Anästhesie (Subject) / Anatomie (Lesson)

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• N. laryngeus recurrens/ N. laryngeus superior N. laryngeus superior versorgt alle Muskeln des Larynx ausser M. cricothyroideus (versorgt vom oberen Kehlkopfsnerv) Sensibel unterhalb der Stimmbänder einseitige Lähmung: Heiserkeit, bds. Atemnot The incidence of injuries to the recurrent laryngeal nerve (RLN) has been reported as 1% - 14% after thyreoid resection   N. laryngeus superior (Vagusast) verläuft medial der Arteria carotis externa. Er teilt sich auf Höhe desZungenbeins in zwei Äste auf: den kleineren motorischen Ramus externus (M.cricothyroideus) den grösseren sensiblen Ramus internus (Larynx oberhalb der Stimmbänder) These nerves innervate muscles that fine-tune the vocal cords. If they are injured the voice quality is usually fairly normal but creating high-pitched sounds may difficult. The incidence of injury to the EBSLN is approximately 2% after thyreoid resection   The superior laryngeal nerve can be blocked below and anterior to the greater cornu of the hyoid bone, which is where the nerve divides into its two branches.  
• Sympathikus Th1-L2/3 Präganglionär: Nucleus intermediolateral - anteriore Nervenwurzel- als Ramus griseus Verschaltung auf 3 Ganglientypen:                           1. Sympathischer Grenzstrang. Verbindung mit Spinalnerven 2. Distale Plexen: cardial, ösophageal, pulmonal 3. nahe Zielorgan: cöliacal, mesenterius sup., aortorenal, mesent. inf. Neurotransmitter: 1. Ganglion nAch, 2. Ganglion NA. Ausnahme: Schweissdrüsen und Nebennierenmark: ACh Innervation Kopf/ Hals: Ganglion stellatae: Fusion inferiores cervikales Ganglion mit erstem thorakalen Ganglion. Neben Kopf der 1. Rippe Ganglion cervikale medius und superius (mittlere Halsganglien): Höhe C6. Die sympathischen Wurzelzellen liegen im oberen Brustmark  
• PArasympathikus Mittelhirn, Medulla oblongata, sakrale Segmente Hirnnerven: III (occulomotorius) - Edinger Westphal- Ganglion ciliare VII (facialis)- N. salivatorius sup. - Ganglion geniculi- Umschaltung im Ganglion Pterygopalatinum IX(glossopharyngeus) - Ganglion oticum X ( vagus) - Herz, Tracheobronchial, Leber, Milz, Nieren, GIT (ausser dist. Colon) Sacral: N. erigentes             pelvic splanchnic nerves --> Ganglion -> Rectum, urogenital    
• Bronchialbaum   The divisions of the bronchial tree are bronchus, bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli. The left lung has two lobar bronchi and they both have five divisions. The right lung has three lobar bronchi. The right upper lobe has three divisions; the right middle lobe has two divisions and the right lower lobe, five divisions. The left main bronchus passes under the aortic arch. It is posterior to the left pulmonary artery and is anterior to the oesophagus, aortic arch and thoracic duct. The right main bronchus lies above and behind the right pulmonary artery and passes under the azygous vein arch.   The airway consists of 23 generations and the respiratory bronchioles are included in the distal seven generations. Gas exchange occurs within the respiratory bronchioles, alveolar ducts and alveoli. The surface area of the alveoli is between 500, 000 - 1, 000, 000 cm² (or approximately 50-100 m²). The velocity of airflow is low because of the large cross-sectional area of airways.    
• Würgereflex The glossopharyngeal nerve forms the afferent (sensory) limb and the vagus nerve the efferent (motor).
• Diaphragma Openings: levels:   T8 (venous content, inferior vena cava, right phrenic nerve) 10 (oesophageal contents, gastric vessels)  12 (arterial contents: aorta, v. azygos) The diaphragm has three arcuate ligaments (medial, lateral and median). At the end of expiration the diaphragm reaches the fifth rib on the right and the fifth intercostal space on the left.   The diaphragm develops in the neck and hence receives its nerve supply from the cervical spinal cord (C4-C5). It develops mainly from septum transversum (central tendon) and cervical myotomes (muscular component). The mesothelial linings are derived from the pleuro-peritoneal membranes (failure of its development leads to Bochdalek's foramen and hernia). The motor nerve supply arises from the phrenic nerve. The phrenic nerves pierce the muscular components (not the central tendon) to reach and supply the diaphragm from below. The sensory nerve (propriozeption) supply is from the lower six intercostal nerves.      
