Qhf

Arteriograms of the shoulder region (A) and forearm (B). (C) Arterial supply of the upper limb. (D) Collateral circulation around the shoulder. The lines from proximal to distal indicate the lateral border of the first rib, the inferior border of the teres major muscle, and the cubital fossa. It is important to be able to identify an artery on an arteriogram and to know which nerve runs with that artery. A anterior circumflex humeral artery AX axillary artery BR- brachial artery CF...

Adh

The profunda fenioris artery branches into the 2. Medial circumflex artery, which provides the main blood supply to the head and neck of the femur in adults D. The popliteal artery is a continuation of the femoral artery at the adductor hiatus in the adductor magnus muscle. It extends through the popliteal fossa, where the popliteal pulse can be palpated against the popliteus muscle with the leg flexed. It has 2. Anterior Tibial artery descends on the anterior surface of the interosseous...

W

Retromammary Space

Nipple secretion typically contains exfoliated duct cells, cx-lactalbumin, immunoglobulins, lactose, cholesterol, steroids, and fatty acids, along with ethanol, caffeine, nicotine, barbiturates, pesticides, and technetium. a. Nipple discharge from a benign cause typically is green, milky, yellow, or brown is bilateral is not spontaneous and affects multiple ducts. b. Milky discharge (galactorrhea) that is accompanied by headache and loss of peripheral vision...

Upper Limb

The subclavian artery extends from the arch of the aorta to the lateral border of the first rib. It has the following branches 1. Internal thoracic artery, which is continuous with the superior epigastric artery, which anastomoses with the inferior epigastric artery (a branch of the external iliac artery). This pathway provides a route of collateral circulation if the abdominal aorta is blocked (e.g., postductal coarctation of the aorta). 3. Thyrocervical trunk, which has three branches a....

Radiology

Common Carotid Circle Willis

Anteroposterior radiograph of the thoracic cage Figure 3-6 B. Anteroposterior aortogram of the thorax Figure 3-7 Figure 3-6. Anteroposterior radiograph of the thoracic cage. 1. Head of first rib. 2. Neck of second rib. 3. Shaft of first rib. 4. Osteochondral junction. 5. Tuberculum of costa 6. 6. Head of sixth rib. 7. Shaft of sixth rib. 8. 12th rib. 9. Breast. 10. Clavicle. 11. Inferior angle of scapula. 12. Diaphragm. 13. Gastric air. Reprinted with permission from Fleckenstein P,...

Clinical Considerations Of The Braches Of The Abdominal Aorta

Superior Mesenteric Artery Blockage

A The major branches of the abdominal aorta. The abdominal vasculature has a fairly robust collateral circulation. Any blockage X between the superior mesenteric artery SM at vertebral level L1 and inferior mesenteric artery IM at vertebral level L3 causes blood to be diverted along either or both of two routes of collateral circulation. The first route uses the middle colic artery, which is a branch of the SM artery, which anastomoses with the left colic artery, a branch of the IM...

A

Dural Sac Spinal Cord

A Spinal cord and meninges. B Craniocaudal extent of the spinal cord and meninges. A adapted with permission from Carpenter MB Core Text of Neuroanatomy, 4th ed. Baltimore, Williams amp Wilkins, 1991 B adapted with permission from Chung KW BRS Gross Anatomy, 4th ed. Philadelphia, Lippincott Williams amp Wilkins, 2000, p 289. Figure 2-1. A Spinal cord and meninges. B Craniocaudal extent of the spinal cord and meninges. A adapted with permission from Carpenter MB Core Text of...

Perineum

The perineum is the part of the pelvic outlet that is located inferior to the pelvic diaphragm. It is diamond-shaped and can be divided by a line passing through the ischial tuberosities into the anal triangle, which contains the anal canal, and the urogenital triangle, which contains the outlets of the urinary and genital organs. B. Clinical consideration. Episiotomy is an incision made in the perineum to enlarge the vaginal opening during childbirth. 1. A median...

Abdominal Vasculature

Celiac trunk, superior mesenteric artery, renal arteries, gonadal arteries, inferior mesenteric artery, and common iliac arteries. The celiac trunk is located at vertebral level T12 and supplies the viscera that derive embryologically from the foregut i.e., intraabdominal portion of esophagus, stomach, upper part of duodenum, liver, gallbladder, and pancreas . It further branches into the following structures 2. The superior mesenteric artery is located at vertebral level LI and supplies the...

