Anatomy Lecture Notes--midterm review by Stephanie Swanson

Thorax:
Breast:
Coopers Ligaments- suspensory ligaments
Glands/Lobulesductssinusesnipple
Retromammary space- behind the breast- allows for movement
Blood Supply: Internal Thoracic Artery on anterior chest parasternal and Lateral
thoracic artery lateral anterior chest
Lymph Drainage: parasternal lymph nodes + apical lymph nodes (75% here)
Superficial Chest:
Cephalic vein (in deltopectoral triangle)
Medial/Lateral cutaneous vessels and nerves
Anterior Muscles:
Pectoralis
Major

adduction, medial rotation, flexion

of humerus at shoulder

medial and lateral

pectoral nerve

Pectoralis
Minor

depresses tip of shoulder,

protracts scapula

medial pectoral n.

External
intercostals

inspiration, moves ribs up

(inferomedially)

Internal
intercostals

Expiration/inspiration
(superiorlaterally)

Innermost
intercostal
Transversus
thoracis

pectoral branch of
thoracocromial trunk a.

Intercostal arteries
Intercostal nerves

act with internal intercostals

depress costal cartilages

internal thoracic a.

Also know where they attach to

Pec major clavicle, sternum, ribs, humerus
Pec minor ribs 3, 4, 5 to corocoid process
Intercostals rib to rib (note direction above)
Trans. Thoracis sternum to ribs
Branches off the axillary arteryScrew The Lawyer, Save A Patient Superior thoracic,
Thoracoacromial, lateral thoracic, subscapular, anterior and posterior circumflex humeral
Chest Wall:
Intercostals Vein, Artery, Nerve (VAN) on top of ribs
-**when putting a needle do it above the rib
These run between the internal and innermost muscles
T4 = nipple
Sympathetic Trunk- from superior cervical ganglia down

Thorax Bone Structure:

Coracoid process (what attaches here)
Acromion
Clavicle
Sternum (3 parts) sternal angle (where rib 2 attaches, level of T4/5, where trachea
bifurcates, aortic arch stops and starts, separates superior and inferior mediastinum, top of
azygos vein arch)
Ribs neck, head, facets, body, intercostal groove (for intercostal vessels) **attach
to their own vertebral body and the one above it and to transverse process of the same
vertebrae
intercostal VAN (vein artery nerves), they run on inferior aspect of ribs, in the costal
groove, not on top or rib as stated in review. Collateral branches run on top. Needle placement
is on top of rib. See p 63 of text.
Also, innermost intercostals probably act with external intercostals. See p 7 of dissector.

-ribs 1, 10, 11, 12 have one facet to their own vertebrae

Scapula (spine, fossas)
Vertebra (lamina, body, canal, pedicle, transverse foramen, spinous process, transverse
process, IV disc: nucleus pulpolsis + annulus fibrosis)
True ribs 1-7; False ribs 8-10; floating ribs 11-12
Lungs + Pleura:
Pleura parietal (outer layer), visceral (on lungs) layers
Costodiaphragmatic recess fills when you breathe at the inferior of the lungpotential space
LungRoot- just the arteries, veins, bronchi
Hilum- root + pulmonary ligament
Pulmonary Arteries (deoxygenated blood) superior run with bronchi
Pulmonary Veins (oxygenated blood) inferior run segmentally
Bronchial Arteries- off of aorta to supply blood to lung tissues
Trachea bifurcates at second rib into primary bronchi (right and left) lobar
segmental bronchi
**azygos vein comes up and loops around the right lung hilum
Lymph Nodes: drain up and around to trachea- can cross over
Innervation of Pleura:
Somatic: mainly to parietal pleura sensation to pain
Autonomic: mainly to visceral pleura pain insensitive
Alveoli-little sacs- respiratory part of the lung (rest is conducting portion)
Right lung: has three lobes: superior, middle, inferior with two fissures
**Horizontal fissure separates the superior from the middle lobe
**Oblique fissure separates the inferior lobe from the superior and middle
**on the right: middle lobe is mostly on the posterior and superior is mostly anterior
Left lung: has 2 lobes + lingula: superior, inferior (oblique fissure separates them) also
has the cardiac notch

**on the left: inferior lobe is mostly seen posterior (aka if someone gets stabbed there)
and superior lobe is anterior

Heart and Great Vessels:

