Thorax

 Part of the axial skeleton, it forms the protective cage of the thoracic cavity protecting
the vital organs and great vessels
 Supports the shoulder girdles and upper limbs
 Point of attachment for the appendicular skeleton i.e pectoral girdle and UE; point of
attachment for muscles of the back, chest, and shoulders
1. Bone
a. Sternum
i. 15 cm/6 inch long flat bone
ii. Fusion of three bones superior to inferior
1. Manubrium
a. Superior lateral aspect features two clavicular notches which are
the points of articulation for the clavicle
2. body
3. xiphoid process
iii. Landmarks
1. Suprasternal/Jugular/ notch
a. Apex of sternum
b. Located laterally are the clavicular notches which the manubrium
articulates with the sternal ends of the clavicle
2. Sternal angle/Sternal Notch/angle of Louie/manubriosternal junction
a. Angle denotes the junction between the manubrium and the
body
b. Clinically significant: indicates the end of the manubrium; the
location for the 2nd rib, aortic arch, and the corina (end of
trachea)
3. Xiphisternal joint
a. Junction between the body and the xiphoid process
b. Clinically significant: pinpoint the location of the xiphoid process;
Heimlich maneuver - based on the premise that air remains in
lung – is performed inferior to this joint in order to forcibly expel
a lodged particle in the wind pipe
b. Ribs
i. Head
1. Articulates with the vertebral column
ii. Neck
iii. Tubercle
1. Articulates with the costal facet (depression of the transverse
process)

iv. Angle
v. Shaft
1. Elongated portion of rib
 vi. Costal groove
1. Hyaline cartilage connects rib to sternum at this point
2. CS: Groove or depression containing VAN
3. Ribs run superior to inferior, thus, each groove directed inferiorly
serves to identify which rib it is

c. Rib Pairs
1. True: Vertebrosternal ribs i.e. 1-7
a. Connected to the manubrium and body of the sternum by
hyaline cartilage forming a junction
2. False: Vertebrochondral ribs 8-10
3. Free/Floating ribs vertebromuscular: 11-12
2. Glands
a. Mammary glands
i. Pectoral fat pad sitting on the pectoralis major
1. Breast suspended by CT
ii. Nipple & areola
iii. Lactiferous Sinus
1. convergence of lactiferous ducts into
posterior to nipple forms the sinus
iv. Suspensory ligament
1. Elastic CT that suspends the breast on the pectoralis muscle
v. Angiology
1. Receives blood from the inferior mammary artery or internal thoracic
artery; IMA/ITA: donor vessel for CABG in CAD patients to be grafted
and infused; other vessels include coronary arteries and great
saphenous vein (lower limb)

3. Musculature
a. Diaphragm
i. Located inferior to the lungs
ii. Centralized tendon of diaphragm with caval opening for the
IVC to run through
iii. Esophageal foramen for digestive system
b. External intercostal: EicM
i. Muscle fibers lateral to medial
 ii. Thick in the back and thins out until insertion in the sternum
iii. Thin membrane explains why IIcM can be seen
c. Internal intercostal: IIcM
i. Muscle fibers medial to lateral
ii. Thick in area of sternum and thins out
till attachment with vertebra
iii. Close proximity to the sternum
d. Innermost intercostal: InIcM
i. Thick at vertebral site, thin in lateral aspect
thick again at sternal point of attachment;
thickest at dorsolateral region
e. Transversus thoracis: TTM
i. Thickest in anteromedial region
ii. Same level of depth as InIcM
f. Accessory muscles: muscle usage when IC paralyzed or non-functioning
resulting in accessory muscle use for respiration
i. Sternocleidomastoid
ii. Serratus anterior
iii. Pectoralis minor
iv. Scalenes (inspiration only)

