Heart Notes y y Inferior Vena Cava is formed by the joining of the two common iliac veins which do not

go through liver SVC is formed by the left and right brachiocephalic veins, which are formed by the joining of subclavian and jugular veins o Azygous vein also drains into the SVC.  Right side: Azygous vein drains blood from right side posterior intercostals veins  Left Side: Hemizygous drains lower 2/3rd , and accessory drains upper 1/3rd , and they will join together and come to azygous as one, or come individual. This is also for posterior intercostals veins Thoracic Levels are going to be inervated by its own intercostals nerve o Region of skin that nerve innervates is called Dermatone o Region of muscle that nerve innervates is called Myotone

Dermatone 1) 2) 3) 4) Top of shoulders C4 Umbilicus T10 Nipple T4 Groin L1

What is the vertebral level of the Umbilicus? L4 spinous process! Neurologically dermatone for Umbilicus is T10

Internal Thoracic Artery changes names into Superior EpiGastric which is going to posterior rectus abdominus and is going to meet up with Inferior EpiGastric. The two meet at approximately the umbilicus. A meeting of arteries is called anastomosis. Inferior EpiGastric artery came from the external Iliacs. Travels up posterior to rectus abdominus. 24 Movable vertebrae within the column. Sacrum is made of 5 segments that are fused. Coccyx is 3-5. y IVD between the vertebrae, which is a ligament holding two vertebrae together y ALL : Runs anterior vertebral bodies and disks through entire spinal column o Limits Extension y PLL: Runs posterior vertebral bodies and disks within the spinal canal o Spinal cord sits posterior to PLL o Pin stuck in ALL Vertebral Body PLL Spinal Cord Ligamentum Flavum which is within spinal canal on back side of spinal cord vs. PLL which is on front side of spinal cord o PLL Limits Flexion y Where does the parasympathetic innervations in majority of organs? Vagus which starts at Medulla, and travels down, starts innervations at approximately oral pharynx down to as much as sigmoid colon y Sympathetic innervations? By way of sympathetic trunk via spinal cord (T1-L1 or 2) Fiber comes out of spinal cord and enters trunk, synapting at either ABOVE, BELOW, or not synapse AT ALL, entering the trunk and exiting right away (ie: Splanchtic nerve)

Ganglion will be surrounding around abdominal vessels:

1) Celiac Trunk Ganglion associated with vessel 2) Superior Mesenteric Ganglion associated with vessel 3) Inferior Mesenteric Ganglion associated with vessel Blood Supply Celiac Trunk irrigates spleen, stomach, gallbladder, some of pancreas Superior Mesenteric Artery Entire Small Intestine & Part of colon about midway transverse colon Repeating pattern, Arteries that come off SMA Jujenal or Ileual arteries which anestomose with each other and form archs/loops forming Archae which have arteries coming off called vasa recta. y y y Middle Cholic Transverse Colo, Hepatic Flexure and part of ascending colon Right Cholic Majority of Ascending Colon IlioCholic Distal ileum (terminal part) & Cecum

Inferior Mesenteric Artery: y y y Left Cholic Descending colon, and remainder of transverse colon, splenic flexure Sigmoidal arteries Sigmoidal colon Superior rectal artery Rectum

Blood from abdominal circulation: o 1) Liver via Hepatic Portal Vein which is formed by the Splenic vein, and Superior mesenteric o 2) Hepatic Portal Vein Liver Blood leaves liver via HEPATIC VEIN which drain into IVC  Problems with circulation: Tumor growing outside hepatic portal vein so that its collapsing hepatic portal vein OR problem with heart which decreases ease of blood flow, and increases resistance (Cirrohsis scarring of hepatocytes due to toxins or alcohol)  Portal Hypertense  Blood make it back to heart via other paths Heart has problem getting blood through liver, so blood backs up and reverses flow: y Caput Medussa Peri umbilical y Esophageal varices y Hemmorhoidal veins Does the HPV receive blood from stomach circulation? YES o does it receive blood from the liver? NO o does it receive blood from duodenum? NO o what about blood from the leg? NO o what about heart? NO