Sits tilted in the chest cavity:
Anterior right ventricle
Posterior left atrium
Thymus in children remnant in adultsover the superior portion of the heart
Phrenic nerve runs on the pericardial sac with the
pericardiacophrenic vessels- to the diaphragm
Auricles- accessory heart muscles that help contract
and open the atria
Apex of the heart
Blood flow: Coronary Sinus/SVC/IVC right atrium (deoxygenated from body + heart)
right ventricle pulmonary trunk right and left pulmonary arteries
(deoxygenated) lungs 4 pulmonary veins (oxygenated) left atrium left
ventricle ascending aorta arch of the aorta descending aorta
**note: 2 pulmonary arteries, 4 pulmonary veins
Pericardial Sac: 2 layers: Fibrous (outer) and Serous (visceral and parietal pleural
layers)
Left ventricular walls are thicker because of more power needs to get body to the whole
body (and therefore pressure is higher)
Three layers/membranes in the heart: endocardium, myocardium, epicardium
Cardiac Sinuses:
Transverse Sinus- goes all the way through between pulmonary veins/ SVC and
pulmonary trunk/aorta
Oblique Sinus- goes under the heart between IVC and between pulmonary arteries (blind
end)
Coronary Arteries and Veins:
Aorta gives off two branches after leaving the
heart: right and left coronary arteries
(RCA/LCA)
RCA SA nodal artery, right marginal artery, left
posterior descending (LPD)
LCA circumflex artery, left marginal artery,
left anterior descending (LAD),
Veins:

Great LAD
Middle PDA
Small RCA/right marginal
Coronary sinus is on the posterior drains into RA
Valves:
right atria to right ventricle = tricuspid valve with anterior, posterior and septal cusps
left atria to left ventricle = mitral/bicuspid valve with anterior and posterior cusps
Semilunar valves: aortic (left, right, posterior); pulmonic (anterior, left, right)
remember this by PLAR- circle the A for aortic, and you have PLR leftover (posterior,
left, right) and circle the P for pulmonic, and you have LAR leftover (left, anterior, right)
Cusps are held by chordae tendinea which attach to papillary muscles in the ventricles
In the atria the rough looking muscles are pectinate muscles
In the ventricles they are trabeculae carnea
Fossa Ovale embryonic remnant of physiological shunt to left atrium
In the right atria there is a Crista Terminale which is a smooth ridge separating the
pectinate muscles from the smooth muscle also there is a conus arteriosus
(infundibulum) that leads to pulmonary trunk: Netter Plate 216)
SA Node (pacemaker of the heart) is in the right atrium fibers go to the AV node in
the bottom part of the right atrium fibers to interventricular septum right bundle
branch moderator band and Purkinje fibers (left bundle branch to left ventricle)
conducts impulses to papillary muscles
Diastole= relaxed ventricles - tri and bicuspids open semilunars closed
Systole= contracted ventricles semilunars open tri and bi open
Posterior Thorax/Wall:
Vertebrae are the most posterior with descending aorta and esophagus, azygos veins on
top (**thoracic duct runs in between azygos and esophagus)
Azygos Veins- azygos are on the right, hemiazygos on the lower left, and accessory
azygos on the upper left
Left recurrent laryngeal nerve comes down (branching off the vagus) and goes
posterior to the ligamentum arteriosum (remnant of the ductus arteriosus) and then goes
back up to larynx
Right recurrent laryngeal nerve comes down under the right subclavian artery and back
up
Vagus (CN X) nerve runs down medial to the phrenic and wraps into a plexus around the
esophagus and branches to the heart then sends parasympathetics to the thorax (and then
abdomen)
-PNS has long preganglionics, and short postganglionics (innervates viscera)

Thoracic duct- runs with (posterior) esophagus from the abdomen (from the cysterna
chyli) delivering lymph into the left subclavian vein (where it gives off the left internal
jugular vein)
Sympathetic Trunk- (T1-L2) runs lateral to the vertebral bodies on the posterior wallcontains sympathetic fibers and ganglia (cell bodies) connects to ventral rami
(intercostal nerves) by rami communicates (grey=post/ white=pre) starts at the
superior cervical ganglia in brain (NOT the spinal cord-only connects to spinal cord)
and ends in lumbar splanchnicssend off greater, lesser, and least splanchnics in the
thorax (all preganglionic sympathetics)
-SNS has short preganglionics, and long post ganglionics (innervates blood vessels and
glands)
Nervous System:
AfferentDorsal
HornDorsal Root
GangliaDorsal
RootSensoryInfo to
CNS
EfferentVentral
HornVentral
RootMotorAway from
CNS

