SECONDARY retroperitoneal organs = A-PAD Adrenal glands, Pancreas, Ascending and descending colon and Duodenum. Omentum = FOLD of the peritoneum. Greater omentum folds back on itself and attaches to the TRANSVERSE COLON. Lesser omentum = HepatoGASTRIC and hepatoDUODENAL ligaments. Greater omentum = GastroPHRENIC, gastroSPLENIC and gastroCOLIC ligaments. Lesser omentum = EPIPLOIC FORAMEN OF WINSLOW. Foramen of Winslow Anterior = PORTAL TRIAD (within the hepatoduodenal ligament), Posterior = IVC and right crus of diaphragm, Superior = CAUDATE lobe of the liver and Inferior = First part of the duodenum. Sigmoid colon = inverted V-shaped. 3 ligaments of liver = Falciform ligament (also has ligamentum Teres or Round ligament in free edge), Hepatogastric ligament and Hepatoduodenal ligament. GastroSPLENIC ligament has SHORT GASTRIC and LATERAL GASTROEPIPLOIC VESSELS. SplenoRENAL ligament has splenic vessels and TAIL of pancreas! ASCITE accumulation of fluid in peritoneal cavity gives distended abdomen. PERITONITIS inflammation of peritoneum.
Anterior Abdominal wall and rectus sheath:
4 quadrants of the abdomen and 9 REGIONS right and left HYPOCONDRIAC regions, right and left LUMBAR regions, right and left ILIOINGUINAL regions, EPIGASTRIC region, UMBILICAL region and HYPOGASTRIC region. Skin Camper’s fascia Scarpa’s fascia External oblique Internal oblique Transverse abdominal Transversalis fascia Parietal peritoneum. Scarpa’s fascia CONTINUOUS with DARTOS (in scrotum) and COLLES fascia (perineum). Also fuses with FASCIA LATA. External oblique = HANDS IN POCKET orientation. CONJOINT TENDON = inferior aponeurotic fibers of INTERNAL OBLIQUE join with those of TRANSVERSUS ABDOMINIS. Arcuate line LOWER LIMIT of POSTERIOR layer of RECTUS SHEATH. Hematoma of rectus sheath from inferior epigastric artery blunt trauma to the abdominal wall (kick). Nerves are found in BETWEEN internal oblique and transversus abdominus. Lymph drainage: ABOVE the umbilicus AXILLARY nodes and BELOW the umbilicus SUPERFICIAL INGUINAL nodes. McBurney’s point located 1/3rd of the way in between ASIS and umbilicus. Anterior abdominal wall FIVE peritoneal folds BELOW the umbilicus MEDIAN (remnant of URACHUS), TWO MEDIAL (remnant of UMBILICAL ARTERIES) and TWO LATERAL (INFERIOR EPIGASTRIC VESSELS).
Supracolic I and II:
Retroperitoneal organs SAD PUCKER supra renal gland, aorta, duodenum (2nd and 3rd segment), pancreas (except for tail), ureters, colon (ascending and descending), kidney, esophagus and rectum. 1
First 2cm of duodenum HAS MESENTARY INTRAPERITONEAL. Esophageal varices enlarge when there is portal hypertension because of their involvement in the ANASTOMOSIS. red blood in stool). Esophagus has THREE NORMAL constrictions CERVICAL (cricopharyngeus muscle upper esophageal sphincter). Gastric canal quick passage of liquid. Carcinoma of stomach TROISER’S SIGN enlarged LEFT supraclavicular node of VIRCHOW! DUODENAL ulcers are MOST common POSTERIOR wall of the FIRST part may erode GASTRODUODENAL artery. Cystic duct + common hepatic duct = COMMON BILE DUCT! Common bile duct + pancreatic duct = HEPATIPANCREATIC ampulla or ampulla of VATER that opens into MAJOR duodenal papilla (sphincter of Oddi) NARROWEST part common site for gallstone to get stuck. Ulcer on POSTERIOR wall adhesion to pancreas and may erode SPLENIC artery. Nerve supply to the liver is from HEPATIC NERVE PLEXUS. other parts of the liver have to work harder = HYPERTROPHY. 2 RECESSES on the RIGHT (pus and fluid can hide here) Subphrenic (between lungs and liver – can drain fluid through 12th rib)) and Hepatorenal (called MORRISON’S POUCH). Ulcer on ANTERIOR wall may cause peritonitis and adhere to ANTERIOR wall. Sympathetic (T6-T9) INHIBIT peristalsis and CONTRACT pyloric sphincter. Cirrhosis of liver fatty liver (CAN fix it) and liver FIBROSIS (CANNOT fix it). Remnant of umbilical vein = ROUND LIGAMENT of liver (goes from umbilicus to the liver). Gall bladder STORES and CONCENTRATES bile CONTINUOUS with CYSTIC DUCT. PORTAL VEIN to IVC and SPLENIC to LEFT RENAL VEIN. Stomach innervation: Parasympathetic anterior and posterior VAGAL trunks INCREASES peristalsis and RELAXES pyloric sphincter.
Venous drainage of the ABDOMINAL esophagus DUAL drainage PORTAL VENOUS SYSTEM (through left gastric) and SYSTEMIC VENOUS SYSTEM (through esophageal veins entering azygous vein) something happens to liver portal CANNOT drain backflow to azygous weak vessels and BURST person bleeds portal hypertension. Splenic vein and SMA come together to form PORTAL VEIN behind the NECK of pancreas! PORTAL-SYSTEMIC anastomoses THREE PLACES between ESOPHAGEAL veins. 2 common hernias SLIDING (cardiac area slides up) and ROLLING (FUNDUS goes through hiatus). THORACIC (broncho-aortic) and DIAPHRAGMATIC (esophageal hiatus). 2
. When these veins get dilated CAPUT MEDUSAE! In order to TREAT portal hypertension. Caudate lobe is ABOVE quadrate lobe and FUNCTIONAL LEFT liver is left lobe PLUS the caudate and quadrate lobes. Ulcer on LESSER curvature may erode GASTRIC ARTERY. between SUPERIOR RECTAL veins and between PARAUMBILICAL veins. Lymph from the liver goes from hepatic nodes celiac nodes cisterna chyli. In liver fibrosis. Duodenojejunal junction is supported by LIGAMENT OF TREITZ! Ligament of Treitz is the cut-off for GI bleeding above it = UPPER GI bleeding and below it = LOWER GI bleeding (black stool vs. PYROSIS “heart burn” does NOT go away with rest gastric reflux CHANGES the epithelium BARRET’S ESOPHAGUS. can make a shunt THREE options SMA to IVC.
camper’s fascia = nothing. middle colic and ileocolic arteries. 5. splenic and common hepatic.