4. Respiration

a. Inspiration: EIc, Sc, Dph

1. diaphragm contracts with the muscle flattening out inferiorly in order
to provide necessary space in thoracic cavity for expansion
2. External intercostal muscles contract to pull ribcage upward and
outward
3. Scalenes elevate 1st and 2nd ribs
4. Inferior part of sternum moves anteriorly
b. Exhalation: Dph, TT, IIc,
1. diaphragm relaxes with the muscle moving superior to occupy space
once again
2. transversus thoracis depresses ribs
3. internal intercostal depress ribs
4. Inferior part of sternum moves posteriorly
c. Respiratory movements
1. Eupnea: quiet/diaphragmatic/ costal breathing
2. Hyperpnea: exertive, deep breaths in high frequency i.e.
hyperventilation
5. Angiology- Arteries
a. Ascending Aorta
b. Aortic Arch
i. Big Three: BcT, LSA, LCC
ii. Braciocephalic trunk: RCCA, RSA
1. Right Common Carotid
2. Right Subclavian
a. Internal thoracic/Mammary artery: blood to the breast
donor artery
b. Axillary artery: lateral continuum of the subclavian artery
supplying blood to the pectoral region of the axilla
iii. Left Subclavian Artery
iv. Left common carotid
c. Descending/Thoracic Aorta- Visceral Branches
i. Bronchial arteries: BrA; 2 BrA supply LT bronchi and
1 BrA branching off IcA supplying O2 blood to RT bronchi
ii. Pericardial
Mediastinal
iii. Esophageal
d. Descending/Thoracic aorta – Parietal Branches
i. Intercostal
ii. Superior phrenic: diaphragm

6. Systemic Veins
a. SVC blood vessels
i. Subclavians: ScV
ii. Brachiocephalic
1. RT BcV branches into RIJV and RScV Receives blood from the
vertebral veins and EJ and IJ
iii. Azygos and Hemiazygos: Chief blood collectors of thorax
1. Azygos empties into SVC
2. Accesory HA and HA drain into azygos
3. Internal thoracic vein anastomoses with
azygos vein to form intercostal system
iv. The left and right external jugular veins drain into the subclavian veins.
The internal jugular veins join with the subclavian veins more medially to form
the brachiocephalic veins.
b. Rudolph the red nose reindeer is a Notre dame fan
Respiratory System
1. Trachea: Descends from larynx to mediastinum 10-12cm/4 inches long; 1 inch diameter
a. Deep to superficial
i. Mucosa
ii. Submucosa
iii. Adventitia
b. Posterior aspect of trachea is C-Shaped cartilage ring with the trachealis muscle
i. During a cough, contraction of the trachea decreases the lumen diameter with
the trachealis muscle contracting medially
 c. Carina: end of trachea before bifurcation into bronchi
2. The bronchial tree/The conducting zone
a. Region of thorax where air conducts/goes in and out
b. Trachea bifurcates at carina into the primary RL bronchi
which are considered extrapulmonary (not inside the lungs)
i. Bronchi
1. RT and LT primary bronchus
ii. Secondary (Lobar)
iii. Tertiary (segmental)
iv. Terminal bronchioles
1. Feeds into the respiratory bronchioles
2. Alveolar ducts
3. alveoli: lined with simple epithelium

