertion: inner surfaces of costal cartilages of 2nd to 6th ribs

Action: depresses ribs in expiration

Innervation: intercostal nerve

Blood Supply: intercostal arteries

 

Transversus Abdominus Muscle

fibers run like a “girdle”

Origin: inner illiac crest (innominate), lateral third of inguinal ligament, thoracolumbar fascia and cartilage of 7th to 12th ribs

Insertion: linea alba

Action: tenses abdonimal wall and assists lateral flexion

Innervation: 7th to 12th intercostal nerve, iliohypogastric nerve, ilioinguinal nerve

Blood Supply: lower intercostal artery, subcostal branch of internal thoracic (subclavian artery), lumbar artery

 

RECTUS SHEATH

 

Rectus Abdominus Muscle

Origin: cartillages of 5th to 7th ribs and xiphoid process

Insertion: pubic crest between tubercule and symphysis (innominate)

Action: flexes trunk and compresses abdomen

Innervation: 7th to 12th intercostal nerve

Blood Supply: superior epigastric branch of internal thoracic (subclavian artery), inferior epigastric branch of external illiac artery

 

Transverse Oblique Muscle

Origin:

Insertion:

Action:

 

Internal Oblique Muscle

fibers run parallel to internal intercostals “L”

Origin: middle illiac crest (innominate), lateral third of inguinal ligament and thoracolumbar fascia

Insertion: linea alba and lower border of 10th or 11th to 12th ribs

Action: ipsilateral rotation of trunk, lateral flexion and flexion of trunk, compresses abdomen

Innervation: 7th to 12th intercostal nerve, iliohypogastric nerve, ilioinguinal nerve

Blood Supply: lower intercostal artery, subcostal branch of internal thoracic (subclavian artery), lumbar artery

 

External Oblique Muscle

fibers run parallel to external intercostals “V”

Origin: lower border of 5th to 12th ribs

Insertion: outer illiac crest (innominate), inguinal ligament and anterior layer of rectus sheath (aponeurosis)

Action: contralateral rotation of trunk, lateral flexion and flexion of trunk and compresses abdomen

Innervation: 7th to 12th intercostal nerve, iliohypogastric nerve, ilioinguinal nerve

Blood Supply: lower intercostal artery, subcostal branch of internal thoracic (subclavian artery), lumbar artery

 

Pyramidial Muscle

Origin: ventral surface of pubis

Insertion: linea alba between umbilicis and pubic symphysis (innominate)

Action: tenses linea alba

Innervation: subcostal nerve

Blood Supply: superior epigastric branch of internal thoracic (subclavian artery), inferior epigastric branch of external illiac artery

 

Levator Costarum Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Cremaster Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

Latissimus Dorsi Muscle

Origin: spinous process of T7 to L5, supraspinous ligament, upper 2-3 sacral segments, iliac crest, lower 8th or 9th to 12th ribs, inferior angle of scapula

Insertion: floor of bicipital (intertubercular) groove of humerus, part of crest of lesser tubercule of humerus

Action: extends arm from flexion, internally (medially) rotates arm, adducts arm, downward rotates scapula

Innervation: thoracodorsal nerve, C6 to C8

Blood Supply: thoracodorsal artery

 

Diaphragm Muscle

Origin: inner xiphoid process, inner surface of 7th-12th ribs, L1-L2/L3

Insertion: central tendon of diaphragm

Action: draws central tendon down to increase thoracic cavity volume

Innervation: phrenic nerve and intercostal nerve (C3-C5)

“C3, 4, 5 Keeps Us Alive”.

Phrenic nerve splits to innervate the crural and costal portions separately. This actions allows most of the diaphragm to contract and increase intra-abdominal pressure but remain uncontracted around the oesophagus for the act of emesis (vomiting).

Blood Supply: inferior phrenic artery, superior phrenic artery and musculophrenic branch of internal thoracic (subclavian artery)

Vena Caval Foramen

-      located in the central tendon

-      allows passage at the level of T8:

Š     “Vena cava” has eight letters ą T8

Š     inferior venae cava

Oesophageal Hiatus:

-      allows passage at the level of T10:

Š     “oesophagus” has ten letters ą T10

Š     eosophagus

Š     left gastric artery

Š     left gastric vein

-      bounded bilaterally by the left crus and right crus

Aortic hiatus

-      located posterior to diaphragm muscle

-      allows passage at the level of T12:

Š     “aortic hiatus” has twelve letters ą T12

Š     thoracic aorta

Š     thoracic duct

Lumbocostal Arches

 

 

Illiopsoas Muscle

Composed of illiacus muscle and psoas major muscle

 

Illiacus Muscle

Origin: inner surface of upper illiac fossa (innominate), anterior inferior illiac spine and anterior capsule of hip joint

Insertion: illiopsoas tendon to lesser trochanter of femur and medial aspect of linea aspera

Action: hip flexion and external rotation of femur

Innervation: femoral nerve, L2, L3, L4

Blood Supply: iliolumbar artery, deep circumflex iliac artery

 

Psoas Major Muscle

Origin: bodies of T12 to L4, intervertebral discs and transverse processes of L1 to L4

Insertion: illiopsoas tendon to lesser trochanter (femur) and medial aspect of linea aspera

Action: hip flexion and external rotation (femur)

Innervation: ventral rami, L1, L2, L3, L4

Blood Supply: iliolumbar artery, lumbar artery, subcostal artery

 

Psoas Minor Muscle

Origin:

Insertion:

Action:

Blood Supply:

 

Quadratus Lumborum Muscle

Origin: lateral lip of iliac crest (innominate) and iliolumbar ligament

Insertion: posterior inferior aspect of 12th rib and transverse process of L1 to L4

Action: stabilises and depresses 12th rib (expands thoracic cavity) and eccentrically stabilises lateral flexion to opposite side

Innervation: ventral rami, L1, L2, L3, L4

Blood Supply: lumbar artery, subcostal artery

 

ERECTOR SPINAE (SPINOTRANSVERSE) Muscle

All supplied by dorsal rami of spinal nerve

All supplied by muscular branches of the aorta

Common action of bilaterally extending the vertebral column, maintaining posture and stabilises vertebral column during flexion and unilaterally bending the vertebral column laterally and ipsilaterally rotating the vertebral column

 