Cn Ii

Gag Reflex Levator

Middle meningeal artery epidural hemorrhage occurs as a result of Discharge of CSF from the external acoustic meatus otorrhea occurs as a result of fracture of the mastoid process and dural tear CN IX, X, XI, sigmoid sinus a mass in the jugular foramen causes difficulty in swallowing dysphagia and speaking dysarthria , paralysis of the uvula, and inability to shrug the shoulders CN XII Medulla of the brain stem, CN XI, vertebral arteries lt 4 Figure 20-6. A Base of the skull interior aspect ,...

Ulcerative Colitis Stool Pattern

Ulcerative Colitis Stool Pattern

Diagram of the anal canal. Note the following structures ampulla of the rectum AR , puborectalis muscle PR , anal columns AC , anal verge AV , pectinate line PL thin dotted line , internal anal sphincter IS , and external anal sphincter ES . Thick dotted line marks the anorectal junction. Adapted with permission from Ernest WA NMS Anatomy, 2nd ed. Media, PA, Harwal, 1990, p 225. III. ANAL CANAL Figure 10-2 is divided into the upper and lower anal canal by the pectinate line. It is...

B

Right And Left External Kidney

View of the lateral chest wall showing an intercostal space and layers. Note their relation to pleura and lung. Tube and diagram indicate the positioning for tube thoracostomy. Needle and diagram indicate the positioning for an intercostal nerve block. Adapted with permission from Moore KL Clinically Oriented Anatomy 3rd ed. Baltimore, Williams amp Wilkins, 1992 p 57 upper inset reprinted with permission from Scott DB Techniques of Regional Anaesthesia. East Norwalk, CT, Appleton...

Subaponeurotic Space

Lateral Views Arytenoids

Aponeurotica and skull subaponeurotic space Lumpy clot, black eye Figure 20-3. A Epidural, B Subdural, Cand D Subarachnoid, and Extracranial hemorrhages. In a clinical vignette question, first identify the clinical features mentioned in the question, then match the features with the appropriate blood vessel and hemorrhage table , and finally identify the correct CT scan. ACo anterior communicating artery most common site for a berry aneurysm Ar- arachnoid B bridging vein Be berry congenital...

Prostate Gland

The prostate gland lies between the base of the urinary bladder and the urogenital diaphragm. The anterior surface is related to the retropubic space the posterior surface is related to the seminal vesicles and rectum. The prostate gland is palpated easily during a digital rectal examination. 2. Structure. The prostate gland has five lobes right and left lateral, right and left posterior, and middle. The prostate gland is a collection of tubulo-alveolar glands and is divided into...

Info

What Does The Thoratic Nodes Look Like

Components 1. The breast lies in the superficial fascia of the anterior chest wall that overlies the pectoralis major and serratus anterior muscles and extends into the superior lateral quadrant of the axilla as the axillary tail. A high percentage of tumors occur in the axillary tail. 2. In a fully developed woman, the breast extends vertically from rib 2 to rib 6 and laterally from the sternum to the midaxillary line. 3. The retromammary space lies between the breast...

Dominant Left Transverse Sinus Drains Both Superior Headache

Medical Students Stroke Syndromes

ARTERIAL SUPPLY AND VENOUS DRAINAGE Figure 20-1 A. The arch of the aorta see Figure 3-7 consists of the following branches 1. Brachiocephalic artery, which branches into B. The external carotid artery has eight branches in the neck. The most important are the superior thyroid, lingual, facial, occipital, maxillary, and superficial tempo- Figure 20-1. Arterial supply of the head and neck region. B Lateral arteriogram and C lat- eral arteriogram with digital subtraction. D Lateral arteriogram...

General Features

The right suprarenal gland is pyramid-shaped. Its apex projects superiorly, and its base surrounds the kidney. The left suprarenal gland is shaped like a half-moon. It covers the superior aspect of the kidney and extends inferiorly along the medial aspect. B. The arterial supply is from the inferior phrenic artery via the superior suprarenal artery the aorta via the middle suprarenal artery and the renal artery via the inferior suprarenal artery. C. Venous drainage is to the right suprarenal...

