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HUMAN ANATOMY LECTURE OUTLINE Steven A Fink Professor of Human Anatomy HUMAN ANATOMY LEC URE OUTLINE gs vq 39 wry PHARYNGOBASILAR iFJ39k5ElAi rensoa veu PALATINI MUSCLE p G I LEVATOR VELI PALATINI MUSCLE LATERAL PTERYGOID PLATE PTERYGOID HAMULUS lGASTRlC MUSCLE PT39Emquot UWNEquot POSTERIOR BELLY F quotFquot39E 0P LSTYLOID PROCESS SLIFEREUE coajmsrniarzmz MLlEELE I STYLOGLOSSUS MUSCLE j STYLOHYOID LIGAMENT V Lr39sLt550PHaza rr IGEu 5 MUSCLE BUCCINATOR F L V PART OF SUPERIOR CONSTRICTORI CREST OF j STYLOPHARYNGEU5 MUSCLE MANDIBLE P MIDDLE corqsrmcrok MUSCLE H OGLOSSUS MUSCLE SUPERIOR HORN o THYROID CARTILAGE 39 THYROHYOID MEMBRANE DIGASTRIC MUSCLE LANTERIOR BELLY 39 MYLHYOD Wg A J lNFERlOR cowsrmcfoa MusCL HYOID BONE STYLOHYOID MUSCLE 39 FIBROUS ARCH THYROID CARULAGE IJElHE OF SPARSE MUSCULATURE CRICOTHYRCHD MEMBRANE L p 5 A 0sC lg CHlC39DFH iETN GEiJ S MUSCLE V 7 L 0VW l Fu LEI OF lNFERIOR CONSTRICTORJ crucormraouo MUSCLE CRICOID CARTIIAGE TRACHEA 39 West Los Angeles College Department of Biological Sciences HUMAN ANATOMY LECTURE OUTLINE 0 2011 BIOBOOKS All Rights Reserved No part of this book may be reproduced in any form or by any means electronic mechanical photocopying or otherwise without the prior written permission of the authorleditor Steven A Fink Any infringements will be prosecuted tn aJUO39oOZZr7ltL IG39nmUOoJgtL39g HUMAN ANATOMY LECTURE OUTLINE Table of Contents TOPIC S Introduction to theHuman Body Cytology Cell Structure amp Function Embryology Histology Tissues The Skeletal System lntegumentz The Skin Arthrologyz The Joints Myology The Muscular System The Digestive System The Respiratory System The Urinary System Hematology The Blood The Circulatory System The Blood Vessels of the Body The Lymphatic System The Endocrine System The Reproductive System The Nervous System Introduction to Body A1 INTRODUCTION l De nitions A Anatomy Greek quotanaquot up quottomequot cutting 1 scienti c study of body structure quotmorphologyquot and development 2 Andreas Vesalius 15141564 a 16th century Father of Anatomy b De llum ani Corporis Fabrica 1543 quotThe Workings of the Human Bodyquot 7volume collection of anatomic drawings 3 International Congress of Anatomists Nomina Anatomica 6th ed B Physiology scienti c study of how the body functions biochemical processes ll Subdisciplines of Anatomy A Levels of Organization within the Human Body The Human Body Gross Anatomy Surface Anatomy Regional Anatomy Radiological Anatomy Orgafii Systems Systemic Anatomy Neuroanatomy 1 Organs l Tissues Histology 60 Trillion Tissue Cells Cytology B all living things begin life as a single cell Embryology prenatal development Teratology as birth gt adult Developmental Anatomy Zygote C Comparative Anatomy D Pathological Anatomy Introduction to Body A2 Ill Describing Anatomic Relations A Anatomic Position See 195 1 body erect with arms at sides 2 palms turned forward B Terms 1 superior cranial a toward the head b ex the heart is superior to the liver inferior caudal a toward the tailend of body b ex the stomach is inferior to the lungs anterior ventral a toward the front of the body b ex the trachea is anterior to the esophagus posterior dorsal a toward the back of body b ex the rectum is posterior to the urinary bladder medial a near the midline of body b ex the heart is medial to the lungs lateral a away from the midline of body 51955 b ex the kidneys are lateral to the spine proximal a nearer to the torso b ex the arm is proximal to the hand distal a farther from the torso b ex the ngers are distal to the elbow super cial external a toward the surface of the body b ex the skin is super cial to the muscles 10 deep internal a deep within the body b ex the heart is deep to the rib cage A2 Introduction to Body A3 11 parietal a the walls of a cavity b ex the parietal peritoneum 12 visceral a covering of an organ b ex the visceral peritoneum 13 supine a on back b ex supine position for situps 14 prone a on belly b ex prone position for pushups IV Describing Sectional Planes Views Through the Body A midsagittal section divides body into right amp le halves B frontal coronal section divides body into anterior front and posterior back portions C transverse cross section divides body into superior top and inferior bottom portions V Major Body Cavities A Dorsal Body Cavity a Cranial Cavity b Vertebral Spinal Cavity B Ventral Body Cavity CoeIom contains visceral organs a Thoracic Pleural Cavity p Pk e B Diaphragm muscle b Abdominal Peritoneum Cavity c Pelvic Cavity Introduction to Body VI Naming Structures of the Body Prefix Mea abdominloy abdomen acrlo extremity adenlo Z gland V angilo y vessel arthrIo Z joint cardio heart A gnondrlo icartllage j cystlo quotbladder ycytIo cell dentlo tooth Z V dermatIo yskiny dermloh skin ymy duodenlo duodenum gastrIo stomach hepatIo my liver Iarynlgo larynx mylo muscle nephrIo kidney 7 neurloy nerve ostelo A bone otlo ear pathloA A disease ypneumonlo lung rhinlo nose stomato mouth A thoraclo t39ho4ryax chest ANATOMICAL TERMINOLOGY Head GOlIhI5 3 Solo oi ii K39IInur M The anatomical position a Anterior view b Posterior view Both common toms and c terms in parentheses are indicated for many of the