Anat-PreMid

• failure of distal R pharyngeal arch to disappear
• encloses the esophagus

L 7th intersegmental artery

Ductus Arteriosus- pulmonary trunk to ascending aorta

MATERNAL RUBELLA!

should close 24 hrs after birth but doesnt involute to form ligamentum arteriosum like it should

• relative to the ductus arteriosus
• -preductual
• -post ductal (common)
• -juxtaductal

1st*


Maxillary a

2nd*

• Hyoid &
• stepedial a

3rd

• Common and
• internal corotid

4th

• Aortic arch (L),
• R. Subclavian (R )

5th**

• Disappears
• completely

6th*

• Pulmonary artery,
• ductus arteriosus

• anterior superior illiac spine (ASIS)
• to pubic tubercle

• T7-L1 (Ventral root)
• (xyphoid to pubic)

• above watershed (umbilicus) = axillary nodes
• below watershed = superficial inguinal nodes

• above umbilicus= 1 layer
• below umbilicus = 2 layers
• 1st is Campers (fat)
• below is Scarpas (sutures)

• External Oblique Uni: rotates trunk to opposite side
• External = extraterrestrial = weird = opposite side
• Internal Oblique Uni: rotates trun to same side
• Internal = Intimate = wants to be on same side

• [skin, superficial fascia]
• external oblique, internal oblique,transverse abdominus (all separated by layers of deep fascia)
• last layer of deep fascia = transversalis fascia
• extraperitoneal fascia (holds organs)
• parietal peritoneum

Lower 1/4 of posterior abdomen

• median = umbilical
• medial = urachus (canal that drains fetal bladder)
• lateral = inferor epigastric a&v

• Medial border- rectus
• abdominis
• Lateral border & superior
• border- inferior epigastric vein
• Inferior border- inguinal
• ligament
• Note: location of inguinal
• hernias

• passes obliquely through abdominal wall
• superficial ring opens up as triangular space above the pubic tubercle
• inguinal ligament divides:
• medial crura = attaches to pubic symphysis
• lateral crura= attaches to pubic tubercle
• conjoint tendon- between the crura to prevent it from separating

Deep- opening in transversalis fascia at the midpoint of the inguinal ligament (contains spermatic cord, round ligament of uterus, and illioinguinal nerve)

Superficial- triangular opening above pubic tubercle (bw crura). opens into external oblique

• they lie OUTSIDE the processus vaginalis. the two developed alongside each other. vaginaliss forms from parietal peritoneum, while testes were from the EXTRAperitoneal cavity.
• the processus vaginalis closes off only leaving behind the tunica vaginalis

• medial crura: attaches to pubic symphysis
• lateral crura: attaches to pubic tuburcle

Deep- pass through Hasselbach's traingle (medial to epigastrics)

Indirect- pass lateral to epigastrics (so not in Triangle)...passes THROUGH deep ring and inguinal canal but still contained WITHIN the spermatic cord

• pampilliform venous plexus- puck up radiated arterial heat
• testicular artery
• genital branch of genitofemoral nerve
• ductus (vas) deferns

An organ that began as intraperitoneal but then became retroperitoneal

[ascending/descending colon, 2 3 4th parts of SI, rectum, head an body of pancreas]

• S = Suprarenal glands (aka the adrenal glands)
• A = Aorta/IVCD =
• Duodenum (second and third segments [some also include the fourth segment] )
• P = Pancreas (tail is intraperitoneal)
• U = Ureters
• C = Colon (only the ascending and descending parts)
• K = Kidney
• sE = Esophagus
• R = Rectum

• failure of processus vaginalis to close and separate from the parietal peritoneum so fluid builds up in this area
• -can occur in spermatic cord only (peritoneum slightly open), or spermatic cord and testes (completely open)

• undescended teste
• inguinal canal

problems with gubernaculum (testes dsescend into inguinal canal but then move interstiatlly elsewhere)

• divided in half by transverse colon
• top half = supracolic = stomach, spleen, liver, gallbladder
• bottom half = infracolic = small intestine, ascending and descending colon
• note: paracolic gutters allows communication b/w these 2 regions VIA the right lateral paracolic gutter

• spaces on the sides of the ascending and descending colon
• L paracolic: can only go up so far because then it is blocked by the spleens phrenicolic ligament
• R paracolic gutter: allows fluid to enter Epiploic foramen/Foramen of Winslow. Omental foramen

Greater: from greater curvature of stomach and 1st part of duodenum and aprons over the rest of the gut

Lesser: lesser curvature and 1st part of duodenum to liver

• separates Liver from Right Kidney
• * continuous w R paracolic cutter
• subphrenic space: ontop of diaphragm

fluid can go from R paracolic --> hepatorenal pouch --> lesser sac --> subphrenic space

b/w diaphragm and 4th part of duodenum [hence @ duodenal-jejunal jnx]