• Liquor  pH of 7.31 im Vgl zum Plasma: geringere Konzentration an Kalium, Calcium, Proteinen, Bicarbonat etwa 2/3 der Glucose Konzentration (3.3-4 mmol/l) leicht höhere Konzentration an Natrium (135-145), Chlorid (115-125) und. Magnesium Zellfrei bzw. weisse Zellen normalerweise < 4/ml Druck < 20 cm Wassersäule Zirkulation CSF is produced by the choroid plexuses within the lateral, third, and fourth ventricles of the brain. Aggregates of arachnoid villi (arachnoid granulations) serve as sites where the CSF diffuses into the bloodstream. CSF leaves the ventricular system of the brain and enters the subarachnoid space between the arachnoid and pia mater, where it cushions and nourishes the brain. In certain areas the arachnoid projects into the venous sinuses to form arachnoid villi. Hydrocephalus occurs when there is obstruction to the outflow of CSF, which can occur if there is blockage of the arachnoid granulations. Menge   CSF is produced by the choroid plexus at a rate of 0.3 ml/min  500 ml are produced per day  The total volume is 150 ml, with two thirds surrounding the brain and one third surrounding the spinal cord. Production is unaffected by changes in intracranial pressure (ICP), but absorption by the arachnoid villi is increased when the ICP is elevated.    
• Hand: Sensible Versorgung   Der Nervus ulnaris versorgt die Haut der ulnaren Finger palmar (1 1/2 Finger) und dorsal (2 1/2 Finger) Die Haut der radialen Finger wird vom Nervus medianus und vom Nervus radialis innerviert: der Nervus medianus versorgt die Haut der palmaren radialen 3 1/2 Finger sowie die Fingerkuppen auf der dorsalen Seite das Versorgungsgebiet des Nervus radialis sind die dorsalen radialen 2 1/2 Finger.  
• Hand, motorische Innervation Die Muskeln der Hohlhand werden nur vom Nervus medianus und vom Nervus ulnaris innerviert. Der Nervus ulnaris ist für die mehr ulnaren Muskeln zuständig. Er versorgt alle Muskeln des Hypothenars sowie den Musculus palmaris brevis, alle Musculi interossei, die zwei ulnaren Musculi lumbricales, Teile des Thenars, und zwar den kompletten Musculus adductor pollicis, den tiefen Kopf des Musculus flexor pollicis brevis. Der Nervus medianus versorgt dagegen alle übrigen Muskeln der Hand, also den Thenar außer derjenigen Muskeln, die vom Nervus ulnaris angesteuert werden, die zwei radialen Musculi lumbricales.  
• Kapaltunnelsyndrom Phalen's test (pushing both hands up into a prayer sign to elicit paraesthesia in the median nerve) and Tinnel's test (tapping the flexor retinaculum to elicit paraesthesia in the median nerve) are both clinical assessments of carpal tunnel syndrome (hence median nerve function). Although the majority of causes of carpal tunnel syndrome are idiopathic, there are strong associations with Pregnancy Rheumatoid arthritis Diabetes mellitus Hypothyroidism and Dialysis-dependant patients.