Inguinal region & Hernia:
Inguinal ligament inferior most part of the EXTERNAL OBLIQUE aponeurosis. transversus abdominus fascia = internal spermatic fascia and peritoneum = tunica vaginalis. ILIOINGUINAL nerve enters the inguinal canal but NOT at the deep ring. width. Spleen 1. 9-11 thickness. Female gubernaculum = becomes ovarian ligament (between ovary and uterus) and round ligament of the uterus (connects uterus to labia majora). Spermatic cord = vas deferens + testicular artery + artery of vas deferens. length. the right hepatic gives off the cystic artery. laterally = cystic duct and medially = common hepatic duct. scarpa’s fascia = dartos and colle’s fascia.
Celiac trunk gives off left gastric.
Cystic artery is found in the TRIANGLE OF CALOT’S boundaries: superiorly = liver. Cancer at the HEAD of pancreas causes bile duct obstruction at ampulla of vater OBSTRUCTIVE JAUNDICE. o Left gastric goes to the lesser curvature of the stomach and gives off an esophageal branch. splenic branches and pancreatic branches. Put the finger in ask them to cough feel it on the back of the finger = DIRECT and if feel it on the tip of the finger = INDIRECT. laterally = inferior epigastric and inferiorly = inguinal ligament. Cancer at the NECK of pancreas causes portal or IVC obstruction. external oblique muscle = external spermatic fascia. After giving these branches. internal oblique fascia = cremesteric fascia. Scrotal layers skin = skin. Nervous supply to pancreas T5-T9 Thoracic splanchnic carry pain sensation. internal oblique muscle = cresmesteric muscle. left gastroepiploic. Abdominal vs. SMA gives off inferior anterior/posterior pancreaticoduodenal. which connects with the left gastric on the lesser curvature. right colic. weight and ribs location. 7. Proper hepatic then divides into right and left hepatic from which. o Splenic runs on TOP of the PANCREAS gives off short gastric. o Site for DIRECT hernias. HASSELBACH’S TRIANGLE boundaries: medially = lateral border of rectus abdominus. transversus abdominus muscle = nothing. 3. o Ligation of arteries when removing spleen has to be at an appropriate site of else it will disrupt the flow to short gastric arteries. In relation to PUBIC tubercle inguinal hernia are ABOVE and MEDIAL whereas femoral hernia are BELOW and LATERAL. CREMESTERIC REFLEX afferent = ilioinguinal and femoral branch of the genitofemoral and efferent = genital branch of the genitofemoral nerve. o Common hepatic gives off gastroduodenal which goes and gives off the superior anterior/posterior pancreaticoduodenal branch (which will anastomose with SMA) as well as it anastomoses with the splenic via the right gastroepiploic artery. 3
. it becomes proper hepatic and gives off right gastric. Lacunar ligament TRIANGULAR shaped attaches to SUPERIOR PUBIC RAMUS. Hernia LATERAL to inferior epigastric = INDIRECT (comes from the DEEP ring) and MEDIAL to epigastric = DIRECT (enters the canal half way).
o Left colic supplies the descending colon. pararenal (paranephric) fat. Murphy’s SIGN 9th costal cartilage can palpate for GALLBLADDER. UNDER the uterine artery). the posterior supplies on the posterior part of the kidney whereas the anterior becomes apical. o Middle part aorta. anterior inferior and inferior there is also a small avascular part good entry site during surgery. MARGINAL artery forms the anastomosis between SMA and IMA. Murphy’s PUNCH TEST place hand on costovertebral angle and hit pain = kidney pathology. posterior surface of the kidney. Ureter pain LOIN AND GROIN pain. anterior superior. UNDER gonadal artery. Kidney covering from inside to outside renal capsule. Kidney pain COSTOVERTEBRAL angle. vomiting and pain in the right iliac fossa. Murphy’s TRIAD fever. o Right colic supplies ascending colon. o Ileocolic supplies the terminal ileum and ascending colon. 4
Kidneys and suprarenal glands:
Kidneys might get stuck when they are ascending and give HORSESHOE kidney blocked by IMA at the level of L3. Renal artery give anterior and posterior segmental arteries once they get into the kidney. Suprarenal glands blood supply: o Superior part inferior phrenic arteries. o Middle colic supplies the transverse colon. the part of the intestine that is being supplied will die vasa recta are END ARTERIES! Enlarged esophageal varices can give hemorrhoids and you can bleed from anus = HEMATOCHESIA! IMV drains into splenic vein and splenic vein joins with SMV to form the PORTAL VEIN! PRINGLES MANUVER put finger in foramen of Winslow and pinch cut blood supply to liver. NUTCRACKER SYNDROME Left renal vein and 3rd part of the duodenum lay in between aorta (posteriorly) and SMA (anteriorly) enlargement of SMA can COMPRESS the left renal vein LEFT testicular vein cannot drain there VERICOCELE or BAG OF WORMS! If the vasa recta is occluded. IMA gives off left colic. the adrenal glands REMAIN in their place because they are in a SEPARATE fascia (attached to diaphragm). renal fascia. If kidneys drop. InterLOBAR arteries arch over the pyramid and divide to give ARCUATE arteries further divide to give interLOBULAR arteries (renal lobule is in between the interlobular arteries). sigmoid and superior rectal arteries. Infection from kidney CAN go to pelvis but CANNOT go medially to the other kidney or to the adrenal glands this is due to the RENAL FASCIA. perirenal (perinephric) fat.
o Inferior anterior/postreior pancreaticoduodenal anastomoses with the superior pancreaticoduodenal from the gastriduodenal branch of the celiac trunk establishes the anastomosis between celiac trunk and SMA. VAP rule to determine the anterior vs. o Inferior part renal artery. OVER the common iliac artery and UNDER the superior vesicular (in females. Ureters WATER UNDER THE BRIDGE ureter runs UNDER renal artery.
