Professional Documents
Culture Documents
Metencephalon is Pons.
Myelencephalon is Medulla oblongata.
Brainstem mean Mid brain, pons, medulla.
Sulcus mean surface depression.
Gyrus means surface elevation.
Cortex Grey matter cover surface of cerebral and cerebellar hemispheres.
Rhomboid fossa is floor of 4th ventricle.
Calamus scriptorius is caudal end of rhomboid fossa (resembles nib of a pen).
Locus ceruleus is bluish grey area in floor of 4th ventricle.
Restiform body is large lateral component of inferior cerebellar peduncle.
Juxtarestiform body is small medial component of Inferior cerebellar peduncle.
Brain and spinal cord are enclosed in meninges dura, arachnoid and pia.
▪ Cranial dura has two layers, an outer endosteal and an inner meningeal layers.
▪ Spinal dura is continuation of meningeal layer.
▪ CSF is formed either by secretion or ultrafiltration from choroid plexus.
▪ Blood vessels of brain run in subarachnoid space.
1. Medualla oblongata continues as spinal cord at the upper border of atlas.
2. Filum terminale is a connective tissue filament extending from conus medullaris to the 1st
coccygeal segment, Initial 15 cm of
3. this is filum terminale internum and extends upto 2nd sacral vertebral where dura and
arachnoid meninges stop.
4. Last 5 cm is filum terminale externum, contains only pial extension and terminates at 1 st
coccygeal segment.
5. Cervical enlargment of spinal cord corresponds to C3 to T2 spinal segments; lumbar
enlargment corresponds to L1 to S3 spinal segments.
6. In spinal cord, grey matter is inside and presents anterior and posterior horns; white matter
is outside and is divided into posterior, lateral and anterior funiculi by emerging dorsal and
ventral roQts of spinal nerves.
7. Grey matter is traversed by Central canal and white matter has ascending and descending
tracts.
8. Posterior funiculus has fasciculus gracillis and cuneatus.
9. Anterior 2/3 of cross sectional area of Spinal cord is supplied by branches of anterior
spinal arterior and the rest by posterior spinal artery and pial plexus.
10. Cervical 8, Thoracic 12, Lumbar 5, Sacral 5, coccygeal 1.
11. Basal ganglia include caudate nucleus and lentiform nculeus.
12. Corpus striatum includes caudate nucleus and lentiform nucleus.
13. Putamen and globus pallidus are subdivisions of lentiform nucleus.
14. Paleo striatum is globus pallidus.
15. Corpus callosum is a great cerebral commissure.
16. Ventricles are cavities lined with ependyma and contain CSF.
17. Illrd ventricle and IVth ventricle communicate with each othr through cerebral aqueduct.
18. IVth ventricle has a floor (Rhomboid fossa) and a roof.
19. Sacral outflow is from SI, S2, S3 spinal segments.
20. Retrolentiform and sublentiform, parts of internal capsule have optic and auditory
radiations respectively.
21. Basal vein is formed by union of deep middle cerebral vein, anterior cerebral vein, and
striate veins. It opens into great cerebral vein.
22. Choroidal vein and thalamostriate vein unite and form internal cerebral veins.
23. Great cerebral vein is formed by the union of two internal cerebral veins
24. Sciatic nerve is a branch of sacral plexus – its tibial component is L4, L5,, S1, S2 and
common peroneal component is L4, S1.S2.
25. Main role of menisci of knee joint is in — Rotation.
26. Main dorsiflexor of foot is — Tibialis anterior.
27. Highest point of medial longitudinal arch of foot is at — Head of talus.
28. Most important ligament in maintainance of medial longitudinal arch is — Spring ligament.
29. Abductor compartment of thigh is represented in upper limb by —Nervus hesitans.
30. Nerve involved in Meralgia paraesthetica is —Lateral cutaneous nerve of thigh (L2,3).
31. Blood supply toS.A.node of heart is derived from —Right coronary artery.
32. Cusps of Semilunar valve of Aorta are —One anterior and two posterior.
33. Cusps of semilunar valve of Pulmonary trunk are — one posterior and two anterior.
34. Cusps of tricuspid valve are —Septal, Anterior, Posterior.
35. Papillary muscles of right ventricle are —Septal, Anterior, Posterior.
36. Circumflex branch of left coronary artery supplies mainly —Left atrium.
37. Apex of heart is situated at —Left fifth intercostal space.
38. Chief muscle of inspiration is —Diaphragm.
39. Motor nerve of diaphragm is from —Phrenic nerve (C3,4,5)
40. Bronchopulmonary segment is not a bronchovascular segment because —It has not got
its own vein lies in intersegmei plane.