• Calcitonin senkt Calcium im Blut
• Parathormon erhöht Calcium im Blut
• Immunglobuline IgG, IgD, IgE: Monomer IgM Pentamer IgA Dimer Immunoglobulin M (IgM) constitutes the natural haemagglutinins (anti-A and anti-B > BG-AB) IgA is the predominant immunoglobulin in normal bronchial secretions (u.a. externen Körperflüssigkeiten) Only IgG freely crosses the placenta (but requires a transport mechanism) IgG has a molecular weight of 150,000 daltons and bears only two antigen-binding sites. Degranulation of mast cells is caused by crosslinking of IgE  
• adrenalin   Abbau - Catechol-O-Methyltransferase(COMT) > Metanephrin    - Monoaminooxidase (MAO): Metanephrin > Vanillinmandelsäure und 3-Methoxy-4-hydroxyphenylethylenglykol (MOPEG) > Urin  The concentration of adrenaline in the synaptic cleft is increased in: The presence of cocaine which inhibits adrenaline reuptake The presence of MAO inhibitors which block the metabolism of adrenaline by MAO The presence of noradrenaline receptor blockers and partial agonist of noradrenaline receptors. Although COMT is also involved in the metabolism of adrenaline this occurs in the blood stream.  
• Nervus trigeminus The trigeminal nerve is a mixed nerve providing sensory supply to the face and motor supply to the muscles of mastication, anterior digastric, mylohyoid, tensor tympani and tensor palati. It has ophthalmic (V1), maxillary (V2) and mandibular (V3) divisions.   The ophthalmic division divides into lacrimal, frontal and nasociliary branches before exiting the skull via the superior orbital fissure. The maxillary division emerges from the skull through the foramen rotundum. Sensorisch: Weicher und harter Gaumen, obere Molaren, obere Incisivi (Schneidezähne) the mandibular division transits the foramen ovale      
• Nervus facialis After exiting the stylomastoid foramen, the facial nerve is entirely motor. It gives off the posterior auricular nerve and branches to the posterior belly of digastric and stylohyoid before entering the substance of the parotid gland. It divides into five major branches within the parotid gland. From superior to inferior, these are the: Temporal branch supplying the extrinsic ear muscles, occipitofrontalis and orbicularis oculi Zygomatic branch supplying orbicularis oculi Buccal branch supplying buccinator and the lip muscles Mandibular branch supplying the muscles of the lower lip and chin Cervical branch supplying platysma. Though it passes through the parotid, the facial nerve does not innervate this gland. This is the responsibility of the glossopharyngeal nerve.
• T-Zellen T cells have characteristic surface glycoproteins and their own form of receptors. Helper T cells recognise foreign antigens in association with HLA class II antigens on presenting cells. Survival of T cells varies from several weeks to the lifetime of an individual, such as the T cells in thymus. They secrete IL-2 when activated. B-lymphocytes express immunoglobulins on their surface and secrete immunoglobulins (not T cells).
• Pharynx The pharynx is a midline structure that extends from the skull base to the level of C6. It consists of three paired muscles (superior, middle and inferior constrictors) and three unpaired muscles (stylopharyngeus, salpingopharyngeus and palatopharyngeus). The venous drainage of the pharynx is via the pharyngeal plexus into the internal jugular vein. The pharynx contains four layers (mucosa, submucosa, muscular and loose connective tissue). The sensory supply to the pharynx is from the pharyngeal branch of the accessory nerve and also the vagus. The motor innervation of the pharynx is from the vagus nerve (except stylopharyngeus which is supplied by the accessory nerve).
• Handgelenk, volar   The usual relationship between the nerves, arteries and tendons (radial side to ulnar side) at the volar aspect of the wrist is as follows: Radial artery Flexor carpi radialis Median nerve Palmaris longis Ulnar artery Ulnar nerve  Flexor carpi ulnaris. The ulnar artery is a larger vessel than the radial artery.  
• Larynx The larynx extends from C3 to C6. It contains six paired (arytenoid, corniculate, and cuneiform) and three unpaired (epiglottis, thyroid and the cricoid) cartilages. The cricoid cartilage is a signet ring shaped cartilage at the level of C6. The larynx contains four extrinsic ligaments (thyrohyoid, hyoepiglottic, cricothyroid and cricotracheal).   ventricle of the larynx is the fossa between the true and false cords Rima glottidis is the space between the true vocal cords All of the intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerves, except the cricothyroid which is supplied by the external branch of the superior laryngeal nerve. Regarding the intrinsic muscles of the larynx: The posterior cricoarytenoids abduct the cords The lateral cricoarytenoids and interarytenoids adduct the cords The sphincters to the vestibule are the aryepiglottics and the thyroepiglottics. Vocal cord tension is regulated by the Cricothyroids (tensors) Thyroarytenoids (relaxors) and the Vocales (fine adjustments). The left recurrent laryngeal nerve is damaged twice as often as the right due to its intrathoracic course making it more vulnerable. A neuropraxia to the recurrent laryngeal nerve results in paralysis of the ipsilateral vocal cord, which causes the vocal cord to adduct (lies near the midline). Complete transection of the nerve results in abduction of the vocal cord.  