various regions of the body A6 r u Cytology B1 Cell Structure amp Function Cytology l The Cell Theory 1838 proposed by Matthias Schleiden Theodor Schwann amp Rudolph Virchow the cell is the smallest unit of life that can maintain amp perpetuate itself ll Limits in Cellular Size amp Multicellularity cells will only grow so big after that they either remain the same size or they divide into two smaller cells Ill Types of Cells A Prokaryotic Cells 1 lack a nucleus 2 includes bacterial cells B Eukaryotic Cells 1 possess a nucleus many complex organelles 2 includes protists 8 the cells in fungi plants amp animals IV The Cell Membrane A provides a membrane boundary shape for the cell B acts as a semipermeable membrane allowing only some substances to enter or leave the cell C double layer quotbilayerquot of phospholipid molecules with embedded proteins D each person has a unique set of glycoproteins on surface of cell E some cell membranes are folded into quotmicrovilliquot that increase its surface area V Cytoplasm A composition B cytoskeleton 1 network of proteins organized into quotmicrotubuesquot amp quotmicrofilaments 2 pennit changes in the shape of the cell viz movement cytoplasmic streaming contraction Cytology B2 VI The Nucleus A nuclear membrane contains pores B nucleoplasm with chromosomes madeup of DNA 0 nucleolus pl nucleoli stores FINA chemical needed for protein synthesis VII The Endoplasmic Reticulum ER A a network of tubular canals that connects the nuclear membrane with cell membrane B functions like a little circulatory system within the cell for transport of molecules C quotSmoothquot ER 1 contains enzyme systems involved in lipid amp steroid metabolism D quotRoughquot granular ER 1 studded with small bodies called ribosomes a the ribosomes composed mostly of RNA are synthesized in in the nucleolus of the cell b the ribosomes are where proteins are synthesized Vlll Golgi Complex A a stack of membranous saccules B gtores modifies amp packages chemical substances formed in the ER including enzymes amp honnones IX Storage Vacuoles amp Vessicles t 39 39 34 act as storage containers A v Sqwahon Vesswhs See 9 Food Vacuoles See 9 viz a white blood cell that phagocytizes engulfs a bacterium Q Lysosomes quotsuicide bagsquot See 6398 1 formed from saccules of the Golgi Complex 2 contain hydrolytic digestive enzymes 3 fuse with Food Vacuoles 4 act as quotsuicide bagsquot in programmed cell death quotautolysisquot 1 a viz programmed cell death in embryonic fonnation of fingers amp toes b viz atrophy of uterus during menopause B2 B2 m8muL3w o9 ampmr E 0 W l 5 W A 1 w Y Vamp m oS m W5 940 w xi mvzmgpsz 0 0 H gt mwm Cytology B3 X Mitochondria the cell39s quotpowerhousesquot A 121000 mitochondria per cell B contains its own DNA C the inner 39 membrane is covered with enzymes D39Cellular Respiration the generation of ATP XI Centrioles A involved in cell divison B each centriole consists of a ring of 9 sets of 3 protein cylinders that can contract 80 Xll organelles for Motion A Flagella 1 whiplike tail 2 consists of 9 paired sets of proteins cylinders surrounding 1 pair in the center 9 2 B Cilia 1 fine motile hairs 2 organized just like flagella 2 XIII Cell Cycle amp Cell Division A lnterphase 1 period from when the cell is formed until the cell starts to divide 2 G1 Phase period of cell growth active protein synthesis amp formation of cytoplasmic organelles 3 3 DNA Synthesis Phase the quotchromosomesquot DNA replicates 4 G2 Phase period of cellgrowth formation of mitotic structures B Mitotic Phase 1 Prophase cell prepares to divide a DNA coilsup into chromosomes b mitotic apparatus forms B3 Cytology B4 2 Metaphase chromosomes lineup in middle of cell 3 Anaphase chromosomes move apart to opposite ends of the cell karyokinesis 4 Telophase a cytokinesis cell constricts into two cells b cell retums back to interphase appearance 1 DNA uncoils back 2 mitotic apparatus breaksdown C Rate amp Frequency of Cellular Division 1 skln cells blood cells and cells lining the alimentary canal divide continuously throughout life 2 liver amp kidney cells divide as needed 3 muscle and nerve cells lose their mitotic ability D Abnormal Cellular Division 1 hyperplasia an increase in number of cells 2 neoplasm tumor a benign tumor b malignant tumor cancer XIV Meiosis A production of haploid sex cells gametes sperm 8 ova B occurs in reproductive organs gonads B4 A 0rganele Cytology Structure Func on l Cell membrane a double layer of phospholipids with embedded globular proteins transport of substances into or out of the cell cytoslteleton 3 anetwork oli proteins openings nuclear pores that P synthesizes amp stores 39 chromosomes quotchromatinquot quot permit cytoplasmic streaming microtubules amp micro laments 8 contraction in the cytoplasm Nucleus Large round structure with toontains the hereditary information necessary for protein synthesis 39amp control of i the cell i Nucleolus nucleoli 1 or more small sacs inside the Nucleus A 39 Location where RNA is stored Endoplasmic Reticulum Rough granular ER tubular network studded with ribosomes transport of chemicals within the cell associated with protein 7 synthesis location oflipid synthesis Small Vessicles l smooth ER no ribosomes