Anatomy Supertable

ANATOMY ANATOMY SUPERTABLE (Review by Doc JA)

VERTEBRAL LEVELS Vertebral Level

Structure

Mnemonic

C1

Mastoid Process of Skull Bone, Jefferson Fracture

C2

Uvula, S vula, Soft oft palate, Angle of mandible, Hangman fracture

US(dito US (dito nakakabili ng C2 bottle)

C3

Hyoid Hyoid

Say HI to C3

C4

Carotid bifurcation Common Carotid

Kinurot kita! You: “Ouch! Kinurot kita! for?” What for ?” :(

C5

Cartilage Thyroid Cartilage

Cart dumaan Cart dumaan sa C5

C6

niac Triangle, Cricoid Cartilage, Cartilage, Chassaniac Triangle, end of LarynX LarynX -> start of Trachea, end of PharynX PharynX -> start of esophagus, *First *First Esophageal Constriction Site

C7

Thoracic Thoracic Duct, Thyroid Thyroid Isthmus

C7-T1

Apex of lungs (above the clavicle)

T1

Sternoclavicular joint

T2-T3

Supra jugular Notch

T4

Manumbrium

T4-T5

Sternal Angle of Louis

T5

Body of Sternum (T5-T9)

Maniac, X X Maniac, San nakipag-sex lying maniac? sa maniac? sa cricoid cartilage Thank Say Th ank you to C7

23 Superman Channel 23 - Super man

Heart/Pericardium (T5-T8) T7-T8

Nipple

T9-T10

Xiphoid

L1

GU Tract: Hilum Tract: Hilum (of Kidneys), Renal Pelvis, First Constriction of Ureter (where is exits the Kidney) GI Tract: Transpyloric Plane of Addison, Addison, Pylorus, Pyloric Antrum, Gallbladder (9 (9th Costal Cartilage)

L2-L3

Head of Pancreas

L3-L4

Umbilicus (Dermatome: T10)

L5-S1

Second Constriction of Ureter (where is passes the Pelvic Brim)

S1-S2

Third Constriction of Ureter (where it pierces the bladder)

S3

End of Sigmoid Colon (Start Colon (Start of Sigmoid is at Iliac Fossa), Start of Rectum

- Nipple is at 4/ 10/19 10/1978 78 Dermatome level T4 T4,, 10 cm from midline, at Verterbral level T7-T8

Ang dami!

34,, protruding na At age 34 Umbilicus sa laki ng tiyan

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VERTEBRAL LEVELS EXTRA NOTES *Diaphgram Openings

T8 -> T8 -> IVC, Right Phrenic Right Phrenic Nerve T10 -> T10 -> Esophagus, Vagus Nerve T12 -> T12 -> Abdominal Aorta, Thoracic Duct (Twelve)

I 8 10 Eggs At 12

*Cysterna Chyli

starts at L2 -> ends at C7

ChyLII

Other Structures at T4-T5 (6 STRUCTURES)

1. Cros Crossin sing g of of Thor Thorac acic ic duct duct from from R -> -> L

2. End of End of Ascending, Start End of Arch, Start of Arch, End of of Descending

3. Left Main Bronchus

4.BIFURCATIONS: 4.BIFURCATIONS: Tracheal Bifurcation, Pulmonary Trunk Bifurcation

VEINS: Start of SVC, Drainaiage of Azygous vein

Second Esophageal Constriction Site

* Esphageal Constriction Sites (THREE)

FIRST: FIRST: C6 - Cricopharyngeus (dito sila nag sex!) - marks the end of esophagus

SECOND: SECOND: T4-T5

THIRD: THIRD: T10 (where is enters the diaphragm)

* Where is the Thymus?