• Zunge, Nervale Innervation   Somatische Afferenz: vordere 2/3 der Zunge: Trigeminus (N. lingualis aus N. mandibularis). Geschmack: vordere 2/3 der Zunge: Chorda tympani, N. facialis Somatische und Geschmacks-Afferenz: hinteres Drittel der Zunge: N. glossopharyngeus Muskulatur der Zunge: N. hypoglossus. Ausnahme: M. palatoglossus (N. glossopharyngeus, accessorius oder vagus)    
• Plexus brachialis Rami ventralis C5 to T1 (C4 and T2) Nervenaustritte zwischen M. scalenus anterius und scalenus medius. Formung von 3 Trunci: Truncus superior, medius und inferior Aufteilung der Trunci in vorderen und hinteren Anteil, die 3 Stränge bilden, benannt nach der anatomischen Beziehung zur A. axillaris: Fasciculus lateralis, medialis und posterior Supraclaviculäre Äste sind: Nervus suprascapularis Nervus dorsalis scapulae Nervus thoracicus longus Nervus subclavius Rami musculares Infraclaviculäre Äste: Nervus pectoralis medialis und lateralis (Fasciculus lateralis und medialis) Nervus musculocutaneus (Fasciculus lateralis) Nervus medianus (Fasciculus lateralis und medialis) Nervus ulnaris (Fasciculus medialis) Nervus cutaneus brachii medialis (Fasciculus medialis) Nervus cutaneus antebrachii medialis (Fasciculus medialis) Nervus axillaris (Fasciculus posterior) Nervus radialis (Fasciculus posterior) Nervus subscapularis (Fasciculus posterior) Nervus thoracodorsalis (Fasciculus posterior) The axillary nerve comes from C5 and C6 and is from the posterior cord. The long thoracic nerve is supplied by C5, C6 and C7 and innervates serratus anterior. The median nerve comes from C6 to T1 but is derived from the medial and lateral cords. The radial nerve is derived from C5 to T1 and comes from the posterior cord. The ulna nerve is derived from C8 and T1 and comes from the medial cord.   Nervus musculocutaneous: Flexoren Oberarm: M. biceps, M. brachialis und M. coracobrachialis, sensibel Hautbereich Unterarm N. radialis: Extensoren Arm, sensibel Dorsalseite Arm N. medianus: Pronation, Beugung Hand, Beugung Dig I-III, Sensibel Hohlhand (ohne den Kleinfingerballen), teilweise Finger I-IV N. ulnaris: sensibel Kleinfinger, ulnare Seite Ringfinger, ulnare Seite Handrücken, motorisch Teile Unterarmmuskulatur, Teile des Daumenballens, Kleinfingerballen, Großteil der kurzen Muskeln der Mittelhand (Spreizen und Schließen der Finger)  N. axillaris: M. deltoideus, teres minor N. thoracodorsalis: M. latissimus dorsi, teres major N. thoracicus longus: M. serratus anterior      
• Tractus spinothalamicus (sensibles anterolaterales Bahnsystem oder Vorderseitenstrangbahn) Sensorische Nerven- Synapse im Hinterhorn spinalwurzel- Kreuzung spinal - Tractus spinothalamicus- thalamus und Formatio reticularis Tractus spinothalamicus anterior: Berührungsempfinden, viscerosensibel   Tractus spinothalamicus lateralis: Schmerz und Temperatur    
• Hinterstrangbahn epikritische Sensibilität (Tastschärfe, Zwei-Punkte-Diskrimination) und Informationen der Tiefensensibilität (Gelenkstellung, Propriozeption, Vibration) jeweils der gleichen Körperseite keine Umschaltung im Hinterhorn, dafür aber in der Medulla oblongata, im Nucleus gracilis für Informationen der unteren Körperhälfte und im Nucleus cuneatus für die der oberen Körperhälfte.   