M E E A a V y 39ln39glsterolds Ribosomes granules madeup of RNA amp location of protein synthesis 39 Wprotein M Golgi complex Body a stack of at sacs eg uF g taa fge jTSngquot quot 39 ER Large vacuoles amp roundsaos a store chemical substances powerhouse of the cell an outer amp inner membrane with enzymes P Lysosornes l membranous sacs containing intracellular digestion 39 ui iae 5a squot 7quot digea Ee onzyn 1 quot quot in Y quot quot 3quot339IT5l T quot quot jY 39 l l Mitochondria l oval structures containing l location of aerobic cellular respiration centgrioles microtubules 90 arrangement of Involved in cell division microtubules f H in animal cells W cilia 92 arrangemenfof l motile hairs that are used for microtubules movement as agella 92 arrangement of motile tail that is used for movement of cells B5 o pEr o Carbbhydrata REQo6NrnaJ Srre h i GL Icor lto39TElN ares T NucLc oPLAsM H2HarEms d WMA p a X P p A 5 Sectetion Nucieolus 8397 W nm nnqnnnn mmmm substances in vacuoles seeeil T f T vtpnime k in k ffi l 1 priI tEr I Il39i Ei II39liE a gt u u I 39 ciectod 1rou nheplasrna 1 membraneTheydigest 39 5quotquot whs11nauoutside1heeelL UuDbuUuuUuU Fl l l a UUUUJUUJUUU j totl39tcptu1eirsertdli pids 5 Theunoodacndoplnsmie A k1E39rF ii 5 39 tutieulum synthesize and stores lipids These lipids include steroid Eavities lcisternnel of the rough endaniasrni tetioulum Ribosomes K GI Rou l lumic Ipiculuzn from a pancreatic eainnr all 3 Lysosomes formed at the Golgi body contain digestive enzymes which break down molecules previously contained within vacuoles that arise at the cell membrane 39 PIlAGOC1TDsS l j Foocl vacuole requot memhm e 39 F LI Ii a as v J 399 3 Lme CELL s W Ian J ih ihEIEiE1Irith eg mm nznmhang mud K K 6 quot3977quot ENDOCHTOSIS ftugocytoutn hvolvu the ol 1 luau molecule by Wl nlnnlic intentions of the all Followha Eukamxicnaaeuaandciaaare oon39IpexshucuresEacl1oneis dnea edbymenettsiaxef uoetl HITOSIVS C 5omprnc CELEL A quotlPLob1 N A fez t1 izat p B m FnLLaPJ nr Tugesj 275355 EEK O KRRWOTWPE his 5 an 5 5B as 3 7 99 5 E 5 quotquot F 4 E II II 45 3 1 20 2 2 Child nth 39 59 I39 unis139arnu1 T quot 39 lquotquotquotquot quotquotquot quot A bar of Homologous s quot 39quot 1 u 39 V p anromosomu HorI39609003 h39m 39 Hquot AH 4 es 3939 393939 cnrornosomes contain 99993 T 393939 quot Iquotv3939quot brtha saned1arNa cIu39iu A an sarne place I9 I r auaaneaeanoneaueueis WW O6 V located at the earshapebcus quot53quot on one chrorrnsorne and the tree eanobe a ele is heated at the earshape locus on the other member 0 Inc homologous pair of dvomosornes We really don A1 11 4 4 5 must hurnan genes are located The exampies presented here are Ior ilustrative purposes only INTERPHASE f cg zom nbf S period of cell period when growth before the DNA is the DNA is replicated replicated mrerphase begins in daughter cal j to T A period a er quot 1 T DNA replication 39 cell prepares p 0 0 for aivisio p S A DAUGHTER CELLSquot BH 2 1H 9 amp g mmsz me u mxam A 62 4e i e p k m P b 5 3 Q 7 1 0 fJ sm Ev o e 5 H3 u e 99 f f f a w a eQx o b mo j 0sc p p Ea 6 1 m lt2QQmv w 1 Human Chi39omosomes EACH gene IS AMHKW c P5 I i F E w 1 HGEI Eluin him scum 19 29 434515 E i nd nen u 54 II 843 Duplicated PRQPHAEE Comparison of mitosis with In mjtosis and meiozsisii idrimmosomes 0 dupliimrlned only the inrterphase prior to P o prIIP1391EampEE39 entails a sin ivtision of d nucleons usuaII Fig 101 Synaptic Allows Crossfnr f 90 occur whIe oats 0 ho mologous chromosomes are in synaosss one Dad 01000 chtomalid can break of and be exchanged tor an amm Ienl pan of its homologous cfiomatod T It HM P p Tetad by P two daughter genetimlijr iidena PZ to time 0 cell Meiosis Enblil 0 o eII L p M ue iZL 17l1quotiu39Il 39lquott39iI 3 leiquotIi EifVfI dauglHer BM 0 P P PRtjFHASE I align It the pilnhe s tDjwUGiHrm gt 4 os Mm E I5 1 E I half the number of chromosomes in the parent cell The steps of mitosis and meiosis are basically similar with the events unique to meiosis all taking place during meiosis L These unique events are called out on the diagram biochemical analysis T PS PKUaIkaptonuria DNA analysis sickle cel anemia amniotic lu tl contains some fetal cells in suspension 1 chorionic villus com entirely of fetal cells T H 1 quot39F i39 CV3 4 quot hquot39n quotquoth O 391 C 3 A 0Tquot 95 Dawn39s Tumer39s KlinefeIter39s owN 5 5 1N gt W no 0 v e1qI2lC 1 L F T39W w 3035 4oMoSom6 xwomnmquot 4 3 Q3 ms 11I x 0 y iii r d 5 cf PL p P x PJm 6 mn isimtiinr Inf 121 y x x s S v 35 0 haw ma p is tru x Ear N x x mush faungwcr man x y 1tquotHIIrIr chmwrziwmcs 39unduuhmdIgr z v fr as P n um39lqrm u Iring z s quotwiJ1an mm Jv rrntaIi39g 3aI539 n very gtjriy vuiuring U5u1IIf biz zrc the is 0 ma sh 7n pmgnmnt y mama p di139 Eul39t5 nhilu r 0 o in htn39mi5njgj mi tpar 1000 births E 25 Numbor of children with Down Syndtomc T Nuclcosomes H Histone Wooubxe V1Iclix p UN00 MAN 5 we DwImNG Super helix fonns as the DNA molecule quotlps around the nuclcosotncs CELL is N0 J m HUMAN EMBRYOLOGY e Prenatal Development I SEXUAL REPRODUCTION A the production of offspring involving the fusion of haploid sex cells eGA ETE3 rectum of mu I e pT p 1 ureter seminal resiiIe j sperms 39 quot 8 in ductus deferens prostate gland T T temple