41. Thinnest wall of all the four -chamber of heart is of —Right atrium.
42. Bundles ofKentare (cause of W.P.W. syndrome)—Abnormal muscle bridges between atria
and ventricle.
43. Duration of cardiac cycle — is 0.8 second.
44. Early functional closure of foramen ovale is mainly due to — Pressure difference.
45. Initial closure of ductus arteriorus is mainly due to — Muscular contraction (Mediated by
bradykinin).
46. Anterior vagal trunk at oesophageal hiatus is formed by — Left vagus.
47. Posterior vagal trunk at oesophageal hiatus is formed by — Right vagus.
48. Tricuspid orifice of heart is located at — Right fifth Interocostal space.
49. Action of vagus nerve on heart is — Inhibitory.
50. Action of vagus on gut is — Facilitatory.
51. Angle of Louis (Sternal angle) is located at — Articulation of second rib.
52. Ligamentum arteriosus is present in between — Left pulmonary artery and arch of aorta.
53. Inferior venacava enters right atrium at the level of — Sixth chondro-sternal joint.
54. Trachea bifurcates at the level of —Lower border of Fourth thoracic vertebra (in cadaver).
55. Level of beginning of arch of aorta is —T4-Vertebra.
56. Level of thoracic aorta piercing diaphragm is —T12 – Vetebra.
57. Level of of Oesophagus passing through diaphragm is —T10.
58. Azygous vein crosses to opposite side at the level of —T4
59. Level of inferior venacava piercing diaphragms is —T8.
60. Level of transpyloric plane is at —LI.
61. Coeliac artery arises from abdominal aorta at the level of —T12.
62. Superior venacava develops from — Right common cardinal vein, Right anterior cardinal
vein.
63. Coronary sinus develops from — Left horn of sinus venosus, Left common cardinal vein.
64. Left umblical vein ends into —Left branch of portal vein.
65. Muscles of back get motor innervation from —Dorsal primary rami.
66. Contents of lieno-renal ligament are —Splenic artery and tail of pancreas.
67. Space of Disse is — a space between hepatocytes and hepatic sinusoids
Erb’s Paralysis …Forcible widening of the angle between the head and the shoulder, upper trunk
at Erb’s point sustains injury resulting in Erb’s paralysis. This leads to Porter tip deformity.
Injury to roots…. (Tearing away of 1st thoracic root) associated with cervical sympathetic
paralysis—Horner’s syndrome. This is characterized by constriction of pupil, ptosis, apparent
enophthalmos, anhidrosis on affected side of face and netk.
Sleep paralysis….Median and radial nerves suffer due to pressure effet while the patient is
asleep under the influence < alcohol.
Winging of scapula ….Due to paralysis of long thoracic nerve common in people carrying heavy
weights on shoulder for the nerve is exposed to injury in posterior triangle, (porter’s paralysis).
Ape hand is due to median nerve injury proximal to origin of its muscular and anterior
interosseous branches.
Pointing index finger …lesion produced due to injury of median nerve just above the middle of
forearm. There is on| weakness in flexion of index finger as the nerve to that part of flexor
digitorum superficialis is given at about the middle forearm.
Ulnar claw hand is due to injury to ulnar nerve….Mild degree of clawing observed which leads to
extension of 1 st phalanges of 4th & 5th fingers and flexion of 2nd and 3rd phalanges. .
True claw hand… a combined ulnar and median nerve lesions at elbow causes ‘true claw hand’.
▪ Ophthalmic artery
▪ Posterior communicating artery
▪ Anterior cerebral artery
▪ Middle cerebral artery.
Most common age group for appendicitis is teenagers and young adults, because at this age the
lumen of appendix is very narrow.
