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Human Gross Anatomy Lecture 1

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by: Anais Ioschpe

Human Gross Anatomy Lecture 1 BISC 2581

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Anais Ioschpe

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GWU Human Gross Anatomy Lecture 1 notes from lecture, powerpoint, and handout.
Human Gross Anatomy
Jeffrey Rosenstein; Raymond Walsh;
Class Notes
anatomy, Human Gross Anatomy, Radiology, LYMPHATIC SYSTEM, Anatomical Terminology, Musculoskeletal System
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This 22 page Class Notes was uploaded by Anais Ioschpe on Tuesday January 19, 2016. The Class Notes belongs to BISC 2581 at George Washington University taught by Jeffrey Rosenstein; Raymond Walsh; in Spring 2016. Since its upload, it has received 137 views. For similar materials see Human Gross Anatomy in Anatomy at George Washington University.


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Date Created: 01/19/16
Human Gross Anatomy Lecture 1 on 12/1/16 Human Gross Anatomy Introduction to the Course — Introduction to Radiology, the Lymphatic System, and Anatomical Terms - Anatomy: term derived (460 B.C.) from the Greek words for “a cutting up”; refers to dissection. Classically defined as the study of structure. Divided into dozens of sub- disciplines. • Gross Anatomy: the study of structure with the unaided eye; visual observation without the use of significant magnifying technologies. • Clinical Anatomy: the study of anatomy that is most relevant to the practice of medicine • Radiographic Anatomy (radiological anatomy): the study of anatomy as observed with the imaging techniques that are derived from the diagnostic and therapeutic tools of radiology Radiographic Anatomy Gross Anatomy Chest Film Thorax (Chest) Dissection Page 1 of 2 Introduction to Radiology Learning objectives: 1) Define radiology and ionization. 2) Describe the basis of conventional radiography. 3) Define attenuation and give examples of high versus low attenuation tissues. 4) Understand the difference between the projection and the view of an x-ray film. 5) Know the significance of contrast media. 6) Define the cross-sectional plane. 7) Describe how a CT scan is viewed. 8) Name two radiology modalities that do not use ionizing radiation. - Radiology: the branch of medicine concerned with the diagnosis and treatment of disease utilizing techniques that employ both ionizing, e.g. x-rays, and non-ionizing, e.g. ultrasound, radiation (Dorland’s Medical Dictionary). • Conventional x-ray imaging needs 3 primary things - Radiation source (x-ray tube) - Object of interest (chest) - Detection system for radiation (photographic film) • Conventional Radiography: projects an x-ray beam through one side of an object whose unique properties modulate the beam as it passes through such that the x- ray beam emerging from the opposite side of the object has an energy pattern that differs from that of the original beam generated at the source. The variations in intensity of the altered x-ray beam, created by the object, are recorded on a photographic film whose emulsion is sensitive to the energy of the emerging x-ray beam. The recording is that of a 3D object “compressed” into a 2D image. - Conventional x-ray imaging has a certain energy pattern, as it passes though the body region of interest the unique body properties of that region modulate the x- ray beam. Such that the energy pattern coming out the other side is different than the one that cam back. And the x-ray film is designed to detect the radiation patterns— and the variation in the patterns gives you the final product of chest film. • Radiation: energy transmitted by waves through space or some medium; a stream of particles such as electrons Page 2 of 2 - X-radiation (x-rays): a form of electromagnetic radiation, some in a wavelength capable of high penetration into objects. Widely used in radiology and the term “x-ray” has become synonymous with the radiographic image generated using this form of radiation. - Ionization: any process by which a neutral molecule or atom gains or losses electrons and thus acquires a net charge; potentially harmful to the DNA of cells. • Attenuation: is the term used in radiology to describe the combined absorption and scattering of radiation particles by tissues - Radiopague: An object with high attenuation (such as bone) means that it absorbs or scatters a lot of radiation particles. Meaning fewer radiation particles pass through the tissue and thus fewer reach the x-ray film, resulting in less photographic exposure to the film and thus an image on the white end of the grayscale. - Radiolucent: An object with low attenuation (such as lungs) means that it doesn’t absorb or scatter a lot of x-ray particles, they go right through it and into the x-ray film. Meaning more radiation particles pass through the tissue and thus more reach the x-ray film, resulting in more photographic exposure of the