Male Reproductive System

The testes are surrounded by a thick connective tissue layer, the tunica albuginea. They are further surrounded incompletely-medially, anteriorly, and laterally, but not posteriorly by a sac of peritoneum called the tunica vaginalis. The testes contain the seminiferous tubules, straight tubules, rete testes, and efferent ductules. Arterial blood is supplied from the abdominal aorta via the testicular arteries. A rich collateral arterial blood supply is provided from the...

Nerve Block Lung

Intercostal Nerve Diagram

Tube thoracostomy is performed to evacuate ongoing production of air and fluid into the pleural cavity. A tube is inserted through intercostal space 5 in the anterior axillary line posterior approach . An incision is made at intercostal space 6, lateral to the nipple, but medial to the latissimus dorsi muscle. 2. The tube penetrates the following structures skin superficial fascia serratus anterior muscle external intercostal muscle gt internal intercostal muscle innermost intercostal muscle...

Venous Drainage

The great cardiac vein follows the anterior interventricular artery and drains into the coronary sinus. B. The middle cardiac vein follows the posterior interventricular artery and drains into the coronary sinus. C. The small cardiac vein follows the right marginal artery and drains into the coronary sinus. D. The anterior cardiac veins are found on the anterior aspect of the right ventricle and drain directly into the right atrium. E. The smallest cardiac veins begin within the wall of the...

Clinical Considerations

Radial Nerve Stretch

A surgical ligature may be placed on the subclavian artery or the axillary artery between the thyrocervical trunk and the subscapular artery, or on the brachial artery distal to the inferior ulnar collateral artery. 2. A surgical ligature may not be placed on the axillary artery just distal to the subscapular artery. B. The radial artery and the cephalic vein are the vessels most commonly used for access during long-term hemodialysis. C. Percutaneous arterial catheterization uses the...

Structure Of The Spinal Cord

Gray matter of the spinal cord consists of neuronal cell bodies and is divided into the dorsal horn, ventral horn, and lateral horn. 2. White matter of the spinal cord consists of neuronal fibers and is divided into the dorsal funiculus, ventral funiculus, and lateral funiculus. 3. The ventral median fissure is a distinct surface indentation that is present at all levels of the spinal cord. It is related to the anterior spinal artery. 4. The dorsal median fissure is a surface indentation...

Mab

Cyst Posterior Upper Pole Parotid Gland

A Anteroposterior radiograph and diagram of an inversion injury of the left ankle. The radiograph shows avulsion of the fifth metatarsal black arrow caused by the pull of the tendon of the peroneus brevis muscle. The epiphyseal growth plate is oriented vertically white arrow . In addition, in an inversion injury, the anterior talofibular ligament usually is torn and the fibula is fractured. B Anteroposterior radiograph and diagram of an eversi n injury of the left ankle. The...

Ductus Deferens

The ductus deferens begins at the inferior pole of the testes, ascends to enter the spermatic cord, transits the inguinal canal, and enters the abdominal cavity by passing through the deep inguinal ring. It is joined by the seminal vesicle at the ampulla of the ductus deferens, to form the ejaculatory duct. The ejaculatory duct passes through the prostate gland and opens into the prostatic urethra at the urethral crest. B. Clinical consideration. In a vasectomy, the scalpel...

Pelvis

Xrays Pelvic Inlet Outlet

BONY PELVIS consists of the following bones A. Two coxal hip bones, each consisting of three parts ischium, ilium, and pubis that join at the acetabulum of the hip joint. B. The sacrum is the posterior portion of the bony pelvis, formed by the fusion of vertebrae SI 5. It contains the dorsal sacral foramina, which transmit the dorsal primary rami of the sacral spinal nerves the ventral sacral foramina, which transmit the ventral primary rami of the sacral spinal nerves and the sacral hiatus,...

Peritoneal Cavity

PERITONEAL CAVITY Figure 7-1 A is a potential space between the visceral and parietal peritoneum. It is divided into the lesser and greater peritoneal sacs. A. The lesser peritoneal sac omental bursa is an irregularly shaped sac that communicates with the greater peritoneal sac through the omental Winslow foramen see I C . The lesser peritoneal sac forms as a result of the 90c clockwise rotation of the stomach that occurs during embryologic development. Its boundaries are as follows 1....