posterior = pudendal nerve and also branches of posterior femoral. Your thoughts are LOGICAL in N-REM sleep – you keep thinking the SAME thing. stage 1 = THETA waves. visceral part of tunica vaginalis and parietal layer of tunica vaginalis. o 2 types of mucosa. Cancer from TESTES LUMBAR lymph nodes. tunica albuginea. stage 3/4 = DELTA waves and REM sleep = BETA waves. stage 2 = k-complex and spindles. when you sleep. From inside to outside on the testes. COMMUNICATING hydrocele processus vaginalis is open and fluid can move freely. VARICOCELE dilation of pampiniform plexus bag of worms disappears when person lies down. Have to be careful in appendix operation so that you don’t cut ILIOHYPOGASTRIC and ILIOINGUINAL.
iPhone notes High activity of Cholinergic neurons could mean either wakefulness or REM sleep if this activity is correlated WITH normal activity of Aminergic neurons = you are AWAKE but if its correlated with ZERO activity of aminergic neurons = REM sleep.o Right suprarenal vein drains into IVC. o Can be mistaken with appendicitis. o 2% of the population.
Testes and Scrotum:
Scrotum innervation anterior = ilioinguinal nerve. your thoughts are ILLOGICAL and movements are INHIBITED! Initially. you tend to wake up for a little while. o 2 feet proximal to ileocecal junction. the perception is INTERNALLY generated.
Infracolic viscera I & II:
Meckel’s diverticulum = syndrome of 2’s. NON-COMMUNICATING hydrocele fluid in tunica vaginalis but the processus vaginalis is CLOSED. Normally. processus vaginalis is obliterated. if their levels are high. o 2 inches long. When Serotonin and NE are released to kick you out of REM. anterolateral = genitofemoral. In REM sleep. HEMATOCELE collection of BLOOD in tunica vaginalis. o 2 major complications (bleeding and obstruction). o Left suprarenal vein drains into LEFT RENAL VEIN. Cancer from SCROTUM SUPERFICIAL INGUINAL lymph nodes. Awake = BETA waves. HYDROCELE persistent PROCESSUS VAGINALIS fluid accumulates glows RED. your deep sleep DISAPPEARS and you have LONG REM-sleep. Cecopexy staple the cecum to the posterior abdominal wall. CRYPTORCHID undescended testes. Ileum fat looks like curtains. 5
. you have LONG DEEP SLEEP and NO REM sleep but as it gets to cycle 4-6.
Evening people = more behavioral/psychological disturbances but are creative thinkers. Narcolepsy EXTREME tendency to fall asleep go STRAIGHT to REM. you have HIGH activity of extra-striate VISUAL cortical area but LOW activity of PRIMARY VISUAL CORTEX (because your eyes are CLOSED).
Memory: Semantic memory = memory that involves MEANING but does NOT involve a certain event. from mammillary bodies to anterior thalamus = mammalothalamic tract. Restless leg syndrome these people have LOW dopamine activity L-DOPA helps. Unilateral Hippocampal lesions NOTHING happens one is enough. there is another set of neurons from hippocampus straight to parahippocampus. sleep becomes RESTRICTED to night ONLY. Sleep WALKING = somnambulism. Sleeplessness = LOW leptin release = OBESITY. Bilateral HIPPOCAMPAL lesions ANTEROGRADE amnesia. Night terrors are NOT during REM sleep. Papez circuit neurons from Hippocampus to mammillary bodies = FORNIX. Memory formation = PAPEZ circuit How Many Apples Can Peter Eat Hippocampus Mammillary bodies Anterior nucleus of thalamus Cingulate cortex Parahippocampal gyrus Entorhinal cortex Hippocampus. If NO sleep given = death in 2-3 weeks. Mg is bound to NMDA receptors (voltage-sensitive ligand gated channels) and BLOCKS it high post synaptic depolarization (by glutamate which is binding to AMPA receptors at this point) Mg is released from NMDA receptors and Ca enters increases nitric oxide synthase activity NO produced and goes to the PRE-SYNAPTIC neuron causes the neuron to release glutamate in HIGH amount PERMANENTLY. B1) deficiency and damage to mammillary bodies people have anterograde and retrograde AMNESIA and CONFABULATION (make up memories). 6
. Wernicke-Korsakoff Thiamine (Vit. 10% of women are BILINGUAL. Also. from anterior thalamus to cingulate cortex = internal capsule. Working memory short-term working capacity of 7-9 numbers PREFRONTAL cortex is important. If NO REM sleep given = death in 4-6 weeks. Sleep TALKING = somniloquy. Parasomnia abnormal behavior or movements during NREM sleep normal in children/adolescent. WADA test paralyzes one side of the brain. from cingulate cortex to parahippocampus = cingulum bundle.
Cerebral Cortex: Language is dominantly in the LEFT hemisphere – 95% of the time for the RIGHT handed people and 61-73% of the time for LEFT handed people. Long-term potentiation = occurs at GLUTAMATERGIC synapses normally. In REM sleep. As a newborn. Light sleep = better PROCEDURAL memory and deep sleep = better DECLARATIVE/EPISODIC memory. the sleep-wake cycle is constant but as you grow older. Sleeplessness can cause METACOGNITION belief that one is right even though they are making the wrong decision.
Morning people = higher satisfaction with life.
o Band heterotopia double cortex.
When neurons migrate to the wrong place grey matter heterotopia double cortex. Miller-Dieker syndrome loss of sulci and gyri. If you displace the otoconia = VERTIGO can do EPLEY MANEUVER to put the otoconia back into there normal place.
