Gross Anatomy

1. Direct hernia: leaves abdominal cavity medial to inferior epigastric vessels

Indirect hernia: leaves abdominal cavity lateral to inferior epigastric vessels

Femoral hernia: protrusion of abdominal viscera through femoral ring into femoral canal

Lumbar puncture: needle into lumbar cistern between spinous processes L3/L4 or L4/L5 Pericardiocentesis: wide bore needle inserted through 5^th or 6^th intercostal space near sternum. Careful not to puncture internal thoracic artery

2. Thyroid C5

Duodenum T12-L1

Sternal notch T2

Kidneys T12-L3

Bifurcation of trachea T4-T5

Conus medularis L1-L2 adult, L3 newborn

Heart: Base T6-T9

Umbilicus L4

Apex 5^th left intercostal space

3. Knee: 1. Patellar ligament- damage to femoral nerve or spinal cord L2-L4. Loss of patellar reflex 2. MCL- tear also tears medial meniscus. Passive abduction of extended leg at knee joint. 3. LCL- passive adduction of extended leg at knee joint. 4. ACL- anterior drawer sign. 5. PCL- posterior drawer sign. 6. Terrible triad- MCL, medial meniscus and ACL tears.

Hip: 1. Posterior dislocation- head of femur moves posterior to the iliofemoral ligament. Presents with lower limb that is flexed at hip joint, adducted, medial rotated and shorter than opposite limb. 2. Fracture of neck of femur presents laterally rotated and shortened.

Shoulder: 1. Dislocation- may be anterior or posterior. If anterior then axillary nerve may be damaged. 2. Separation- results in a downward displacement of clavicle.

Clavicle: 1. Fracture- most common at medial 1/3. Results in upward displacement of proximal fraagment and downward displacement of distal fragment

3. Brachial Plexus: 1. Axillary n- dislocation of shoulder, abduction (deltoid) and lateral rotation (teres minor) are compromised. 2. Long thoracic n- winging of scapula (serratus anterior). 3. Radial n- wrist drop (extensors of forearm). 4. Median n- ape hand (thumb muscles) and flexors of forearm if damage is at elbow or above. 5. Ulnar n- claw hand and radial deviation of hand, loss of some flexors if at elbow or above.

3. Peripheral nerves: 1. Common peroneal n- foot drop (tibialis anterior m) and inversion (peroneus muscles). 2. Deep peroneal n. entrapment- Compression of anterior compartment muscles of the lower leg by ski boot or athletic shoes that are too tight. Causes pain in the dorsum of the foot that radiates to the space between the first two toes.

3. Hands: 1. Carpel Tunnel Syndrome- compression of median nerve by inflammation, weakend flexion and abduciton and opposition of thumb, loss of extension of index and middle fingers, sensory loss of index, middle and half of ring fingers and palmar part of thumb. 2. Cubital tunnel syndrome- sorry I was not able to find this one. 3. Dupuytren’s contracture- progressive fibrosis of palmar aponeurosis, pulls digits into marked flexion at MCP joints.

3. Blood-testes barrier: There is a barrier that exists between the blood vessels that supply the testes (branches of the testicular artery and vein) and the duct system in which spermatozoa are produced and transported. The testis is derived partly from celomic mesoderm and partly from intermediate mesoderm with the blood vessels migrating in around the duct system.

3. Abdominal arteries:
   1. Celiac trunk(CT)-FOREGUT-left gastric a., splenic a., hepatic a.
   2. Superior messenteric a.(SMA)- MIDGUT- part of duodenum through proximal 2/3 of transverse colon.
   3. Inferior mesenteric a.(IMA)-HINDGUT- distal 1/3 of transverse colon to upper rectum

Collaterals:

1. Internal thoracic a. to superior epigastric a. to inferior epigastric a.

2. Superior pancreaticoduodenal a.(from CT) to inferior pancreaticoduodenal a. (from SMA)

3. Middle colic a. (from SMA) to left colic artery (from IMA)

4. Marginal a. (from SMA and IMA)

5. Superior rectal a. (from IMA) to middle rectal a. (from internal iliac a.)

9. Bone:

1. Metaphysis: between epiphysis and diaphysis.

2. Epiphysis: growth plate responsible for linear bone growth.

3. Diaphysis: long part of bone responsible for annular bone growth.

Category: Anatomy Notes