c. Structural changes occur as diameter of bronchi decreases

i. Cartilage rings replaced with irregular hyaline cartilaginous plates
ii. Mucosal epithelium: Pseudostratified Columnar  Cuboidal
iii. Cartilage becomes absent and is replaced by increasing amounts of smooth
muscle – asthmatic attack caused by smooth muscle contracting via
parasympathetic
d. Respiratory membrane
i. Type 1 cells epitheliocytes/pneumocytes
1. Flattened cells lining the wall of the alveoli
ii. Type II cells
1. Secrete surfactant needed to reduce
surface tension in alveoli which prevents collapse of wall
iii. Alveolar macrophages/dust cells
1. Function to maintain the sterility of alveoli
2. Remove contaminants inside the alveoli
iv. respiratory membrane: fused basal laminas of alveolar epithelium and capillary
epithelium necessary for gas exchange; respiratory bronchiole feeds air into the
alveolar ducts which will in turn feed air into the alveoli (very small microscopic
air sacs surrounded by small networks of capillaries for gas exchange)
v. alveolar pores allows for collateral ventilation which
maintains pressure in adjacent alveoli
vi. Lung tissue has CT, trabeculae, smooth muscle, lymphatics, and elastic fibers
(capacity to recoil after expansion)
3. Lungs – anatomy
i. Apex (cupola) – dome shaped
ii. Base (sits on diaphragm) concave base
iii. Root (primary bronchus and veins and arteries)
a. Lobes
i. Superior
ii. middle (not present in LT lung)
iii. inferior – Cardiac notch continues to lingula at inferior aspect of LT superior lobe
b. Fissures
a. Horizontal (not present in LT lung) – divides RT lung into superior and middle
lobes
b. Oblique – divides LT lung into superior and inferior lobes and RT lung into
inferior and middle lobe
c. Surfaces
a. Costal: contact with ribs
b. Mediastinal: contact with mediastinum
c. Cardiac notch: contact with heart
d. Angiology
a. pulmonary trunk  RT and LT pulmonary arteries  arterioles pulmonary
capillaries  venules  veins
b. thoracic/descending aorta gives rise to the – BrA
i. 1 BrA RT and 2 BrA LT supply blood to the bronchioles and lung tissue
ii. Hilar view/root view: anterior to posterior
RT Lung VAB
LT lung: VBA/above
iii. RT lung has 7 vessels entering
iv. LT lung has 6 vessels entering
c. pulmonary plexus:
i. parasympathetic motor and visceral afferent fibers (feel pain)
4. Pathology
a. Aspiration – RT lung is more prone to aspiration due to a larger diameter
of the bronchus and vertical entry (gravity)
b. COPD
i. Obstructive emphysema: alveolar enlargement and deterioration of
alveolar walls
ii. Chronic bronchitis: result of inhaled irritants results in swelling submucosa
iii. Asthma: smooth muscle increase down the respiratory tract responsible for
bronchospasms; swelling of the submucosa causes wheezing sound
iv. Tuberculosis: M. tuberculosis bacteria responsible; increased risk of cancer
because infection begins in alveoli and spreads to lung tissue
v. Lung cancer: begins in the bronchus, alveoli, and bronchioles and can
spread to entire lung
c. Segmentectomy v. pneum(on)ectomy
d. Thoracocentesis: procedure performed to remove trapped air or fluid from the
pleural cavity
i. External Intercostal muscle
ii. Internal intercostal muscle
iii. Innermost intercostal muscle
iv. Endothoracic fascia
v. Parietal pleura
vi. Potential space: space between visceral and parietal pleurae
vii. Visceral pleura
 5. Pleurae – thin serous membrane lining the lungs and inner walls of the chest
a. Parietal
i. the outer membrane which is attached to the inner surface of the thoracic cavity.
It also separates the pleural cavity from the mediastinum
b. Visceral
i. Delicate serous membrane lining covering the surface of each lung

Cardiovascular system
1) Heart
a) Weighs between 250-350 grams
b) Located in mediastinum (extends obliquely from 2nd to 5th intercostal space except in 3rd
trimester pregnancy)
c) Size of a person’s fist
d) Ice cream cone: Base and Apex
i) Apex: target site for valve replacements in minimally invasive procedures where
valve is inserted through the apex
ii) Base: LT atrium, small portion of RT atrium, and proximal part of great veins (SVC,
IVC, and pulmonary veins)
2) Anatomical orientation and superficial anatomy
a) Borders
i) Superior, RT, inferior, and LT
b) Sternocostal surface
i) RT atrium and RT ventricle contact with sternum
and costal cartilages
c) Diaphragmatic surface
 i) Posterior and inferior wall of LT ventricle in
contact with diaphragm
d) Atrial appendages/auricles
i) Anatomical landmarks which indicated
the location of the atria
e) Coronary sulcus
i) Superficial groove separating atria from ventricles
ii) RT coronary artery lines sulcus
f) Interventricular sulci
i) Anterior and posterior IV: Superficial groove separating
RT and LT ventricles on the external surface of the heart