In the Adult, Superior Mediastinum, In children, it is a fatty remnant at the Inferior, Inferior, Anterior Mediastinum

T5-T9, Somewhere around T5-T9, since the Inferior Mediastinum is posterior to the body of the sternum

*The Oblique Fissure is at the 6th Costal Cartilage *The Kidney spans from T12-L3

THORACIC CAGE There are 12 Ribs 12 Ribs TRUE versus FALSE RIBS True Ribs

Ribs 1-7

Vertebrocostal

False Ribs

Ribs 8-10

chondral (chos Vertebrochondral kasi False)

Floating Ribs

Ribs 11-12

Ribs 8-10 joints Rib 7 Ribs 11 and 12 Ends blindly

TYPICAL versus ATYPICAL RIBS Typical Ribs

Ribs 3-9

Typical ribs have: 1. a head with two facets 2. a neck 3. a tubercle twisted body 4. a twisted body

Ribs 1, 2, 10, 11, 12 Rib 1 is 1 is atypical because it has a:

1. head with 1 facet 2. horizontal body horizontal body 3. scalene tubercle with 2 depressions for depressions for the subclavian artery and vein

Rib 2:

angulated body angulated body

Rib 10

1 facet

Rib 11 and 12

1 facet no neck no

Atypical Ribs

TIP: LAHAT ng may “1”, 1 lang facet, (Rib 1, 10, 11, 11, 12)







MUSCLES RELATED TO BREATHI B REATHING NG Scalene Muscle

When ribs elevate on inspiration, Rib 1 does NOT elevate because of this muscle

Grynfeltt-Lesshaft Triangle

12th 12th Rib, I Rib, Internal nternal oblique, Quadratus Lumborum

12 lang 12 lang IQ ng IQ ng La Salle (Mnemonic lang!)

*Rib 12 doesn’t move because of the Quadratus Lumborum

During SILENT INSPIRTATION: INSPIRTATION: Depressors (SPIT (SPIT))

SPI (Serratus Posterior Inferior)

Elevators (SLISE (SLISE))

S (Serratus Posterior Superior)

I (Internal Intercostal)

When you spit, PABABA T (Transversus Thoracis) ang laway.

L (Levator Costarum)

After slicing the cake, umeksena ka, IT ITAAS AAS mo.

I (Innermost intercostal) S (Subcostalis) (External Intercostal) E (External

During FORCED INSPIRTATION: INSPIRTATION: MAIN MUSCLES involved: SS S CM

Scalene

SECONDARY MUSCLES involved: INTERCOSTALS External intercostal

Elevator

Internal Intercostal

Rib to rib: Depressor CC to CC: Elevator

Innermost intercostal

During FORCED Expiration: FORCED Expiration: MAINLY, Abdominal Muscles LOWER BORDERS OF THE LUNGS AND PLEURAL CAVITY 6-8-10

8-10-12

6th Rib, MCL

8th Rib, MCL

8th Rib, MAL

10th Rib, MAL

10th rib, sides of Vertebral Column

12th rib, sides of Vertebral Column

LOWER margin of lungs at full EXPIRATION/ EXPIRATION / Margins VISCERAL pleura of VISCERAL pleura

LOWER margin of lungs at full INSPIRATION/ INSPIRATION / Margins of PARIETAL Pleura/ COSTAL LINE of PLEURAL RELFECTION

LUNG LOBES, FISSURES, AND SEGMENTS RIGHT

LEFT

LOBES: SIM Superior, Inferior, Middle

LOBES: SI Superior, Inferior NO MIDDLE!

SEGMENTS (Each lobe has segments)

SEGMENTS (Each lobe has segments)

Superior: AP APA A Apical, Posterior, Anterior

Superior: Superior: APASI Same as Right + + Superior Lingula, Inferior Lingula

Middle: Lateral, Medial

NO MIDDLE LOBE!

Inferior: PSALM

Inferior: PSALM (same as right)







CLINICAL CORRELATES What is damaged when an object is impaled in the first ICS?

UPPER Half of Superior Vena Cava

What is damaged when an object is impaled in the 2nd CC?

LOWER half of Superior Vena Cava

Fracture of the R and L Sternoclavicular Joint damages which structure?

Braciocephalic Vein

Which structure is damaged when there is a fracture of the medial 3rd of the clavicle

Subclavian Vein

The costoclavicular ligament is also known as what?

