This document is the property of Nerdy Notes (www.nerdy-notes.com).Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. nerdy-notes.com uploaded by user pancholi Class: ANP 300 Lecture/Exam: Exam 3 School: SBU Semester: Spring 2012 Professor: Baab This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. Cardio Plasma is the liquid ground substance of blood. Platelets are fragments of megakaryocytes o They do coagulation of blood o Platelets stick together and form a plug in the damaged vessel. o Fibrogen, a protein, forms a fibrin clot to seal the hole. Diapedesis – WBC’s squeeze through capillaries Hemopoiesis – production of blood cells. o Lymphoid stem cells give rise to leukocytes o Myeloid stem cells give rise to everything, including some leukocytes Pericardium – sack that surrounds the heart o Fibrous pericardium – attaches to the diaphragm and blood vessels. o Serous pericardium – Reflects at the vessels Parietal pericardium – sticks to fibrous pericardium Visceral pericardium – sticks to the heart The parietal reflects and becomes visceral, etc. Pericardial cavity- in between visceral and parietal layers. Cuspid Valves – between Atria & Ventricles o Bicuspid – Left atrium/ventricle o Tricuspid – right atrium/ventricle o Powered by papillary muscles Contraction keeps the valves closed. o Muscles are attached to the chordae tendinae Semilunar Valves – o Passive – there is no muscle o Blood backwash fills the cusps. Pressure has to overcome the closed cusps to open the valves. Right Atrium – o Fossa Ovalis (Foramen ovale) o Pectinate muscles. o Coronary sinus opens here. Ventricles have trabeculae carnae muscles Electrical signal set up o SA Node sends signal to AV node & Atria o AV node delays it This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. o Sends it down the atrioventricular bundle o The bundle branches into left/right which branch off into the purkinje fibers. [Know arteries & veins of the heart) Innervation – o Parasympathetic – Vagus Nerve o Sympathetic trunk o Visceral sensation follows sympathetic Arteries act a pressure reservoir while veins act as a volume reservoir. Arteries have more smooth muscle and no valves. Types of Capillaries - o Continuous – least permeable – only small molecules like O2 can get in. o Fenestrated – larger openings – kidneys, intestines, o Sinusoid (discontinuous) – Has huge openings, and is the most permeable. In liver, spleen, bone marrow. Blood pressure – 120/80 in arteries, nothing in veins o Driving pressure = flow rate * peripheral resistance. o Arterial Pressure = Cardiac Output * peripheral resistance Cardiac output = stroke volume * rate This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. Glossopharyngeal nerve does visceral sensation to carotid body and carotid sinus (stretch receptors) 3 portal systems o Hypothalamic – hypophyseal o Hepatic (intestines to liver) o Nephronic (kidneys) See Fetal Circulation PDF Prenatal postnatal structures Pretnatal Postnatal Ductus arteriosus Ligamentum arteriosum Foramen ovale Fossa Ovalis Ductus venosus Ligamentum venosum Umbilical veins Ligamentum teres Umbilical arteries Medial umbilical ligaments Lymph System – Functions o Return interstitial fluid back to blood o Transport products of fat digestion o Filter foreign substances and dead cells o Make up part of immune system Components - o Lymph – extra interstitial fluid RBCS or platelets Dissolved lipids, and lymphocytes & macrophages. o Lymph Vessels – 4 levels Capillary Larger diameter and more permeable. Blind ended. Called Lacteals in small intestine. Lympathic Thinner walls and more valves than veins. Passes through the nodes. Drains everything except cornea & CNS Superficial structures – follows veins Deep structures (Except lungs) – follows arteries Lungs o Paratracheal, tracheobronchial, bronchopulmonary. Lympathic trunks (paired) Jugular, subclavian, bronchomediastinal, intestinal, lumbar Lymph duct Thoracic duct – most of the blood Right lymphatic duct This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. o Has only right jugular and right subclavian trunks . Both empty into the brachiocephalic veins. o Lymph Organs Nodes Spleen Thymus o Lymphatic Tissue Tonsils Pharyngeal, palatine, and lingual. Pharyngeal is nasopharynx, while other 2 are oropharynx. Peyers Patches On walls of ileum in small intestine. Respiratory You have 3 conchae and 3 meatuses (channels through conchae) o Inferior nasal conchaeis its own bone. Other 2 come from ethmoid. Sinuses – frontal, ethmoid, sphenoid and maxillary. o Sphenoid sinus empties into sphenoehtmoid recess o Some ethmoid empties into superior meatus o Rest of ethmoid, frontal, and maxillary empty into