3) Coverings of the heart

a) Fibrous pericardium
i) Outermost layer which protects, anchors (diaphragm and great vessels), and
prevents blood overfill; Dense CT and loose CT
b) Serous pericardium: composes the pericardial cavity
i) Parietal: lines the inner fibrous pericardium; attached to the fibrous pericardium
ii) Visceral: also epicardium, the outermost layer of the heart wall

iii) Serous cavity in between parietal and visceral pericardium

4) Layers of the heart wall
a) Epicardium- infiltrated with adipose tissue; this is the visceral layer of the pericardium
b) Myocardium: layered muscular tissue (contractile), CT, blood vessels, and nerves
c) Endocardium: continuous with endothelium (simple squamous epithelial layer) resting
on CT; continuous with endothelium of great vessels

5) Fibrous heart skeleton

a) Composed of collagen and elastic fibers
b) Encircles bases of pulmonary trunk, aorta, and heart valves
c) Functions
i) stabilize cardiocytes/valve positioning
ii) reinforce blood vessels and nerves
iii) provide elasticity

6) Internal anatomy and organization

RT SIDE
a) Right atrium
i) Big three veins: SVC, IVC, and Pulmonary veins drain deoxygenated blood
into the RT atrium
ii) Coronary sinus
iii) Pectinate muscles
(1) Ridges found in the wall of the heart
(2) found mostly in RT atrium
(3) remnants of primordial heart in fetus
iv) Interatrial septum
(1) Separates the RT and LT atria of the heart
v) Fossa ovalis
(1) Depression in the atrial wall
(2) Remnant of primordial heart in fetal circulation where blood bypasses the LV
and RV and goes from RA to LA through this foramen ovalis which is a shunt
(small opening or passage allodu movement of fluid)
(3) Closes at birth when lungs become functional and blood pumps into LA pushing
up against the foramen ovalis and turning it into the fossa ovalis; if not, ASD or
atrial septal defect occurs
b) Tricuspid valve
 i) Valve regulating flow of blood from RA to RV; AV valve
c) Right ventricle
i) Chordae tendinae
(1) Blood pushes up against the cusps cause valve to close inducing papillary muscle
contraction and CT taut to prevent back flow
(2) When valve is open, CT become flaccid and papillary muscles relax to allow blood
flow
(3) Mechanism to prevent mitral valve prolapse and backflow
ii) Papillary muscles
iii) Trabeculae carneae
(1) Ridges in heart wall found only in the RT and LT ventricles
iv) Semilunar valve
(1) Valve regulating blood flow from RV to pulmonary trunk
v) Pulmonary trunk
(1) Gives rise to pulmonary arteries

LT SIDE
a) Left Atrium
i) LT and RT pulmonary veins pump oxygenated blood into the LA
b) Bicuspid/Mitral valve: AV valve
c) Left Ventricle
i) Aortic semilunar valve controlling blood flow from the LV to the ascending aorta
ii) Aortic sinuses: depressions opposite to the semilunar valve
iii) Ascending aorta: follows to aortic arch with BcT, LSA, and LCC
iv) Chordae tendinae
(1) Blood pushes up against the cusps cause valve to close inducing papillary muscle
contraction and CT taut to prevent back flow
(2) When valve is open, CT become flaccid and papillary muscles relax to allow blood
flow
(3) Mechanism to prevent mitral valve prolapse and backflow
v) Papillary muscles
vi) Trabeculae carneae
(1) Ridges in heart wall found only in the RT and LT ventricles