film and an image on the black end of the grayscale. A tissue with low attenuation, such as the lungs are filled with air which do not absorb or impede the radiation particles. Radiopague Radiolucent Page 3 of 2 • Projection (e.g. PA): denotes the direction that the radiation beam passed through the body. Effects the sharpness of boundaries and the magnification of structures. In conventional X-ray imaging the clarities of the boundaries of a structure and its magnification varies depending on its proximity to the x-ray film. X-ray films are labeled according to the projection. Ex: shadow puppets • View (e.g. AP): denotes the direction from which the anatomy in the x-ray film is viewed. - Standard chest film- radiation comes from the back to the front; an AP view is one in which you are looking “through the body” from it’s anterior to its posterior surface. • You typically look at a x-ray film as if you are looking at the patient, unless you are conducting spinal surgery in which you would be looking at the patient with a PA view - A= Anterior, P=Posterior PA projection, AP view • “Plane” film: uses the body’s natural attenuation properties Page 4 of 2 “Plain” film of the pelvis anatomy - Since you can’t see a lot in a “plain” film, you need to increase the attenuation of an object or organ of interest by using contrast media or agents that the patient typically swallows or gets it injected. Barium sulfate is most common for swallowing and iodine is most common for injection • Contrast media: used to selectively increase attenuation Renal vasculature following vascular administration of iodine contrast Stomach and small intestine following (angiography) oral administration of Barium contrast Page 5 of 2 - When using contrast media, with digital technology you can delete an images of bones that show up in the film - Another note about contrast, you’re not looking at the stomach itself with the contrast but the lumen of the stomach the is filled with contrast • Ex: taking a picture of a glass of milk. Then with photoshop you subtract the class, all you have is the milk. But the milk itself shows the contour of the cup itself. • Computer Tomography (CT) scan - It is viewed as a cross-sectional (transverse, axial) plane: it is a 90 degree angle to the long axis of the body. - tomography means “drawing of a slice” - the cross-sectional plane is particularly relevant to radiology because computed tomography (CT) scans are primarily generated in the cross-sectional plane. - Source of radiation (x-ray tube) —> pass radiation beam through region of interest —> detector on the opposite side • Takes thousands of images and with computer technology it creates a 2-D scan CT Scanner CT Scan of the Thorax with Vascular Contrast Page 6 of 2 • Orientation of a CT scan for viewing • View — a CT scan is positioned for viewing as if the patient were lying on their back and the viewer was positioned at the patient’s feet looking superiorly toward the patient’s head. From this perspective the anterior surface of the patient is up, the posterior surface is down, the left side of the patient’s body is to the viewer’s right, and the right side of the patient’s body is to the viewer’s left. Anterior Posterior • Modalities that do not use ionizing radiation and thus are less harmful to cells and tissues - Ultrasonography (Sonography): the visualization of body structures by recording their reflection patterns to pulses of high-frequency sound waves. Page 7 of 2 • Magnetic Resonance Imaging (MRI): use of a magnetic field to align the free protons in the hydrogen nuclei in molecules of water that are then deflected by pulses of radio waves; a signal is produced as the deflected ions return to their magnetically aligned state. Complex computer algorithms analyze the signals and create the images. - Very expensive but is the best. Conventional x-ray can is ionizing radiation that can affect DNA, no ionizing radiation with sonography or a MRI. MRI gives a great amount of detail, much greater than “plain” film. MRI of the Knee— can see the anterior cruciate ligament (ACL) AP Plain Film of the Knee — all you can see is bones Visible Human Project (National Library of Medicine) - The NIH felt that the public and the scientific community would benefit from a database of a human male and a human female (adults). Therefore they started the Visible Male Project to create a digital database of the entire human body - The received a volunteer from a man on death row and they froze his body in blue solution and cut slices of him at 1 cm from the head down Page 8 of 2 An original Visible Male digital image An edited Visible Male image and one rotated to be viewed like a CT scan Sagittal Visible Male image created from the original cross-sectional digital images Page 9 of 2 Introduction to the Lymphatic System Learning objectives: 1) Describe the fluid dynamics in tissues and the role of lymphatic vessels. 2) Define edema. 3) Describe the basic anatomical organization of lymph nodes. 