Iliocostalis Lumborum Muscle

Origin: common tendonous origin from sacrum, iliac crest (innominate) and spinous processes of lower thoracic and most lumbar vertebrae

Insertion: lower border of angles of 6th to 12th ribs

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Iliocostalis Thoracis Muscle

Origin: upper border of 6th to 12th ribs medial to iliocostalis lumborum’s insertion

Insertion: lower border of angles of 1st to 6th ribs

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Iliocostalis Cervicis Muscle

Origin: angles of 1st to 6th ribs

Insertion: transverse processes of C4 to C6

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Longissimus Thoracis Muscle

Origin: common tendonous origin

Insertion: transverse process of T1 to T12 (all), between tubercules and angles of 1st to 12th ribs (all) and transverse processes of upper lumbar vertebrae

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Longissisus Cervicis Muscle

Origin: transverse processes of T1 to T6

Insertion: transverse processes of C2 to C6

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Longissimus Capitis Muscle

Origin: transverse and auricular processes of middle and lower cervical vertebrae and transverse processes of upper thoracic vertebrae

Insertion: posterior aspect of mastoid process of temporal bone

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Spinalis Thoracis Muscle

Origin: common tendonous origin

Insertion: spinous processes of T3 to T8

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Spinalis Cervicis Muscle

Origin: spinous processes of C6 to T2

Insertion: spinous processes of C2 and mybe C3 and C4

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Spinalis Capitis Muscle

Origin: spinous processes of lower cervical and upper thoracic vertebrae

Insertion: between superior and inferior nuchal lines (occipital bone)

Action: bilaterally extends and stabilised during flexion of the vertebral column and maintains posture and unilaterally bends laterally and ipsilaterally rotates the vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

TRANSVERSOSPINAL MUSLCES

All innervated by dorsal rami of spinal nerve

All supplied blood by muscular branches of aorta

 

Semispinalis Thoracis Muscle

Origin: transverse processes of T6 to T12

Insertion: spinous processes of lower cervical and upper thoracic vertebrae

Action: bilaterally extends vertebral column, especially head and neck, controls contralateral, maintains head posture

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Semispinalis Cervicis Muscle

Origin: transverse processes of T1 to T6, sometimes lower thoracic

Insertion: spinous processes of lower C2 to T5, sometimes T6

Action: bilaterally extends vertebral column, especially head and neck, controls contralateral flexion, maintains head posture

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Semispinalis Capitis Muscle

Origin: transverse processes of T1 to T6, auricular processes of C4 to C7

Insertion: between superior and inferior nuchal lines of occipital bone

Action: bilaterally extends vertebral column, especially head and neck, controls contralateral flexion, maintains head posture

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Multifidus Muscle

Origin:

  Cervical region : auricular processes of lower cervial vertebrae

  Thoracic region : transverse processes of all thoacic vertebrae

  Lumbar region : mamillary processes of all lumbar vertebrae, deep surface of tendonious origin of erector spinae muscle, lower portion of dorsal sacrum, posterior superior illiac spine

Insertion: spious processes extending from C2 to L5 (skips 2-4 vertebrae superiorly)

Action: bilaterally extends vertebral column, controls contralateral flexion, unilaterally rotates vertebral column to opposite side

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Long Rotatores Muscle

Origin: transverse process of each vertebrae (ie : T7)

Insertion: spinous process of  vertebrae two superiorly (ie : T5)

Action: contralateral rotation, bilaterally extends vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

DEEP BACK Muscle

 

Short Rotatores Muscle

Origin: transverse process of each vertebrae (ie : T7)

Insertion:  base of spinous processes of superior vertebrae (ie : T6)

Action: contralateral rotation, bilaterally extends vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Interspinalis Muscle

Origin: spinous process of each vertebrae (ie : T7)

Insertion: spinous process of superior vertebrae (ie : T6)

Action:extends vertebral column

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Intertransversari Muscle

Origin:

Cervical region: anterior tubercule of transverse process of vertebrae, posterior tubercule of transverse process or vertebrae

Throacic region: poorly developed

Lumbar region: lateral aspect of transverse process of vertebrae, mamillary process of vertebrae

Insertion:

Cervical region: anterior tubercule of superior vertebrae, posterior tubercule of superior vertebrae   

Thoracic region: poorly developed

Lumbar region: lateral aspect of transverse process of superior vertebrae, accessory process of superior vertebrae

Action: laterally flexes each pair of vertebrae

Innervation: dorsal rami of spinal nerve

Blood Supply: muscular branches of aorta

 

Longus Coli Muscle

Origin: lower anterior vertebral bodies and transverse processes of vertebrae

Insertion: anterior vertebral bodies and transverse processes of vertebrae several segments above

Action: flexes the head and neck

Innervation: ventral rami of C2 to C6

Blood Supply: muscular branches of aorta

 

Longus Capitis Muscle

Origin: upper anterior vertebral bodies and transverse processes of vertebrae

Insertion: anterior vertebral bodies and transverse processes of vertebrae several segments above

Action: flexes the head and neck

Innervation: ventral rami of C1 to C3

Blood Supply: muscular branches of aorta

 

Rectus Capitis Anterior Muscle

Origin: anterior base of transverse process of atlas

Insertion: occipital bone anterior to formamen magnum

Action: flexes the head

Innervation: ventral rami of C2 and C3

Blood Supply: muscular branches of aorta

 

Rectus Capitis Lateralis Muscle

Origin: transverse process of atlas

Insertion: jugular process of occipital bone

Action: bends head laterally

Innervation: ventral rami of C2 and C3

Blood Supply: muscular branches of aorta

 

Papillary Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Dartos Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Cremaster Muscle

Origin:

Insertion:

Action:

Innervation:

Blood Supply:

 

Muscles of the Urogenital Diaphragm

Both innervated by the perineal nerve (pudnedal nerve [S2, S3, S4])

 

Deep Transverse Perineal Muscle (Transversus Perinei Muscle)

Origin: medial surface of the ischial ramus

Insertion: perineal body (central perineal tendon), also the vaginal wall in females

Action: steadies the perineal body, supports the pelvic floor and viscera as part of urogential diaphragm

Innervation: perineal nerve (pudnedal nerve [S2, S3, S4])

Blood Supply:

 

Sphincter Urethrae Muscle

Origin: medial surface of inferior pubic ramus bilaterally, base of bladder,

Male: invests the prostrate in the male anteriorly and anteriolaterally

Female: inferior portion blends with the anterolateral wall of the vagina (urethrovaginal sphincter)