Vestibular System: Spatial orientation receives information from THREE areas VISUAL. In the two VERTICAL canals. Conflict of information = carsickness. When you tilt the head. BOTH things in the ALLOCORTEX (olfactory and hippocampus) form NEW NEURONS. o Subcortical within the white matter. Maculae are in OTOLITH membrane and this is a HIGH DENSITY layer and therefore these cells DON’T move by simple endolymph movement. Tertiary sulci is the LAST to form and premature babies DON’T have them. posterior and lateral). it’s going down the spinal cord and brainstem (layer V has MOTOR neurons and layer VI sends output to THALAMUS). Alzheimer’s disease early = layers II and IV and later = layers V and VI. Neocortex has 6 layers. Eyes are the FIRST input to the brain moving bus when it isn’t moving. Stereocilia movement TOWARDS stereocilia = DEPOLARIZATION and AWAY = HYPERPOLARIZATION. Semicircular canals are for detection of circular acceleration arranged perpendicular to each other. If you SHOW it to them. There are 3 types: ALL HAVE EPILEPSY! o Subemendymal around ventricles. Layer III and V are PYRAMIDAL layers and contain BETZ CELLS (large pyramidal cells). Schizencephaly cleft from ventricle to cortex and abnormal pattern of sulci and gyri. In HORIZONTAL one. ANGULAR acceleration is detected by CRISTAE AMPULLARES (anterior. Information comes in to layer IV and then if it goes to I and II. Damage commissural fibers one side of the brain CANNOT communicate with the other side. forces like gravity pull the membrane and there is tangential force. they CAN verbalize what they see. Acoustic neuronima is really a schwannoma and most commonly starts from CN VIII but is NOT acoustic. since visual information goes to BOTH cortices. Layer IV is the one that has INTERNEURONS – receives input from the THALAMUS. Allocortex has THREE layers two subtypes are PALEOCORTEX (Olfactory) and ARCHICORTEX (Hippocampus). smooth brain and you go from 6 layers to 4 layers genetic disorder. Hair cell has ONE stereocilia and a bunch of KINOCILIUM. they CAN detect it but CANNOT SAY it. It’s the MOST COMMON brain tumor at the PONTOCEREBELLAR angle will cause vertigo or loos of 7
. kinocilia is on the UTRICLE side AMPULOPETAL movement endolymph moves TOWARDS the ampulla = ACTIVATION. If it goes to layers V and VI. PROPRIOCEPTIVE and VESTIBULAR. You give them an object to touch. its going to higher cortical areas – most prominent is the ASSOCIATIVE cortex. kinocilia is on the OTHER side AMPULOFUGAL movement endolymph moves AWAY from the ampulla = ACTIVATION. LINEAR acceleration is detected by MACULAE (Utricle and Saccule). Horizontal = Utricle and Vertical = Saccule.
inferior. BASE of the BASILAR MEMBRANE (area CLOSER to the outside of the ear) detects HIGH frequency sound waves whereas the APEX detects LOW frequency waves (because they travel further). they contract to keep the balance. When the tip links are COMPRESSED = HYPERPOLARIZATION.
balance or unsteady gate if the VESTIBULAR part is affected and will cause hearing loss if the COCHLEAR part is affected. VEMP vestibular evoked myogenic potential = sound saccule vestibular nerve vestibular nuclei brainstem motor nucleus of XI SCM. certain ones bend more = GREATER RESPONSE.
Auditory System: Sound pushes base of stapes OVAL window is pushed fluid (perilymph) movement moves the basilar membrane waves come back and hit the ROUND window. medial and lateral. fibers from inferior colliculus to medial geniculate = BRACHIUM of INFERIOR COLLICULUS and from medial geniculate to auditory cortex = INTERNAL CAPSULE (as ACOUSTIC RADIATIONS). Cochlear nerve/nuclei superior OLIVE INFERIOR colliculus MEDIAL geniculate Auditory cortex. When you move the head to left. There are FOUR vestibular nuclei superior. MENIERE’s DISEASE high endolymphatic pressure affects BOTH cochlear and vestibular functions recurring vertigo and progressive hearing loss. From SUPERIOR OLIVE onwards. Normally. TONOTOPIC organization from high to low frequency detection. when the hair cells bend. eyes compensate and move towards the right. the pathway is BILATERAL unilateral hearing loss has to be due to a lesion BEFORE superior olive. COWS cold water = OPPOSITE side nystagmus (right or left nystagmus is determined by the compensatory FAST movement). Depolarization of ear cells: stereocilia are connected via TIP LINKS if the fluid moves them TOWARDS the LONGEST cilium = DEPOLARIZATION (K comes in and causes depolarization opens Ca channels causes neurotransmitter release activates AFFERENT nerve endings). Fibers from superior olive to inferior colliculus = LATERAL LEMNISCUS. LATERAL RECTURE of the RIGHT eye is working and the MEDIAL RECTUS of the LEFT eye is working to cause the movement connected via the MLF (medial longitudinal fascicle) and PPRF pathway. LATERAL vestibulospinal tract from lateral vestibular nucleus to sacral spinal cord activates the ANTIGRAVITY muscles = IPSILATERAL EXTENSORS (such as when you fall.
. Loud noise hits the BASE first and therefore. Warm water = SAME side nystagmus. Acoustic Emission = ear PRODUCES sound important for examining children. Nystagmus is involuntary eye movements CAN be physiological. What neuron gets activated depends on WHERE the sound is coming from. repeated exposure will harm the ability to hear HIGH frequency sound waves. MEDIAL vestibulospinal tract goes to cervical or thoracic level coordinates head and neck. Loudness higher vinbration of basilar membrane SELECTIVITY of hair cells DECREASES and other cells will start responding. Vestibulo-Ocular reflex VOR senses head movements and compensates the eye movements image stability on a bumpy road.
For the RIGHT eye: When you LOOK towards the LEFT. WEBER’s test Normally. place it next to the ear normal = they SHOULD hear it once next to the ear because AC>BC. AUDITORY cortex processes VISUAL information SIGN LANGUAGE! OLIVOCOCHLEAR tract HYPERPOLARIZATION = you are sensitive to CERTAIN frequencies cocktail party effect. In DEAF people. If there is a nerve lesion on ONE side DOUBLE vision (can be vertical or horizontal). sensorineural hearing (skips the outside and ONLY sound from inside) RINNE vs. o MLF lesion = ADDUCTION problem (in the IPSILATERAL eye). ABDUCENS damage (could be due to high intracranial pressure) cannot look LATERALLY from that eye COMPENSATORY head movement TOWARDS the affected eye. conductive hearing loss = BC>AC and sensorineural hearing loss = AC>BC.