Somatic
GSA: touch, temp,
proprioception, sharp pain
only part in the abdomen
is the omenta

Visceral
GVA: all of viscera (organs)
in the gut: dull pain
(bellyache)

GSE: skeletal muscle

GVE: smooth muscle

-SNS/PNS- 2 ganglia
system (always run with
VA)

Dermatomes represent the area of the skin supplied by the nerve root- these are segmental
Cutaneous innervation is different it represents different nerve sensory areas on the skin
Back and Spinal Cord:
33 vertebrae 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccyx
C1 = atlas (has no body)
C2 = axis (with dens/odontoid process)
C2, 3 have bifid spinous processes
Vertebral artery runs through transverse
foramen
Spinal nerves run through vertebral
foramen
Vertebra and all its parts:
Note connections to ribs discussed in
thorax (above)
Intervertebral Disc- consists of nucleus pulposis (squishy inside; remnant of notochord)
and annulus fibrosus (fibrous outside)
Ligaments:
Nuchal ligament: from occipital bone of skull to first couple spinous processes

Intraspinous ligaments: from spinous process to spinous process

Anterior longitudinal ligament: most anterior thing- anterior of body
Posterior longitudinal ligament: posterior of body anterior of the canal
Ligamentum Flava: posterior of the canal (the pop when you do a lumbar puncture)
Extrinsic muscles- are involved with the movements of upper limbs- innervated by
anterior/ventral rami
Intrinsic muscles- are deep and support and move vertebral column- innervated by the
posterior/dorsal rami
Back Muscles:
Muscle
Type
Group

Muscle Name
Trapezius

Intrinsic
(innervated by
posterior/dorsal rami)

Extrinsic

Superficial

Intermediate

Deep

Latissimus
Dorsi
Levator
Scalpulae
Rhomboid
Minor
Rhomboid
Major
Serratus
Posterior
Superior
Serratus
Posterior
Inferior
Spinotransversales:
1. Splenius
capitus
2. Splenius
Cervicis
Erector Spinae:
1. Iliocostalis
2. Longissimus
3. Spinalis

Muscle
Function
elevate,
depress,
adduct, &
medially rotate
scapula
extend, adduct,
& medially
rotate humerus

Nerve
Innervation

Arterial
Supply

accessory
spinal nerve
(CN XI)

transverse cervical

Thoracodorsal

thoracodorsal

dorsal
scapular
dorsal
scapular
dorsal
scapular

dorsal scapular

elevate ribs

ventral rami

Intercostal a.

depress ribs

ventral rami

Intercostal a.

elevate scapula
retract scapula
retract scapula

together: pull
head back,
extend neck;
individually:
move head to
same side as
contraction
maintain
upright
posterior, bend
back

dorsal rami

Transverse
cervical

dorsal scapular

segmentally:
deep cervical,
intercostal,
subcostal, lumbar

dorsal rami

Bone Structures:
Scapula (spine, coracoid, acromion, supraspinous fossa, infraspinous fossa, suprascapular
notch, superior, medial, lateral, inferior borders)

Suprascapular notch- suprascapular artery goes over the ligaments in it, the nerve goes
through the notch (remember the army goes over, the navy goes under)
Suboccipital Triangle- underneath the trapezius in the back of the neck this holds the
vertebral artery, posterior arch of C1, and the greater occipital nerve (off of C2)
Spinal Cord:
Extends from brain to L1/L2 in adult (the whole spinal column in infants)
There are two enlargements: cervical (for extra tissue for upper limbs) and lumbosacral
(extra tissue for lower extremity)
**Spinal nerves exit the transverse foramen above the vertebra for the cervical nerves,
and below for all the rest
Though there are 33 vertebrae there are only 31 spinal nerves (8 cervical, 12 thoracic, 5
lumbar, 5 sacral, 1 coccygeal)
Vertebral houses the spinal cord in the vertebral canal- spinal cord is protected by layers
of connective tissue membranes (meninges) and spaces:
Pia mater: adhered to spinal cord (like a viscera) extends inferiorly into the filum
terminale and medially into denticulate ligaments
Subarachnoid Space: between the pia and arachnoid maters holds the CSF (this is
where we do lumbar punctures
Arachnoid mater: thin, shiny membrane on the surface of the dura mater
Subdural Space: between the arachnoid and the dura maters this is where you often get
subdural hematomas even though this is a potential space
Dura mater: thickest, most external, white membraneoffers good protection
Epidural Space: this is where we do epidurals contains fat with vessels
Arterial supply to the spinal cord starts superior with the vertebral artery branches to
anterior spinal artery / segmental arteries Artery of Adamkiewicz is very important
because it supplies a huge portion of the thoracic spinal cord arteries occlusion here
would cause a major effect on spinal cord
There is an extensive venous plexus drainage system segmental veins go to IVC
Scapula and Deltoid Region:
Muscles:
Muscle Name
Supraspinatus
Infraspinatus
Posterior
Scapula