Insertion: fibers join at midline around the urethra, some fibers encircle the membranous urethra in the male

Action: voluntary sphincter compresses the urethra

Male: membranous urethra

Female: urethra and vagina

Innervation: perineal nerve (pudnedal nerve [S2, S3, S4])

Blood Supply:

 

 

 

 

Fascia of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

 

 

 

 

Trigger Points of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

 

 

Arterial Supply of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

Ascending Aorta

Aortic Arch

n      Right Brachiocephalic artery

n      Right Common Carotid artery

n      Right Subclavian artery (see Upper and Lower Limb for more branches)

n      Internal Thoracic artery

n      Anterior Cutaneous artery

n      Anterior Intercostal artery two per each of the upper six intercostal spaces, supply these spaces, external intercostal muscle, internal intercostal muscle, innermost intercostal muscle, serratus anterior muscle, pectoralis major muscle, pectoralis monir muscle

n      Upper branch anastomoses with posterior intercostal artery

n      Lower branch anastomoses with collateral branch of the posterior intercostal artery

n      Pericardiophrenic artery accompanies phrenic nerve, supplies the pericardium, pleura and upper surface of diaphragm muscle

n      Perforating branch perforate the internal intercostal muscle and accompany the anterior cutaneous branches of the intercostal nerve, supplies pectoralis major muscle

n      Medial Mammary branches from the 2nd to 4th perforating branches

The internal thoracic artery terminates at the sixth intercostal space as it divides into :

n      Musclophrenic artery laterally, supplies diaphragm muscle, pericardium and muscle of the abdominal wall, anastomoses with the deep circumflex iliac artery at the 10th intercostal space

n      Anterior branches two per each of the costal spaces from the 7th to 9th 

n      Superior Epigastric artery medially, descends on deep surface of rectuc abdominus muscle within rectus sheath, anastomoses with the inferior epigastric artery, supplies rectus abdominus muscle, diapgragm muscle, peritoneum and anterior abdominal wall

n      Left Common Carotid artery (see Head and Neck for branches)

n      Left Subclavian artery

n      Internal Thoracic artery identical branches to internal thoracic artery of right subclavian artery

Descending Aorta

n      Thoracic Aorta

n      Posterior Intercostal artery which the upper six anastomoses with anterior intercostal artery (internal thoracic artery) and the others continue on with the corresponding intercostal nerve

n      Collateral branch

n      Dorsal branch

n      Spinal branch

n      Lateral Cutaneous branch

n      Brachial artery

n      Abdominal Aorta which passes into abdomen through left and right crurae of the diaphragm muscle at level of T12

4 branches anteriorly

      - Coeliac Trunk

      - Superior Mesenteric

      - Inferior Mesenteric

      - Median Sacral

4 Branches laterally

      - Inferior Phrenic

      - Suprarenal

      - Renal

      - Gonadal

+ lumbar arteries

-        1 for each vertebrae

-        4 from abdominal aorta

-        1 from internal iliac

n      Inferior Phrenic artery

n      Superior Suprarenal artery

n      Celiac Trunk

n      Common Hepatic artery

n      Right Gastric artery

n      Hepatic A. Proper

n      Left Hepatic artery

n      Right Hepatic artery

n      Cystic artery

n      Gastroduodenal artery

n      Right Gastroepiploic artery

n      Splenic artery

n      Short Gastric artery

n      Left Gastroepiploic artery

n      Pancreatic branch

n      Left Gastric artery

n      Middle Suprarenal artery

n      Superior Messenteric artery which arises from aorta below celiac trunk

n      Middle Colic artery which anastomoses with the left colic artery via the marginal artery

n      Right Colic artery

n      Intestinal arteries

n      Ileocolic artery

n      Anterior Cecal artery

n      Posterior Cecal artery

n      Ileocecal artery

n      Appendicular artery

n      Renal artery comes of the aorta at L1

n      Inferior Suprarenal artery

n      Segmental artery which passes into the hilum of the kidney

n      Interlobal artery which passes between renal pyramids

n      Arcuate artery which passes between medulla and coretex

n      Interlobular artery which passes into coretex

n      Afferent arteriole which enters the glomerulus

n      Efferent arteriole which exits the glomerulus

n      Inferior Messenteric artery

n      Left Colic artery

n      Descending branch

n      Ascending branch which anastomoses with the middle colic atery via the marginal artery

n      Sigmoid artery

n      Superior Rectal artery

n      Testicular artery

Descending Aorta then terminates as it bifurcates at …

n      Common Illiac artery

n      External Illiac artery

n      Internal Illiac artery

 

(Obliterated) Umbilical artery

costocervical artery

thyrocervical artery

right coronary artery

left coronary artery

ovarian artery

inferior pancreaticoduodenal artery

jujenal artery

ileal artery

anterior superior pancreaticoduodenal artery

right gastroepiploic artery

posterior superior pancreaticoduodenal artery

 

 

 

 

Venous Drainage of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

Supeior Vena Cava

n      Azygous vein

n      Right Posterior Intercostal vein (5th to 11th)

n      Right Subcostal vein

n      Transverse Connecting vein joins the hemiazygous vein and/or accessory hemiazygous vein

n      Right Bronchial vein

n      Right Ascending Lumbar vein

n      Right Superior Intercostal vein

n      Hemiazygous vein joins the accessory hemiazygous vein inferiorly

n      Left Posterior Intercostal vein

n      Left Subcostal vein

n      Left Bronchial vein

n      Left Ascending Lumbar vein

n      Accessory Hemiazygous vein joins the hemiazygous vein superiorly

n      Left Superior Intercostal vein

 

internal vertebral venous plexus

 

Brachiocephalic vein

n      Internal Thoracic vein

n      Anterior Intercostal vein

n      Superior Epigastric vein

 