Bile y y y y Where is bile formed? Liver Leaves the liver via Right and Left hepatic ducts which form the common hepatic duct Bile is concentrated in Gallbladder, where it will be released through cystic duct Common bile joins main pancreatic duct to drain into duodenum via major duodenal papilla

y y y y

Lower Right Quadrant o Lower Left Quadrant Upper Left Quadrant : Stomach, Spleen, Part of Pancreas Upper Right Quadrant : Gallbladder, Liver, Part of Transverse Colon, Hepatic Flexure, Part of Ascending Colon, Duodenum, Part of Pancreas

Anterior Muscles Pectoralis Major Adduction (arm bringing close-er-er) Innervated by Lateral and Medial Pectoral Nerves Pectoralis Minor Stabilizing and protraction of Scapular Innervated by Pectoral Nerve NO DIRECT EFFECT ON HUMEROUS, since it doesn t cross the joint

Abdominal Vasculature Superior Mesenteric Artery Small Intestine, Large Intesitne (cecum, ascending colon, hepatic flexure, part of transverse colon) Celiac Trunk Spleen, liver, stomach, gallbladder, part of duodenum, part of pancreas Inferior Mesenteric Splenic Flexure, Descending colon, remainder of transverse colon, sigmoid colon, part of rectum

Folds of tissue in Digestive System 1) Stomach Rugae 2) Small Intestine Pilcae Circulares 3) Large Intestine Pilca semilunaris y In comparison, Jujenum has MORE Pilcae Circulares than Ileum, since there is greater need for digestion higher up. y Between the Plica Semilunaris in the large intestine, between any two pilca is called the Haustra y There are musculature associated with movement of GI tract o For Stomach Oblique, Logitudinal, Circular , respectively o For Small Intestine Longitudinal, Circular o Large Intestine Logitudinal is stripped down to three stripes Tenea Cholae

What are some structure attached to Colon? o Epiploic Appendages/Appendices  Small pouches of peritoneum filled with fat and situated along the colon and upper part of the rectum  Chiefly appended to the transverse colon and sigmoid parts of colon What forms the Erector Spinae? o i) Spinalus, Longissimus, Iliocastalis , medial to lateral respectively o ii) Involved in Voluntary Movement What muscle group is responsible for non-voluntary, responsible for stability of the spine? o Muscle group is called Transversospinal group  Rotatores Span 1-2 vertebral segments  Multifidus Span 2-4 vertebral segments  Semispinalis Span 4-6 vertebral segments What motion is caused by contraction of Erector Spinae? o Depends if it s one or both  Lateral Flexion if it s one  Extension if it s both Erector Spinae o Contraction of the erector spinae will be responsible for anterior pelvic tilt, which is also associated with the hip flexors (iliacus and rectus femoris) conjunction results in anterior pelvic tilt o Posterior Pelvic Tilt:  Hamstring and Rectus abdominus work in conjunction and opposite to muscles trying to cause anterior pelvic tilt How would you define the root of the lung? o Hilum: The connection at the lung, where the great vessels and bronchial tree meet (root of lung) o Hilum Lymph Nodes Remember it s normal to feel lymph nodes in groin and tonsils in neck, sometimes in the lower back. o Red Flags : non-movable, hard, tender lymph nodes

How would you describe the Visceral Pleura? o Covers entire lung, except the hilum o The mediastinal part is not covered by visceral pleura o Parietal Pleura covers entire area of thoracic cavity  Region that lungs rest on is called diaphragmatic  Region that is lateral most aspect of thoracic Costal  Region around very top Cupola

How would you describe the Parietal Periotneum? o Covers the anterior and most of lateral region of cavity o DOES NOT cover posterior of cavity - retroperotoneal (spleen, pancreas, kidneys, part of duodenum, part of ascending & part of descending colon)