Muscle
Function
Abduct arm to
first 15 degrees
Lateral Rotation
of arm

Nerve
Innervation

Arterial
Supply

Suprascapular

Suprascapular

Suprascapular

Suprascapular

Origin

Insert

Superior
Scapula
inferior
scapula

Top of
Humerus
middle
humerus

Teres Minor

Lateral Rotation
of arm

Axillary Nerve

Posterior
circumflex
humoral artery

Lateral
scapula

greater
tubercle

Teres Major

medial rotation
and extension of
arm

Inferior
subscapular
nerves

circumflex
scapular artery

posterior
scapula

anterior
humerus

Anterior
and
posterior

Anterior
scapula

Deltoid

Major Abductor of
the arm after first
15 degrees

Subscapularis

medial rotation of
arm

Serratus
Anterior

Rotation/protracti
on of scapula

Axillary Nerve
Upper/lower
subscapular
nerves
Long Thoracic
Nerve

Post. Circumflex
humoral artery,
deltoid branch of
thoracoacromial

clavicle

middle of
humerus

subscapular
artery

lesser
tubercle

anterior
side of
humerus

Lateral Thoracic
artery

ribs 8-9

scapula

Remember: a Lat between two Majors on the humerus insertions are: pec major, lat.
Dorsi, teres major (lateral to medial)
Muscles of Rotor Cuff: SITS : supraspinatus infraspinatus teres minor
subscapularis
Bone Structure:
Humerus: greater tubercle (for SIT), lesser tubercle (for subscap), deltoid tuberosity
(for deltoid), radial groove (for radial nerve), intertubercular groove (for long head of
biceps tendon), anatomical (upper) and surgical necks (lower) inferior humerus is in
arm (below)
Quadrangular space: Axillary nerve runs with post. circumflex humeral artery
Borders: long head of triceps, teres minor, teres major, humerus
Upper triangular space: circumflex scapular vessels
Lower triangular space: radial nerve and deep branchial artery
Borders: long head of triceps, teres major, medial head of triceps
Shoulder joint:
Bursa: sacs with fluid so that they help slide the joint
Glenohumeral ligaments
Coracoacromial ligament
Acromioclavicular ligament
Glenoid Fossa
Vessels in shoulder have lots of anastomosis- so can bypass a blockage more easily
Brachial Plexus:
Axilla:
Anterior: pec major/minor
Posterior: subscapularis
Medial: serratus anterior/ribs/intercostals
Axillary Sheath: contains arteries, vessels, nerves
Plexus: C5-T1 roots

Really Thirsty? Drink Cold Beer roots, trunks, divisions, cords, branches
End branches are MARMU
(musculocut, axillary, radial, median,
ulnar)
Really you just need to know how to
draw it, with the small branchesInnervation of Brachial Plexus:
Dorsal Scapular
Long thoracic
Suprascapular
Nerve to subclavius
Lateral pectoral
Musculocutaneous
Medial pectoral
Medial cutaneous of arm
Medial cutaneous of
forearm

Skin to lateral side of forearm

Skin medial of distal 1/3 of arm
Skin medial of forearm

Median

palm surface lat. 3.5 digits &

lateral side of palm and mid of
wrist

Ulnar

palm surface of med. 1.5 digits

& dorsal of med 1.5 digits

Superior subscapular
Thoracodorsal
Inferior subscapular
Axillary
Radial

Rhomboid major/minor
Serratus anterior
Supra and infraspinatus
Subclavius
Pec. major
anterior compartment of arm
Pec. major/minor

upper lateral part of arm

Post. arm/forearm, lower lat.
Surface of arm, dorsal lateral of
hand)