Visual System: Eye Movements: Occulomotor palsy = PTOSIS. CONVERGECE IS INTACT Internuclear ophthalmoplesia. larger (irregular) pupils and eyelid abnormalities. Myasthenia gravis also get PTOSIS because the muscles get tired. RINNE put the tuning fork on the mastoid process and when person CANNOT hear it. Perinaud’s syndrome cannot look UP. Strabismus abnormal alignment of the eye. the RIGHT cortex sends input to PPRF on the LEFT side (neurons cross) this then synapses with the abducens nucleus (STILL ON THE LEFT SIDE) causes LEFT eye to ABDUCT it then sends information via MLF back to the RIGHT side (neurons crossed again) synapses at occulomotor nucleus the RIGHT eye ADDUCTS BOTH eyes moved towards the LEFT. WEBER’S place the tuning fork in the middle of the forehead and ask for sound localization conduction loss = sound is LOUDER on the AFFECTED ear and if sensorineural loss = sound is LOUDER in the UNAFFECTED ear. TROCHLEAR palsy eyes move UP AND IN (inferior oblique takes over) COMPENSATORY head movement is to TILT HEAD AND CHIN TUCK AWAY from the affected eye if on one side = VERTICAL diplopia.
Sensory speech center = BA 39/40 for UNDERSTANDING speech damage here = WERNICKE APHASIA they have trouble UNDERSTANDING the question and whatever they do speak DOES NOT make sense (word salad). 9
. Conductive (transmission of sound from outside to inside) vs. air conduction is BETTER than bone conduction. HYPERACUSIS sensitivity to loud sounds. OCCULOMOTOR palsy PTOSIS and DOWN & OUT occulomotor passes in between posterior cerebral and superior cerebellar arteries and high pressure can damage this nerve. Tinnitus sensorineural loss buzz or ringing in the ear. the RIGHT eye CAN look but the left eye CANNOT ADDUCT. ONE AND A HALF SYNDROME damage the MLF AND PPRF on the SAME side for example if the damage is on the LEFT side then you CANNOT look to the LEFT with EITHER eye but when you are trying to look to the right. o Pontine lesion = look AWAY from the LESION (slightly). TENSOR TYMPANI middle ear muscle for protection from very loud noise makes the area stiff and prevents sounds from damaging the ear. o Cortical lesion = look TOWARDS the lesion (slightly).
they see snippets. o Marcus Gunn pupil = when you shine the light in one eye. Acetylcholinesterase is on the OUTSEIDE of the cells and works as a SERINE PROTEASE step 1 is when the molecule reacts with the enzyme and CHOLINE is released. BOTH dilate.
Pupil CONSTRICTION when you shine a light in one eye. NE. Muscarinic receptors sweat glands and brain PARASYMPATHETICALLY innervated BLOCKED by ATROPINE. They are formed by the following pathway: L-TYROSINE L-DOPA Dopamine NEpi Epi. Inhibitory nt increase Cl influx or K EFFLUX.
Visual System: Pathways: The right CORTEX sees the left VISUAL FIELD and visa versa. Ca influx. Catecholamines are things like dopamine. o Argyll Robertson pupil = ACCOMODATES but does NOT react (prostitute). Excitatory nt increase Na and sometimes.
Neurotransmitters: Biogenic amines are formed when amino acid is DECARBOXYLATED.
INTERNAL CAROTID artery is right next to the optic chiasm can cause NASAL HEMIANOPIA of the IPSILATERAL eye. Association visual cortex Parietal lobe = WHERE pathway and TEMPORAL lobe = WHAT pathway damage to the parietal pathway and they can't see someone moving from one side to the other but instead. 10
. Prosopagnosia face recognition. Pituitary is right ON the optic chiasm can cause BITEMPORAL hemianopia. the information goes to BOTH EW nuclei from there. Step 2 is when you regenerate the enzyme by adding H2O. The only way to fix this is RESYNTHESIS of the enzyme. it goes to constrict BOTH eyes. Organophosphates INACTIVATE the acetylcholinesterases by binding IRREVERSIBLY to SERINE residue of the enzyme. Epi etc. Nicotinic receptors are LIGAND-GATED Na-channels and are BLOCKED by CURARE poison. NEITHER pupils dilate but when you shine it in the other one.
Bipolar cells and ganglion cells. Going from NEpi to Epi requires METHYLATION (of N) and uses SAM.
Visual System – Retina: Retina is arranged in 3 VERTICAL cells Photoreceptors. Going from L-tryptophan to 5-hydroxytryptophan requires TRYPTOPHAN HYDROXYLASE with the help of BioH (because we are hydroxylating an aromatic group). TCA prevent the reuptake of NEpi and 5-HT. it DETACHES from opsin this is the BLEECHING of the retina vitamin A is needed to reattach. 5-HT to Melatonin ACETYLATION and METHYLATION (by SAM). Cocaine and Methylphenidate prevent NEpi. Benzodiazepines SENSITIZE the GABA receptors can NEVER kill Valium. Rhodopsin are G-protein coupled 7 transmembrane molecules when light hits. Synthesis and inactivation of GABA requires VITAMIN B6 glutamate GABA Succinic semialdehyde. 5-HT AND DOPAMINE reuptake. These nt are picked back up by Na-COTRANSPORTERS. o 5-Hydroxytryptamine detected as 5-HYDROXYINDOLEACETIC ACID. SSRI prevent 5-HT reuptake SPECIFICALLY. 5-HT and dopamine. NEITHER inhibits histidine. COMT uses SAM to METHYLATE a carbon on the AROMATIC group (NOT the same methylation as in the conversion of NEpi to Epi). o NEpi and Epi detected as VANILYLMANDELIC ACID. In the second step. L-tryptophan 5-hydroxytryptophan 5-HT Melatonin. L-DOPA works because its taken up by the brain FIRST and THEN converted to dopamine carbidopa allows for this to happen.
Going from L-Tyrosine to L-DOPA you need TYROSINE HYDROXYLASE and this requires BioH (every hydroxylation on an aromatic group requires BioH) CONTROL STEP! L-DOPA is STILL an amino acid because it has N and C terminal. Going from dopamine to NEpi OXYGEN is taken off. 11
. Amphetamine cause the RELEASE of NEpi. Ophthalmoscopy fundus of the eye is the ONLY place in the body where the blood vessels can be seen DIRECTLY. 2 MODULATORY cells are HORIZONTAL and AMACRINE. How do you detect excess of a biogenic amine? In the URINE! o Dopamine detected as HOMOVANILLIC ACID. Glutamate to GABA DECARBOXYLATION. This results in the net replacement of NH3 group by CHO (ALDEHYDE). The more L-DOPA you give more dopamine is made more is degraded higher H2O2 production THAT’S why you give MAO-B inhibitors to prevent the breakdown. MAO-A inhibits 5-HT and MAO-B inhibits Dopamine and BOTH inhibit N-Epi. Going from L-DOPA to Dopamine you need VITAMIN B6 and it’s a DECARBOXYLATION. GABA to Succinic semialdehyde DEAMINATION you are left with an ALDEHYDE. INACTIVATION of catecholamines is done by MAO (deAMINATION) and COMT (METHYLATION) either one of these enzymes can work first followed by the second one MAO works by taking off the NH3 group and the H’s accepted by FAD to give FADH2 FAD is REGENERATED after OXYGEN takes H’s from FADH2 to give H20 and FAD. From 5-hydroxytryptophan to 5-HT DECARBOXYLATION with the help of VITAMIN B6. Barbituates ACTIVATE the GABA receptors CAN kill you.