middle meatus o Nasolacrimal duct empties into inferior meatus Pharynx o Nasopharynx – choanea (opening to nasal cavity) & soft palate. o Oropharynx – Fauces (opening), & hyoid o Layngopharynx – cricoid cartilage is end of it. Has superior, middle, and inferior constrictors. Vagus innervations. Larynx o Arytenoid cartilage – where vocal cords attach o Vestibular fold & vocal fold o Rima glottides – opening b/w vocal folds o All laryngeal muscles are innervated by recurrent laryngeal nerve from vagus Except cricothyroid – external laryngeal nerve. o Posterior cricoarytenoid abducts while all of the others adduct the cricoarytenoid joint. Right lung has 3 lobes. Bronchus is straighter and shorter. Left lung has linguala and cardiac notch. Lungs have plural sac consisting of serous membrane This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. o It’s reflected, and has both visceral and parietal layers o Full of serous fluid Each lung segment gets its own tertiary bronchus, and branch of both pulmonary artery and vein. Inspiration is active, exhalation is passive. Symphatic nerves do bronchodilation Vagus does bronchoconstriction Medulla & pons control breathing. Phrenic nerve (C3-5) control the diaphragm. Chemoreceptors from carotid bodies (CN 9), aortic bodies (CN X) and the central chemoreceptors affect breathing. Digestive System Oral Cavity o Plaotglossol arch is in front of the palatopharyngeal arch, with palatine tonsil in between the 2. Muscles of mastication o Temporalis, masseter, medial pterygoid, lateral pterygoid o Innervation by V3 Buccinator, orbicularis oris – VII Glossus muscles – CN XII Palato muscles – CN X Dentition o 2 incisors, 1 canine, 2 premolars, 3 molars. Salivary glands- submandibular gland & sublingual gland & parotid gland o Submandibular and parotid glands have ducts. Sublingual doesn’t really have a duct. Layers of GI Tract tube o Serosa – epithelial and connective tissue membrane o Muscularis – muscle. Circular muscle is deep. Longitudinal is superficial. o Submucosa – connective tissue w/ vessels and nerves. o Mucosa – epithelial layer. Thin layer of smooth muscle. Peritoneum – serous membrane lining the abdominal organs o Has visceral & parietal layers Mesentary – double fold of peritoneu connecting organs to body wall o Contains nerves and blood vessels o Organ to wall mesenteries This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. Falciform ligament – liver to antererior wall THE Mesentary – post. Wall to small intestine Transverse & sigmoid mesocolon – post wall to colons o Organ to organ mesenteries – Greater omentum Lesser omentum Esophagus o Begins from laryngopharynx and goes to stomach o Goes through diaphragm at T10 o Has adventitia instead of serosa o Muscularis layer has skeletal muscles for top 1/3 and smooth for the rest. o Somatic control is done by vagus. Blood supply o Foregut – celiac artery o Midgut – superior mesenteric artery o Hindgut – inferior mesenteric artery Foregut – liver, gallbladder, esophagus, pancreas, stomach, duodenum, spleen. [Know arteries and all] Stomach – cardia, fundus, body, greater/lesser curvature, and pylorus. o Gastric glands in mucosa secrete gastric juice o Contains a deeper layer of muscle called oblique fibers Duodenum – part of small intestine, but part of foregut o Major duodenal papilla – where the juices from organs flow in. Pancreas – deep to the stomach. Exocrine & endocrine. Liver – know the 4 lobes. o Porta hepatis – where the hepatic artery, portal vein, and common bile duct enter/exit o Hepatic artery – oxygenated blood into the liver o Portal vein – blood that has to be cleaned up from gut o Common bile duct – sends out bile through here. o Each lobule in the lung has empties into the central vein Gallbladder – stores bile that the liver makes. This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. GI tract veins empty into portal vein, which goes to liver. Midgut organs – ascending, transverse colon, jejenum & ileum. Duodenum and jejenum have plicae circularis – they create tons of surface area for absorption Illeum has peyers patches – lymph tissue Colon has hepatic flexure & splenic flexure Ascending and descending colon are retroperitoneal, transverse, and sigmoid aren’t retro Hindgut – descending & sigmoid colon. Rectum as well. o Don’t get parasympathetics from vagus. Get from pelvic splenhic nerves instead. o External anal sphincter gets somatic from pudenal nerve. Urinary System Kidney coverings superficial to deep o Pararenal fat o Renal fascia o Perirenal fat o Renal capsule Flow of urine in kidney o Cortex pyramid renal papilla minor calix major calix renal pelvis ureter bladder urethra porcelain goddess. Renal