Ant. compartment of forearm, 3 thenar of

thumb, 2 lateral lumbrical muscles (no
flexor carpi ulnaris & flexor digitorum
profundus)
intrinsic muscles of hand (no median
nerve ones), flexor carpi ulnaris, med.
Flexor digitorum profundus)
subscapularis
latissimus dorsi
subscapularis, teres major
deltoid, teres minor
posterior compartment of arm/forearm

Arm:
Bone Structure:
Humerus: medial and lateral epicondyles, coronoid fossa (anterior), olecranon fossa
(posterior), trochlea (medial), capitulum (lateral)
Forearm: ulna (olecranon)- by the pinky finger / radius (styloid process)- by the thumbarticulates with the scaphoid and lunate
-interosseus membrane goes between two bones
Muscle
Group

Anterior

Muscle
Name

Muscle Function & Facts

Biceps
brachii

flex arm (long head) & forearm,

supinate if elbow is flexed

brachialis

flex forearm

Coracobrachialis

flex forearm, adduct arm

Nerve
Innervation

Arterial Supply
brachial

Musculocutaneous

brachial + radial
recurrent
brachial

Posterior

Triceps
brachii

extend forearm at elbow, long

head can adduct or extend arm
at shoulder

radial

profunda brachii

also know insertions:

Biceps- long head (supraglenoid tubercle of the scapula), short head (coracoid process),
both originate from radius bone
Brachialis- from ulna to humerus
Coracobrachialis- from coracoid process to humerus
Triceps- long head (inferior border of scapula), lateral head (humerus), medial head
(humerus) all insert into biceps tendon onto olecranon
Cubital fossa: at the elbow- borders (medial = protonator teres / lateral = brachioradialis /
proximal = biceps brachii) median cubital vein runs here with biceps tendon and
brachial artery

Superficial
Posterior

Brachioradialis

Accessory flexor of
elbow

Extensor carpi
ulnaris

Extends & adducts wrist

Extensor digiti
minimi

Extends little finger

Extensor
digitorum

Extends fingers & wrist

Extensor carpi
radialis brevis
Extensor carpi
radialis longus

Deep
Posterior

Radial nerve
Posterior
interosseous
(a continuation
of the deep
branch of radial
nerve)

Radial recurrent
Ulnar artery
Interosseous
recurrent from ulnar
interosseous
recurrent & posterior
interosseous

Extends & abducts wrist

Deep branch of
radial

Radial artery

Extends & abducts wrist

Radial nerve

Radial artery

Anconeus

Abduction of ulna in
pronation; accessory
extensor of elbow

Radial nerve

interosseous
recurrent

Supinator

Supination

Extensor
indicis
Extensor
pollicis longus
Extensor
pollicis brevis
Abductor
pollicis longus

Extends index finger

Extends IP joint of thumb
(also CMC & MCP joints)
Extends MCP joint of
thumb (also CMC joint)
Abducts carpometacarpal
joint of thumb

Hand:
Bone Structure:
Phalanges (3)
Metacarpal (1)
Carpals (8)
DIP: distal interphalangeal joint
PIP: proximal interphalangeal joint
MCP: metacarpophalangeal joint

Posterior
interosseous
(continuation of
deep branch of
radial nerve)

recurrent
interosseous
Posterior
interosseous

CMC: carpometacarpal joint

Wrist Bones:
Some Lovers Try Positions That They Cant Handle Scaphoid Lunate Triquetrum
Pisiform Trapezium Trapezoid Capitate Hamate-Hook of hamatewhere the ulnar nerve
lies
Pisiform is a sesamoid bone
Muscles:
T
y
p
e

Muscle
Group

Muscle Name
Palmaris brevis

Thenar
(FAO)

Intrinsic

Hypothe
nar
(FAO)

Lumbricals

Dorsal
interossei
(4 bipennate)
Palmar
interossei
(4 unipennate)
Adductor
pollicis
Opponens
metacarpal
pollicis
Abductor
pollicis brevis
Flexor pollicis
brevis
Opponens digiti
minimi

Muscle Function & Facts

deepens cup of palm & improve
grip; origin at palmar aponeurosis &
insertion in dermis of skin
(DAB) abduct index, middle, & ring
finger; flexion & extension of fingers
(through dorsal hoods)
(PAD) adduct thumb, index, ring, &
little fingers; flexion & extension of
fingers (through dorsal hoods)
Adducts thumb & opposes thumb to
rest of digits in gripping
Medially rotates thumb; rotates &
flexes metacarpal I so pad faces
pads of fingers (opposition)
Abducts thumb at
metacarpophalangeal joint
Flexes thumb at
metacarpophalangeal joint
Rotates metacarpal V toward the
palm (lateral rotation) - movement
less dramatic than thumb's