Halsted Ligament *also Ligament *also the landmark in insertion of Swan Ganz catheter into the Subclavian Vein

TRACHEA Condunction Zone (T->T (T->T))

Trachea -> Primary Bronchiole -> Secondary (Lobar) Bronchiole -> Tertiary Tertiary (Segmental) Bronchiole) -> Terminal Bronchioles

Respiratory Zone

Respiratory Bronchiles -> Alv. Duct -> Alv. Sac -> Alveoli

“Upper” Respiratory Zone

until Pharynx

Blood Supply of Trachea Proximal 2/3: ITA: Internal Thoracic Artery

ITA BA Distal 1/3: BA: Bronchial Artery

Diameter of the Airways Trachea - 18mm

Terminal - <1mm

Primary - 12.2mm

Respiratory - 0.5mm

Secondary - 8.3mm

Alveolus - 200 micrometers

Tertiary - 5.6mm BREAST BLOOD SUPPLY SUPPLY LATERAL

MEDIAL

Lateral Thoracic Artery

Internal Thoracic/Internal Mammary Artery

INNVERATION = 4th - 6th Intercostal Nerves VENOUS DRAINAIGE = Axillary Vein LYMPHATIC DRAINAIGE C (Central) H (Humeral/Lateral) A (Apical) P (Pectoral/Anterior) - First site of drainaige S (Subscapular/Posterior)

Axillary Group [CHAPS [ CHAPS]] drain the Upper Outer Quadrants







SURGERY CORREL ATE Level 1 (Lateral to Pectoralis Minor)

PECTORAL, SUBSCAPULAR, HUMERAL

Level 2 (Posterior to Pectoralis Minor)

CENTRAL, ROTTERS NODES

Level 3 (Anterior / Medial to Pectoralis Minor)

APICAL

What structure divides the Axillary Lymph nodes into 3?

Pectoralis MINOR

Parasternal LNs

Drains Upper Inner Quadrants

Inferior Phrenic LNs

Drains the Lower Quadrants

Rotter’s Nodes

=

Interpectoral Nodes

AXILLARY ARTERY BRANHCES 1st Part has 1 Branch

STA ST A Superior Thoracic Artery

2nd Part has 2 Branches

TL (T TL (Tulo ulo Laway) Thoracoacromial Artery, Artery, Lateral Thoracic Artery, Artery,

3rd Part has 3 Branhces

Mnemonic: @S@ (iyong dalawang swirly daw is Circumflex) Subscapularis (largest) Artery Post. Circumflex Artery Ant. Circumflex Artery

What divides the Axillary Artery into three branches?

Pectoralis MINOR

What marks the transition of Subclavian Artery to Axillary Artery? Artery ?

First Rib

What marks the transition of Axillary Artery to Brachial Artery? Artery?

Teres MAJOR

SUBLCLAVIAN ARTERY BRANCHES VIT C & D 1st Part has 3 Branches

VIT Vertebral VIT Vertebral Internal Mammary/Thoracic, Thyrocervical*

*What are the branches of the Thyrocervical Trunk?

(THYO = TAYO = SIT SIT)) Suprascapular, Inferior Thyroid, Transverse Cervical

2nd Part has 1 Branch

C Costocervical

What are the branches of the Costocervical Trunk?

(Sa COAST COAST[COSTO] [COSTO],, may DEEP SEA [SIA] [SIA])) Deep Cervical, Superior Intervertebral Artery

3rd Part has 1 Branch

D Dorsal Scapular

What are the branches of the Doral D oral Scapular?

(Open The Door for Rhomboids and Levator Scapula)) Rhomboids, Levator Scapulae Scapula







HEART VALVES VALVES AND THEIR THE IR CUSPS VALVES

C U SPS

Mnemonic

Tricuspid (Three cusps)

Anterior, Septal, Posterior

tricASP tricASPid id

Mitral (Bicuspid) (Two Cusps)

Anterior, Posterior

mAP

Pulmonary

Left, Anterior, Right

pulmoLARy LARy

Aortic

Posterior, Left, Right

PALoR

What is located 1 fingerbreadth above fingerbreadth above the Septal leaflet of the Tricuspid?