• Koronarien Die linke Koronararterie (LCA) entspringt dem hinteren Aortensegel, teilt sich nach etwa 1 cm in den Ramus circumflexus (RCX) und den Ramus interventricularis anterior (RIVA, engl.: left anterior descending, LAD), welcher vorne zwischen linker und rechter Herzkammer zur Herzspitze zieht, auf. Bis zur Gabelung spricht man vom Hauptstamm (Truncus communis). Manchmal teilt sich der Hauptstamm auch in drei Gefäße auf, das mittlere wird dann als Ramus intermedius bezeichnet. Die linke Arterie versorgt die Herzvorderwand, die Seitenwand und das Septum. Die rechte Koronararterie (RCA) hat einen Hauptast, den Ramus interventricularis posterior (RIVP, engl.: posterior descendent artery, PDA), der aus dem anterioren Aortensinus entspringt. Abgang des Ramus marginals dexter Richtung Herzspitze. Dort Anastomose mit LAD.   Normalfall (bei rund 75 % der Bevölkerung): Die Arteria coronaria sinistra versorgt: den linken Vorhof, die Muskulatur des linken Ventrikels, den Großteil des Septums interventriculare, einen Anteil der Vorderwand des rechten Ventrikels. Die Arteria coronaria dextra versorgt: rechten Vorhof, rechten Ventrikel, den hinteren Teil des Septum interventriculare, den Sinusknoten, den AV-Knoten, einen Anteil der Hinterwand des linken Ventrikels bei 85% auch den inferioren linken Ventrikel Wenn die linke Herzkranzarterie auch die Hinterwand und die Knoten mitversorgt, spricht man von einem Linksversorgertyp (10%), wohingegen man bei einer (Mit-)Versorgung der Vorderwand durch die rechte Koronararterie von einem Rechtsversorgertyp spricht; der Normalfall wird als Intermediärtyp bezeichnet.     Venös The oblique vein together with the small, middle and great cardiac veins drain into the coronary sinus, which drains into the right atrium. The anterior cardiac vein drains directly into the right atrium.    
• Leistenkanal Inhalt Leistenkanal Männer:  ilioinguinal nerve and spermatic cord ( pampiniform plexus, cremasteric artery, vas deferens, sympathetic plexus and genital branch of the genitofemoral nerve). Frauen: round ligament and ilioinguinal nerve. Begrenzung  anterior superior iliac spine and the pubic tubercle. Anterior (aponeurosis of external oblique, internal oblique muscle.) Posterior (fascia transversalis and conjoint tendon, tendons of internal oblique and transversus muscle, weak transversalis fascia laterally) Inferior (inguinal ligament,  lacunar ligamen) Superior (transverse abdominis and internal oblique)  
• Gallensäuren Bile is an alkaline, hypotonic electrolyte solution composed of bile pigments and salts.   Approximately 300-500 mg (ml) of bile acids are synthesised per day from cholesterol by the liver. They are conjugated with taurine and glycine before excretion into the bile and then stored in the gallbladder. A small amount of unesterified cholesterol is excreted in the bile. Bile acids undergo enterohepatic reabsorption, where approximately 96% is reabsorbed in the terminal ileum. Intestinal metabolism of bile acids by excessive gut bacteria may result in malabsorption and diarrhoea.    
• Gefässversorgung Lunge The bronchial arteries are branches of the descending aorta (not pulmonary arteries) and supply the bronchi, the lung connective tissue and the visceral pleura. The bronchial veins communicate with the pulmonary veins and drain into the azygos and hemiazygos veins. The terminal branches of the pulmonary arteries deliver deoxygenated blood to the alveoli (not oxygenated). Following oxygenation the blood leaves the alveolar capillaries and drains into the tributaries of the pulmonary veins, which follow the intersegmental connective tissue septa to the lung root, thus there are a total of four (not two).