urethra bulbourethrol glnzndl scrmum urinary bodder epididyrnis seminiferous tubules of testis site at sperm formation iperrn Fertilizing b v ovum penis i a vor mole urethra V rectum of female sperms Fn vogino uterus is Schematic sagittal section of the male and female pelvis showing the penis in the vagina The sperms are produced in the seminiferous tuhutes of the testis and stored in the epididymis During ejaculation the sperms pass along the ductus deterens and tints the urethra where they mix with secretions from the seminal vesicles prostate and lh ulbo urethral glands This mixture called semen is deposited in the upper portion of the vagina close to the external opening of the uterus The sperms pass through the cavity of the uterus and out to the outer third of the uterine tubes where fertilization occurs Ll Fertilization II FERTILIZATION Conception A normally occurs within the Fallopian Tube of the female reproductive tract 0Valquotj3939 nutltine amri39ttyT B penetration of sperm into the ovum x250 zono pellucidc meiotic spindle a corona rodioto 1st polar body 23 an CYCLE T 12 34 5 s 7 8 9 L9m11l 12nt1m14 15 1517 is 1920 21 iIl39I EH rm mo II IELEISEII 2 Mr mu in Tllist am as mean X 22 23 24 25 23 27 23 T1 Il iflll l IECIIS Gill llllil NUMBERS quotSIFE DAYSquot BEILIIREB HUHBERS quotIJHSAFE IJAYSquot III PREEBIBRYONIC PHASE 1st 3rd weeks inclusive A The 1st Week of Development 0 H rnorulo eightcell fourcell twocell zygele Ef ilel siflelfg sage F jquothE 5 0 rp 11 f bluslecjrslsE greasing follicles posterior wall I of the uterus endornetriurn9 e 2 I myornetriurn H V 39 11 I 39 x K E v K quot V g J E A 239 1 39 I quot I E A 39 y u I I I In quot39 1 6 quot I rnotu re ll llifll lrII3939inlf1 I rnbrin follicle gewna w oocyte Diag ramrnatic summary of the ovarian cycle tertilization and development during the first week The numbers indicate days after fertilization The ovum is released from the ovary at ovulation and passes into the uterine tube where it is met and fertilized by a sperm The zygote divides repeatedly as it passes down the uterine tube and becomes a rnorula The rnorula enters the uterus develops a cavity and becomes a hlastocyst The blastocyst begins to invade the andomatrial lining of the uterus HGOT 2tBELL 34 3 i 4cELL 8cELLED gt MORULA STAGE EMBRYO memo mayo E39LllEI D em smcs C4 0 i ieAMNIcrncsAc 1 Structure of the Blastocyst Stage Embryo pO iwre Hmunu degenemu ng E 3 3 a zone 4 pe udda cav y Wwe hph bb L ET CHgh1aNc h d early blastocyst d loin blostocysf Canes SECTION C5 29 3 Trophoblast Layer uterine wall endometrium develops into the CHORION b Inner Cell Mass biamcy develops into the EMBRYO 5 Amnion 2 The Blastocyst implants into the endometrial lining of the Uterus by the end of the 1st Week Deacon cA nLbRIs or amomemum DEEJWA pnh OF S fWEht3i L eL E W VESSELE n l Eq am u4wmS mEm 5 uuu 3 mucH c ant ES hymm EmgmauE u a EE m m zau ma lmE amp EH auta T E5 TREE nm mEnEE Hanw uEcmmu ampE DEnmaa 3 DEM mi uampEmnw w m 53 Eatanmu E EE my u mEm s E Emu Ea unE Eu wwn E 21 mnuaumWc Emma n E n mmE1mm 3 mVanw1mEmW wwu Bc LORBOEQ BmE aE3nuu 1mE baa ampu E amampuEampEE ueEcu Ho uE5 ac 2c EwE MEEEB HmEu wmumamp a wma unmmu 4 g iai uu Em wuDhu HuumEm4 wO mam uan by PQ iquotnm 2 39mEn sm AiIm an which is RENE 4393 P2 afrgr sslnyb ng E uafrbatramrn and as sampie obtained 5rmge cnmaining grewfife an W M M M m m M m 23 mg ajcbaa unfc Mw frlr39 ntr139r39 rrr be ps t I is as was P v i catheter is 1 and urzder iims u d In anmar and p I fbfff f U f r fI39nmquoti39A P war 2 mbre mam 0 rmr mm are awn Ia canfam ta rbeKpas rmn of 0 aI aFnmugb we 7 pA s e mmtmn of ibe abut irz an 53 the um re1ma39u um The LHMUON ERoNbosuM Clloalo ELL N V sac vi 3 Th 0 opposite qives an overall viewnoi the embryo and surrounding structures shown in the subsequent figures The surrounding membranes are partially removed to show the embryo The black arrow indicates the plane of section of the diagram below Yolk 4 P 8 The amniotic cavity was opened and the embryo was cross sectioned arrow 1 Arrows 2 and 3 show other planes of section studied in the following pages Plane 1 passes through the umbilical region Plane 2 is caudal to the umbilical region Plane 3 is cephalic to the umbilical region B The 2nd Week of Development 1 development of Ghorienie Villi aEH EIDN FETDS f portion of the Chorion that develops Chorionic Villi b Chorion Laevi a portion of the Chorion that faces the Decidua Capsularis and does not develop villi eiPumm A 1 the membrane formed by the CHORION FRONDOSUM DECIDUA BASALIS 2 functions in the exchange of 02CO2 nutrientswastes between the fetal blood vessels in the Chorionic Villi and the maternal blood vessels in the Decidua Basalis 2 differentiation speciali 3 types of Germinal Tissues a ECTODERM l b MESODERM c ENDODERM 39 EMBMO A a u lHm1omc S SAC Y5 C8 C The 3rd Week of Development 1 development of the Neural 322 CNS Diagram at right shows midsagittal section through Embryo black line indicates a crosssectional transverse plane through Embryo Crosssectional plane through Embryo E E Q39 Rlm4 Cross transverse Section through 17DAY old Embryo Note the 3 Germinal Tissues comprising the Embryo 2 differentiation of the 3 Germinal Tissues a ECTODERM urface E