Duodenum I = Superior Part (SD)

Duodenum II = Descending (DD)

Duodenum III = Horizontal (HD)

Duodenum IV = Ascending (AD) [Treitz]

• Omentum: parietal folds b/w organs
• Mesentary: pareital folds bw/ organs and walls [carry all types of vessels]

Intraperitoneal

• Tail
• (Pancreas), Jujenum/Ileum, Caecum/Appendix, Transverse Colon, Sigmoid Colon, Stomach, Liver,
• Duodenum I, Spleen

• Primary
• Retroperitoneal

• Kidneys, Ureters, Aorta, IVC,
• Sympathetic Trunks

• Secondary
• Retroperitoneal

• Head/Body
• (Pancreas, Dudoenum II-IV,
• Ascending/Descending Colon, Rectum

• SMA is infront of the 3rd part of the duodenum
• Abdominal aorta is behind the 3rd part of the duodenum
• ...hence, the 3rd pt of the duodenum is sandwhiched with these two structures (along with the left renal vein) so an aneurism to any of these structures can constrict the duodenum of LRV like a "nutcracker"

retrocecal

• Inferior messenteric trunk
• drains into superior mesenteric trunk
• drians into celiac trunk
• which drains into cisterna chyli

structures basically drain upwards

foregut: pharynx, larynx, esophagus, stomach upper duodenum, liver, gallbladder, pancreas

midgut: remaining duodenum, jejunum, ileum, ascending colon. 2/3 transverse colon

hindgut: last 1/3 transvers, left colic flexure, descending colon, sigmoid, rectum

it receives blood from both R & L systems

• lamps hepatic artery
• proper and portal vein to prevent excessive bleeding when liver is lacerated by
• blocking bloodflow into the liver in the 1st place

• cystic duct
• hepatic duct
• liver

• anastamosis of the superior messenteric vein with the splenic vein
• occurs behind neck of pancreas

gastroduodenal artery gives rise to the superior pancreaticoduodenal arteria (SPDA) (head)

SMA gives rise to the IPDA (neck)

Celiac trunk gives rise to splenic artery (which supplies pancreatic body and tail)

note: celiac trunk --> common hepatic artery --> gastroduodenal artery --> SPDA

posterior border (greater curvature) grows more rapidly than anterior border (lesser curvature)

90 degree rotation around vertical axis brings lesser curvature to the right

90 degree rotation around AP axis brings proximal end of stomach to left

applies to spleen

• Measurements: 1x3x5
• Weight: 7 oz
• 9x11: between these ribs on L
• hand side

• Ventral bud- smaller bud that wraps around
• ---forms the head and uncinate process
• Dorsal bud- larger bud
• ---forms the rest of the pancreas (neck body tail)

*both form the main pancreatic duct, but accessory duct formed only by dorsal

when the ventral (smaller) bud is bifid and wraps around the second part of the duodenum forming a constrictive pancreatic ring around it

• Appears as U shaped tube on
• vertical dorsal mesentery
• Omphaloenteric duct connects
• midgut loop to umbilical vesicle through umbilicus
• Superior mesenteric artery
• runs in the middle to the dorsal mesentery to reach the midgut loop

• Artery divides the midgut
• loop into cranial and cuadal limbs

Cecum- caudal limb

• As gut grows and elongates,
• it herniates out into the umbilical cord
• It rotates 90 degrees
• counterclockwise around the axis of the superior mesenteric artery

• Cranial to the right, caudal
• to the left

• As the midgut absorbs
• mesentery, it is pulled back into the peritoneal cavity and continues to
• rotate another 180 degrees (270 degrees total)

• Cranial left, caudal right
• Cecum is subhepatic (b/c no
• ascending colon is developed yet)

• It descends to the right
• iliac fosa as the gut tube grows and forms the ascending colon

• Note: duodenum is BEHIND the
• SMA
• Ascending and descending
• colon become fixed to post abdominal wall as secondarily retroperitoena

outpouching of intestines through the umbilical cord

• NR: small bowel on right
• RR: transverse colon BEHIND SMA
• SHC: cecum can adhere to the liver and not descend
• MV: bowels not fixed so very mobile

• -small buldge (persistence) in the small intestine from remnant of omphaloenteric duct
• may be connected to umbilicus by fibrous cord or fistula
• -most common GI malformation

• rule of 2's : 2 inches long, 2 ft from cecum, in 2% of the population
• 

where common bile duct and pancreatic duct preforate the 2nd part of the duodenum

• congenital megacolon caused by the abscene of parasympathetic ganglia in segment of descending colon so neural crest cells fail to migrate
• no peristalsis motion in this part of gut, so fecal matter can back up
• 