On and off center cells enhance CONTRAST!
Basal Ganglia: Direct and indirect pathways. COMMON BILE DUCT is occluded and you can't release bile from liver ENLARGED liver IRRITATED baby because of HIGH BILIRUBIN. Retinitis pigmentosa mainly rods affected first causes night blindness and then results in tunnel vision. Vitamin A deficiency = NIGHT BLINDNESS CANNOT convert the retinal from Trans to Cis. Spleen is NOT a foregut derivative and comes from MESODERM supplied by CELIAC TRUNK! In development. MESENTARY PROPER and MESOCOLON. Sensory motor cortex PUTAMEN Gpi thalamus (VA and VL) cortex. Association cortex CAUDATE Gpi thalamus cortex. In LIGHT things are HYPERPOLARIZED Cis retinal converted to Trans activation of phosphodiesterase low cGMP and Na channels closed low transmitter release. mesentery is divided into: MESOGASTRIC. 12
. Macular degeneration cones affected CENTRAL vision is lost. Pancreas comes from a ventral AND dorsal bud ventral part rotates due to DUODENUM. Hemibulismus = damage to STN HIGH cortex activity. bile is stored in the DUODENUM first bowel of the baby is green color (good) = MECONIUM. When it goes out. Limbic cortex NUCLEUS ACCUMBENS VENTRAL PALLUDIUM thalamus (DM) limbic cortex. Shh in endoderm INDUCES the Hox expression from mesoderm their interaction is what causes different things to form. Parkinson’s = damage to SNc high striatum activity LOW cortex activity. MESODUODENUM.
In the DARK things are DEPOLARIZED Cis retinal is bound high cGMP and open Na channels high transmitter release. Physiological herniation liver pushes the mid-gut out to be developed there. Albino CANNOT make the pigment blue eyes. another 180-degree counterclockwise turn takes place and JEJUNUM is the FIRST to come back. When coming back in. Duodenum is SECONDARY RETROPERITONEAL. The reason why rods don’t provide sharp vision is because the adjacent rod cells are connected via gap junctions and change a single circuit to ONE ganglion cell. Ileal/Meckel’s diverticulum connected to umbilicus via vitelline ligament. Esophagus undergoes changes during development: stratified columnar partial/total occlusion of lumen (if stuck here = STENOSIS) reopens as simple columnar multilayered ciliated column (stuck here = CONGENITAL BARRET’S ESOPHAGUS) stratified epithelium. it moves 90 degrees counterclockwise around SMA VERY IMPORTANT now the transverse colon in ON TOP OF duodenum. Huntington’s = damage to striatum (caudate) low striatum activity HIGH cortex activity. Ventral mesentery is divided into FALCIFORM LIGAMENT and LESSER OMENTUM (made of hepatogastric and hepatoduodenal ligaments).
Development of Gastrointestinal system: Behind the GUT TUBE. If there is EXTRA-hepatic biliary atresia.
upper chest and upper shoulder). Superficial Veins communicate with dural sinuses in this region. Posterior auricular. Injury to vagus nerve abolishes COUGH REFLEX. MACULA DENSA = sense [Na] and JG CELLS (on afferent arterioles) = SENSE BP and produce RENIN. INTRAglomerular mesangial cells can change the diameter of the tube and therefore. Thyrocervical. DIGASTRIC (SUBMANDIBULAR). Inferior thoracic. PCT HAS microviili in the lumen whereas DCT does NOT. Large amount of water intake INHIBITS ADH you pee more. Subclavian branches VIT. Anterior triangle = SUBMENTAL. PERIORBITAL ECCHIMOSIS = black eyes!
Triangles of the Neck: Anterior triangle connects neck to thorax. through the Deep Facial Vein (via pterygoid plexus) and Superior Ophthalmic Vein (via Cavernous Sinus). Wry neck SCM stays CONTRACTED.Urinary system: EXTRAglomerular mesangial cells LACIS cells between afferent and efferent arterioles produce EPO. Ascending pharyngeal. Occipital. Cervical plexus Greater auricular (ear and skin below jaw angle). JG APPARATUS LACIS cells = EPO production. Facial. Retropharyngeal space between PREVERTEBRAL and BUCCOPHARYNGEAL fascias potential space can cause infection to MEDIASTINUM. you cut the STELLATE ganglion. lesser auricular (skin behind the ear). CAROTID and MUSCULAR.
Root of the neck: To relieve RAYNAUD symptoms. Posterior triangle OMOCLAVICULAR triangle injury here will damage CN XI. Thoracic OUTLET syndrome affected areas are BRACHIAL PLEXUS and SUBCLAVIAN artery can be due to an extra rib. transverse (anterior skin of neck) and supraclavicular (root of the neck. and going up to the region between the eyes. Backflow can cause infection to get into the dural sinuses. the filtrate and can also PHAGOCYTOSE and REMOVE the aggregated proteins on the common basement membrane. Cervical and Dosal scapular. o The Facial Vein has no valves. CD Vertebral. Posterior triangle connects thorax to upper limb. Branches of EXTERNAL CAROTID Some Angry Lady Figured Out PMS Superior thyroid.
Face and Scalp: DANGER TRIANGLE OF THE FACE: A triangle approximately covering the nose and maxilla. Maxillary and Superficial temporal.