4) Define a palpable lymph node. - Lymphatic System • Fluid dynamics in tissues - molecules in a liquid phase pass from the arterial ends of capillaries to the interstitial fluid in the extracellular compartment between the cells of a tissue; the cells in turn exchange molecules and fluid with the interstitial fluid. The part of the extracellular compartment containing the interstitial fluid is referred to as the interstitial space. - in order to maintain homeostatic conditions in the interstitial space the volume of fluid entering the interstitial space has to equal the volume of fluid exiting the interstitial space. - due to hemodynamic forces large molecular weight compounds in the interstitial space cannot gain access to the lumen of capillaries on the venous side; some fluid is retained with these large molecular weight compounds. - fluid uptake is a major function of the lymphatic system and it accounts for about 10% of the volume of fluid that flows out of the interstitial spaces of the body • 100% Arterial Efflux= 90% Venous Influx + 10% Lymphatic Influx - Lymphatic vessels: (the smallest of which are called lymphatic capillaries) begin in tissues as blind tubes that eventually drain into the venous end of the systemic Page 10 of 2 2 circulation via two large lymphatic vessels located in the neck named the thoracic duct and the right lymphatic duct. Lymphatic vessels resemble veins in that they comprise a low pressure system with valves. - Edema: the abnormal accumulation of fluid in tissues; typically occurs in he interstitial spaces of the extracellular compartment • Examples - Elephantiasis: A physical blockage of lymph flow through nodes leading to edema - Milroy Disease: a genetic defect in the valves of the lymphatic vessels in the lower limbs leading to edema Page 11 of 2 - Fluid within the lymphatic system is called lymph; about 120 ml of lymph flows into the blood circulation of a resting adult per hour. - Lymph nodes • reside along the paths of the lymphatic vessels • filter out foreign materials (e.g. particulate matter, bacteria) carried in the lymph • mount an immune response - Anatomical organization of lymph nodes Lymph nodes are organized into region groups with specific regional drainages • (e.g. inguinal lymph nodes in the lower limb, axillary nodes of the upper armpit and chest wall, etc) • Palpable vs non-palpable lymph nodes— palpable lymph nodes are located near the body surface and can be felt (palpated) if enlarged • Metastasis: the spread of malignant (cancer) cells. Lymphatic vessels are structurally a path of least resistance because of their permeable walls and as such they are a primary route for metastasis. The progression of malignant cells from an organ can be assessed by noting their progression to the regional lymph nodes to which the lymph of the organ flows. • Axillary Lymph nodes Page 12 of 2 • Lymph vessels and nodes of the Lower Limp Inguinal Lymph Nodes Page 13 of 2 Anatomical Terminology Learning objectives: 1) Define the anatomical position and describe the position of the body when in it. 2) Describe the five anatomical planes. 3) Define each of the terms of relationship and comparison. - The Anatomical Position: the position of the body from which all anatomical terminology is based; the standard reference position. The anatomical position is essentially the military stance of attention EXCEPT that the palms of the hands are rotated such that they face forward (anteriorly), the fingers are straight and together, and the thumbs are positioned 90 degrees from the fingers. • Anatomical Planes - Median plane: a vertical plane passing through the center of the body; divides the body into left and right halves - Sagittal planes: vertical planes passing though the body parallel to the median plane. The median plane itself may also be called the median sagittal plane. - Frontal (coronal) planes: vertical planes passing though the body at right angles to the median plane; divide the body into anterior (front) and posterior (back) portions. - Transverse (cross-sectional or axial planes: horizontal planes passing through the body at right angles to both the median and frontal planes; divide the body into superior (upper) and inferior (lower) portions Page 14 of 2 2 • Terms of Relationship and Comparison— paris of opposite terms that are used to compare the relative positions of two structures - Medial vs lateral: closer to (medial) or further from (lateral) the median plane - Proximal vs distal: closer (proximal) or further from (distal) the trunk of the body or from the origin of a structure. The latter includes linear structures such as the branches of blood vessels, airways, etc - Anterior (ventral) vs posterior (dorsal): closer (anterior) or further from (posterior) the front and back of the body respectively - Superior (cranial) vs inferior (caudal): describes structures relative to the vertical axis; superior is closer to the head, inferior is closer to the feet - Superficial vs deep: closer (superficial) or further from (deep) the surface of the body - Palmar (palm): the anterior (palm) surface of the hand (palmar side) - Plantar (sole): the inferior surface (sole) of the foot (plantar side) - Dorsum: the top of the foot or the back (posterior) side of the hand. Page 15 of 2 2 Introduction to the Musculoskeletal System Learning objectives: 1) Define origin and insertion of a muscle. 