Attachments o Mesentery: Tissue that is attached to intestines that holds it to posterior wall o Mesentery Proper would hold small intestine to posterior wall o Mesocolon suspends the large intestine to posterior wall (Transverse mesocolon, sigmoid mesocolon)

Lungs o Right Lung  3 Lobes separated by horizontal and oblique fissures o Left Lung  2 Lobes separated by oblique fissure  Lingula : Inferior most portion of superior lobe o Bronchial Tree  Comes off as Trachea  Bifurcation is called Carina (sp?)  Primary Bronchus Going to the Lung  Secondary Bronchii Lobar (associated with number of lobes)  How many total Branching to get to alveoli? 23 o Lungs receive blood from Aorta via Posterior Intercostals Arteries which will irrigate the actual tissues of the lung (NOTE: The heart and liver also have dual blood supply) Inguinal Canal o Runs through superficial abdominal muscles (Internal, External & transverse obliques) o Superficial inguinal ring is formed mostly from external ring o Deep inguinal ring is formed by rectus abdominis o Round Ligament travels through inguinal canal Labia Majora Female o Spermatic Cord travels through inguinal canal Scrotal Sac Male  Contents of Spermatic Cord: y Cremaster muscle on the outside o When stimulated causes elevation of the scrotum/testis o Temperature of Testis is modulated by cremaster muscle  The other muscle involved is the dartos muscle o Nerve innervations: Genital branch of Genito-femoral Nerve y Inside of Spermatic Cord: o Ductus Deferen o Testicular Artery o Panpinifor Plexus

What muscles are involved in Trunk Rotation? o Oblique Muscles  External Abdominal Oblique will work with Internal Abdominal Oblique of other side Is it normal to have fat between pericardial space? YES What is the space between the outer portion of the lung, and the inner portion of the lining of the breast cavity? Pleural Space it s normal to have small amount of fluid here o No fluid in the pleural space, or a process that doesn t allow smooth sliding of wall of lung against wall of thoracic cavity can lead to a condition called Pleurisy

y y

What are the major arteries for coronary circulation? o Left coronary artery :  Circumflex coronary artery travels through atrioventricular groove from front all the way posterior which then anastomose with terminal branch of right coronary artery  Anterior Interventricular Artery is drained by Great Cardiac Vein y Great Cardiac Vein is going to travel with circumflex coronary artery, then connect to the coronary sinus RA Right coronary artery:  Posterior Interventricular Artery: Irrigates the interventricular septum posteriorly y Drained by Middle Cardiac Vein Great and middle cardiac veins Left Marginal Coronary Artery is drained by Left Marginal Cardiac Vein Right Marginal Coronary Artery is drained by Small Cardiac Vein

o o o

Heart y y y y Trabeculae Carneae are associated with Right and Left Ventricles Mitral and Tricuspid Valves associated with Chordae Tendinae and papillary muscles Pulmonary semilunar valve Pulmonary trunk Left and right Pulmonary arteries Right Atrium: o Pectinate Muscle o Fossa Ovalis Three arteries of the Aortic Arch o Right Brachiocephalic Trunk :  Right common carotid  Right subclavian irrigates right upper extremities, internal thoracic arteries o Left common carotid o Left subclavian

Remember Trunk Flexion Contraction of rectus abdomenis Associated with posterior pelvic tilt Hip Flexion Associated with anterior pelvic tilt

Rhomboid Action Retraction of Scapula o Serratus Posterior Superior is just DEEP to Rhomboid What muscle attaches from superior medial angle of scapula to transverse processes of cervical spine? o LEVATOR SCAPULA : you may have to recognize origin/insertion as described by instructor. What structure is foiund in the transverse foramen of the cervical spine? o Vertebral Artery What structure is found in the transverse foramen of thoracic spine? o NONE, there ain t no transverse processes in thoracic spine, foo! Side Note: Spinal Nerves are found at every level of spine, from C1 Coccyx

The phrenic nerve travels anterior with respect to root of the lung, vagus nerve travels posterior with respect to root of the lung. Vagus nerve will send out recurrent laryngeal nerves (left travels under aortic arch, right travels under right subclavian artery).