d) Vestigial structures
i) Ligamentum arteriosum
(1) Remnant of fetal circulation
(2) Remnant of ductus arteriosus which is a shunt from the pulmonary trunk into
the aortic arch; closed at birth
ii) Fossa ovalis
e) Clinical diagnosis of multiple thrombi via transesophageal echocardiogram; non-
responsive to blood thinners revealed to be anomaly; growth of pectinate muscles in LA
2) Functional anatomy of valves
a) AV valve
i) Blood pushes up against the cusps cause valve to close inducing papillary muscle
contraction and CT taut to prevent back flow
ii) When valve is open, CT become flaccid and papillary muscles relax to allow blood
flow
iii) Mechanism to prevent backflow of blood from ventricles into atria during VC or
systole when blood is pushed from the ventricles and pressure increases closing the
AV valves; defect can cause mitral valve prolapse
b) Semilunar valves
i) No chordae tendineae
ii) Found in ascending aorta and pulmonary trunk
iii) Work by gravity
(1) Ejection of blood in Ventricular contraction (VC) results in decreased pressure in
the LV and RV
(2) Gravity causes blood flow towards the valves and results in the cusps/leaflets
filling and closing
(3) Blood trickling downward by gravity into cusps fills the coronary arteries sending
blood to the myocardium
iv) Found in the arteries leaving the heart, at the bases of ascending aorta and
pulmonary artery

3) Coronary circulation – Arteries LCA -

a) Left coronary artery – branches LCA –
LC(ircumflex)A(nterior descending artery/nterior interventricular artery)
i) Anterior interventricular/left anterior descending artery
Supplies
(1) Interventricular septum
(2) Anterior walls or RT and LT ventricle
ii) Circumflex artery – supplies
(1) LT atrium
(2) Posterior walls of LT ventricle
b) Right coronary artery
i) Marginal artery - Supplies
(1) RT lateral part of myocardium
ii) Posterior interventricular artery
(1) Posterior ventricular walls
c) Anastomoses
i) Fusing of blood vessels coming from opposite directions
4) Coronary circulation – Veins
a) Coronary sinus
i) Receives blood from great, middle, and small cardiac veins

5) Cardiac cycle
a) Systole/ventricular contraction
i) Chamber contraction
ii) Atrial- .1s
iii) Ventricle .3s
b) Diastole/ventricular relaxation
i) Chamber relaxation - .4s
c) Coordination of contraction
i) Nodal cells
(1) Modified cardiocytes function to conduct electrical impulses
(2) Sinoatrial node (pacemaker) and Atrioventricular node
ii) Conducting fibers
(1) Modified cardiocytes function to distribute stimuli to myocardium
(2) Purkinge fibers and AV bundle
iii) Brady and Tachy

d) Heart sounds
i) 1st Lubb sound – beginning of ventricular systole/closure of AV valves
(1) AV force closure as ventricles contract trying to open the semilunar valves while
atria is relaxed
(2) Post-lubb: SLV open and blood is pumped into PT and ascending aorta
ii) 2nd dupp sound – beginning of ventricular diastole/ closure of semilunar valves
(1) blood is draining into atria passively with both valves closed during dupp
(2) post-dupp: atria and ventricles relaxed; AV valves open and ventricles begin to
fill with blood
iii) 3rd/4th sounds – associated with ventricular blood flow and atrial contraction
(1) AV valves open and ventricles begin to fill with blood
(2) Atria contraction with semilunar valves closed
6) Pathology
a) Pericarditis
i) Swelling and irritation of the pericardial sac can lead to cardiac tamponade
ii) Pericardium swells causing parietal and visceral layer to approach one another and
begin to rub and cause friction and can result in a break in the heart wall which leaks
fluid into the pericardium
iii) Pericardiocentesis to drain fluid

7) Mediastinum
i) Viscera between pulmonary cavities
ii) Covered by mediastinal pleura
iii) Space between pulmonary cavities, posterior to sternum, inferior to the neck,
anterior of the vertebra, superior to the diaphragm
iv) Blood & lymphatic vessels
v) Lymph nodes
vi) Nerves
vii) Adipose
viii) Loose CT & lung elasticity accommodates movement
a) Boundaries
i) Superior thoracic aperture/thoracic inlet
ii) Diaphragm
iii) Sternum
iv) Thoracic vertebral bodies
b) Divisions
i) Superior – TET BATS PRV
(1) Superior vena cava
(2) Brachiocephalic vein
(3) Aortic arch
(4) Thoracic duct
(5) Trachea
(6) Esophagus
(7) Thymus
(8) Vagus nerve
(9) Recurrent laryngeal
(10) Phrenic
ii) INFERIOR parts
iii) Anterior – I AS Lymph VN
(1) Not a lot of space here for VAN; think pericardium to sternum and adipose
(a) Sternopericardial ligaments: anchors pericardium to sternum
(b) Adipose
(c) Lymphatic vessels
(d) Lymph nodes
(e) Internal thoracic vessels
 (2) Middle – PH APS AaB
(a) Pericardium