AV Node

WHERE TO AUSCULTATE AUSCULTATE FOR THE HEART SOUNDS (see picture below) Mnemonic: Always Pray To Mama Mary (APTM ( APTM)) at 22:45 (10:45pm bago matulog) A

2nd ICS, Right

P

2nd ICS, Left

T

4th ICS, Right or Left

M

(Apex)) 5th, Left MCL Left MCL (Apex

SURFACE ANATOMY: EXACT LOCATION OF THE VALVES (see picture below) TRy TRy

Pending Pending

A

M

S (Intercostal Space)

C (CC)

S (ICS)

C (CC)

4

3

3

4

R

L

L

L

PAM, TRy TRy mo naman ipareserve iyong Student Center Student Center, Dial Mnemonic: “Mumshie PAM, lang.” After tawagan ni Pam: “Hay 4334 lang.” end ing naku Mumsh, p end ing pa iyong reservation.” Tricuspid

4th ICS, Right ICS, Right

Right half of Behind Right half Sternum

Pulmonary

3rd CC, Left

Behind Medial End of 3rd Left Costal Cartilage

Aortic

3rd ICS, Left

Behind Left Half of Sternum

Mitral

4th CC, Left

Behind Left Half of Sternum

All are BEHIND the STERNUM, except the Pulmonary, ulmonary, which is at the END of the costal cartilage (kaya Pending. ending. *Note: TR TRy. Tricuspid lang and Right!









SURFACES OF THE HEART (see picture below) Pulmonary Surface

RA (Right)

Si Doc RA, RA, may bag na LV. Sosyal.

LV (Left) LV (Left) Sternocostal (Anterio (Anterior) r) Surface (MOST anterior)

RA (Superior)

RA and RV RV Si Doc RA and

RV (Inferior) RV (Inferior) Diaphragmatic (Inferior) Surface

both ventricles, mainly LV

Base Base

LA

Apex

LV, LV, 5th ICS LMCL

Bala! (as in bullet)

The Right Atrium is at the Right 4th Parasternal Border CARDIAC SILHOUETTE (3365) RIGHT

3rd Right CC

3rd Left CC

6th Right CC

5th ICS Left MCL

LEFT

RIGHT ATRIUM Which 5 Veins directly drain into the RA?

SVC, IVC, Coronary Sinus, Anterior Cardiac Vein, Thesbian Veins Eustachian Valve (VICE Ganda (VICE Ganda))

What is the valve of the IVC? What is the valve of the Coronary Co ronary Sinus?

Thesbian Valve

What is the smooth part of the RA?

Sinus Venarum

What is the rough part of the RA? Which structure separates the smooth part from the rought part? What is the remnant of the foramen ovale?

Failure of the Fossa Ovalis to close results in?

What is the earlike structure in the RA?

Pectinate muscle/Muscusli pectinati Crista Terminalis internally Sulcus Terminalis externally Fossa Ovalis

ASD (MC Type: Secundum Secundum))

Auricle

RIGHT VENTRICLE What are the muscles in the RV?

Trabeculae carnae, papillary muscle, cord tendinae, moderator band













CONDUCTION SYSTEM Internodal Pathways (AMPlifier) AMPlifier)

Eponym (BAWAT)

Location (AP (APO OL)

Anterior

Bachmann

Anterior of SVC

Middle

Weckebach

Posterior of SVC

Posterior

Thorell *inside Terminalis

Lateral to SVC

Where is the RBBB?

It is covered by the Moderator Band

ModeratoRB ModeratoRB BBand BBand

Where is the LBBB?

Just below the endocardium

Where is the SA Node?