• blood supply- phrenic artery, inferior phrenic artery
• nerve supply- phrenic nerve (C3,4,5)

• origin: body of lumbar vert
• insertion: femur
• function: flexion of thigh @ hip joint
• Innervation: L1-3

• origin: body of lumbar vert
• insertion: pelvis
• function: weak flexion of vertebral column
• innervation: L1

• origin: transverse processes of lumbar vertebrae
• insertion: transverse processes of lumbar vertebrae & 12th rib
• function: deprersses and stabalizes 12th rib and lateral abduction of trunk
• innervation: T12-L4

• origin: pelvis
• insertion: femur
• function: flexion of thigh @ hip joint
• innervation: Femoral nerve L2-4

• subcostal: t12
• illiohypogastric: L1
• illioinguinal: L1
• Genitofemoral: L1,L2
• Lateral femoral cut: L2, L3
• Femoral: L2,3,4
• Obturator: L2,3,4
• Lumbosacral: L4,5

• -renal pelvis
• -pelvic brim
• -bladder

buildup of urine in the kidneys due to the inferior renal artery obstructing the pelvis/ureter

WITHIN the WALLS of organs

abdominal viscera

Parasympathetic PREganglionics

Sympathetic POSTganglionic

• Visceral: dull, diffuse
• Somatic: sharp, localized

• General Visceral sensations-
• travel with parasympathetics

• Ex: Blood pressure, blood
• gases

• Visceral pain from infection,
• etc- travel with sympathetics

• Visceral pain below parietal
• peritoneal floor of pelvis- travel with parasympathetics of S2-4

Cyanotics = Trouble = T = R --> L

• Tetrology of Fallot
• Transposition of great vessels
• patent Trunkus arteriosus

• Acyanotic = any defects you can abbreviate = L --> R
• ASD
• VSD
• PDA

• Teres Major
• Teres Minor
• Triceps Long Head
• Humerus

[axillary artery, posterior humeral circumflex a]

• Teres Minor
• Teres Major
• Triceps Long head

[circumflex scapular artery]

• Triceps lateral is actually lateral to the body!
• Triceps long is next to it and more posterior

• transcerse cervical a
• posterior circumflex humoral a
• subscapular a

• "Royce Totally Drinks Cold Beer"
• Roots 5 (c5,6,7,8, t1)
• Trunks 3 (upper middle lower)
• Divisions 6 (3 ant 3 post)
• Cords 3 (LPM)
• Branches 5 (MARMU)

• rhomboids
• c4 c5

• supraspinatus and infraspinatus
• c5 c6

• serratus anterior
• c5 6 7

pec major minor

pec major/minor

latissimus dorsi

subscapularis

subscapularis + teres major

• c5 6 7
• biceps, brachialis, coracobrachialis (BBC)

• teres minor and deltoid
• c 5 6

• c5-t1
• extensors of upper limb

• c5-t1
• flexors of forearm

• c8-t1
• intrinsic hand muscles

• thumb: c6 (digit 1)
• index: c7
• pinky: c 8 (digt 5)

pinky is always last!

• SITS
• Supraspinatus (0-15 degree abduction)
• Infraspinatus (lat rotator)
• Teres minor (lat rotator)
• Subscapular (medial rotator)

• biceps brachi short head: medial
• biceps brachi long head: lateral (looks shorter because deltoid covers it)

*coracobrachialis is deep to short head, so also medial

borders: brachioradialis, pronator teres, line between humeral epicodyles "BEP"

located near anterior elbow

contains: bifurcation of brachial artery into radial and ulnar nerve, and also has median nerve

"Radical Palm Trees Down Under"" + Pronator (From thumb to pinky...follow tendons)

• Flexor Carpi Radialis (largest)
• Palmaris Longus (above retinaculum)
• Flexor Digitorum Superficialis
• Flexor Carpi Ulnaris (by pinky)

Median Nerve (+9 tendons)

cephalic vein

"Uncle Max Drinks Blue Label BA!"

• EC Ulnaris
• E Digiti Minimi
• E Digitorum
• EC Radialis Brevis
• EC Radialis Longus
• Brachioradialis
• Aconeus

• Blue = Radial N
• Green= Posterior Interossei N

• pollicis longus
• pollicis brevis
• abductor pollicis longus

• dislocated: lunate
• fractured: scapphoid

fracture of distal end of radius

• thickening of palmar aponerosis
• ring finger affected first
• then pinky
• then middle

All fingers initially share a common synovial sheath except the thumb, which has its own.

The synovial sheath extends into the pinky, but then the other fingers also develop their own.

infection can spread easily.

T7 (xiphoid) to L1 (pubic)

Above watershed line (umbilicus) = axillary nodes (the regular)

Below watershed line= superficial inguinal nodes