Lower Limb

Peroneal Nerve Vaginal

The obturator artery is a continuation of the internal iliac artery. It passes through the obturator foramen close to the femoral ring, where it may complicate surgical repair of a femoral hernia. The obturator artery has the following branches 1. Muscular branches to the adductor muscles 2. Artery of the ligamentum teres artery to the head of the femur . This artery is important in children because it supplies the head of the femur proximal to the epiphyseal growth plate. After the...

Vertebral Column

THE VERTEBRAL COLUMN consists of 33 vertebrae Cl-7, Tl-12, Ll-5, Sl-5 sacrum , and Co 1 4 coccyx . The vertebral canal contains the spinal cord, dorsal nerve root, ventral nerve root, and meninges. The spinal nerve is located outside the vertebral canal by exiting through the intervertebral foramen. A. Vertebral levels Table 1-1 are used to reference the location of important anatomic structures. Knowledge of these vertebral levels is helpful when answering clinical vignette questions. For...

Anterior Chest Wall

Anterior Chest Wall Muscles

Insertion of a central venous catheter Figure 3-2A . Access to the superior vena cava SVC and the right side of the heart is required to monitor blood pressure, maintain long-term parenteral feeding, or administer drugs. The internal jugular vein IJV and subclavian vein SCV usually are used. 1. IJV central or anterior approach . The needle is inserted at the apex of a triangle formed by two heads of the sternocleidomastoid muscle and the clavicle on the right side. 2. SCV infraclavicular...

Superficial Perineal Space

Perineal Fascia Female

The boundaries of the superficial perineal space are the inferior fascia of the urogenital diaphragm perineal membrane and the superficial perineal fascia, which is continuous with Colles fascia. B. Table 17-2 shows the anatomic structures found within the superficial perineal space in males and females. Figure 17-1. A The male perineum, showing the diamond shape, extending from the pubic symphysis to the coccyx. A transverse line joining the anterior ends of the ischial tuberosities divides...

Acl Femoral Attachment

Plantar Artery Small Saphenous Vein

Trauma at femoral triangle Pelvic fracture Anterior hip dislocation Radical retropubic prostatectomy Extension of leg is lost Sensory loss on anterior thigh and medial leg Adduction of thigh is lost Sensory loss on medial thigh Loss of knee jerk reflex Anesthesia on anterior thigh Surgery in area Posterior hip dislocation Poliomyelitis Gluteus medius and minimus function is lost Ability to pull pelvis down and abduction of thigh are lost Gluteus medius limp, or waddling gait Surgery in area...

The Pericardium

Infrasternal Angle

The pericardium consists of three layers a visceral layer of serous pericardium known histologically as the epicardium a parietal layer of serous pericardium and a thick connective tissue layer called the fibrous pericardium. The pericardial cavity, which normally contains a small amount of fluid, lies between the visceral and parietal layers of serous pericardium. The fibrous pericardium fuses superiorly to the adventitia of the great vessels, inferiorly to the central...

Clinical Procedures

Spinal Anaesthetic Subarachnoid Space

Lumbar puncture Figure 2-4 can be performed to withdraw cerebrospinal fluid or to inject an anesthetic e.g., spinal anesthesia . 1. A needle is inserted above or below the spinous process of vertebra L4 i.e., L3 4 or L4 5 interspace, respectively 2. The needle passes through the following structures skin superficial fascia supraspinous ligament interspinous ligament ligamentum flavum epidural space containing the internal vertebral venous plexus dura mater arachnoid subarachnoid space...

Urinary System

Linea Brodel

The kidneys are retroperitoneal organs that lie on the ventral surface of the quadratus lumborum muscle and lateral to the psoas muscle and vertebral column. The upper pole of the left kidney is located at vertebral level T12 and is related to the 11th and 12th ribs, the pancreas, the spleen, and the splenic flexure of the colon. The upper pole of the right kidney is located at vertebral level LI and is related to the 12th rib, the liver, the duodenum, and the hepatic...

Tracheobronchial Tree and

Tracheobronchial Tree Anatomy

PLEURA is the serous membrane that envelops the lungs and lines the thoracic cavity. 1. Visceral pleura adheres to all surfaces of the lung. The visceral pleura is reflected at the root of the lung and continues as parietal pleura. 2. Parietal pleura adheres to the chest wall, diaphragm, and pericardial sac. The parietal pleura is named according to its associated anatomic region. a. Costal pleura is associated with the internal surface of the sternum, costal cartilages, ribs, and sides of...