2) Define isotonic (concentric and eccentric) and isometric contraction. 3) Describe what the actions of a muscle depends upon. 4) Describe what it means for a muscle to work with a fixed insertion. 5) Define the role of a prime mover, antagonist, synergist, and fixator muscle. 6) Understand the role of gravity as a prime mover. 7) Describe the various types of movement, e.g. flexion, extension, etc. 8) Define fascia and contrast superficial versus deep fascia. 9) Describe the differences between superficial and deep veins. - Muscle Attachments and the Contraction of Muscles • Know the name of the muscle, function of muscle nerve, associated vessels nearby, joints, etc • Structural component of the limbs - Skin - Bones - Muscles (skeletal, striated) - Fascia - Joint - Nerves - Blood Vessels • Voluntary muscles are often called skeletal muscles because they typically produce movement of the skeletal system. They are also called striated muscles because the contractile cells, called muscle fibers, that make up a skeletal muscle have microscopic transverse bands or striations along their length. • Most muscles are attached to two or more different bones that are separated by one or more joins. The attachment sites of a muscle are called its origin and insertion - Origin: typically defined as the more proximal of the attachments Page 16 of 2 2 - Insertion: usually the more distal attachment - Tendon : a continuation of the non-contractile connective tissue component of a muscle that serves to indirectly anchor the muscle fibers of the muscle to the bone • Muscle contraction creates movement due to a physical change in the length of the muscle; muscles create movement by getting shorter (muscles pull, they don’t push). - Types of contraction • Isotonic contraction: the spatial positions of the origin and insertion are altered by changes in the length of the muscle - Concentric: the origin and insertion approach each other as the muscle shortens in length - Eccentric: the origin and insertion recede from each other as the muscle actually lengthens. An example is the use of the deltoid muscle to control the descent of the upper limb; the rate of descent of the limb is controlled by intermittent contractions and relations of muscle fibers with the deltoid muscle, which is actually elongating as the limb descends. The intermittent contractions control the rate of descent; the relaxations permit the muscle to elongate Page 17 of 2 • Isometric contraction: muscle contraction without significant movement at a joint, in which case the length of the muscle remains constant but the tension generated within it increases. - Important in maintaining the position and posture of the body - Actions— the movements created by a muscle • Depend on the spatial relationship of the muscle to the joint(s) it crosses as well as the types of movements permitted at the joint(s) • Typically defined as if the origin of the muscle remained relatively stationary while its insertion moved • Many muscles, particularly those of the lower limb, often function with the insertion remaining relatively stationary while the origin moves. If the insertion of a muscle remains stationary while its origin is permitted to move, contraction of the muscle creates the same spatial change between the articulating bones except that the bone undergoing the greatest degree of movement is now reversed. - Example • The quadriceps muscle of the anterior thigh that functions to extend the knee joint, such as when advancing the lower limb during walking. With a fixed insertion (created by firmly planting the feet on the ground), extension of the knee joint created by the quadriceps muscles can now be used to raise the trunk of the body from a sitting position. Under conditions where the insertion of a muscle is rendered relatively stationary and the origin moves, we say the muscle is working with a “fixed insertion”. - Muscle Classification Based on Actions • Prime mover: a muscle whose contraction is responsible for the desired action, e.g. flextion of the elbow • Antagonist: a muscle whose action is opposite to that of the primer mover, e.g. extension of the elbow joint. Antagonists, via eccentric contraction, play an important role in controlled the movements created by the prime mover since one “cannot turn off a muscle and bring it to a dead stop.” • Synergist: a muscle that cancels out unwanted movements created by a prime mover. For example contraction of a flexor of the elbow joint may concurrently cause unwanted rotation at the joint. In this case a synergist would be a rotator of Page 18 of 2 2 the elbow joint in the opposite direction whose simultaneous contraction