arteries (From aorta) & renal veins enter through the renal hilum. [understand nephron flow] Innervation of kidney – renal plexus o T10-T12 sympathetics Vasoconstriction for less filtration This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. o Parasympathetic from vagus Ureter is like GI tract, but has adventia, and the muscles are switched – circular is superficial, and longitudinal is deep. o Ureter innervated by sympathetic from T11-L2, and parasympathetics from vagus for top part, and pelvic splanchnic for bottom part. Bladder has 4 layers, just like GI tract. Detrusor muscle is in the muscularis layer. o Has internal urethral sphincter (Smooth muscle ) aand o External urethral sphincter (skeletal muscle) Urethra o Females Conducts only urine. 3-5 cm lone o Males 3 parts – prostatic(3-4cm), membranous (1cm), and spongy (15 cm) Carries sperm and crap too. Piss reflex o Distention (bladder is full) goes through pelvic splanchnic nerves o Pelvic splanhnics relax internal sphincter, and contract the detrusor muscle o Sympathetics get inhibited, and the internal sphincter is allowed to relax o Somatic motor (pudental nerve) is inhibited so that the external sphincter relaxes. o You piss! Reproductive Pelvic floor/pelvic diaphragm Muscles o Levitator Ani Puborectalis Kinds rectum to prevent crapping your pants Pubococcygeus Illiococcygeus o Coccygeus Perinium is crap below the pelvic floor Urogenital triange is deep and superficial Deep – deep transverse perineus, and external urethral sphincter This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. Superficial – bulbospongeous, ischocavernosus, superficial trasverse perineus Developmental homologues Female Male Labia majora Scrotum Labia Minora Spongy Urethra Glans/crus of clitoris Glans/crus of penis Bulb of Vestibule Bulb of penis Vestibule Membraneous urethra Vestibular glands Bulbourethral glands Ovaries Testes External vagina o Under bulbospingeous, you have the corpus spongeous o Under the ischiocavernous, you have the corpus cavernosum o Both meet up at the clitoris External penis o Glans is tip o Corpus cavernosum make up the sides, with corpus spongiosum in between it. o Bulb is at the bottom Internal female stuffs o Ovary is connected to uterus via ovarian ligament o Uterus is connected to labia majora via round ligament o Both ovarian and round ligaments are from the gubernaculum o Layers of uterus Endometrium (most inner) Myometrium (smooth muscle) Perimetrium – outside layer where peritoneum sticks to the uterus. o The peritoneum makes 2 sacs around the uterus Rectouterine pouch and vesicouterine pouch o Other ligaments Uterosacral ligament, broad ligament, and suspensory ligament of the ovary Broad ligament is double fold of peritoneum o Vascularization Ovaries get ovarian artery from aorta via suspensory ligament Right ovarian vein goes to the IVC Left ovarian vein goes to renal vein Uterine artery and veins come from iliac artery and veins via the broad ligament. o Innervation This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. Sympathetics + vagus nerve for parasympathetic. For Ovary and fallopian tubes. Sympathetics + pelvic splanchnics for parasympathetics Visceral pain goes through sympathetics, but distention goes through parasympathetic Inferior ¼ of vagina is somatic. Internal Male anatomy o ductus deferens + seminal vesicle duct = ejaculatory duct o Sperm pathway – Seminiferous tubules rete testis efferent ducts epididymis ductus deferens ejaculatory duct urethra o Seminal vesicles and prostate both contribute to semen. o Bulbourethral glands secrete mucin into penis o Erection is parasympathetic o Ejaculation is sympathetic o Layers of Scrotum What is was before the balls dropped Scrotum Skin Skin Subcutaneous tissue Dartos muscle & fascia Aponeurosis of ext. oblique muscle External spermatic fascia Internal oblique muscle Cremasteric muscle Internal oblique fascia Cremasteric fascia Transversalis fascia Internal spermatic fascia Peritoneum Tunica vaginalis Hernias o Direct – viscera push through the wall of canal through the superficial inguinal ring o Indirect – viscera push through patent processus vaginalis. This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. Lab Manual Notes Lab 9 – Thorax Boobies o Alveoli lobules lobe lactiferous sinuses lactiferous ducts ducts o Areola around the nipple. o Adipose tissue & Suspensory ligaments Ribs o 1-7 are real o 8-10 are fake o 11-12 are floating Costoscapular muscles o Pectoralis minor – medial pectoral nerve o Serratus anterior – long thoracic nerve o Transversus thoracis – sternum to ribs. Innervated by intercostal nerves. Internal thoracic artery passed behind. o