Inferior Vena Cava passes through central tendon of diaphragm muscle

n      Left Hepatic vein

n      Middle Hepatic vein

n      Right Hepatic vein

Alll three drain the

n      Hepatic Sinusoids of the liver

n      The Liver receives the Portal vein through the Porta Hepatis. The portal vein receives blood from the digestive tract and Spleen. It drains:

n      Pyloric vein

n      Cystic vein

n      Splenic vein

n      Short Gastric vein

n      Left Gastroepiploic vein

n      Pancreatic vein

n      Inferior Messenteric vein

n      Superior Rectal vein

n      Sigmoid vein

n      Left Colic vein

n      Superior Messenteric vein

n      Right Gastroepiploic vein

n      Right Colic vein

n      Omental vein

n      Iliocolic vein

n      Intestinal vein

n      Left Gastric vein

n      Inferior Phrenic vein

n      Lumbar veins

n      Right Suprarenal vein

n      Right Gonadal vein (Right Testicular vein or Right Ovarian vein)

n      Right Renal vein

n      Right Segmental vein 

n      Right Interlobal vein

n      Right Arcuate vein

n      Right Interlobular vein

n      Right Efferent venule ???

n      Right Afferent venule ???

n      Left Renal vein which has identical branches to right renal vein and is also joined by

n      Left Segmental vein 

n      LeftInterlobal vein

n      Left Arcuate vein

n      Left Interlobular vein

n      Left Efferent venule ???

n      Left Afferent venule ???

n      Left Suprarenal vein

n      Left Gonadal vein (Left Testicular vein or Left Ovarian vein)

n      Common Illiac vein

n      Ascending Lumbar vein

n      Internal Illiac vein

n      External Illiac vein

n      Median Sacral vein

 

 

thoracoepigastric vein joins the lateral thoracic vein and the superficial epigastric vein

subcostal vein

pulmonary vein

 

 

 

Lymphatic Drainage of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

Spleen, Gonads

 

Lumbar lymph nodes lie bilateral to abdominal aorta and inferior vena cava. Receives lymph from posterior abdominal wall, kidneys, ureters, testes, ovaries, uterus and uterine tubes and also receives lymph from the inferior mesenteric lymph nodes and common iliac lymph nodes (descending colon, pelvis and lower limbs).

 

Cisterna Chyli is an inferior expansion of the thoracic duct. Absent in some people. Located between the origin of the abdominal aorta and the azygos vein on the right side of the bodies of L1 and L2, posterior to the right crus of the diaphragm muscle.

 

Thoracic Duct is the main lymphatic duct which begins at the cisterna chyli and ascends through the aortic hiatus (diaphragm muscle) into the thorax. It empties lymph from the entire body except for the left half of the head and neck, the right upper limb and the right upper thorax into the vascular system at the lateral side of the junction of the left subclavian vien and left internal jugular vein.

 

 

 

 

Innervation of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

-  Pudendal Nerve

 

Spinal nerves (31 pairs): are formed by junction of dorsal root (dorsal root ganglion) and ventral root of spinal cord, divides into dorsal ramus and ventral ramus (anterior cutaneous branch and lateral cutaneous branch), sympathetic ganglion, posterior border of spinal nerve is postvertebral muscle, dorsal rami in the lower parts of both secondary curvatures have little, if any, cutaneous distribution, dorsal rami of all spinal nerve except C1 are mixed (sensory and motor), dorsal roots are sensory

n      8 Cervical nerves : medial branches are cutaneous

C1:

C2:

C3:

C4:

C5:

C6:

C7:

C8:

n      12 Thoracic nerves: upper thoracic middle branches are mostly cutaneous, middle thoracic lateral branches are mostly cutaneous

T1 - T11 (Intercostal nerve) have branches lateral cutaneous nerve, anterior cutaneous nerve, are branches of the anterior primary ramus

T1 - T6 supply thorax and pass between internal intercostal muscle and innermost intercostal muscle

T1: in part joins brachial plexus

T2: sometimes contributes to brachial plexus

T3:

T4:

T5:

T6:

T7 - T12 supply thorax and abdomen and pass between internal oblique muscle and transverse abdominus muscle outside of costal margin

T7:

T8:

T9:

T10:

T11:

T12 (Subcostal nerve):

n      5 Lumbar nerves:

L1:

L2:

L3:

L4: lateral branch is a mixed nerve supplying both muscle and deep structures.

L5:

n      5 Saccral nerves:

S1:

S2:

S3:

S4:

S5:

n      1 Coccygeal nerve:

 

Spinal Cord

three meninges

n      Pia mater : delicate, closely invested in spinal cord and nerve

n      Arachnoid mater (“spider like”): delicate

n      Dura mater (“tough mother”): outermost, tough

n      Most superficial and toughest of the leptomeninges covering the CNS. The meningeal layer of the cranial dura is continuous with the spinal dura at the formaen magnum (occipital)

 

Dura, pia and arachnoid known as leptomeninges

dural sac (thecal) is composed of dura and arachnoid and forms sheath around neural structures

epidural space seperates dural sac from walls of vertebral canal

subdural space is a potential space between dura and arachnoid

subarachnoid space is between arachnoid and pia and contains cerebrospinal fluid (CSF)

spinal medulla ends at the level of the first lumbar vertebrae (L1)

 

chorda equinae

conus medallaris

filum tenrminallae

ligamenta denticulata

 

Pudendal nerve

n      Inferior Rectal nerve

n      Perineal nerve

n      Deep branch

n      Superficial Posterior Scrotal nerve (males)

n      Superficial Labial nerve (females)

n      Dorsal Nerve of the Penis (males)

n      Dorsal Nerve of the Clitoris (females)

 

Phrenic nerve (innervates a. costal and b. crural portions)

Vagus nerve

Recurrent Laryngeal nerve

greater splanchic nerve

lesser splanchic nerve

least splanchic nerve

illiohypogastric nerve

illioinguinal nerve

sympathetic trunk

pelvic splanchnic nerve

sinoatrial node

atrioventricular node

purkinje fibers

atrioventricular bundle

cardiac plexus

thoracic splanchnic nerve

thoracoabdominal nerve

 

PARASYMPATHETIC NERVOUS SYSTEM

SYMPATHETIC NERVOUS SYSTEM

 

AUTONOMIC NERVOUS SYSTEM

SOMATIC NERVOUS SYSTEM

 

 

 

 

Cutaneous Innervation of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

 

 

 

Organs of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

 

-  Gallbladder

-  Female Reproductive Organs

 

PERICARDIUM

Fibrous Pericardium :

Serous Pericardium :

Transverse Sinus :

Oblique Sinus :

 

CARDIOVASCULAR SYSTEM

 

HEART

Passage of Blood

Systemic venous circulation to right atrium via superior vena cava and inferior vena cava