• Rückenmark und Spinalwurzeln There are 31 pairs of spinal roots from the spinal cord: Eight cervical Twelve thoracic Five lumbar Five sacral and One coccygeal. The spinal cord is supplied by two posterior and one anterior spinal arteries which do not form a direct anastomosis. The anterior spinal artery supplies the anterior two-thirds of the spinal cord and medulla. Disruption of the anterior spinal artery supply is characterised by ischaemia or infarction of motor tracts (corticospinal) and loss of pain and temperature sensation below the level of the lesion. The posterior spinal arteries supply the posterior columns (posterior third of the spinal cord). Infarction of the posterior columns results in the loss of proprioceptive, vibration and two-point discrimination. The spinal cord normally ends at the level of L1 or L2 in an adult and L3 in a newborn.
• Craniale Austrittspunkte von Nerven und Gefässen   Fissura orbitalis superior  Nervus oculomotorius (III. Hirnnerv) Nervus trochlearis (IV. Hirnnerv) Nervus abducens (VI. Hirnnerv) Vena ophthalmica superior Nervus ophthalmicus (V1, erster Ast des V. Hirnnervs, Nervus trigeminus) Foramen rotundum N. maxillaris Foramen ovale N. mandibularis Foramen jugulare  Nervus glossopharyngeus (Nervus IX)  Nervus vagus (Nervus X)   Nervus accessorius (Nervus XI)  Arteria meningea posterior  Vena jugularis interna Canalis caroticus  > Arteria carotis interna  Foramen spinosum Vena und Arteria meningea media sympathische Nervenfasern rückläufig der Hirnhautast (Ramus meningeus) des Nervus mandibularis. Foramen magnum A. vertebralis  
• Nervus fibularis communis ist einer der beiden Hauptäste des Nervus ischiadicus. Der andere Ast ist der Nervus tibialis. Der N. fibularis communis zieht seitlich des Knies, am Wadenbeinkopf vorbei    > Fussheberschwäche durch Schädigung im Bereich der Wade bei Steinschnittlage, besonders bei Seitenlage Ebenso Schädigung bei Dehnung durch extreme Hüftflexion in Steinschnittlage
• Fetale Circulation The fetal circulation is specially adapted preferentially to supply the brain and coronary blood vessels with blood with the highest possible oxygen concentration. Which of the following is the single most important adaptation making this possible?   Oxygenated blood reaches the fetus via the umbilical vein (PaO2 4.7kPa; SaO2 80-90%). Up to 60% of this blood flow bypasses the liver in the ductus venosus (DV) which then becomes the inferior vena cava (IVC). At the junction of the IVC and the right atrium (RA) a tissue flap directs the more highly oxygenated blood, streaming along the dorsal aspect of the IVC, across the foramen ovale (FO) and into the left atrium (LA). In the LA, the oxygen saturation of fetal blood is 65%. This better oxygenated blood enters the left ventricle (LV) and is ejected into the ascending aorta. The majority of the LV blood is delivered to the brain and coronary circulation thus ensuring that blood with the highest possible oxygen concentration is delivered to these vital structures. Oxygen delivery is dependent on haemoglobin concentration, cardiac output and oxygen saturation. The cardiac output of the fetus is regarded as the total output of both ventricles - the combined ventricular output (CVO). About 45% of the CVO is directed to the placental circulation with only 8% of CVO entering the pulmonary circulation. The presence of fetal haemoglobin and a high CVO will help to maintain oxygen delivery despite low PaO2. With the high pulmonary vascular resistance and the presence of the ductus arteriosus most of the right ventricular output passes into the arch of the aorta just distal to the origin of the arteries to the head and upper limbs.
• Rippe I   The lower trunk of the brachial plexus lies on the upper surface. The scalene tubercle provides the insertion for the tendon of scalenus anterior. The stellate ganglion does lie anterior to the neck of the first rib. The subclavian artery runs in a separate groove behind the scalene tubercle. The upper surface of the first rib (in front of the scalene tubercle) bears a groove for the subclavian vein.  