Ampulla is the widest portion of rectum, lying just above the pelvic floor. It is usually empty
because faeces are stored in sigmoid colon.
The cardinal features of large gut (i.e taeniae, appendices epiploicae and sacculations) are
absent in rectum.Houston’s valves are semicircular rectal folds present at inner wall of rectum.
They are three in number. because of mesenteric attachment, liver moves with diaphragm during
respiration.
Anatomically right and left lobe are separated by a line passing along falciform ligament.
The line of division of surgical lobes passes from gall bladder fossa to inferior venacava. Liver
has been divided into eight segments, which has got importance in segementectomy of liver,
jixamural portion in the narrowest portion of CBD.
Mucosal fold in cystic duct is called ‘Valves of Heister’, which maintains the patency of cystic
duct. G3 can undergo distension upto 50 times.
Posteromedial wall of neck of Gall bladder is dilated, and is known as Hartmann’s pouch.
Calot’s triangle is formed by common hepatic duct on the left, liver above and cystic duct on the
right side. In 90% cases, 3 sac artery lies in Calot’s triangle. Failure of complete rotation of
ventral bud leads to annular pancreas.
Portal vein is formed by union of superior mesenteric vein and splenic vein behind the neck of
pancreas at the level of L2 vertebra.
Umbilicus corresponds to T10 spinal segment. Deep fascia is absent over anterior abdominal
wall.
Space between the external oblique aponeurosis and membranous layer of superficial fascia
near inguinal region is called “superficial inguinal pouch”.
Reflected part of inguinal ligament and pectinate ligament are other extensions of inguinal
ligament.
Superficial inguinal ring is an opening in the external oblique aponeurosis located just above and
lateral to crest of pubis.
Deep inguinal ring is a gap in transversalis fascia present about 1.25 cm above mid inguinal
point.
Space between hip bone and inguinal ligament is pelvifemoral space. Through this vessels,
nerves and two muscles pass from abdomen to thigh.
Inguinal canal is a musculo aponeurotic tunnel extending from deep inguinal ring to superficial
inguinal ring. It is about 4 cm long.
Rectus sheath : An aponeurotic sheath which envelopes the rectus abdominis muscle. It
prevents bow stringing of the muscle.
Umbilicus — T|{)
Carcinoma head of pancreas speedily involves the bile duct and may cause jaundice or may
press on portal vein and cause ascites or obstruct pylorus.
Blood less zone of Brodel is not blood less in kidney – Hence radial or intersegmental incisions
are preferred during surgery on kidney.
Safe position to divide the ureter is 2 cm below the bifurcation of common iliac artery as the
inferior vesical artery supplies the lower part.
Pubococcygeus supports vagina, urethra and anus, Injury to pubococcygeus and pelvic fascia
results in cystocele.
Prostatic tumors may spread to vertebrae as the prostatic venous plexus drains to inferior
venacava through sacral veins and vertebral venous plexus.
Removal of metastatic lymph nodes from the lateral pelvic wall may cause damage to obturator
nerve (as it runs in the extra peritoneal tissue of lateral pelvic wall) resulting in weakness of
adduction of thigh on the affected side.
Abscess in the rectouterine pouch can be drained through posterior vaginal wall at posterior
fornix.
In mediolateral episiotomy levator ani muscle is usually spared as that muscle supports pelvic
floor.
All muscles of anterior group of thigh are innervated by femoral Nerve (L2,3,4)
Locking of knee occurs by Medial Rotation of lower and of femur on tibia during terminal stages
of extension, when feet are supporting the body weight.
Remnants
Pancreatic islets are more abundant in the tail of the pancreas and contain a cells which secrete
glucogen; P cells which secrete insulin; y cells secrete somatostatin which inhibits secretory
activity of beta or more a alpha cells.
GEP (Gastro Entero Pancreatic) endocrine system belongs to APUD cell series and has
scattered solitary hormone producing cells in gastrointestinal mucosa and pancreas.
Lamina propria of the intestine is the chief site for production of the secretory immunoglobulin
(IgA). Secreted IgA coats the mucosal surface and prevents the attachment of the antigen to the
intestinal cells. IgA is important for local immunological process through out the body.