What is the action of latissimus dorsi? o -Adduction, also extension and internal rotation What muscle shares a common tendon with latissimus dorsi and has same action? Teres major What is the action of the upper part of the Trapezius Muscle? Elevation of the shoulder o Trapezius is also involved with motion of the shoulder, specifically abduction

y y

Whats the scapula-humeral rhythm? For every 2 degrees of rotation of humeral Abduction, the scapula rotates 1 degrees If the rhythm is off, then it can cause impingement syndrome which causes irritation of bursa, which is very painful 6-120 degrees, but less painful at terminals o Starting when? 30 60 degrees abduction

Suboccipital Triangle RCP major, RCP minor, Oblique Capitis superior, Oblique Capitis inferior Oblique Capitis Superior -> C1 transverse process to skull Oblique Capitis Inferior -> C2 spinous process to C1 transverse processe

What is found within the triangle?  Vertebral artery and subocciptal nerve which innervates the muscles of the triangle What is the structure inferior to the suboccipital nerve?  Greater occipital nerve

Greater occipital nerve innervates skin of the back of the head. Gets there by piercing what muscle?  Semispinalis Capitis

REVIEW # 2 y The order of progression from esophagus to o Esophagus  Bottom end connects to stomach through cardiac sphincter : the stomach is a bag that can be closed off at two ends, upper cardiac sphincter, the bottom pyloric sphincter o Duodenum, C shaped wrapped around head of pancreas, last part of duodenum comes up and makes a curve, apex of that curve is the end of duodenum and beginning of jujenum where the structure (ligament of teretz) jujenum for a while, then connects to ileum and the dividing line between jujenum and ileum is not clear but can be telled in lab by pleacae o Ileum will stick to cecum by ileocecal valve cecum appendix is connected to cecum which is posterior aspect of cecum for most people Cecum is then continuous with ascending colon, which turns at hepatic flexure transverse colon splenic flexure descending colon sigmoid colon rectum anus The musculature around the gut tube is primarily two muscles: o Logitudinal muscles all fibers side by side to make solid tube Peristalsis o Circular muscles srruounded by longitudinal  BUT in stomach there is oblique muscles AS WELL, to help stomach move in a way that would mash mix food, which is different Oblique is farthest out o Longitudinal muscles are condensed into 3 stripes of longitudinal muscles tenea cholae  You would see tenea cholae only in the colon  Circular muscle all the way through o Colon has got, folds of tissue called Plaeca semilunaris between two pleaca semilunaris the space is a houstrum, or houstra. o Houstra are externally visible, tinea chola externally visible, epiploic appendages only at colon/large intestine  Also, related to part of the large intestine greater omentum which attaches to transverse colon Transverse mesicolon where does greater omentum attaches? y Greater curvature of stomach and o Thoracic Cavity  The entire thoracic cavity is lined with parietal pleura, and entire surface pleura is covered by visceral pleura except hilum, or mediastial portion  Areas of the paeriatal pleura y Costal area, diaphragmatic, mediastinal, top area copular of parietal pleura y What are the specific dividing lines that make up the mediastinum? o It s a region, no one structure is fully there, its imaginary medial 1/3rd  There are autonomic nervous system nerves that are going to innervate thoracic level structures, sweat glands, blood vessels, etc y Autonomic nerves start at spinal cord enter into the sympathetic trunk synapse either at that level they came out of cord OR some area above OR some area below OR enter trunk and exit without synapsing heading down spinal colum to end up in enteric ganglion o Celiac ganglion o Inferior mesenteric ganglion inferior mesenteric artery  Autonomic nervous system is a two neuron pathway y 1) first neuron is the one that cell body at spinal cord and is going to exit the spinal cord and enter the sympathetic trunk, the axons of that are myelinated, those are for pre-ganglionic sympathetic, they re also known as white rami communicons