quot d 1 quot1 EPIgt Rm euroectoderm CEAJS E Peraxial Mesoderm b MEEOEEEMo gt Intermediate Hesoderm Sgmati M s derm Ep1enehnie Hesoderm RD EK 3 DC liggxELOPMENT Am39niU 1 i cavity lt4 fmbr39rnniVy disc bmni n Yolk sac W quotweakquot a 3 secretion of Chorionic Gonado31gpg391 CG hormone by the chorionic villi into the maternal cir Last 39 culation quot39 3939f 39 1 a CG stimulates the mother39s ovaries to 1 quot secrete Progesterone and estrogen H throughout the pregnangy ij mm thus CG produced by the embryo 2oWmi n Y controls the mother39s reproductive system during pregnancy there are ii Vslaszocyst no more menstrual cycles until 1 V quot 393quotquotquot39 3 39 a after the end of the pregnancy 3 Implantation p rOck 1 b CG begins to be detectable within the 39 Q 135mm3 mother39s bloodstream and is the T Z 39 iPemrs39amhwa definitive test for pregnancy Z First W pJ EmhHdaif 3 A Az missed b aepr39imi tia s lt Test penod sires sings bsglEr1s Z lube 5 wveE iitJiie 3 S T 1 ii 5 39 Y3ou a2rZ5 Ion II IL MENSTHUAL IV EIPEBRYONIC PHASE 4th 8th weeks inclusive this is the most critical period of human b Actual sizes of embryos and their t mem rancs in relation to a time scale based on the embryonic developmen mothcrg menstrual history A The 4th Week of Development 1 development of the flat embryonic disk into a tubular shaped embryo CH SAC Midsagittal Section through 22 DAY Embryo constriction between the midgut and the yolk sac development of the brain into 3 regions a forebrain b midbrain c hindbrain External view of a 22 DAY Embryo from the dorsal back side C I2 segmentation of the Paraxial Mesoderm into 43 pairs of quotsomitesquot See p 12 0 a Neum was 39 yolk sac ruin edge of amnion rsumss ECTODEKM h AMNIOTLC CAVIMTY 39Snrfaee T DORSAL 1 CAVITY Vm sohhbenm HE AT AHGTUGHGRD 7 MESODERM T HQMETIG MESODERM EHRTA SPLAHEHI MESODERM CIIORION FRONDOSUM Cross transverse Section through the midgut region of a 22rDAY Embryo 5 development of a beating heart 4 wae CI3 g DORSAL A RT i M qgghA Midsagittal Section through 25DAY Embryo HIMDEREIH g nLLnNTDIG SAC Llhfw Crosssectional plane through Embryo DORSAL AORTA IHTETJ lIAT MESODE SOMAIIC MESODERMW ELannHN1crmsonERMj Cross transverse Section through the midgut region of a 25DAY Embryo SOMITES EEAH Hif Gill ARCHES External Lateral pV View of a 25Day quotquot quot Embryo slavelnping Forelimb HEART POUCH 5 Sl Developinie Ear L Actual Size Maxillary Process of 1st Arch Dve1apinquot Eye External Lateral View of a 28Day Embryo CI5 CORD p c Y e h h rh h5EEHIS oFsKIE VERIEBRAL coLnn Vvt j equott g t Axial Skeleton hh39o j J Tj y T SPIRAL HEEWEA Leone ltgtI r oSKELETAL MUSCLE 39 Asa h i e womoc onn E JDNhr to jet f R5AL ampURT gn 39 IHFERIDR nn x A r hrf g T5 oeeo Ah T Vr T I h r pE h H1om A HT UHmILIEa Bonn Cross transverse Section through the midgut region of a 28DAX Embryo 016 The Extraembryonic Membranes l The YOLK SAC 2 The ALLANTOIC SAC Allantois Comparison 01 the extraembryonic membranes in the a chick and b mammal zhorinn li wii 395 0 lrtsl portion of ifI I HIfI39I a a 9 7 G cod Vessels an WJ 7 rquot 1 L ES ELS B The 5th Week of Development 1 further differentiation of the Mesodermal Tissues F a Paraxial Mesoderml V I Myotome SOMTES h F 39 V i clerotome b Intermediate Mesoderm Urogenital System Somatic Mesoderm c Lateral Plate Mesodermlt Splanchnic Mesoderm 2 development of the forelimbs and hindlimbs 3 rotation of the stomach into a horizontal position 4 development of the body stalk into the Umbilical Cord 18 Fer Iili ed ovum Illddle quotquot p 0 0 lube II39 eiulmaje in I oftaalh V ppt qelium V H quot7 I andomctoryeptthellum A 7 p andolfactoty nerve p 2 Outer a pithliuwm p val Early K Lnnsofuyo U v Ii Bram mummy 3 Granlairnotnrnewes O 39 re z I re Urmory lzdladder y A I pm z llnlnrmgcliuta D H H v quot PH 9 nmsax arms P 5 395 M Eaniulic 1quot I WWW N 3 0ty w I quot gt Larleral Retina and v E quot Barrel mnsroadarm Pi quot If sun mnl glvi li 1 e P n 39l5l3quotWlE5l mums a mnres 5P l CON in 39 4 IlJIuail n ueu H 5 h V 0r i To u V q 39 m ma h39dIvett ill AppmdicuIumIam 9 q 39m pm t quotM5 Co actinz tubules Eh 0 l ducts Ext anal tries at I A P amnion and hi h h 7 k ii 5 E l lm Sammie I Psiuh 393 quot9 A um D I Ehl ml Pn r an OIS HM a Strong H 0 3 chart Indicates origin of eplthallnl part mm 365 t I H 1 of organ onty These organs all have 5 quot P 333quot um um 39 V pLl I quot I T secondary supporting investrnonts of mussels at H Endalhet new car r Chart showing derivation of various parts of the body by progressive differentiation and divergent specialization Note especially how the origin of all the organs can be traced back to the three primary germ layers ECTQDERM SURFACE ECTODERM gt EPIDERMIS OF SKIN NEUROECTODERM NERVOUS SYSTEM MZESODERM 1 DERMATOME gtDERMIS or SKIN mroro11E gt SKELETAL MUSCLES scLERoIo1I2 AXIAL SKELETON PARAXIAL MESODERM I SOMITES INTERMEDIATE MESODERM T UROGENITAL SYSTEM KIDNEYS 5 REPRODUCTIVE ORGANS 39 gSOMATIC MESODERM PARIETAL PLEURA amp PAEIEEQ PERITONEUM n5PLAE39Umi39IC IESJETDIEEEJI jfp VISCERAL PLEURA amp VISCERAL PERITONEUM LIIIEERIIIPLETE U E ENDODERM DIGESTIVE srsrm RESPIRATORY SYSTEM ENDOCRINE GLANDS CH rnadibular process maxillary de develop 9 v er pmtgi rmE I P39 D 39F citaeloplng l cervical