(b) Heart

(c) Ascending aorta
(d) Pulmonary trunk
(e) SVC

(f) Azygos arch

(g) Main bronchi
(3) Posterior – Thoracic AD Esophagus P Lymph N HA
(a) Thoracic aorta
(b) Thoracic duct
(c) Lymph nodes
(d) Azygos vein
(e) Hemiazygos vein
(f) Esophagus
(g) Esophageal plexus

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Abdomen

1. Cavity
a. Retroperitoneal (pancreas and large intestine)
i. Located behind the peritoneal cavity
ii. SAD PUCKER
iii. Suprarenal glands
iv. Aorta and IVC
v. Duodenum (everything besides first part)
vi. Pancreas
vii. Ureters and bladder
viii. Colon (ascending and descending)
ix. Kidneys
x. Esophagus
xi. Rectum
b. Intraperitoneal (stomach)
i. SALTD SPRSS
ii. Stomach
iii. Appendix
iv. Liver
v. Transverse colon
vi. Duodenum (1st part only)
vii. Small intestines
viii. Pancreas (tail)
ix. Rectum (upper third)
x. Sigmoid colon
xi. Spleen
c. Posterior abdominal wall
i. Kindeys
ii. Ureter
iii. Urinary bladder
iv. Urethra (bladder and urethra mostly in pelvic region)

2. Muscles of the abdominal wall

a. Rectus abdominis
b. External oblique
i. Lateral to medial
c. Internal oblique
i. Medial to lateral
d. Transversus abdominis
e. Hernia: abnormal exit of tissue or an organ through the
wall of the cavity it normally resides in
 i. Inguinal, umbilical, abdominal
ii. Wall of the gut tube can protrude to the point
where ischemia results and a loss of blood to the area occurs
Linea alba – medial fibrous structure from xyphoid process to pubic symphysis
Linea nigra in late trimester pregnancies