Dorsal spinocerebellar FG CLARK’S COLUMN INFERIOR cerebellar peduncle Cerebellum. VESTIBULOCEREBELLAR – “balance” afferent information from the vestibular apparatus and the corollary motor fibers (from vestibulospinal tract) enters the FLOCCULO-NODULAR lobe via the INFERIOR CEREBELLAR PEDUNCLE information goes to FASTIGIAL nucleus signal sent out via the INFERIOR CEREBELLAR PEDUNCLE. Hyperthyroidism: HAS to be from the THYROID gland NOT ELSEWHERE. Information comes to cerebellum via Anterior Spinocerebellar (distal LOWER extremities). From hebanula nucleus to Basal forebrain STRIA MEDULLARIS THALAMI. o Opercularis BA 44 14
. Cuneocerebellar FC LATERAL CUNEATE NUCLEUS ICP Cerebellum.
Higher Cortical Functions: Broca’s area inferior frontal gyrus of DOMINANT hemisphere. SPINOCEREBELLAR (ANTERIOR LOBE OF CEREBELLUM) – “fixing movements” cerebellum gets INTENDED movement from the Red Nucleus also gets the information about STATE OF THE MUSCLES (Anterior and Dorsal spinocerebellar and Cuneocerebellar pathways) via SCP or ICP makes proper adjustments information is sent out by the GLOBOSE and EMBOLIFORM nuclei sends output to red nucleus via SUPERIOR CEREBELLAR PEDUNCLE. Dorsal spinocerebellar (proximal LOWER extremities) and cuneocerebellar (UPPER extremities). o Grave’s disease o Tumor o High TSH
Cerebellum: ONLY excitatory fibers within are the granulosa and from the OUTSIDE. it’s the Mossy and Climbing (coming ONLY from inferior olivary nucleus and synapse on PURKINJE).
Limbic System: From amygdala to hypothalamus STRIA TERMINALIS. APPENDICULAR ATAXIA damage to the CEREBELLAR HEMISPHERES cannot do finger-nose-finger or dysdiadochokinesia. TRUNCAL ATAXIA damage in the vermis/flocculonodular lobe deviate TOWARDS the side of the lesion when walking. Romberg test if fall BEFORE closing eyes cerebellar problem and if fall AFTER closing eyes damage to PROPRIOCEPTIVE systems. Anterior spinocerebellar fasciculus G SPINAL BORDER CELLS Superior CEREBELLAR peduncle Cerebellum. PONTOCEREBELLAR – “planning movements” corticospinal tract sends signal from the cortex to the POSTERIOR LOBE of cerebellum about the intended movement does it via MIDDLE CEREBELLAR PEDUNCLE this then projects to the DENTATE nucleus fixed information is sent out to VL via the SUPERIOR CEREBELLAR PEDUNCLE.Thyroid Hormones: HYPOthyroidism: o Myxedema in adults lower metabolic rate and edema. o Crenticism in infants mental deficiency and stunted growth.
Inferior parietal lobule GESCHWIND’S TERRITORY. cox 2 is the DOMINANT one in terms of prostacyclin production selective cox 2 INHIBITORS decrease the PROSTACYCLIN production thromboxane production is STILL taking place at the SAME RATE this gives an IMBALANCE this INCREASES the chances of thrombus formation. Low cAMP leads to platelet activation thromboxane is made and CONSTRICTS the wound. LOW vitamin D LEVELS LOW 25-OH. LOW vitamin D ACTIVITY LOW 1.
o Triangularis BA 45 Wernicke’s area much LARGER on the DOMINANT side BA 22. Phospholipase A2 inhibited by ANTI-INFLAMMATORY STEROIDS.
. 5-lipoxygenase inhibited by ASTHMA INHIBITORS bronchial DILATION. OsteoPETROSIS LOW osteoCLAST activity HIGH bone deposition.
Parathyroid Gland: PTH causes high osteoclast activity. Aspirin inhibits Cox 1 NOT the same consequences LOW MI risk.25-OH. Cox inhibited by NSAIDs. o Supramarginal gyrus BA 40 phonological processing. o Angular gyrus BA 39 reading and semantic processing. Vitamin D is given as a PRODRUG gets converted to 1. you use CALCITRIOL this can cause HYPERCALCEMIA. More than one language is NEUROPROTECTIVE. RIGHT DORSOLATERAL PREFRONTAL CORTEX switching between two different languages. causes kidneys to reabsorb more Ca AND form vitamin D (calcitriol) and this vitamin D is used to absorb more Ca from the INTESTINES. Cox 1 found everywhere. Cox 3 derivative of cox 1 in brain important for PAIN and FEVER.
Introduction to Hormones: Membrane lipids phospholipase A2 arachadonic acid can either become leukotrienes (via lipoxygenase) or PGE2/TXE2/PGG2 (via cyclooxygenase) PGG2 can be further converted to PGH2 (via peroxidases) and this can then be converted to specific things at different tissues. Cox 1 and 2 TOGETHER make the prostacyclins (to RELAX endothelial smooth muscles) in an injury (such as plaque).25-OH (active product) this conversion will NOT happen in kidney failure in that case. Normally. o Located BETWEEN parietal and temporal lobe PLANUM TEMPORALE. OstroPOROSIS LOW bone deposition and HIGH bone loss. Cox 2 found mainly in the WBC activated by cytokines. Prostacyclins RELAX vascular smooth muscles used as ANTI-COAGULANTS. When Ca concentration is HIGH THYROID gland releases CALCITONIN. High Ca outside binds to Ca sensing receptors ON THE CELL leads to IP3 and PLC pathway causes INTRACELLULAR Ca release DECREASES PTH release. Low vitamin D = bone DEMINERALIZATION RICKETS or OSTEROMALACIA. Ca uptake in GI is dependent on the NUMBER OF TRANSPORTERS! [Ca]x[PO4] = CONSTANT so they are regulated in REVERSE.