V p2 llexure 0 0 g al brain p a ldle shaped l fela elbow forelimb moi hand length 0 V Y pl l hindlibl PY o 30 i 1 day I il day mandibular arch E maxillary process P epilt heart prominence umbilical oord l B agar 0 330 etarrn a l ear eyelid e notches webbed between fgngen nger early umbilical ll1amprn39iaampiiIrn rays notches between T toe rays l toe gt42 l39day s C20 oi fctory pit The formation of the nose and nostrils Fingers separated 39 e I V Fanshaped g 43 l39 day webbed toes H 43 i 3959 swan a K Q9 quot maxi11ary process marvdibular process i 5 C The 8th Week of Development 1 further development of the Eyes Ears amp Nose 2 Head makesup k of the whole Embryo 3 digits on hands and feet develop X 4 Bones begin to calcify ii 5 development of the Deciduous quotbabyquot Teeth FETAL PHASE 9th Week gtBirth inclusive fetus Latin for quotyoung onequot 2 inches long CR Ag 14inches long CR 2 oz 2 33 7 lbs A The 3rd Month 12th Week lo sex of the child can be determined from external genita1ia E 2 eyelids are formed amp closed 3 lanugo quotdowny hairquot appears over skin 4 nails begin to develop on the digits 55 Permanent Teeth begin to develop 6 Kidneys begin producing urine B The 4th Month 16th Week mandible has developed so that fetus exhibits a chin C The 5th Month 20th Week 1 mother can begin to feel fetal movements quotquickeningquot 2 greasy cheesy Yernix Caseosa begins to cover skin 3 hair appears on the head DIhe 6th Month 24th Week 1 eyebrows amp eyelashes present 4K 2 Pulmonary alveoli begin to develop E The 7th Month 28th Week gtTl Fetus normally rotates into the Cephalic Presentation 2 mother may feel fetus hiccup 3 deposition of subcutaneous fat 4 Fetus capable of probably surviving premature birth QZ7 F The 8th Month 32nd Week very active movements by fetus G The 9th Month 36th Week 5 testes begin to descend down into the scrotum H FULL TERM 9 lunar months 38 Weeks I The 10th Month 40th Week POSTTERM 1 testes have fully descended 2 nails project beyond the digits 3 lanugo hair is disappearing I555mri39snn f the Pf fi39 39l39l39 Ei 13 E and inf tjS Ed lei uuse of an adult hmmmn C23 CONGENITAL MALFORMATIONS AND THEIR CAUSES mHmaanE A E mEEuumu I n bUum I A A p E nm ogtu1 Nuuu wu Apnm xm nn n ogt5Eo DEDn oucaaE 299 oa2Eo u ouu 0 man oEEou 2auz o o1gt 3 102 2 m m H 9 m w n 3 m g 55 024 I Eo w N 9uo3 1ooa 3 1 E oo3c o uono A 1 t 0 N N MULTIPLE BIRTHS A FREQUENCY 1 ggggg 101000 births in USA a Ethnic Differences 21000 gt 401000 JAPAN NIGERIA b About 23 of these are FRATERNAL TWINS 2TRIPLETS 111000 3 QUADRUPLETS 1900000 B FRATERNAL VERSUS IDENTICAL TWINS 1 FRATERNAL DIZYGOTIC TWINS a results from the separate fertilizations of 2 different ova b Cause 2 or more ova developed and were ovulated the same month Monozygotac TWITIS 1 tends to run in families 2 generally occurs more frequently in older women 2 IDENTICAL MDNOZYGOTIC TWINS a results from the splitting of the inner cell mass of a B1astocyst stage embryo b Twins are genetically identical c CONJOINED quotSiamesequot TWINS results from the incomplete splitting of the inner cell mass region Dizyglotic Twins 25 s or vmmz E3 mwmmmgt oocElt N a voo mc3wE coElt Uoo mooED gt ocooro 9 58 U005 wc9m2 omm vogt ogtnEm 9 9 C005 umwcmmgtxowB mmmo cmgt mopE3 mmmmmgt voo QCnEw cmEoo uEm 0 k E8 8gE ijgt A P9 72m mEmoma 9 uoo 0COgtnEm E39 mmcmtm monE3 C26 Page 52 HISTOLOGY THE STUDY OF TISSHES glntroduction All organisms begin life as a single cell In humans and other multicellular organisms that carryon sexual reproduction this first cell is called a zygote The zygote develops into the multicellular organism by a process of cell division called mitosis As mitosis pro ceeds these geneticallyidentical somatic body cells undergo differen tiation Differentiation isgthedevelopmental process that results in the formation of different specialized types of cells newece I i ii Vustypusofoalls achqndaliudfnraspo i ctnd Differentiation results as the gghryonic cells begin to synthesize different types of proteins Because all the cells contain the exact same hereditary instructions it is not clearly understood how this process occurs and differentiation remains an area of intense research In a multicellular organism groups of cells that have similar struc ture and function are called tissues The study of tissues is called histology In the vertebrate animals there are 4 major categories of tissues 1 epithelial composed of epithelial cells 2 connective composed of connective tissue cells 3 muscle composed of muscle cells 4 nerve composed of nerve cells These tissues are organized into functional structures called organs For example the heart is com posed of epithelial muscle and connective tissues ORGHN STRUCTURE mamup ogsg gg MORE bI I EPITHELIAL TISSUES Page 53 A General Characteristics 1 embryologic origin develop from all 3 germinal layers ectoderm mesoderm amp endoderm 2 the epithelial cells adhere closely to one another 3 epithelial tissues contain no blood vessels noneyascular 4 often found covering a body surface or lining body cavities B Classification of Epithelial Tissues 1 based on the arrangement layering of the cells a simple single layer of cells b stratified multiple layers of cells j e Z iinnh 2 based on the