2) Gray Rami Communicon common from other side of sympathetic trunk after the WRC met there y Lateral horn is from T1-L2 Vagus neve is going to synapse to ganglion that is close to target y LONG perganglionic WRC y SHORT postganglionic GRC y

Transverse Foramina  What Levels? CERVICAL ONLY  Vertebral artery goes through it  Vertebral artery that goes through that part is going to exit at C1 , turn and loop past a structure the structure is suboccipital triangle, vertebral artery passes right past it on its way to farmamen magnum. also know suboccipital nerve which innerve the muscles of the triangle know the muscles of the triangle  Know the origins and insertions for the muscles of the triangle  RCP minor C1 posterior tubercle to back of skull, and medial to RCP major o Part of the vertebrae that supports the majority of the bodys weight of all the levels, is the vertebral body what part connects the body to spinous process Pedicle o Spinous process o Lamina unite posteriorly for spinous process o Autonomic nerves  Sympathetic innervations to heart would come from sympathic trunk T1-4 o Sympathetic to gut coming from thoracic segments  1) nerve does not synampse at symp trunk, goes and synapses at ganglion in gut y Splanchnic Nerve  Thoracic autonomic/sympathetic nerves o Parasympathetic to stomach vagus o The Heart  Heart is surrounded by pericardial sac: serous and fibrous pericardium make up parietal pericardium  Visceral pericardium Epicardium closely invested to surface of the myocardium  Take a pin from outside to in o Ventricular space is lined with musclular ridges that attach entire wall of ventricule tubercula carnae o Pappilary muscles are associated with valves via chordate tendenae o What two valves are associated with papillar muscles  Mitral and tricuspid or atrioventricular valves o The valves that are associated with blood exiting the ventricules:  Pulmonary and aortic semilunar valves o Muscular ridges that line the right atrium pectinate muscle o Atria also have a thin section called fossa ovalis o Blood supply to the heart  Coronary circulation o Right coronary artery long, wraps around posteriorly on its way back giving right marginal coronary artery, o Venous drainage:  Great cardiac vein parallel to LAD  Great cardiac vein and circumflex artery travels around through atrio-ventricular groove right marginal coronary artery small cardiac vein will drain blood from right marginal artery

middle cardiac vein will drain blood from posterior interventricular artery

REVIEW # 3

Posterior Pelvic Tilt 1) Top of pelvis, rectus abdomins (pubic bone to lower ribs) if it contracts thorax stays stationary it is the pelvis that s gonna move, the pubic bone will go up, that is rolling the pelvis back posterior pelvic tilt 2) Hamstring are going to attach the lower extremities to ischael tuberosity, when they contract they pull the ischael tubercosity down rolling the pelvis back (ref. top of iliac crest) the reference point will go back posterior pelvic tilt Anterior Pelvic Tilt 1) Hip flexores contract and the body is staying stationary Anterior pelvic tilt, which is associated with increases lumbar lordosis 2) Hip flexores work in conjunction with muscles of back. Muscles of the back contraction also cause anterior pelvic tilt

What are the Hip Flexor Muscles? o 1) Rectus Femoris Associated with Quadriceps o 2) Iliopsoas Vagus comes from the Medulla; vagus travels close to carotid and enters thoracic cavity posterior to root of lung o Left recurrent laryngeal travels around arch of aorta o Right recurrent laryngeal travels around right subclavian artery If above C3 is damaged, Phrenic is affected (anything above C5)

What are the parts of the Sternum? o o o o o Manubrium Sternal Body Manubosternal Angle Xiphoid Jugular Notch

y y y y y y

1-7 attached to sternum and spine (true) 8, 9, 10 atach to cartilage, which attach to cartilage, no bone attachment 11, 12 floating ribs Have only one attachment What is Pneumothorax? How do you get it? How about Hemothorax? Costodiaphragmetic Recess When is it relavent clinically. aPep Monkey what do the letters stand for? Where are they according to lecture