Epithelium covering the Payer’s patches has “M” cells which help in immune responses.
Lining of terminal bronchioles is simple columnar or cuboidal epthelium with or without cilia but
without mucous glands or goblet cells in the wall.
Interalveolar septum in between the alveoli is composed of lining cells of adjacent alveoli and
structures interposed between them (capillaries).
Striated ducts of the salivary glands modify the composition of alveolar secretions.
3 cells of the islets comprise 60-90% of all the islets cells. They are in the central part, a cells are
located in peripheral part.
Terminal bronchioles are the finer divisions of conducting part of respiratory system which are
0.5 mm or less in diameter.
Sertoli cells of the testis produce steroids, secrete fluids including androgen binding protein,
inhibin in adult and Mullerian inhibiting hormone in the fetus and estrogens.
One type of entero endocrine cell may become numerous and produce carcinoid tumour,
characterised by excessive secretion of serotonin.
Premature infants suffer with respiratory distress syndrome due to lack of type II pneumocytes in
lungs.
Talus is the key stone of the arch. It receives body weight and transmits it to the arches below.
Body to the axis (C2) bears a strong process getting vertically upwards from its superior surface.
This process is “odontoid process” which is the detached centrum of atlas.
Bodies of 5th to 8th thoracic vertebrae on left side show flattening due to pressure of thoracic
aorta.
Failure of fusion of two arch centres posteriorly results in “spina bifida” occurs commonly in
lumbar region. If the deformity is not associated with neurological abnormality it is “spina bifida
occulta”.
When the defect involves one or several arches, spinal cord with meninges may prolapse
(meningomyelocele).
Fractures of spine most commonly involve T12 LI and L2 — cause is usually flexion compression
type of injury.
Disc prolapse or prolapsed intervertebral disc is protrusion of nucleus pulposus posteriorly into
vertebral canal through posterior part of annulus fibrosus either due to trauma or degenerative
changes in the annulus. Most common sites are L4L5 or L5/ SI.
Plane of greatest pelvic dimensions is at the level of pelvis where the cavity is most spacious. It’s
antero posterior diameters taken from a point between 2nd & 3rd sacral vertebrae and middle of
symphysis. Children under 9 years and males have anthropoid type of pelvis (dolichopelvic).
▪ Abrupt pronation during tennis play causes sprain or partial tear of radial collateral
ligament. This is manifested as pain tenderness over lateral epicondyle.
▪ Tennis elbow is a condition which has either sprain of lateral ligament of elbow joint or tear
of some fibers of extensor radialis brevis or an inflammation of its bursa.
▪ Lumbar triangle of Petit is triangular area bounded by Latissimus dorsi, iliac crest and
external oblique.
▪ arcuate ligament is a poorly defined arch in front of aorta connecting the medial tendinous
Median margins of crura of diaphragm.
▪ Medial arcuate ligament is the tendinous arch in fascia covering the psoas major muscle.
▪ Lateral arcuate ligament is the tendinous arch in anterior layer of thoraco-lumbar fascia
covering Quadratus lumborum muscle.
▪ Biceps brachii is a flexor of elbow and a powerful supinator of forearm when the arm is
semiflexed.
▪ Brachioradialis is flexor of elbow when the forearm is in mid prone position.
▪ Lumbrical muscle tendon in hand turns round the lateral sides of fingers, but in foot they
turn round the medial sides of to reach the dorsal digital expansions.
▪ Motor supply to skeletal muscles is through spinal or cranial nerves, but to cardiac and
smooth muscles it is through autonomic nerves.
▪ All the muscles of mastication are supplied by mandibular division of trigeminal nerve (V
Cranial).
▪ All anterior crural muscles are supplied by deep peroneal nerve..
▪ Posterior crural muscles are all supplied by tibial nerve.
▪ A muscle which initiates and maintains a movement is a prime mover.
▪ A muscle which can initiate and maintain an opposite movement of the prime mover is
antogonist.
▪ A muscle which can eliminate the additional unwanted movements produced by a prime
move at a joint other than the desired joint is called a synergic muscle.