shape of the cells a squamous t 3 quotb cuboidal Em columnar in l 11 Squamous 0 J I a 7quot 39Tr ay39nquot QItlib g 39 39 PI 391 39 39 7 If quot I2 Ag 139 I H gt 39 5 as gt p EAVVillil 39 w Ii 3amp5 quot F1 nquot39equotmquotE ti5445 quotE j Cnr39a3911Ectijv e tissue T ewla jzep I j p l EWQ 39U39E Ell i L33quot p Co nneefiii 39E tissue 39 ajzz b 8 D2 Page 3 based on cellular modifications usually present only in columnar epithelial cells A gt mtR V L39 a cilia C142 ej jaJ quot S 39 w A fine motile hairs b microvilli quotbrush borderquot 1 fingerlike extensions of the cell 2 increases the surface area of the cell viz for absorption c mucussecreting quotgobletquot columnar cells C TYPES OF EPITHELIAL TISSUES 5l Simple Squamous Epithelium a makesup the alveoli air sacs ivl F of the lungs 3953 b makes up the lining of all gay blood vessels as well as the walls of capillaries called the quotendotheliumV c makes up various membranes within the body such as the peritoneum called a quotmesothe1iumquot S Nucleus Simple squamous epithelium gtx 2 Simple Cuboidal Epithelium makes up the urinary tubules of the kidney the liver pancreas thyroid and other glands of the body Thin segment Thick ascending segment of HenIe39s loop Co etfing tubule out n gi 4 4 M pd 02 nun 1 06 e pZ Vi Blood vessels 7quot p A J if la 1 i i i e i 0k a all I 1 pl O T P 7 u If 7 iv 4 h V Q u iivnm 39R6M nu3uLes Thin segment Thick ascending segrnenf of Henws loop cross sech39an cross section Cross section through the medulla of the kidney From W M Copenhaver R P Bunge and M B Bunge Bailey39s Textbook of Histology Ed 16 The Williams amp Wilkins Co Baitimore 1971 3 Simple Columar Ciliated Epithelium makes up the lining of a woman39s Fallopian Tubes ovi ducts 39 Z dmakesup the lining of the stomach mlcrovnlli n 2 5 Simple Columnar Brush Border EpitheliumwithGnbletg ells7 makes up the lining of the intestine g 6 Pseudostratified Columnar in Ciliated Epithe1iumwith Goblet Cells quotciliated yEcous Membranequot a the nuclei appear at different levels because the columar cells are not all the same heigh b makesup the lining of the respiratory tract 7 Transitional Epithelium a makesup the lining of the urinary bladder b this stratified tissue becomes stretched as the urinary bladder becomes filled with urine I E I V A 39 n uoIU u Lqpu n 41 uu 4 u jun r rs1 a 39 1 I quot 39 Drawings of transitional epithelimn from the human bladder A in collapsed condition B in distended condition Addison Piersol s Normal Histology ed 15 Phila delphia Lippincott a D6 T LDNGITUDINAL MUSCLE Page LYMPH A MUCOSA Microscopic qms section through the ileum of 3 mt E e 7 e e iqEi1 39TEgt q T Vim Tamara 0R quot39ii Ein 391 J pL pL quot rgt5F39 39quotIEiL 39 V 39quot N 5 quot fe2i eu 39 e T P 39 A I 0M lntersapers ed quot 39 j V within the gar Simple Coltquot 5quotvquot7e coLuwWmrH Epithelium nHg Ld 0 fovl ll N1 G03 LET CELLS F r e 1 L I 39 I quot L quot 1 39 7 513 e W i fa quot ii Right Note the microvilli quotbrush 4 borderquot Page Q 8 Stratified Squamous Epithelium SHORE STAIN CORNIFI ED r PRECORNIFIED a T a a named according to the appearance of the surface layer of cells b located in areas of the body subject to abrasion c there are 2 subtypes of stratified sqamous epithelium gtXltl Nonkeratinizing 5TRPr39nH 39b s V3MDv5 p THeL UM a no dead layers of cells b makesup the lining of the oral cavity anal canal and vaginal canal 2 Keratinizing STILHTIFIED SQUAMDUS EPITHELIUM a dead layer of cells present b makesquotup the Epidermis of the Skin V g a V V 3 1 39 139 quotquot3quot 9quot 3 quotquots39 quot quot39 p U H 5 quot I n all I 4 J 3 H II a 3 1 I 39 5 T 13 K NONKERATINIZING TYP E KERATINIZING TYPE EPIDEIZIVUS Embe vns 2 DERMIS r II CONNECTIVE TISSUES A General Characteristics 1 embryologic origin develop only from mesoderm 2 the connective tissues consist of cells and intercellular matter secreted by the cells 3 connective tissues are highly vascularized 4 generally function to connect and support the other tissues of the body B Classification of Connective Tissues 1 based on the type of cell or cells 2 based on the type of intercellular matter found between the cells C TYPES OF CONNECTIVE TISSUES Q 1 Areolar Loose Connective Tissue 4 a cells present 1 fibroblasts a principal type of cell b secrete proteins into the spaces between the cells 2 macrophages engulf foreign agents 3 mast cells secrete histamine amp other chemical mediators of inflam mation LQCAL INjs39LAMMAr1oN IHESUT5 1 local di391ntin39eofmb1boo v ssee5a 39V MA T 0 if 2 local permeability of 0 sma more leakg f 3 local stimulation of pain fibers gt pain mequot 39 blood vessels gtsyel ing H Schematic Representation of Procoiiagen Synthesis Posttranslational Processing and Secretion by Fibroblasts As indicated most of the processing occurs in the cisternee of the rough endoplasmic retic ulum but folding into the triplehelical conformation may occur at a later stage The protein is secreted through the smooth vacuoles of the cell The gure does not indicate synthesis and removal of quotprequot or quotsignalquot sequences Elastic bers COIIQQBNOUS 7quotquots p T it P is V E L P bers 1 39 o 39 b intercellular matter 1 protein gel much like quotJe11oquot containing