External/internal/innermost intercostal muscles Diaphragm – vena caval foramen (T8), esophageal hiatus (T10), Aortic hiatus (T12) Lung divisions o Bronchus Primary – 1 per lung Secondary (lobar) – 1 per lobe Tertiary (segmented) – 10 per lung o Bronchiole Bronchiole Terminal bronchiole o Alveoli Alveolar duct Alveolar sac Alveolus Right lung – 3 lobes – superior, middle, inferior o Horizontal fissure & Oblique Fissure Left lung – 2 lobes – superior & Inferior o Oblique fissure only o Lingula + cardiac notch. Heart vessels o Arteries Left coronary artery Circumflex Anterior interventricular Right coronary artery This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. Marginal Posterior interventricular o Veins Great/middle/small cardiac veins combine to make a coronary sinus, which drains into right atrium. Chapter 10 – Abdomen Rectus abdominis – rectus sheath - linea alba External oblique – internal oblique – transversus abdominus Post wall – quadratus lumborum, psoas major/minor Large intestines have bands called taeniae coli which cause bulges called haustra. Arteries o Celiac artery Left gastic artery Splenic artery Left gastroepiploic Hepatic artery Gastroduodenal artery o Right gastroepiploic o Right gastic artery o Cystic artery o Superior mesenteric artery Jejunal & illeal branches Middle & right colic artery Illeocolic artery o Inferior mesenteric artery Left colic artery Sigmoid branches Superior rectal artery Veins o The branchs are drain the same o Inferior mesenteric vein joins splenic, which will then join superior mesenteric, This creates the hepatic portal vein Kidneys o Each kidney gets a renal artery & renal vein o Adrenal gland gets superior suprarenal artery (from inferior phrenic artery), middle suprarenal arter (From aorta) and inferior suprarenal artery (from renal artery) o On the left, the suprarenal vein joins with renal vein first This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. o On the right, the suprarenal vein goes direct to the IVC. Gonadal blood o Arteries come off of the abdominal aorta o Left vein goes into left renal vein o Right vein goes to the IVC directly. Chapter 11 – The Pelvis Pelvis – pubis, ischium and illium o Auricular surface - greater sciatic notch – ischial spine – lesser sciatic notch – ischial tuberosity o Anterior/posterior sacroiliac ligament o Sacrospinous ligament o Sacrotuverous ligament o Sex differences Subpubic angle – females have it wider Ischiopubic ramus – men is convex, female is concave Body of pubic – men have it tall and narrow. Greator sciatic notch – more pronounced in females Auricular surface – bigger on males Anococcygeal raphe – part of that middle tendon from rectum to sacrum Perineal body – tendom from urogenital hiatus to rectum Ischiorectal fossa – space filled with fat around anal sphincter Pouches o Rectovesical in males o Uterovesical & rectouterine in females Fornix – fold of vagina past the cervix Ovary o Tunica albuginea is the outside. o Under that is the germinal epithelium o Stroma is what ovaries are filled with o After a mature follicle releases a cell, it becomes a corpus luteum. o After that, the corpus luteum becomes the corpus albicans o Mesovarian – “messentary” that connects ovary to tubes Blood supply o Arteries You have ovarian/testical. Superior rectal from the inferior mesenteric. This document is the property of Nerdy Notes (www.nerdy-notes.com). Permission is granted to view this document only to authorized users; under no circumstances are you allowed to distribute, store or transmit this document without the express, written consent of Nerdy Notes, Inc. External iliac artery gives off inferior epigastric artery.. which gives off a branch to the cremaster muscle Internal Iliac artery branches into post & ant Posterior branches into lateral sacral artery Anterior branches into a bunch of things Umbilical artery, which also gives off superior vesical artery Middle rectal artery Either inferior vesical artery (men) or uterine artery (women) Internal pudendal artery o Inferior rectal artery o Perineal artery o Artery of clit/penis o Veins – Follow same exact thing as the arteries Nerves o You have lumbar & sacral plexuses at play. o Ventral rami of S2-S4 make the pudendal nerve, which provides inferior rectal nerve to anal sphincter. The pudendal than breaks into perineal nerve or dorsal nerve of clit/penis o Sympathetic trunks run down through the abdomen via paravertebral ganglia untill they merge in front of coccyx at the superior hypogastric plexus. o The nerves from the superior hypogastric plexus then travel down to where it forms with the inferior hypogastric plexus with the parasympathetic pelvic splahnic nerves.