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BIPN100 H - SSN Anatomy 29 September 2004 Rob RWH2103 and...

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SSN Anatomy 29 September 2004 Rob: RWH2103 and Agni? AKP2101 Written general advice: practice tests, CD, questions in book. Focus on clinical correlates. Not so big on veins, lymphatics, muscle insertions. Loves veins and arteries. I. Superficial stuff: A. Langer’s lines . Contours on skin. Only thing to remember: if you’re a surgeon, cut parallel to Langer’s lines whenever possible. B. Two main layers: 1. Superficial fascia a. Campers: (fatty) fat camp. b. scarpas (holds sutures) 2. deep fascia. Does not come off muscle C. Breast (April’s favorite) 15-20 lobules. Each has own duct. All dump in separately into nipple. He loves this. Also likes the fact that nipples darken after conception irreversibly. Most of breast is lateral to nipple (75%) a lot of it is in axilla. Drained by axillary lymph nodes. If you have breast cancer, will often spread to axillary lymph nodes and they will need to be removed (this will lower drainage to the arm. Also lymph nodes right along sternum (parasternal lymph nodes). Cancer can metastasize via these lymph nodes into other breast. Breast supported by ligaments of cooper (suspensory ligaments). Tumor on coopers will cause breast dimpling. Breast lies completely in superficial fascia (very mobile, easy to cleave entire section during surgery) II. Nervous system: remember mnemonic SAME DAVE (sensory afferent, motor efferent; dorsal afferent, ventral efferent) A. CNS: brain and spinal cord B. PNS C. Somatic 1. Sensory (afferent) 2. Motor (efferent) D. Visceral (autonomic) -- ONLY EFFERENT. Any pain will be referred. 1. Parasympathetic: rest, digest 2. Sympathetic: fight or flight. Sympathetic nerves only (only location for white rami) T1-L2. Signal from head has to go here to get to sympathetic chain. Back = dorsal horn. (Sensory) Lateral = (sympathetic) Front:= ventral horn (motor)
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SSN Anatomy 9.29.04 E. Pathways: 1. Somatic afferent . Sensory from skeletal muscle (anything voluntary). 3 neuron system. Sensory information comes in from periphery, comes into spinal nerve through dorsal root ganglion. Synapse on dorsal horn, goes up. Third neuron is in brain. 2. Somatic efferent . 2 neuron system. From brain, through ventral root, then goes wherever it needs to go. 3. Sympathetic : from brain, synapse in lateral horn of spinal cord, through ventral root, enters sympathetic chain through white ramus. (only one synapse has occurred). This signal can now do three different things: a. synapse at that level (T3), exit through grey ramus, go through spinal nerve to control piloerection or sweating. b. go up or down sympathetic chain, synapse at different level (T4, T5), exit through grey ramus at different level to control sweating etc. c.
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BIPN100 H - SSN Anatomy 29 September 2004 Rob RWH2103 and...

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