Right atrium to right ventricle via tricuspid (atrioventricular) valve

Right ventricle to pulmonary circulation via pulmonary (semilunar) valve into pulmonary trunk

Pulmonary circulation to left atrium via pulmonary vein

Left atrium to left ventricle via biscupid (atrioventricular) valve

Left ventricle to systemic arterial circulation via aortic (semilunar) valve into ascending aorta

 

left pulmonary artery has a fibrous connection to the arch of aorta called ligamentum arteriosum which is the remains of ductus ateriosus

 

Valves

Semilunar Valves : separate the ventricles from the major arteries

n      Pulmonary Valve : separates the right ventricle from the pulmonary circulation

n      Aortic Valve : separates the left ventricle from the systemic circulation

Atrioventricular Valves : separate the atria from the ventricles

n      Tricuspid Valve : separates the right atrium from the right ventricle

n      Biscupid or Mitral Valve : separates the left atrium from the left ventricle

 

Most of the right atrium is formed from the joining of the superior vena cava and inferior vena cava, the small muscular portion, the right auricle, makes up the rest of the right atrium and lies anteriorly.

Most of the left atrium is formed from the joining of the pulmonary vein, the small muscular portion, the left auricle, makes up the rest of the atrium and lies anteriorly.

Papillary muscle act to ensure the atrioventricular valves don’t collapse into the atria from the pressure.

Blood supply to the heart comes directly from the ascending aorta.

Fossa Ovalis is a hole which allows the right and left atria to communicate whilst an ebryo. This becomes covered by a fibrous layer before birth.

 

Sinoatrial (SA) node, atrioventricular (AV) node, purkinje fibers, atrioventricular bundle, cardiac plexus, bundle of his, autorhythmic,

SYMPATHETIC STIMULATION

PARASYMPATHETIC STIMULATION

right coronary artery, left coronary artery (circumflex), pulmonary arteries, anterior interventricular artery, posterior interventricular artery, pulmonary trunk, right marginal artery,

great cardiac vein, middle cardiac vein, small cardiac vein, oblique cardiac vein

ligamentum arteriosum, coronary sulcus, coronary sinus, pericardium (fibrous, serous), trabeculae carnae, chordae tendinae, barareceptors, blood pressure, anterior interventricular groove, left auricular process, right auricular process, apex, fossa ovalis, interatrial septum, musculi pectinati, crista terminalis, infundibulum, atrioventricular septum,

 

 

RESPIRATORY SYSTEM

 

Inspiration

Muscles of Inspiration

Quiet (Unforced) Inspiration

diaphragm muscle, external intercostal muscle, interchondral internal intercostal muscle,

 

Forced Inspiration

anterior scalene muscle, middle scalene muscle, posterior scalene muscle, serratus posterior superior muscle, serratus posterior inferior muscle, quadratus lumborum muscle, lavatores costarum muscle,

 

Both the diaphram muscle and external intercostal muscles are capable of maintaing inspiration (and expiration) by themselves, although breathing may be laboured.

 

Quiet (Unforced) Expiration

Expiration requires no muscular assistance but relies on the elastic recoil of the lung and the chest wall.

 

Muscles of (Active) Expiration

internal intercostal muscle, subcostal muscle, transversus thoracis muscle, rectus abdomius muscle

 

Trachea

-      is the inferior continuation of the respiratory system inferior to the larynx

-      begins at the inferior border of cricoid cartilage at C6

-      bifurcates at the level of the sternal angle and the junction of T4 and T5 into

-      Right Bronchus

Š         is shorter and more vertical compared to left bronchus

Š         more common site for foreign body lodgement

-      Left Bronchus

Š         Primary Bronchi

o        Tertiary Bronchi

§         Terminal Bronchi

Š         Alveolar Sacs

o         Alveoli

 

Lungs

Right Lung is smaller, heavier, shorter, wider

n      Right Main (primary) Bronchi is inferior to arch of azygous vein, single bronchial artery

n      Superior (Upper) Lobar (secondary)  Bronchi 

n      Segmental (tertiary) Bronchi

n      Apical bronchopulmonary segment

n      Posterior bronchopulmonary segment

n      Anterior bronchopulmonary segment

n      Horizontal Fissure

n      Middle Lobar (secondary)  Bronchi

n      Segmental (tertiary) Bronchi

n      Superior Linguilar bronchopulmonary segment

n      Inferior Linguilar bronchopulmonary segment

n      Oblique Fissure

n      Inferior Lobar (secondary)  Bronchi

n      Segmental (tertiary) Bronchi

n      Lateral Basal bronchopulmonary segment

n      Posterior Basal bronchopulmonary segment

n      Anterior Basal bronchopulmonary segment

n      Medial Basal bronchopulmonary segment

Left Lung two bronchial arteries

n      Left Main (primary) Bronchi

n      Upper Lobar (secondary) Bronchi

n      Segmental (tertiary) Bronchi

n      Apicoposterior bronchopulmonary segment

n      Anterior bronchopulmonary segment

n      Medial bronchopulmonary segment

n      Lateral bronchopulmonary segment

n      Oblique Fissure along the line of the 6th rib

n      Lingula

n      Lower Lobar (secondary) Bronchi

n      Segmental (tertiary) Bronchi

n      Lateral Basal bronchopulmonary segment

n      Posterior Basal bronchopulmonary segment

n      Anterior Basal bronchopulmonary segment

n      Medial Basal bronchopulmonary segment

 

apex, root, base

pulmonary hilum

pulmonary ligament

Bronchopulmonary Branches are the units of the lungs, they consist of secondary or tertiray broncus, branches of the pulmonary artery and lung tissue

Cardiac Notch

Linguala (tongue) is a tongue shaped portion of the left lung covering part of the pericardium medially, corresponds to the middle lobe of the right lung

Visceral Pleura extends into fissures

 

pulmonary vein

pulmonary artery

Hilum :

pulmonary artery superior

brachial artery

bronchus posterior

two pulmonary vein anterior and inferior

bronchial vein

arteries and bronchi tend to branch together

 

 

DIGESTIVE SYSTEM

Mucosa

n      Epithelium

n      Lamina Propria

n      Muscularis Mucosa

Submucosa : which contains the submucosal nerve plexus

Muscularis which contains the myenteric nerve plexus between the two muscle layers

n      Inner Circular muscle layer

n      Outer Longitudinal muscle layer

Serosa (Adventitia)