Abductor digiti
minimi

Abducts little finger at

metacarpophalangeal joint

Flexor digiti
minimi brevis
Medial
(bipennate)
Lateral
(unipennate)

Flexes little finger at

metacarpophalangeal joint
Flex metacarpophalangeal joints
while extending interphalangeal
joints

Nerve
Innervati
on
ulnar

Arterial Supply
ulnar artery

dorsal and palmar

metacarpal
ulnar

palmar
metacarpal
deep palmar
arterial arch

Recurrent
branch of
median

Radial artery

ulnar

ulnar artery

ulnar
median

superficial palmar
arterial arch

Palmar aponeurosis membrane that helps keep the cup part of the palm
Extensor retinaculum membrane covering the extensor muscles
Flexor retinaculum membrane covering the flexor muscles
Carpal Tunnel: covered by the transverse carpal ligament-contains flexor pollicis
longus (in its own sheath), flexor digitorum superficialis (2 on top of two- digits 3 and 4
on top of 2 and 5) and profundus (4 in a row)median nerve also runs here
Abdomen:
Regions of the abdomen:

Quadrants- xiphoid to pubic symphysis and horizontal through umbilicus

8 regions- subcostal and interspinous horizontal lines and two vertical midclavicular
lines- right hypochondrium, epigastric, left hypochondrium, right flank, umbilical, left
flank, right inguinal, hypogastric, left inguinal

Abdominal Wall

Muscles:
Muscle
Name
External
Oblique

Compress abdominal contents;

flex trunk (bilateral); bend trunk
laterally (unilateral - to same side)

Internal
Oblique

Compress abdominal contents;

flex trunk (bilateral); bend trunk
laterally (unilateral - to same side)

Transversus
Abdom-inis

Compress & support abdominal

contents

Rectus
Abdominis

Compress abdominal contents;

flex vertebral column; tense
abdominal wall

Pyramidalis
Psoas
major
Posterior Abdominal Wall

Muscle Function & Facts

Tenses linea alba

Flexion of thigh at hip joint; flexion
& laterally bending of lumbar
vertebral column

Nerve
Innervation

Arterial Supply

Ventral rami T7T12

superior epigastric, inferior

epigastric

Ventral rami T7L1;

iliohypogastric,
ilio-inguinal
Ventral rami T7L1;
iliohypogastric,
ilio-inguinal

superior epigastric, inferior

epigastric
superior epigastric, inferior
epigastric

Ventral rami T7T12

superior epigastric,
intercostal, subcostal, inferior
epigastric

ventral rami T12

subcostal & inferior epigastric

Ventral rami L1L3

subcostal (=T12) & lumbars

Ventral rami L1
(L1 =
iliohypogastric &
ilioinguinal)
ventral rami T12L4;
T12=subcostal
nerve

Psoas
minor

Weak flexion & lateral bending of

of lumbar vertebral column

Quadratus
lumborum

Depress & stabilize 12th rib;

laterally bend the trunk

Iliacus

Flexes the thigh at hip joint; flexes

pelvis on thigh if thigh is fixed

Femoral

iliolumbar

Diaphragm

inspiration: pushes the abdominal

viscera inferiorly, vol. of thoracic
cavity

Phrenic

inferior & superior phrenic;

musculophrenic

Bone Structure:
Lumbar vertebrae- posterior
Iliac crest and Ilium bone inferior
-anterior superior iliac spine
Ribs- superior
Pubic tubercle
Abdominal Wall:

lumbars

subcostal & lumbars

Anterior: Skin campers fascia (fatty) scarpas fascia (membranous) rectal

sheath internal oblique external oblique transversalis abdominus transversalis
fascia

Arcuate line where the rectus sheath goes anterior completely

-above:
-below:

Nerves/arteries are segmental to the abdominal wall

-T10 is the umbilicus
Iliohypogastric nerve sensation to suprapubic region
Internal thoracic from thorax comes down and splits musculophrenic + superior
epigastrics (anastomose with inferior epigastrics)
Iliac circumflex arteries-also anastomose with epigastrics laterally
Diaphragm is superior portion with right and left crus
Right = caval hiatus (T8) with IVC and phrenic
Right = esophagus hiatus (T10) with vagus
Left and Right = aortic hiatus (T12) with thoracic duct, azygos veins, greater
splanchnics
**Remember: I ate (8) 10 eggs at noon (12)
Anterior wall folds:
Median fold- with embryological urachus
Medial folds- remnants of umbilical vessels
Lateral folds- inferior epigastrics
Hesselbachs triangle- medial=lateral edge of rectus abdominus / lateral=inferior
epigastric vessels / inferior=inguinal ligament
Spermatic Cord/Testis:
Inguinal ligament- runs from anterior superior iliac spine to pubic tubercle- made from
external oblique
Internal ring of the inguinal canal- genitofemoral nerve passes through it with the
spermatic cord (**NOT the ilioinguinal nerve)- made from the internal oblique
External ring of the inguinal canal- ilioinguinal nerve + genitofemoral nerve passes
through it with the spermatic cord- made from the transversalis abdominus
Ilioinguinal nerve- sensory on the testes
Dartos muscle- regulates testes temperature but wrinkling the testes
Spermatic cord: cremasteric muscle, vas deferens, genital branch of the genitofemoral
nerve, ilioinguinal nerve, pampiniform plexus, testicular artery

In the testes--layers:
Tunica albuginea- white adherent fascia
Tunica vaginalis- loose anterior sac
Internal oblique cremasteric muscle
External oblique external spermatic fascia
Transversalis abdominis nothing (ends before testes)
Transversalis fascia internal spermatic fascia
Flow of sperm: STEVE seminephrous tubules epididymis (superior-posterior)
vas deferens ejaculatory duct
Abdomen GI:
Greater omentum- from stomach/transverse colon hanging down over intestines
Colon: ascending (from cecum/appendix) right colic flexure transverse colon
splenic/ left colic flexure descending colon sigmoid colon rectum anus
-colon has haustra (pocket-appearance by semilunar folds) made by tenia coli muscles
(lead to appendix)
Lesser omentum- stomach to liver-creates lesser sac/epiploic foramen (IVC-posterior,
portal vein-anterior)
Small intestine: order: Dow Jones Industrial
duodenum- C-shaped, ampulla of vater (where bile duct comes in), ligament
of Treitz holds duo to diaphragm-has semi-circular folds
jejunum-feathery appearance due to lots of semi-circular folds ileum-smooth with solitary lymph tissue (peyers patches)
Stomach: regions: cardiac, fundus, body, pyloric (antrum then canal) greater and lesser
curvatures
-Rugae folds in the stomach
Retroperitoneal Structures: AC/DC Rocker Kids Party Down Asc. and desc. Colon,
rectum, kidneys, pancreas, duodenum
Enteric Nervous System: motor and sensory neurons in the GI in two plexuses:
independent systems but can be influenced by autonomics (SNS/PNS)
-Myenteric/Auerbachs and Submucosal/Meissners- both help in GI functions
Peripheral Visceral Nerves: efferent = PNS/SNS (pre and post ganglionic) // afferent =
one fiber
Liver: most of liver is under ribs
4 lobes: right (biggest), left, caudate (top posterior), quadrate (bottom posterior)
Right and left lobes are separates by the falciform ligament (attaches liver to anterior
abdominal wall) and ligamentum teres hepatis (embryonic remnant)

Hepatogastric and hepatoduodenal ligaments- forms lesser sac (anterior)

Liver triad: portal vein (from all GI organs (portal venous system), common bile duct,
hepatic artery at inferior
Hepatic vein goes superior to IVC (systemic venous system)
Right and left hepatic duct common hepatic duct combine with cystic dust
common bile duct combine with pancreatic duct into duodenum
Gallbladder: between right lobe and quadrate (remember GQ: gallbladder next to
quadrate)
Pancreas: head in the arms of the duodenum body tail near spleen
-sends pancreatic duct to combine with bile duct- there is an accessory pancreatic duct
also (see embryo: pancreas development)
Posterior of the body are the SMA/SMV
Splenic artery runs along body and tail to spleen
Spleen: filters blood- splenic artery is torturous from the celiac trunk
Abdominal Arteries:

Unpaired- celiac trunk, SMA, IMA

Paired- inferior phrenics, suprarenals, renal, gonadal, lumbar

Abdominal Veins:

note: IMV goes to splenic vein

remember: lymphatics follow blood supply so gonads drain lymph to lumbar aortic
area
Posterior Abdominal Wall:
IVC on the right and aorta on leftDiaphragm- has arches across the backMedian arch- aorta
Medial psoas muscles
Lateral- quad. laborum
Nerves: there is a plexus and ganglia for every artery (basically i.e. SMA SMA
plexus and ganglia
Lumbar plexus, sacral plexus even though these are basically sympathetic the vagus
comes down and travels through them
On the wall:
Some Idiots Ignore Lab, Fs Given Out subcostals, iliohypogastric, ilioinguinal,
lateral cutaneous of the thigh, femoral, genitofemoral (on psoas muscles), obturator
Kidneys: blood supply from aorta lots of variations- right kidney is lower
Perirenal fat- closest to kidney- inside of the fascia
Perarenal fat- outside of fascia
Filters in this order: cortex medulla pyramids renal papilla minor calyx
major calyx renal pelvis ureter bladder urethra
Suprarenal glands: above the kidneys- secrete norepinephrine and epinephrine three
blood supplies: from inferior phrenics, aorta, and renal arteries
Clinical Problems: note this is not all the blue boxes in the text (look them up!)
Breast Cancer- some can affect coopers ligaments and causes peau du orange
appearance
Pneumothorax- air in pleural cavity to fix put in chest tube around rib 6 above the rib
Chylothorax- lymph in the pleural cavity
Hemothorax- blood in the pleural cavity to fix put chest tube in between ribs 8 and 9
above the rib in the axillary region
Pleuritis/Pleurisy- inflammation of the pleura-painful
Fractured Ribs
COPD- people with breathing use their accessory breathing muscles
Right Bronchi is more vertical so more likely to aspirate
Pericarditis- inflammation of heart sac
Pericardial effusion- is a buildup of fluid in the space between the heart and the sac
around the heart
Cardiac tamponade- pressure on heart
Hemopericardium- blood in sac
Heart Attack myocardial infarction

Referred pain from the heart to the left shoulder

Auscultation of the Heart right 2nd rib space = aortic / left 2nd rib space = pulmonic /
left 3rd rib space = 2nd pulmonic / 4th rib space = tricuspid / 5th rib space midclavicular
(below the nipple) = mitral
Tumor in the vertebral canal - can impinge on spinal cord
Meningitis infection in the spinal column in the meninges
Lumbar Puncture have patient either on side in fetal tucked position on sitting up
tucked- feel for iliac crests, go over to L4/L5 and stick needle into either epidural (to give
anesthesia) or subarachnoid (for CSF)
Shoulder Dislocation most common anterior-inferiorly because not as many tendons
that direction
Bursitisinflammation of the bursa- most common in subacromial bursa
Winged Scapula injury to long thoracic nerve (to serratus anterior muscles)
Clavicle Break if broken the proximal clavicle can move upward (because of
sternocleidomastoid) and the distal clavicle can move downward (because of pec major,
etc)
**Problems with nerves to Hand- DR CUMA
dropwrist = radial nerve clawhand = ulnar nerve median nerve = apehand/benediction

Colles Fracture- fracture of the scaphoid (most common falling on your hand fracture)
Hand Dislocation most common dislocation is the lunate
Carpal tunnel syndrome- median nerve is squeezed and get apehand (above)
Caput medusa- in portal HTN get this pouching out of the umbilicus because these
vessels connect systemic and portal system
Inguinal HerniasDirect=medial to inferior epigastrics in the hesselbachs triangle or through
abdominal wall
Indirect=lateral to inferior epigastrics in spermatic cord
-often from persistent processus vaginalis
Varicose Vein/Varicocele- of the pamp. plexus cause infertility because no temperature
regulation
GERD- gastroesophageal reflux disease-acid reflux
Hiatal Hernia- esophageal hernia into thorax
Stomach Cancer
Ulcers- irritations of GI lining- can go all the way through and eat into pancreas from
stomach or to gastroduodenal artery from duodenum
Crohns Disease- inflammation of intestines
Diverticulosis- outpocketing of intestines- mainly in descending/sigmoid colon

Meckels Diverticulum- remnant of the vitelline duct- in the ileum (look at embryo)
Portal Hypertension- an increase in portal vein pressure because of liver cirrhosis or
blockage in liver can get enlarged spleen causes systemic/portal anastomoses to
open up esophagus, umbilical, rectal, intestinal (colon)
Pancreatic Cancer- aggressive tumor, no real symptoms until its to late
Pancreatitis- inflammation of the pancreas
Horseshoe Kidney-sometimes to get one big kidney shaped like horseshoe, stops at the
IMA
Kidney Stones- crystal calcifications in the kidney