temperature and itch Myelination INCREASES from Aa to C-fibers. Slowly adapting sensory receptors tell about DURATION of stimulus. Trigeminal pathways: o Touch pathway: Information synapses in TRIGEMINAL GANGLION (1st order neuron) at the PRINCIPLE (or CHIEF) SENSORY NUCLEUS OF V axons decussate in the PONS synapse at VPM (2nd order neuron) 3rd order neuron goes from VPM to the POST-CENTRAL gyrus where the axons for the facial region reside. A(delta) = pain and temperature and C-fibers = pain. of V. o Above T6 = fasciculus CUNEATUS. it causes a VERY HIGH effect leads to VERY LOW PTH release CAN cause HYPOcalcemia. Pacinian corpuscle – rapid – VIBRATION – LARGE receptive field. AB = touch. o Pain pathway: 1st order neurons begin in TRIGEMINAL GANGLION enter pons and DESCEND as spinal-trigeminal tract synapse in CAUDAL MEDULLA at the SPINAL NUCLEUS OF V 2nd order neurons begin from here and DECUSSATE ascend as trigemino-thalamic tract synapse at VPM 3rd order neurons go from there to POST-CENTRAL gyrus in the cortex. A(delta) fibers COLD temperature and C-fibers HOT temperature. pain and paresthesia. Rufini’s endings – SLOW – PRESSURE – LARGE receptive field. Joint receptors slowly adapting = STATIC information and rapidly adapting = DYNAMIC information. Meissner’s corpuscle – rapid – touch. o Proprioceptive pathway jaw jerk reflex involves mesencephalic nucleus of V BILATERAL synapse with motor n. o Romberg’s test if patient sways DORSAL COLUMN DAMAGE. o Information goes from the outside to the DRG (1st order neuron) ascends IPSILATERALLY to DORSAL MEDULLA synapses at CUNEATE or GRACILE nucleus (2nd order neuron) DECUSSATES as INTERNAL ARCUATE FIBERS ascends as MEDIAL LEMNISCUS synapses at VPL of thalamus (3rd order neuron) goes to the cortex (POST-CENTRAL gyrus) via INTERNAL CAPSULE.
HYPERcalcemia give CINACALET prevents PTH release it does NOT bind the active site but when Ca binds to it. o TABES DORSALIS manifestation of NEUROSYPHILIS 3 symptoms (APP) ataxia.
Somatosensory System and Disorders: Aa = proprioception. TERIPARATIDE human PTH analog causes BONE FORMATION moderate SPIKES of PTH lead to bone FORMATION!!!!!!!! Can also give calcitonin in case of hypercalcemia. Dorsal column Medial Lemniscus: o Below T6 = fasciculus GRACILIS. Hair-follicle receptor – rapid – touch. Merkel’s endings – SLOW – touch. Rapidly adapting sensory receptors tell about INTENSITY of stimulus.
Gustation: o Taste cells are RECEPTOR cells take information to the FIRST ORDER NEURON. o Testosterone to estrogen AROMATASE. o Ventromedial female sexual behavior and SATIETY. 17
.CNS Blood Supply: MEDIAL medullary syndrome ANTERIOR SPINAL ARTERY OCCLUSION causes: problems in CORTICOSPINAL tract. o PALE LATERAL tract goes to pyriform cortex. o SCN circadian rhythms. 11a-hydroxylase and 21-hydroxylase = CORTISOL. o Olfactory cortex consists of APE amygdala. 21-hydroxylase and 18-HYDROXYSTEROID DEHYDROGENASE = ALDOSTERONE. o Arcuate Dopaminergic and Ghrelin induce hunger. o Anterior heat DESSIPATION. pyriform cortex and entorhinal cortex. LATERAL medullary syndrome or WALLENBERG’S SYNDROME. o Lateral induce hunger.
Diencephalon: Thalamic nuclei: o Mammillary bodies memory formation.
Adrenal Hormones: Cholesterol pregnenolone (done by DESMOLASE) progesterone can go on to be come either testosterone. o Progesterone to glucocorticoids 17a-hydroxylase. o Capsaicin opens receptors for C-fibers make you feel hot! o 1st neuron from VII. MEDIAL LEMNISCUS tract and HYPOGLOSSUS NUCLEI (CN XII). IX or X goes to NUCLEUS SOLITARIUS via SOLITARY TRACT 2nd neuron goes to VPM 3rd neuron goes to INSULA. glucocorticoids or mineralocorticoids. WEBER’S SYNDROME occlusion of POSTERIOR CEREBRAL ARTERY. o Progesterone to mineralocorticoids 11a-hydroxylase. o Dorsomedial causes wakefulness damage = narcolepsy. o Preoptic male sexual dimorphism. 18-hydroxylase. BENEDIKT’S syndrome damage to ventral and tagmental regions of midbrain. o Progesterone to testosterone 17a-hydroxylase and 17-21 lyase. o Supraoptic and Paraventricular ASOP ADH and Oxytocin. amygdala and entorhinal cortex and THEN goes to THALAMUS! o MEDIAL tract has BILATERAL inputs BASAL FOREBRAIN and LIMBIC structures. o Posterior heat CONSERVATION. ACTH causes the formation of corticosteroids via this pathway ONLY CROTISOL CAN NEGATIVE FEEDBACK!
Chemosensation: Olfactory: o 1st neurons synapse in a specific area of olfactory bulb 2nd order synapse with the MITRAL cell.
For GOLGI TENDON reflex Ib picks up the signal goes to spinal cord INHIBITORY signal is sent to a-motor neuron you DROP the weight. 1+ = hypoactive. Sensory Alpha Ia = MUSCLE SPINDLE and Alpha Ib = GOLGI TENDON. 2+ = normal. 3+ = hyperactive (WITHOUT clonus) and 4+ = hyperactive (WITH CLONUS).2-ENOYL CoA ISOMERASE converts cis to TRANS configuration. FA SYNTHESIS needs Acetyl CoA CARBOXYLASE uses ATP and BIOTIN.
Fatty Acid Metabolism: In order to do beta-oxidation. Reciprocal inhibition is when you RELAX the ANTAGONIST muscle in the reflex such as relax triceps in the biceps reflex.Myotactic reflex: Motor Alpha (Aa) = EXTRAFUSAL and Gamma (Ag) = INTRAFUSAL. MONO-UNsatureated requires 3. GAMMA motor neurons are under BRAIN CONTROL! 0 = absent reflex. Very Long Chain use ACYL CoA OXIDASE done in PEROXISOMES.
. Unripe Akee fruit has HYPOGLYCIN breaks down HMG-CoA DEHYDROGENASE you get high fat in the plasma and LOW for ENERGY USAGE. the first enzyme is HMG-CoA DEHYDROGENASE it REQUIRED FAD (riboflavin).4-DIENOYL CoA REDUCTASE and ISOMERASE. POLY-Unsaturated requires 2. UMN lesion = SPASTIC paralysis and LMN lesion = FLACCID paralysis.