3. Abdominal aorta and branches –

Big three superior to inferior
CT, SMeA, IMeA
unpaired
a. Celiac trunk: provides blood to the
liver, Stomach, and Spleen LSS - branches LG S CH
i. LT gastric
ii. Splenic
iii. Common hepatic arteries
b. Superior mesenteric artery
i. Pancreas, SI, most of LI
c. Inferior mesenteric artery
i. Terminal/sigmoid colon and rectum
Paired- LS RIG
d. Inferior phrenic
i. Inferior aspect of diaphragm
e. Suprarenal
f. Renal
g. Gonadal
h. Lumbar
4. Veins draining the abdomen
a. Lumbar
b. Gonadal
c. Hepatic
d. Suprarenal
e. Phrenic
5. Mesentery
a. Fused double sheets of peritoneal membrane providing routes for blood vessels,
lymphatics, and nerves
b. Mesentery proper is attached to all parts of the SI and anchors the SI
c. Organ reinforcement and prevents entanglement
i. Anchors intestines to posterior abdominal wall
d. Greater omentum
i. 1st membrane encountered when the abdomen is cut vertically at linea alba
ii. drape-like
 iii. sites of attachment are the greater curvature of stomach and transverse colon
iv. other parts of mesentery attached to the mesocolon (transverse and sigmoid)
e. lesser omentum
6. Organs
a. Esophagus: posterior mediastinum
i. Hollow muscular tube 25cm long 2cm diameter
ii. C6-T7
iii. Angiology
1. Esophageal artery
2. Thyrocervical trunk
3. External carotids
4. Bronchials
5. Celiac trunk
6. Inferior phrenic artery
7. Focus on 5&6
iv. Innervation
1. Vagus nerve
2. Esophageal plexus
v. Made of non-keratinized stratified squamous epithelium
vi. Change of musculature in esophageal wall as it proceeds to the cardia (terminus of
esophagus)
1. Superior 1/3: skeletal muscles fibers
2. Middle third: smooth/skeletal
3. Inferior third: Smooth
vii. Outer layer of adventitia in superior two-thirds
viii. Serosa found only in the inferior 1/3 of the esophagus
b. Stomach
i. Storage of ingested food, mechanical breakdown, and chemical digestion (forms
chyme) chyme
1. Ingested food becomes bolus by peristalsis
2. Chyme in the stomach
ii. T7-L3
iii. 15-25cm long; 50ml-4000mL/4L
iv. rugae
1. gastric folds in the mucosa present only when the stomach is empty
v. cardia/upper opening of the stomach
1. not a true sphincter
2. created by tendons or crus of the diaphragm which mimics the act of a
sphincter
3. lack of true sphincter and close proximity to heart
vi. fundus
1. expansive portion of stomach
2. targeted by bariatric surgeons due to high presence of grehlin cells in the
fundus
 3. upper medial aspect of stomach lateral to the cardia
vii. lesser curvature – medial border RT
viii. greater curvature – lateral border LT
ix. Pylorus
1. End of the stomach in pyloric sphincter considered a true sphincter due to
the increased musculature in the area
x. esophageal hiatus: created as the esophagus enters the stomach or becomes the
cardia, surrounded by crus or tendinous structure below the diaphragm
c. stomach angiology
i. LT gastric
1. Lesser curve and cardia
ii. Splenic
1. Fundus and greater curve
iii. Common hepatic (lesser/greater curves of pylorus
iv. Musculature
1. Circular: constrict and dilate the lumen of the stomach
2. Longitudinal: shortens (contracts) and lengthens (relaxes) lumen of the
stomach
3. Oblique: “twist” felt when empty stomach by visceral efferent fibers
d. Small intestine
i. Major digestive organ
ii. 6m long; 4cm-2.5cm in diameter
iii. 90% of nutrient absorption
iv. plicae circulares
1. infoldings of the mucosa found throughout the SI
v. Duodenum
1. Circular fold arrangement tightly coiled
2. Retroperitoneal (L1-L4)
3. C-Shaped
4. Ampulla or opening where the pancreatic sphincter and hepatic sphincter
dump contents; exits through major duodenal papilla
vi. jejunum
1. Circular fold arrangement tightly coiled
2. 2.5m long
3. blood supply from SMA

vii. Ileum
1. Peritoneal
2. 3.6m long
3. ends at ileocecal valve (true sphincter) into the cecal pouch of LI
4. PC more scattered
e. Large intestine
i. 3 sided border on SI and extends from ileocecal valve to the anus
 ii. functions
1. resorption of water/electrolytes and compaction of feces
2. vitamin absorption by e. coli
iii. cecum and vermiform appendix
iv. colon
1. hausta or bulges
2. taenia coli: longitudinal muscle on three sides of the LI spanning the entire
organ
3. epiploic appendages: fatty tags in close proximity to taenia coli; unique to
the LI and a marker to differentiate between small and large intestines
v. colonic regions
1. ascending
2. hepatic flexure
3. transverse colon
4. splenic flexure
5. descending
6. sigmoid flexure
7. sigmoid colon
vi. rectum
1. anal canal/columns
2. internal and external anal sphincter
3. anal orifice