▪ Muscles of head can be grouped into muscles of facial expression and muscles of
mastication.
▪ Trumpeter’s muscle is buccinator.
▪ In quiet inspiration, the thoraco-abdominal diaphragm is the sole muscle concerned with
movements.
▪ Triangle of auscultation—a space bounded by trapezius, latissimus dorsi and medial
border of scapula. Deep to this triangle, cardiac orifice of stomach lies (on left side). (1) In
oesophageal obstruction s splash of swallowed liquied can be ausculated in the region of
left side. (2) Apex of lower lobe of both lungs is located beneath this area of corresponding
sides.
▪ Torticollis is deformity due to contracture of sternocleidomastoid muscle.
▪ Paralysis of gluteus medius and minimus produces lurching gait.
▪ Triangle of Koch is area on where AV node is located in right atrium.
▪ Annulus of Vieussen’s is Arterial circle formed by right and left conus arteries at the
commencement of pulmonary trunk.
▪ Recurrent artery is central branch arising from anterior cerebral artery.
▪ Rateson’s plexus is internal vertebral venous plexus.
▪ “Moderator band” runs in septomarginal trabecul to anterior papillary muscle.
▪ On the left aspect of Interatrial septum “Lunate impression” is the representative of osteum
secundum.
▪ Superior thyroid artery is related to external laryngeal nerve. Nerve lies frequently on a
more posterior plane.
▪ Superior laryngeal artery which is in close relation with internal laryngeal nerve is a branch
of superior thyroid artery.
▪ Axillary artery is the continuation of subclavian artery at the outer border of 1st rib.
▪ Arteria princeps pollicis is a branch of radial artery. It turns medially into palm and supplied
nutrient artery to 1 st metacarpal bone.
▪ Arteria radialis indicis frequently arises from arteria princeps pollicis.
▪ “Thoracic Aorta commenses at lower border of T4 and terminates at lower border of T12
(aortic opening of diaphragm) and continues beyond that level as abdominal aorta upto L4
vertebra. Here it divides into two common iliac arteries.
▪ Supraduodenal artery is a branch either from gastroduodenal or hepatic vessels.
▪ Gastroduodenal artery is a brach of hepatic and divides into superior pancreatico
duodenal (supplies pancreas &
▪ duodenum) & right gastroepiploic arteries.
▪ Gastro epiploic vessles run in greater omentum along the greater curvature of stomach.
▪ Coeiiac artery supplies lower part of oesophagus, stomach, 1 st and upper half of 2nd part
of duodenum.
▪ Profunda femoris artery gives lateral and medial circumflex femoral and four perforating
arteries.
▪ Femoral artery runs in adductor canal (subsartorial canal) and becomes popliteal artery at
the level of adductor opening.
▪ Coronary sinus opens into right atrium and guarded by a valve; tributatries are great
cardiac vein, small cardiac vein,middle cardiac vein, posterior vein of left ventricle and
oblique vein of left atrium.
▪ Superior vena cava drains upper limbs, head, neck and thorax into posterior part of right
atrium.
▪ Veins draining the face:Angular, Facial maxillary, Middle temporal
▪ Tributaries of Internal Jugular vein are :Veins of tongue, Veins of pharynx, Veins of thyroid,
Veins of face (through facial vein), Inferior petrosal sinus
▪ Right coronary artery supplies conducing system of heart as far as proximal parts of the
right and left bundle branch.
▪ SA node is supplied by right coronary artery (artery to SA node or nodal artery).
▪ AV node is supplied by right coronary artery (branch of large posterior septal artery, a
branch of posterior interventricular branch of right coronary artery).
▪ Posterior interventricular artery is a branch of right coronary given at the crux of heart.
▪ Anterior interventricular artery is a branch of left coronary artery.
▪ “Circle of willis” is formed by posterior cerebral, middle cerebral, anterior cerebral,
posterior communicating arteries and is located in inter peduncular fossa of base of brain.
▪ Tonsillar artery is a branch of facial artery.
▪ Middle meningeal artery is a branch of maxillary.
▪ “Anastomosis around the elbow” is between superior and inferior ulnar collateral,
descending branches of profunc
▪ brachi, ulnar recurrent, radial recurrent, and interosseous recurrent arteries.