What Does A Vaginal Cyst Look Like

Vaginal Cyst

The vagina extends from the cervix to the vestibule. It is the longest part of the birth canal. The degree to which it can distend during childbirth is limited by the ischial spines and sacrospinous ligaments. It forms a recess around the cervix called the fornix. The fornix is divided into three regions 1. The anterior fornix is located anterior to the cervix. It is related to the vesicouterine pouch. On digital examination, the urinary bladder is palpable through the...

Ovaries

Crus Clitoris

The ovaries are almond-shaped structures located posterior to the broad ligament. They are attached to the lateral pelvic wall by the suspensory ligament of the ovary a region of the broad ligament , which contains the ovarian artery, vein, and nerve. The surface of the ovaries is not covered by peritoneum they are covered by a simple cuboidal epithelium called the germinal epithelium. The arterial supply is from the abdominal aorta via the ovarian arteries. Venous drainage...

Abdominal Wall

Layers Abdominal Fascia

The abdomen can be divided topographically into nine regions right hypochondriac, epigastric, left hypochondriac, right lumbar, umbilical, left lumbar, right inguinal, hypogastric, and left inguinal. II. CLINICAL PROCEDURE. In paracentesis Figure 6-2 , a needle is inserted through the layers of the abdominal wall to withdraw excess peritoneal fluid. Knife wounds to the abdomen penetrate the layers of the abdominal wall in the same order. A. In the midline...

Buck S Fascia Rupture

Rectovesical Pouch

A Photograph of calcium oxalate calculi shows that these kidney stones are colorless, octahedral-shaped crystals that look like small squares crossed by intersecting diagonal lines. These are the most common 80 type of kidney stone. B Photograph of magnesium ammonium sulfate struvite or triple phosphate calculi shows that these kidney stones are colorless, rectangular, prism-shaped crystals. These are the second most common 15 type of kidney stone. C...

Lungs

The right lung consists of three lobes upper, middle, and lower separated by a horizontal fissure and an oblique fissure. 1. The right upper lobe lies in a superior and anterior position. 2. The right middle lobe lies in an anterior position between costal cartilages 4 and 6. 3. The right lower lobe lies in an inferior and posterior position. 4. The horizontal fissure runs at the level of costal cartilage 4 and meets the oblique fissure at the midaxillary line. 5. The diaphragmatic surface...

Conduction System

Serratus Anterior

The sinoatrial SA node is the pacemaker of the heart. It is located just beneath the pericardium, at the junction of the SVC and the right atrium. Impulses spread from the SA node throughout the right atrium, to the left atrium, and eventually to the atrioventricular AV node. B. The AV node is located just beneath the endocardium, on the right side of the interatrial septum, near the ostium of the coronary sinus. C. The bundle of His travels in the subendocardial layer on the right side of...

Sigmoid Colon Rectum and Anal Canal

Sphincter Stretching

The sigmoid colon is the segment of the large intestine between the descending colon and the rectum. Its primary function is storage of feces. It begins at vertebral level SI sacral promontory pelvic inlet and ends at S3 rectosigmoid junction , where teniae coli longitudinal bands of smooth muscle are replaced by a complete circular layer of smooth muscle of the rectum. The sigmoid colon is intraperitoneal, being suspended by the sigmoid mesocolon. The left ureter and left...

Liver Cirrhosis Collateral Circulation

Imv Varix Liver Cirrhosis

The hemiazygous vein ascends on the left side of the vertebral column and drains blood from the left renal vein to the azygous vein. B. The inferior vena cava IVC is formed by the union of the right and left common iliac veins at vertebral level L5, drains all the blood from below the diaphragm even portal blood from the gastrointestinal tract after it percolates through the liver to the right atrium. The IVC may be damaged during surgical repair of a herniated intervertebral disk. The IVC...

Vascular Supply Of The Spinal Cord

Spinal Cord White Ramus

There is only one anterior spinal artery, which arises from the vertebral arteries. It supplies the ventral two-thirds of the spinal cord. B. Posterior spinal arteries. There are two posterior spinal arteries that arise from the vertebral arteries or the posterior inferior cerebellar arteries. They supply the dorsal one-third of the spinal cord. C. Radicular arteries. The radicular arteries arise from the vertebral, deep cervical, ascending cervical, posterior...