7. accessory organs
a. liver
i. largest visceral organ/largest gland
ii. metabolic and hematological regulation
iii. hepatocytes secrete bile
iv. falciform ligament: exterior outermost aspect of liver is a falciform ligament
which is simply a visceral peritoneum anchoring the liver to the anterior abdominal
wall
v. ligamentum teres/round ligament of the liver
1. remnant of the umbilical vein in fetal circulation
vi. porta hepatis: region of liver containing the portal and hepatic vein; bile duct in this
vicinity
vii. 4 lobes
1. RT is the largest
2. LT
3. Caudate
4. Quadrate
viii. Further divided into lobules
1. Functional unit of the liver with portal triad (VA and bile duct) at each angle
of the hexagon
 2. Rows of hepatocytes leading to the center containing a central vein
ix. 8 segments
x. supplied by the hepatic artery proper and the portal vein
b. gall bladder
i. mostly storage for bile
ii. fundus: expansion part
iii. body: narrows down to the neck
iv. neck: narrows to the cystic duct where bile is stored; continuous with the common
hepatic duct where it receives bile from RT and LT hepatic ducts; from here it travels
down the bile duct into the hepatopancreatic ampulla and then major duodenal
papilla into the duodenum
v. gall stones/cholelithiasis
c. pancreas
i. exo/endo gland in the retroperitoneal cavity
1. exocrine: ducts; pancreatic juice digestive enzyme
2. endocrine: ductless; islets of Langerhans
a. alpha cells: insulin
b. beta cells: glucagon
c. delta cells: somatostatin
ii. main pancreatic duct/duct of wirsung
iii. accessory pancreatic duct/duct of santorini
d. hepatic portal system
i. tributaries
1. inferior mesenteric
2. superior mesenteric
a. fusion of SMV and splenic vein forms hepatic portal vein
3. splenic
e. Kidney
i. Renal cortex (superficial layer)
ii. Renal medulla (core)
iii. Medullary pyramids
iv. Renal columns
1. Made of cortical tissue
2. Separates medullary pyramids from one another
v. Minor calyces
1. In contact with the individual pyramids
2. Two or three Converge to form a major calyx
vi. Major calyx
1. Made of converged minor calyces
2. Converge into renal pelvis
vii. renal pelvis
1. funnel-like dilated part of the proximal ureter
viii. renal sinus
1. cavity within the kidney where minor, major, and renal pelvis are contained
 2. adipose tissue to reinforce calyces and cushion the renal pelvis
3. collapse can result in backlog of urine
f. renal histology
i. passage of urine
1. minor calyces
2. major calyces
3. renal pelvis
a. 1-3 contained within the renal sinus
4. ureter
a. mucosa
b. longitudinal (inner)
c. circular (outer) ; PERISTALSIS defined by combo of longitudinal and
circular muscles
d. adventitia
5. bladder
6. urethra (proximal urethra made of urothelium)
g. kidney angiology
i. blood entering in renal artery is unfiltered
ii. blood leaving in renal veins is filtered
iii. abdominal aorta  branches of renal artery  segmental arteries  interlobar
arteries (located in between renal columns and renal pyramids ) arcuate arteries
interlobular arteries afferent arterioles  glomerulus efferent arterioles 
peritubular capillaries vase recta/straight arterioles  venules  interlobular
veins arcuate veins interlobar veins renal veins
 h. kidney pathology
i. kidney stones or Urolithiasis/Nephrolithiasis/Ureterolithiasis
1. when blocking the calyces or renal pelvis, this causes a backlog of urine
known as hydronephrosis
2. if there is a development of pus in the renal pelvis (calyces leading to it)
pyelitis
3. if the infection spreads to the rest of the kidney, pyelonephritis
ii. nephroptosis
1. dilation of the calycles leading to the renal pelvis on xray is indicative of this
condition
2. kidney drops down causing a bend in the ureter which can also leed to
hydronephrosis
iii. horseshoe kidney
1. ren arcuatus
2. renal fusion
3. super kidney
8. adrenal glands
a. paired
b. cortex
i. glomerulosa: mineral
ii. fasciculata: glucocorticoids
iii. reticularis: gonadocorticoids
c. medulla
d. malfunction of the adrenal cortex can result in formation of adipose tissue at C-
7/buffalo hump and rounding of the face known as Cushing’s syndrome due to
hypersecretion of glucocorticoids
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