• Pädiatrischer Atemweg The tongue is large during the neonatal period, reaching normal proportions by the age of 1 year. The vocal cords lie opposite C4 and only reach the adult position opposite C5/6 by the age of 4 years. The larynx is more anterior in infants, due to the underdeveloped cricoid cartilage, which is why the cricoid ring is the narrowest part of the paediatric airway (in the adult the narrowest part of the airway is at the level of the vocal cords). The epiglottis is relatively large and inclines at an angle of 45 degrees to the laryngeal opening. The carina is at the level of T2 in the paediatric population (T4 in adults) and the left and right main bronchi divide at similar angles. Neonates have a comparatively small number of alveoli and this number increases to a maximum by the age of 8 years. Neonates are obligatory nose breathers and any obstruction can cause respiratory distress (for example, choanal atresia).
• Nervus femoralis The femoral sheath contains the femoral artery and vein as well as lymphatics, but not the nerve. The femoral nerve lies behind and lateral to the sheath. The femoral nerve gives off three cutaneous branches: Two from its anterior division (medial and intermediate cutaneous nerves of thigh which supply the skin of the medial and anterior surfaces of the thigh) and One from its posterior division (saphenous nerve). The saphenous nerve runs down the medial side of the leg and supplies the medial side of the calf as far as the medial malleolus.  It terminates in the region of the ball of the big toe and may supply the medial side of the dorsum of the foot. The femoral nerve is the largest branch of the lumbar plexus and comes from the same lumbar nerves as the obturator nerve, L2, 3 and 4.
• N. accessorius Damage to the spinal accessory nerve will cause an inability to shrug the shoulder on the affected side and rotate the head to the side against resistance. This is due to the weakness of the trapezius and sternomastoid muscles.
• N. hypoglossus (XII)   Damage to the hypoglossal nerve causes wasting of the tongue and inability to move from side to side.  
• N. glossopharyngeus   The glossopharyngeal nerve provides motor supply to the stylopharyngeus („Griffel-Rachen-Muskel“). It also carries sensory fibres of taste from the posterior 1/3 of the tongue and carotid sinus, carotid body, pharynx and middle ear.  
• N. vagus The vagus nerve provides motor supply to larynx, pharynx and palate; parasympathetic innervation to the heart, lung and gut, sensory fibres from the epiglottis and valleculae.
• oxygen consumption (VO2) resting oxygen consumption (VO2): 3.5 ml/kg/minute (one metabolic equivalent or 1 MET).  in young children: approximately 7 ml/kg/min at birth. The metabolic cost of respiration is higher than in adults and may reach 15% of total oxygen consumption. Similarly the metabolic rate in infants is almost twice that of adults and consequently alveolar minute volume is greater and the FRC relatively low. At term of pregnancy, oxygen consumption at rest can increase by as much as 40% (5 ml/kg/minute) at term and further increase during labour to 60%. sepsis syndrome, VO2 and resting metabolic rate are enhanced by 30% (4.55 ml/kg/minute) compared with normal basal metabolism. VO2 falls in septicaemic shock. Dobutamine hydrochloride was infused to 12 healthy male volunteers starting at a dose of 2 micrograms/min/kg and gradually increased to 4 and 6 micrograms/min/kg. Each dose of dobutamine was infused for 20 minutes. VO2 increased by 10-15%. (3.85-4 ml/kg/minute).  
• N. phrenicus   The phrenic nerve originates from the anterior primary rami of C3-5 on each side and supplies motor innervation to the diaphragm. It also coveys sensory fibres from the diaphragm, pleura and pericardium (hence referred shoulder tip pain from diaphragmatic irritation). It descends vertically on the scalenus anterior muscles, and passes the root of the neck beneath the sternocleidomastoid muscle. The right phrenic nerve enters the thorax behind the subclavian/internal jugular venous junction, whereas the left nerve enters the thorax between the subclavian artery and vein.  
• Kapilaren Capillaries link the arterioles and venules and are involved in the delivery of blood to the cells themselves. Therefore capillaries permit the leakage of plasma through fenestrations. The ability of blood to flow through these capillaries is closely controlled by arteriolar tone. They do not have smooth muscle themselves. Hence exercise can stimulate greater opening up of the capillary beds. The diameter of a capillary is 5 - 10 microns. Erythrocyte diameter is 6 - 8 microns.