served to cancel out the undesired rotation. • Fixator: a muscle that serves to stabilize the base of action of a prime mover. For example, the fine precision movements of the fingers that are needed to thread a needle requires a stable base of action at the wrists, thus muscles capable of steadying the wrists would in this instance serve as fixators - Gravity as a Prime Mover— It is important to appreciate the role of gravity as a prime mover. For example in the descent of the upper limb it is actually gravity that causes the descent of the upper limb without muscle work. Gravity is thus the prime mover with the deltoid muscle, serving as the antagonist, controlling the speed and degree of descent of the upper limb. Descent of the upper limb against resistance would require the activation of prime movers (called adductors) whose contraction generates a force greater than that of the resistance. - It is important to appreciate that movements are complex variations of multiple actions and that the role of muscles as prime movers, antagonists, synergists, and fixators is constantly changing. - Muscle Groups: there are over 50 individuals muscles in both a lower limb and an upper limb. An understanding by organizing the muscles into muscle groups that: • are anatomically compartmentalized in the limbs • have similar actions at the same joints • typically have the same nerve and blood supply - Types of Movement • Flexion vs extension: a decrease (flexion) vs an increase (extension) in the angle between two limb segments or between a limb segment and the anterior surface of the trunk of the body • Abduction vs adduction: movement away from (abduction) or toward (adduction) the median plane • Circumduction: circular movements such that the distal end of the limb segments move in a circle requires a combination of flexion, extension, adduction, and abduction. • Internal (medial) vs external (lateral) rotation: turning or revolving a limb segment along its long axis; internal rotation brings the anterior surface of a limb Page 19 of 2 2 segment to face toward the median plane, external rotation bring the anterior surface of the limb segment to face away form the median plane • Dorsiflexion vs plantar flexion: flexion at the ankle join such that the toes point interiorly (plantarflexion). The top of the food is called its dorsal surface or dorsum of the foot, the bottom of the foot is called the plantar surface or sole of the foot • Inversion vs eversion: turning the foot such that the sole of the foot faces toward the median plane (inversion) vs turning the foot such that the sole of the foot faces away from the median plane (eversion) - Fascia: sheets of connective tissue. The term denotes dissectible, fibrous connective tissue other than that of specifically organized structures such as tendons and ligaments; often pass between or around structures, can be dense and strong or loose and flimsy. • The body is covered by two types of fascia, superficial fascia and deep fascia. - Superficial fascia: “subcutaneous” tissue (directly below the skin); variable thickness and fat content • Typically contains large amounts of fat (thermal insulation) embedded among the fibrous connective tissue although the fat content varies significantly among different regions of the body. - Deep fascia: directly below superficial fascia; thin, dense, inelastic, and fat-free (fascial cleft) Page 20 of 2 Anterior View— thin white sheet is Cross-Section— the deep fascia of the thigh Intermuscular septum - Fascial cleft: the plane between superficial fascia and deep fascia. Rub the skin on the back of your hand and note how easily it “slides”. You are sliding skin and superficial fascia on immovable deep fascia, the sliding of which occur at the fascial cleft - Intermuscular septa (sing. septum): extensions of deep fascia that project from the deep fascia near the body surface to bones; create “fascial compartments” that house different muscle groups - Veins • Superficial veins - reside within superficial fascia; the latger ones are names - are not paired with arteries - Communicate with deep veins via perforating veins that pierce the deep fascia - Function in thermoregulation (vasoconstriction to conserve body heat, vasodilation to dissipate body heat) - Clinically they are the veins that one typically draws blood from or injects fluids into (an IV) - Varicose veins: abnormally dilated veins; those of the lower limbs are often readily visible within the superficial fascia Superficial Veins— not paired with arteries Page 21 of 2 2 - Deep veins • Reside below the deep fascia layer • Are typically paired with a correspondingly named and sized artery Deep Veins— paired with artieries - Collateral circulation • An alternative or secondary blood flow pattern, often designed to circumvent an area of arterial compression at a joint • Based on anastomoses, which are physical communication of variable size between blood vessels Page 22 of 2 2


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