▪ Arteries taking part in “anastomoses around the knee joint” are medial & lateral genicular
arteries, descending genicular artery, descending branch of lateral circumflex femoral,
circumflex; fibular, anterior and posterior tibial recurrent artery.
▪ “Cruciate anastomoses” is formed by 1st perforating branch of profunda femoris, branch of
inferior gluteal, branch medial and lateral circumflex femoral vessels.
▪ Trochanteric anastomosis is formed by branches of superior gluteal artery, ascending
branch of lateral circumflex and deep circumflex iliac artery.
▪ Emissary veins connect the intercranial venous sinuses with extracranial veins.
▪ Cavernous sinus contains internal carotid artery, III, IV, VI and maxillary division of V
cranial nerves in its walls wide communication with veins outside the skull.
▪ Sigmoid sinus is in close relation to mastoid antrum.
▪ Great cerebral vein opens into straight sinus.
▪ Basivertebral veins drain the bodies of vertebrae.
▪ In fetus, internal iliac artery is twice as large as external iliac artery.
▪ 1st part of superior vesical artery is the proximal patent section of umbilical artery.
▪ Superiorand middle thyroid veins open into internal jugular vein and Inferior thyroid veins
into brachiocephalic of corresponding sides.
▪ Shadow of left profile of aortic arch in X-ray photographs is called “aortic knuckle”.
▪ In wounds of Palmar arches, ligature of vessels proximal to wrist may be inefffective as
there is anastomoses between radial and ulnar arteries through their palmar and dorsal
carpal branches and other branches.
▪ There is constant anastomosis between branches of last sigmoidal and superior rectal
arteries “Critical point of Sudack” is non anastomatic area on sigmoid colon when the
above anastomosis is absent.
▪ Facial vein has communications with cavernous venous sinus, hence infective thrombosis
of facial vein may extend to the intracranial venous sinuses.
▪ In thrombosis of superior bulb of internal jugular vein IX, X, & XI nerves are involved.
▪ Cannulation of basilic vein is more liable to be successful than cephalic as the basilic vein
continues as axillary vein without angulation.
▪ Axillary vein thrombosis in prolonged abduction (Eg. Painting a ceiling) may be due to the
groove produced by subclavius muscle on the 1st part of vein where there is a valve in the
wall.
▪ Obstruction of portal vein may produce opening of sites of portocaval anastomoses which
are at:
▪ Lower end of oesophagus — leads to oesophageal varices. (Communication between left
gastric & azygos system of veins).
▪ Umbilicus-caput medusae—due to opening up of para umbilical veins
▪ Lower end of rectum & anal canal — communication between
▪ The Schwann cells form the neruolemma and myelin sheath of nerve fibres in the
peripheral nervous system whereas oligodendrocytes form myelin around nerve fibres in
the CNS
▪ This is the only long bone that lies horizontally in the body
▪ It is the first time to ossify in the body
▪ It is the only long bone which ossifies from two primary centres
▪ It has no medullary cavity
▪ Occasionally, it is pierced by middle supraclavicular nerve
The largest cerebellar efferent bundle is the superior cerebellar peduncle. This is formed by
fibres from the globose, emboliform and dentate nuclei.
According to Wolff’s law, the bone formation is directly proportional to stress and strain
Motor point is the site where the motor nerve enters the muscle
It is osseofibrous tunnel between concave palmar suface of carpal bones and deep surface of
flexor retinaculum of wrist Contents
2.Four Tendons of Flexor Digtorum Profundus These 8 tendons are enclosed in a common
synovial sheath (Ulnar Bursa)
3.Median Nerve
End Arteries
Artereis which do not anastomose with their adjacent one are called end arteries. e.g.
Branches
—Ant.interventricular branch.
— Circumflex branch.
Distribution
Note : Branches of both Rt. & Lt. coronary arteries supply interatrial and interventricular septa.
IMPORTANT RELATIONS
B.Retroduodenal part
C. Infraduodenal part
1. Anteriorly : a groove in the upper and lateral parts of the posterior surface of the head of the
pancreas.