On the epicardium, specifically specificall y, lateral to lateral to entrance of the SVC to the RA in the sinus venarum

Where is the AV Node? At the interatrial septum, septum , near the opening of the Coronary Sinus CORONARY ARTERIES Remember LARP : The LCA supplies the Anterior nterior heart, the RCA supplies LCA supplies the A RCA supplies the Posterior heart RCA (Si Rica) branches Conus Artery

LCA Branches Mneominic: Si Lady Diana Diana ay ay (X patay ( patay X) na at Kulot (obtuse) LAD (Left Anterior Descening) - most common in MI

Si Lady, the widow maker artery or the Third coronary artery

SA Nodal Artery

(In 35% of people, it branches from the LCA)

Diagonal

Si Diana

AV Nodal Artery

(In 25% of people, it branches from the LCA instead)

Circumflex

(X (X)

Obtuse

Kulot

Marginal Artery PDA (Posterior Descending Artery)

Nakipag PDA si PDA si RICA (In 10% of people, it branches from the LCA instead)

In Right Dominance, Dominance, PDA is from RBA (90%). In Left Dominance, Dominance, PDA is from LCA (10%).







ESOPHAGUS Distance from the Incisor of the following: 15cm

Criophayngeus

25cm

Second Constriction Site

31cm

Hiatal Opening

56-59cm

Duodenum

APPPLICATION: If bleeding was seen at (EGD), which part of the GIT is 47cm (EGD), involved?

+3 if from External Nares

Somewhere at the stomach, it may be a Gastric Carcinoma

BLOOD SUPPLY of Esophagus ITA BE LGA (Itabi ang Liga) 1st Part

ITA IT A

Internal Thoracic Art.

2nd Part

BE

Bronchial Art., Esophageal Art.

3rd Part

LGA

Left Gastric Art.

*Note: These are branches of the Thoracic Aorta, the 3rd-11th PIAS (Posterior Intercostal Arteries) also branch from the Thoracic Aorta.

LARGE INTESTINE What differentiates the LI from SI?

Taenia coli, coli , Haustrations, Omental appendages

What are the 3 kinds of Taenia Taenia Coli?

Taenia Libera, Taenia Mosocolia, Taenia Omentales

Length of the different segments:

Ascending: 10cm, Transverse: 45cm (LONGEST),, Descending (25cm), (LONGEST) Sigmoid (35-40cm) APPENDIX

What are the possible locations of the Appendix? What are the 3 kinds of Taenia Taenia Coli?

Retrocecal (MOST COMMON), Retroileal (LEAST COMMON) Taenia Libera, Taenia Mosocolia, Taenia

*Note: The 1st and 2nd PIAS come from SIA from SIA (Superior Intercostal Artery)







ABDOMINAL AORTA AND THEIR BRANCHES SUPERTABLE SU PERTABLE ABDOMINAL AORTA DIRECT BRANCHES

1ST GENERATION BRANCHES

Inferior Phrenic Artery

Branch: Superior Suprarenal Artery > Superior part of the Adrenals

2ND GENERATION BRANCHES

3RD GENERATION 4TH GENERATION BRANCHES BRANCHES

Middle Suprarenal Artery -> Middle Part of the Adrenals Renal Artery

Branch: Inferior Suprarenal Artery > Inferior Part of Adrenals

Celiac Trunk (Supplies Foregut)

Branches: Si Celia, nagpa-CS with nagpa-CS with LiGation 1. Common Hepatic Artery (CHA)

2. Splenic

3 Branches of Common Hepatic Artery (CHA) GHRelin: GHR elin: 1. Gastrodudeonal 2. Hepatic Artery Proper 3. Right Gastric

2 Branches of Gastroduodenal : 1. Superior Pancreaticodudeo nal 2. Right Gastroepiploic

2 Branches of Hepatic Artery Proper: 1. Right Hepatic Artery 2. Left Hepatic Artery

1 Branch of Right Hepatic Artery: Artery: 1. Cystic Artery -> -> Gallbladder

What divides the Foregut and Midgut?