 

Foregut

Structures:

-                                   Stomach

-                                   Duodenal Cap

-                                   Descending Duodenum

-                                   Liver

-                                   Gall bladder

-                                   Pacreas

Arterial Supply:

Celiac trunk and its branches

Venous Drainage:

Portal vein

Lymphatic Drainage:

Celiac nodes and its branches

Innervation:

-      Parasympathetic: vagus nerve (perivascular)

-      Smypathetic: greater thoracic splanchnic nerves (T6 to T10)

Referred Pain:

Epigastric region

 

Midgut

Structures:

Structures:

-                                   Horizontal Duodenum

-                                   Ascending Duodenum

-                                   Jejunum

-                                   Ilium

-                                   Cecum

-                                   Ascengin Colon

-                                   Transverse Colon (first 2/3rds)

Arterial Supply:

Superior Mesenteric artery and its branches

Venous Drainage:

Superior Mesenteric vein

Lymphatic Drainage:

Supeiror Mesenteric nodes

Innervation:

-      Parasympathetic: vagus nerve (perivascular)

-      Smypathetic: lesser thoracic splanchnic nerves (T9 to L1)

Referred Pain:

Umbilical region

 

Hindgut

Structures:

-                                   Transverse Colon (distal 1/3rd)

-                                   Descending Colon

-                                   Sigmoid Colon

-                                   Rectum

-                                   Anal Canal (superior portion)

Arterial Supply:

Inferior Mesenteric artery and its branches

Venous Drainage:

Inferior Mesenteric vein

Lymphatic Drainage:

-      Inferior Mesenteric nodes

-      Right and Left Common Iliac nodes drains rectum

Innervation:

-      Parasympathetic: vagus nerve (perivascular)

-      Smypathetic: lesser thoracic splanchnic nerves (T9 to L1)

Referred Pain:

Hypogastric (suprapubic) region

 

STOMACH

The stomach is the continuation of the gastrointestinal tract between the oesophagus superiorly and the small intestine (duodenum) inferiorly.

Cardiac Notch : lies between the fundus and the oesophagus

Angular Notch : lies between the body and pylorus

Greater Curve : lateral edge of the stomach, gives rise to the lesser omentum

Lesser Curve : medial edge of the stomach, gives rise to the greater omentum

Cardiac Stomach :

Fundic Stomach :

Body of the Stomach :

Pyloric Stomach : communicates with the duodenum via the pyloric sphincter

 

The Stomach has an additional layer of muscle in the muscularis :

n      Innermost Oblique

 

rugae, pyloric sphincter, cardiac sphincter

 

SMALL INTESTINE

deuodenum, jejunum, illeum, deuodenal flexure, greater deuodenal papilla, lesser deuodenal papilla, hepatopancreatic ampulla, arcades, lymphoid aggregations, the messentery

 

LARGE INTESTINE

ileocecal junction, ileocecal valve, caecum, viriform appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anorectal junction, anus, sphincters, appendices epiploicae (small fat bags), sigmoid mesocolon, transverse mesocolon

Teniae Coli : are the longitudinal muscle which form three bands around the innner circular muscle layer thus forming a “three leaf clover” appearance of three haustra (semilunar folds)

n      Tenia Libera : lies anteriorly

n      Tenia Mesocolica : lies medial to the ascending and descending colon and realtes to the origin of the mesocolon on the transverse colon

n      Tenia Omentalis : lies posteriorly and medially at transverse colon below origin of greater omentum

 

PANCREAS

pancreatic duct, inferior pancreaticoduodenal artery, empties into duodenum, pancreatic juice is basic (high pH)

Exocrine : glucagon (beta cells), insulin (alpha cells), somatostatin (delta cells)

Endocrine :

Pancreatitis, alcoholism

 

LIVER

largest visceral organ and largest gland, nutirents from the gut go to the portal/hepatic circulation first and are metabolically prepared by the liver for use by the body, moves with breathing, attaches to diaphragm,

falciform ligament, left triangular ligament, right triangular ligament, ligamentum teres hepatis (left umbilical vein), portal vein, hepatic artery, common bile duct, portal triad, round ligament, cystic duct, common hepatic duct,

hepatojugular reflex, enterohepatic circulation

 

gallbladder fossa

- shallow depression on inferior visceral surface of quadrate lobe

 

right lobe (anterior-superior area, posterior-superior area, medial-superior area, posterior-inferior area, anterior-inferior area, medial-inferior area), left lobe (lateral-superior area, lateral-inferior area),

ligamentum venosum, coronary ligament, inferior vena cava, quadrangular ligament, caudate ligament, porta hepatis, lesser omentum,

 

Gall Bladder

 

SPLEEN

splenic artery, splenic vein, central artery, white pulp, red pulp, hilus, capsule, stores red blood cells, lymph node

 

URINARY SYSTEM

Micturition : act of urination

 

KIDNEYS

lies at the level between L1 and L4, ureter (right ureter lies behind duodenum), minor and major calyx, renal pelvis, sinus (inside hilus), suprarenal glands, renal capsule, renal pyramid, renal column (between pyramids), hilus, renin, coretex, medulla, medullary rays, lower and upper poles, renal fascia, renal papillae

 

renal vein anteriorly, ureter posteriorly, renal artery in middle

 

Nephrons : Bowman’s capsule, glomerulus (bunching of arterioles within Bowman’s capsule), urinary pole, vascular pole (where the afferent arteriole enters and efferent arteriole exits), proximal convoluted tubule, loop of Henle, distal convoluted tubule

vasa vecta (straight venule, straight arteriole)

 

Renal artery

n      Segmental arteries :

n      Interlobal arteries : passes between renal pyramids

n      Arcuate arteries : passes between medulla and coretex

n      Interlobular arteries : passes into coretex

n      Afferent arterioles : passes into glomerulus

n      Efferent arterioles : passes out of glomerulus

Renal vein is fed from

n      Segmental vein 

n      Interlobal vein : passes between renal pyramids

n      Arcuate vein : passes between medulla and coretex

n      Interlobular vein : passes medulla

n      Efferent venules : passes out of glomerulus  ????????

n      Afferent venules : passes into glomerulus ??????????