• Halsdreieck, hinteres The posterior cervical triangle is bounded: Anteriorly by the posterior border of the sternocleidomastoid muscle Posteriorly by the anterior border of the trapezius muscle Inferiorly by the middle third of the clavicle. The arteries in the posterior triangle are the: Third part of the subclavian artery Transverse cervical artery Suprascapular artery Occipital artery. The nerves in the posterior triangle include: supraclavicular part of the brachial plexus. N. accessorius Cervical plexus Lesser occipital nerve Great auricular nerve Transverse cervical nerve Supraclavicular nerves Phrenic nerve.
• Ösophagus The oesophagus is composed of striated muscle (upper) and smooth muscle (lower) with a mixture of the two in the middle. Thus striated muscle does end at the junction of the upper and middle third. Stratified squamous epithelium (Plattenepithel) lines the oesophagus usually down to the level of the diaphragm. The lower end of the oesophagus is anchored by the phreno-oesophageal ligament. Manometric measurements can show pressures as high as 500 mmHg within the oesophagus, but are more commonly approximately 100 mmHg.
• Chromosomen There are 22 pairs of autosomal chromosomes and one pair of sex chromosomes. Due to meiosis, only 23 chromosomes are found in the germinal cell. Females have two X chromosomes but only one is activated and the other stays dormant as the Barr body. In Klinefelter's syndrome, the male cell has an extra X chromosome.
• Neugeborene Haemoglobin concentration At birth: 18 g/dl By the age of 3 months: 10 g/dl  by one year: 12 g/dl basal oxygen consumption of a neonate is 7-8 ml/kg per minute  2-3 times that of an adult  surface area:body weight ratio of a neonate is around twice greater than that of an adult  Together with reduced subcutaneous adipose tissue and immature heat producing mechanisms (for example, shivering), they are particularly susceptible to heat loss and hypothermia. Temperature regulation Neonates are homeothermic and vasoconstrict in response to cold. There is an increase in triglyceride metabolism in brown fat stores, which is under sympathetic nervous system control.
• N. axillaris Typische Schädigung bei Arm-Abduktion über 90° während OP Motor effects: Inability to abduct arm (deltoid) and chronic wasting Weak lateral rotation of arm (teres minor). Sensory effect: Loss of sensation on outer aspect of lower deltoid (regimental badge anaesthesia)
• Wirbelsäule Cervical disc herniations are less common and the discs most affected are those between the fifth and sixth or sixth and seventh vertebrae. Each spinal root emerges above the corresponding vertebrae; thus, the C5-C6 disc protrusion compresses the C6 nerve root. Each transverse process of the cervical vertebrae possesses foramen transversarium but the vertebral artery passes only through the foramen transversarium of C1-C6. Costal facets are present on the sides of the bodies of all the thoracic vertebrae and transverse processes of only the first ten thoracic vertebrae. The lumbar vertebrae have no facets for articulation with the ribs and no foramina in the transverse processes. The intervertebral discs contribute to one quarter of the length of the vertebral column. They are thickest in the cervical and lumbar region. No discs are found between the first two cervical vertebrae or in the sacrum or coccyx.  
• Urin   Urine is coloured yellow by the pigments urochrome and uroerythrin, but it darkens on standing due to the oxidation of urobilinogen to urobilin. Abnormal constituents of urine include Glucose Ketones Bilirubin Erythrocytes Large numbers of leucocytes and Casts.   Despite the concentrating ability of the kidney, a minimum of 500 ml/day is required to eliminate the urea and other electrolytes.
• Trachea, Lunge, Pleura Sympathetic fibres from T2 - T4 and parasympathetic fibres from the vagus, form a posterior pulmonary plexus at the root of the lung. Fibres then pass around the root of the lung to form the anterior pulmonary nerve plexus. Fibres then accompany the blood vessels and bronchi into the lungs. The lower margin of the pleura is at the level of: The eighth rib in the midclavicular line The tenth rib in the midaxillary line (lowest level) The twelfth thoracic vertebra at its termination. Each lung has an oblique fissure but only the right lung has a transverse fissure. The trachea extends from the lower margin of the cricoid cartilage, at the level of the sixth cervical vertebra, to the carina.

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