1.The upper pole of each kidney is related to the corresponding suprarenal gland. The lower
poles lie about one inch to the iliac crests.
2.The medial border of each kidney is related to (i) the suprarenal gland, above the hilus; and (ii)
to the ureter below hilus.
3. Posterior relations .
The posterior surfaeces of both kidneys are related to : (1) the diaphragm; (2) the medial and
lateral arcuate ligaments; (3) the psoas major; (4) the quadratus lumborum; (5) the transversus
abdominis; (6) the subcostal vessels; and (7) the subcostal, iliohypogastric and ilioinguinal
nerves. In addition, the right kidney is related to 12th rib, and the left kidney to 1 lth and 12th ribs.
1.Anterior relations:
1.Right suparental gland; (2) liver; (3) second part of duodenum; (4) hepatic flexure of colon and
(5) small intestine. Out of these the hepatic and intestinal surfaces are covered by peritoneum.
2.The lateral border of the right kidney is related to the right lobe of the liver and to the hepatic
flexure of the colon.
1.Anterior relations :
1.left suprarenal gland; (2) spleen; (3) stomach; (4) pancreas; (5) splenic vessels; (6) splenic
flexure and descending colon; and (7) jejunum. Out of these the gastric, splenic and jejunal
surfaces are covered by perotoneum.
2.The lateral border of the left kidney is related in the spleen and to the descending colon.
B.The anterior surface is devoid of peritoneum, except for a small part inferiorly. It is related to :
(1) the inferior vena cava medially; (2) the liver, laterally; and (3) occasionally to the duodenum,
inferiorly.
D.Anterior border. A little below the apex it presents the hilum where the suprarenal vein
emerges.
E.Medial border. It is related to : (1) the right coeliac ganglion; and (2) the right inferior phrenic
artery.
Relations of Left Suprarenal Gland A.Anterior surface. From above downwards it is related to : (1)
the cardiac end of the stomach; (2) the splenic artery; and (3) the pancreas. The upper end may
be related to the posterior extremity of the spleen. Near the lower end there is the hilum through
which the left suprarenal vein emerges. Only the gastric impression is covered by peritoneum (of
the lesser sac):
B.Posterior surface. It is related to : (1) the kidney, laterally; and (2) the left crus of the
diaphragm, medially.
C.Medial border. It is related to : (1) the left coeliac ganglion; (2) the left inferior phrenic artery;
and (3) the left gastric artery.
THORAX
Contents
a. Muscles attached to sternum (sternothyroid and sternohyoid)
b. Remnants of thymus gland
c. Vessels
1. Arch of aorta
2. Origin of brachiocephalic, left common carotid, and left subclavian arteries
3. Left and right branchiocephalic veins
4. Superior vena cava
d. Trachea
e. Esophagus
f. Nerves and plexuses
1. Vagus—right and left
2. Left recurrent laryngeal
3. Phrenic—right and left
4. Cardiac plexus (superficial)
g. Lymphatics
1. Brachiocephalic and tracheobronchial nodes
2. Thoracic duct
Inferior mediastinum—has three subdivisions that extend downward from lower border of
superior mediastinum to diaphragm
1. Anterior mediastinum
a. Location—posterior to body of sternum and attached costal cartilages, anterior to heart
and pericardium
b. Contents
1. Fat
2. Remnants of thymus gland
3. Anterior mediastinal lymph nodes
2. Middle mediastinum
a. Location—between anterior mediastinum and posterior mediastinum
b. Contents
1. Heart and pericardium
2. Beginning or termination of great vessels
3. Pulmonary arteries and veins
4. Phrenic nerves
5. Bifurcation of trachea
6. Tracheobronchial lymph nodes
7. Cardiac plexus (deep)
Posterior mediastinum
a. Location—posterior to heart and pericardium, anterior to vertebrae T5-T12
b. Contents
1. Esophagus
2. Descending aorta and origins of posterior intercostal arteries
3. Azygos system of veins and termination of posterior intercostal veins
4. Nerves
a. Vagus nerves
b. Splanchnic nerves
5. Lymphatics
a. Thoracic duct
b. Posterior mediastinal nodes
c. Tracheobronchial nodes
d. Bronchomediastinal trunk