 

Ureters

-      thick walled, distensible muscular ducts

-      transmit urine from kidneys to the urinary bladder via peristalsis

-      continuous superiorly with the renal pelvis

-      narrow lumen

-      one bilaterally on each side, 2 in total

-      divided into two parts at the pelvic brim (abdominal ureter and pelvic ureter)

-      Abdominal Ureter

-      about 12cm long and 5mm wide

-      adheres closely to parietal peritoneum

-      lies retroperitoneal through its entirety

-      descends almost vertically anterior to the psoas major muscle

-      lie close to lumbar lymph nodes and the sympathetic trunk

-      right ureter lies close to the inferior vena cava

-      crosses the posterior brim of the pelvis and the external iliac artery just distal to the bifurcation of the common iliac artery on its anterior aspect

-      becomes the pelvic part of the ureter inferior to the pelvic brim

-      Pelvic Ureter

-      pass postereoinferiorly on the lateral wall of the pelvis external to parietal peritoneum and anterior to the internal iliac artery

-      curve atereomedially at around 1.5cm superior to the ischial spine (ischium) superior to levator ani muscle adhered to the peritoneum

-      Male

-      vas deferens passes between the ureter and the peritoneum

-      ureter lies lateral to vas deferens

-      ureter enters the postereosuperior angle of the urinary bladder immediately superior to the seminal vesicle

-      Female

-      descends on lateral wall of the pelvis minor forming the posterior border of the ovarian fossa

-      passes medial to the origin of the uterine artery

-      continues to the level of the ischial spine (ischium) where it is crossed superiorly by the uterine artery

-      passes close to the fornix of the vagina and enters the posteriosuperior angle of the urinary bladder

-      Arterial Supply

-      abdominal part

-      renal artery, gonadal artery (testicular artery or ovarian artery), abdominal aorta

-      pelvic part

-      external iliac artery, internal iliac artery, superior vesical artery and/or inferior vesical artery (male), uterine artery (female)

-      Venous Drainage

-      gonadal vein (testicular vein or ovarian vein)

-      Lymphatic Drainage

-      superior part of ureters join the kidney lymph vessels or pass directly into the lumbar lymph nodes (lareal aortic lymph nodes)

-      middle part of the ureters drain into the common iliac lymph nodes

-      inferior part of the ureters drain into the common iliac lymph nodes, external iliac lymph nodes or internal iliac lymph nodes

-      Innervation

-      All supply autonomic parasympathetic and sympathetic nerve fibers

-      renal plexus (lesser splanchnic nerve, lowest splanchnic nerve)

-      gonadal plexus (testicular plexus or ovarian plexus)

-      inferior hypogastric plexus

-      dorsal roots of T11, T12 and L1 supply sensory fibers

 

SUPRARENAL GLAND

endocrine gland, epinephrine (adrenaline), norepinephrine (noradrenaline), lies superior to kindeys, is attached to renal fascia

inferior suprarenal artery (renal artery), superior suprarenal artery (inferior phrenic artery), middle suprarenal artery (aorta),

 

BLADDER

urethra, trigone, ureters, transitional epithelium

 

Urogenital Diaphragm

-        Thin sheet of striated skeletal muscle stretching between the two sides of the pubic arch

-        Covers the anterior part of inferior pelvic aperture (pelvic outlet)

-        Anterior and posterior fibers run transversely (deep transverse perineal muscles)

-        Middle fibers surround membranous urethra (sphincter urethrae muscle)

 

Perineal Body

-        tendinous centre of the perineum

-        small and wedge shaped mass of connective tissue

-        landmark of perineum

-        attachment site of: deep transverse perineal muscle, bulbospongiosus muscle, levator ani muscle, external anal sphincter

 

REPRODUCTIVE SYSTEM

 

MALE REPRODUCTIVE ORGANS

prostrate gland, bulbourethral glands, ejaculatory duct, seminal vesicle

vas deferens

ductus deferens

genitofemoral nerve, superficial posterior scrotal nerve, dorsal nerve of the penis

testicular artery, deep artery of the penis, dorsal artery of the penis

 

PENIS

Penis is erectile tissue, homologous with the female clitoris, contains corpus spongiosum and paired corpus cavernosa

Corpus Spongiosum contains the urethra and is the inferior muscle of the penis, it is covered superiorly by the paired Corpus Cavernosum each of which contain a deep artery of the penis

Tunica Albunigea is fibrous connective tissue which covers the corpus cavernosum and corpus spongiosum

Tunica Vaginalis is a peritoneal sac that covers the front and sides of the testis and epididymis

Septum of the penis is the part of the tunica albunigea which separates the two corpus cavernosa

Bulbospongios muscle inserts into the corpus spongiosum

Ischocavernosus muscle inserts into the corpus cavernosum

Glans Penis is the continuation of the corpus spongiosum

Prepuce is a free fold of skin which covers the glans penis

Fenulum is the median ventral fold of the glans penis

 

TESTICLES

Scrotum are sacs of skin which contain pubic hair and sweat glands, outer most layer of the testicles, is homologous to the female labia majora

Epididymis

Seminiferous Tubules

Spermatic Cord

 

 

 

 

Viscerotomes of Thorax & Abdomen

 

 

 

 

 

Regional Anatomy of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>

 

 

MEDIASTINUM

 

Superior Mediastinum

BORDERS

n      Lateral : pleural cavity

n      Medial :

n      Inferior : plane from sternal angle to intervertebral disc between T4 and T5

n      Superior : oblique plane of 1st rib

n      Posterior :

n      Anterior : manubrium

CONTENTS

n      trachea

n      oesaphagus

n      thymus

n      phrenic nerve

n      vagus nerve

n      cardiac plexus

n      cardiac nerve

n      left recurrent laryngeal nerve (vagus nerve)

n      arch of aorta (brachiocephalic artery, left common carotid artery, left subclavian artery)

n      superior vena cava (both brachiocephalic veins)

n      terminal thoracic duct

n      lymph nodes

 

Anterior Mediastinum

BORDERS

n      Lateral : pleural cavity

n      Medial :

n      Inferior : diaphragm muscle

n      Superior : superior mediastinum

n      Posterior : pericardium, middle mediastinum

n      Anterior : sternum

CONTENTS

n      lymph nodes

n      mainly fat and connective tissue

 