Ampulla of Vater

4 Branches of Splenic D&G D&G:: 1. D osal osal Pancreatic 2. G reater reater Pancreatic 3. Left Gastroepiploic 4. Short Gastric

3. Left Gastric Superior Mesenteric Artery (Supplies Midgut)

Branches of SMA: MR JI IC IPANC









ABDOMINAL AORTA AND THEIR BRANCHES SUPERTABLE SU PERTABLE ABDOMINAL AORTA DIRECT BRANCHES

1ST GENERATION BRANCHES

Inferior Mesenteric Artery (supplies Hindgut)

Branches of the IMA: LSSS IMA: LSSS (Last Song Syndrome Syndome)

2ND GENERATION 3RD GENERATION 4TH GENERATION BRANCHES BRANCHES BRANCHES

1. Left Colic - > Descending colon 2. Sigmoidal 3. Sigmorectal 4. Superior Rectal Testicular/Ovarian Arteries Lumbar Arteries Medial Sacral Arteries Common Iliac Arteries

Branches of the Common Iliac: 1. Internal Iliac -> Anterior and Posterior Divisions

Anterior Division Branches: IIIOUUVM (I I I Owe You You Very Much) 1. Internal Pudendal 2. Internal Iliac 3. Inferior Gluteal 4. Obturator 5. Umbilical 6. Uterine 7. Vaginal 8. Middle Rectal Posterior Division Branches ILS Branches ILS (I Love Sex) 1. Sex) 1. Iliolumbar 2. Lateral Sacral 3. Superior Gluteal

2. External Iliac LIVER What divides the liver ANATOMICALLY into right and left parts?

Falciform Ligament







The Letter “H” Ligamentum Venosum (LV),

Caudate Lobe

IVC

Ligamentum Teres Hepatis (Round Ligament) Si Taylor Tayl or Laughter bilog ilong

Quadrate Lobe Gallbladder

The Ligamentum Venosu m is a remnant of?

Ductus Venosu Ductus Venosu s

Ligamentum Teres Hepatis (Round Ligament) is a remnant of?

Umbilical Vein

Components of the Portal Triad

HAp PY BDay! BDay! Hepatic Artery, Portal Vein, Bile Duct

What ligament covers the portal triad?

HepatoDUODENAL LIGAMENT HepatoGASTRIC ligament

These 2 ligaments = LESSER OMENTUM

GALLBLADDER What maintains the neck of the gallbladder neck open at all times (Valves of the Cystic Duct)?

Valves of Hesiter

T he he cystic duct can be bypassed through these ducts because they have a direct connection from the gallbladder to the liver.

Ducts of Lushka

SMALL INTESTIVE 1st Part

Superior (Cap)

5cm

2nd Part

Descending

7-20 cm

3rd Part

Horizontal

6-8 cm

4th Part

Ascending

SHORTEST

Intraperitoneal Head of Pancreas Retroperitoneal Ligament of Treitz







CLINICAL CORRELATES HERNIAS LITTRES HERNIA

MECKEL’S DIVERTICULUM

LITTLE kids have Meckel’s

RICHTERS NERNIA

INCAR INCARCERATED CERATED

Ang mga RICH, may CAR

COOPERS HERNIA

FEMORAL HERNIA W/ TWO SACS TWO SACS

OO - TWO O’s

VELPEAU HERNIA A HERNIA IN THE GROIN IN IN FRONT OF THE FEMORAL BLOOD VESSELS AMYANDS HERNIA

APPENDIX

A-A

INCISIONS

SPACES AND SIGNS

KOCHERS

RIGHT SUBCOSTAL, SUBCOSTAL, FOR GALL BLADDER OPERATION

BOGROS SPACE

SPACE BEHIND INGUINAL LIGAMENT

CHEVRON

BILATERAL SUBCOSTAL

RETZIUS SPACE

SPACE BEHIND PUBIC SYMPHYSIS

MERCEDES

BILATERAL ON THE COSTAL CARTILAGE ITSELF, ITSELF, SA TAAS NG CHEVRON

BALLANCES SIGN

DULLNESS IN LEFT FLANK DUE TO COAGULATED BOOD

ROCKY DAVIS/ LANZ

TRANSVERSE THROUGH MC BURNEY’S POINT

KEHRS SIGN

PAIN ON THE RIGHT SHOULDER DUE SHOULDER DUE TO SPLENIC RUPTURE

GRIDIONS

OBLIQUE

DUNPHYS SIGN

INCREASED PAIN

Anatomy Supertable

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