Middle Mediastinum

lies between right and left pleural cavities

BORDERS

n      Lateral : pleural cavity

n      Medial :

n      Inferior : diaphragm muscle

n      Superior : superior mediastinum

n      Posterior : posterior mediastinum

n      Anterior : anterior mediastinum

CONTENTS

n      heart

n      pericardium

n      main bronchi

n      phrenic nerve

 

Posterior Mediastinum

BORDERS

n      Lateral : pleural cavity

n      Medial : pleural sacs

n      Inferior : diaphragm muscle

n      Superior : superior mediastinum

n      Posterior : vertebral column

n      Anterior : pericardium

CONTENTS

n      oesophagus

n      oesophageal plexus (vagus nerve)

n      sympathetic trunk

n      splanchnic nerve

n      descending aorta

n      azygous vein

n      hemiazygous vein

n      thoracic duct

n      lymph nodes

 

PLEURA

Parietal Pleura : lines the wall of the pleural cavity in the thorax, very sensitive to pain

n      Costal Pleura lines the thoracic wall, forms anterior, lateral and posterior walls of pleural cavity

intercostal nerve

internal thoracic artery, superior phrenic artery, posterior intercostal arteries, superior intercostal

arteries

n      Cervical Pleura (Cupula of the Pleura) is the superior continuation of the costal pleura, rises above level of 1st rib

n      Diaphragmatic Pleura is the inferior continuation of the costal pleura, forms the floor of the pleural and thoracic cavity, costal portion supplied by intercostal nerve, central portion supplied by phrenic nerve

n      Mediastinal Pleura is continuous anteriorly and posteriorly with the costal pleura, and inferiorly with the diaphragmatic pleura, surrounds the root of the lung, supplied by phrenic nerve

Visceral (Pulmonary) Pleura : covers the outside of the lungs and enters into fissures, insensitive to pain

vagus nerve

bronchial arteries

pulmonary vein

 

PLEURAL CAVITY

Pleural Cavity : is a potential space between the parietal pleura and the visceral pleura, contains fluid

n      Costodiaphragmatic Recess exists where costal pleura rises up to the superior surface of the diaphragm

n      Sternocostal Recess exists where costal pleura double backs on itself to become mediastinal pleura

n      Retroesophageal Recess exists where mediastinal pleura continues posteriorly with costal pleura

 

PERITONEUM

* = peritoneal ligament, not the same as a bone to bone ligament, contain blood vessels and and lymph

 

Retroperitoneal Organs : lie posterior to the peritoneum

n      kidneys

n      duodenum

n      pancreas

n      ascending colon (25-50% is covered)

n      descending colon (25-50% is covered)

n      sigmoid colon

n      rectum

n      abdominal aorta

n      celiac trunk

n      superior mesenteric artery

n      inferior mesenteric artery

n      inferior vena cava

n      superior mesenteric artery

n      inferior mesenteric artery

gastrointestinal regions alternate from retroperitoneal to peritoneal to stop twisting and tangling of gut

 

Intraperitoneal Organs: completely or mostly covered in peritoneum

n      stomach

n      liver

n      gall bladder

n      transverse colon

n      jejunum

n      ileum

n      cecum

 

Parietal Peritoneum: lines the wall of the peritoneal cavity

Visceral Peritoneum : covers the visceral organs of the abdomen

 

Gastrocolic Ligament* : duodenum and adjacent 2/3rds of stomach to transverse colon

Gastrolineal (Gastrosplenic) Ligament* : continuation of the gastrocolic ligament which joins the stomach to the spleen

Lineorenal Ligament* : continuation of the gastrolineal ligament which joins the spleen to the posterior abdominal wall, contains splenic vessels and tail of pancreas

Gastrophrenic (Phrenicosplenic) Ligament* : connects the fundus of the stomach and lower oesophagus to the diaphragm muscle, located above the spleen

Hepatogastric Ligament* : part of lesser omentum connecting the liver to the stomach

Hepatoduodenal Ligament* : is a continuation of the hepatogstric ligament which connects the liver to the duodenum, contains bile duct, hepatic artery, portal vein

 

Greater Omentum : connects to greater curve of stomach, fuses with messentery of transverse colon, contains lots of fat

Lesser Omentum : connects lesser curve of stomach, lower oesophagus and the first part of the duodenum to the inferior surface of the liver

 

Transverse Mesocolon : part of the greater omentum which connects to the transverse colon

Sigmoid Mesocolon : part of the greater omentum which connects to the sigmoid colon

The Mesentry : part of the greater omentum which connects to the small intestine

 

Epiploic Foramen : communication between the lesser sac and the hepatorenal recess of the greater sac

Greater Sac : anterior region created by greater omentum

Lesser Sac (Omental Bursa) : region posterior to stomach, created by lesser omentum

 

PERINEUM

 

ABDOMINAL REGIONS

 

Four Quadrants

Divided by

-      Midsagital plane: which passes through the midline vertically

-      Transumbilical plane: which passes through the umbilicas transversely

Creates four quadrants

-      Right Upper Quadrant (RUQ)

Š      Contains

o      

-      Right Lower Quadrant (RLQ)

Š      Contains

o      

-      Left Upper Quadrant (LUQ)

Š      Contains

o      

-      Left Lower Quadrant (LLQ)

Š      Contains

o      

 

Nine Regions

Divided by

-      Left and right Midclavicular lines: passes vertically through the midclavicular and midinguinal

-      Transpyloric Plane: passes transversely through the midpoint of the jugular notch (manubrium) and the pubic symphysis

Š     Passes through the level of L1

Š     Many important structures are located at this level

Š         gall bladder

Š         liver

Š         pylorus (stomach)

Š         duodenal bulb

Š         pancreas body and tail

Š         kidneys

Š         spleen

Remembered by Grandparetns Like Paediatric Doctors Preventing Kids Sickness

-      Subcostal Plane: passes transversely through the inferior most margin of the ribs

-      Transtubercular Plane: passes transversely through the pubic tubercule

Creastes nine regions

-      Upper

Š     Right Hypochondriac

Š     Epigastric

Š     Left Hypochondriac

-      Middle

Š     Right Lumbar

Š     Umbilical

Š     Left Lumbar

-      Lower

Š     Right Inguinal

Š     Hypogastric (Suprapubic)

Š     Left Inguinal

 

 

 

 

Umbilicus

In normal, physically fit individuals lies between L3 and L4

 

 

 

 

Surface Anatomy of the Thorax & Abdomen

<Thoracic & Abdominal Anatomy>