protein fibers a collagen protein fibers confer strength to the tissue b elastin protein fibers confer elasticity to the tissue 2 all proteins are synthesized and secreted by the fibroblasts c Areolar CT is the most widely distributed tissue in the body serving to support and nourish via the blood vessels the other tissues of the body 2 Adipose Fat Connective Tissue 39 39 V Electron micrognph of intact collagen fibrils obtainzd from skin The preparation was sluduwed with chromin Micrograph by Dr Inone Gran Intercellular Matter a cells present closely packed adipose fat cells each containing a large fat fi11ed V vacuole Po b intercellular matter small amount of protein fibers secreted by the fat cells c adipose tissue provides a reserve of food for energy insulates against heat loss supports amp protects the organs it encloses d locations 1 under the skin subcutaneous fat 2 around the kidneys amp eyeballs 3 buttocks amp breasts Dto Page G41 3 Dense Fibrous Connective Tissue a cells present fibroblasts b intercellular matter principally collagen protein fibers secreted by the fibroblasts which confers strength to the tissue c there are 2 subtypes of Dense Fibrous Connective Tissue based upon how the protein fibers are arranged f39 392quoti39I V A 39 V quot ase a men Arranged Fl rows CT gtKql Regularly Arranged FIBROUS cm a the protein fibers are arranged in parallel bundles b locations 1 tendonsfcords that connect muscles to bones pay f T w amp3 Fmnms f 2 ligamentscords that connect bones together 3 dura mater fibrous CT sheet that encloses the brain amp spinal cord 4 fascia fibrous CT sheets that enclose muscles 5 perichondriumamp periosteum fibrous CT sheets that enclose cartilage amp bones 2 Irregularly Arranged DENSe F13R U CIT a the protein fibers are interwoven running in all directions b locations 1 Dermis of the Skin Q 2 Sgar Tissue bH 4 Cartilage quotGristlequot 39 0 Z p i ll H I i39r E 39 quot I V I Hyaline cartilage from the trachea of a guinea pig Notice the more intense staining of the cap sular or territorial matrix immediately surrounding the groups of isogenous cells The cells immediately be neath the perichondrium rap recently added in appositional growth are single and elongated Hetnatoxylin and eosin min X400 a cells present chondrocXtes usually arranged in groupings of 2 to 4 cells surrounded by a pocket of fluid called a lacuna b intercellular matter protein gel much like quotJelloquot containing protein fibers Sltc eartilgge contains no blood vessels nonvascular and is thus an E cepti n tn the general pattern of connective tissues E d cartilage tissue is capable of growing in both length amp width thick ness e there are 3 sub types of Cartilage based upon the nature of the intercellular matter shondrery1e Canilage cell pY Elastic fibers Collagenous quot T fibers while Finocannage Page 34 7gfl Hyaline Cartilage a the intercellular matter is madeup of a gel interwoven with collagen protein fibers secreted by the chondro cytes b locations 1 the embryonic long bones of the body 2 the ffonf of the nose 3 the trachea amp larynx 0 4 the surfaces of articulating bones 2 Fibrocartilage a the intercellular matter is madeup of a gel containing large bundles of collagen protein fibers b locations the intervertebral disks 3 Elastic Cartilage a the intercellular matter is madeup of a gel containing elastin protein fibers b locations the external ear pinna 5 Bone Tissues a cells present osteocxtes each surrounded by a pocket of fluid called a lacuna b intercellular matter 1 calcium salts calcium phosphate amp calcium carbonate 2 collagen protein fibers interwoven in the calcium salts c bone tissues are highly vascularized n d bone tissue is only capable of quotgrowing in width thickness e there are 2 subtypes of Bone Tissues based upon its organization gtx 39 a Compact Bone Tissue B the osteocytes are arranged in concentric circles called Haversian gystems osteons b Spongy Cancellous Bone Tissue the osteocytes are arranged in a spongy network OSTEOBLASTS osteocytes secrete calcium mineral 9 rm ihsrguae OSTEOCLASTS breakdown calciumquot mineral Bone rzesomu o M 1513 Page G Compact and spongy bone in the upper end of the femur thigh bone From 1 Subaru and J P McMun39ich An AM of Human Anatomy Vol I G E Steichert and Co New York 1936 cube of the cancelious bone compact bone of shaft Proximal 39 epiphysis h cavity of 5 uaa qu containing red marrow Dsaphvsis i Pi L p amt Distal epiphvsis e DH i Haversian system osteon Blood vessel into marrow cf hmrczsian gt Ic111 as compact ban mum 0 quot I 39 39TH p P 39uJ17aI haclicc tau Fersi p shuwijnblmd vaxei the hav cm39m q thrcggh V911msann s ama1L Th p 2 Vhjlghly magni amp PN K p Bctmc f a within liacni ic Volkmamfs canal NEEE that Eh lacuna are innrccrmctcd5l by canaiiculi 39 0 X V 0 0 p In haversian canal P HAVERSIAN SYSTEM 39 9 L NEAR A BIFURCATION LAMELLAE P LACUNA Microscopic eras section of ah portion of dried compact bone 39 D f General Structure of Bones 39 The types of bones A A long bone B A short bone C A flat bone D A39n irregular bone 1 Structure of Long Bones a Diaphysis shaft of the bone b Epiphysis 1 proximal epiphysis 2 distal epiphysis FIufrient canai 39 r A Photograph of the upper half of the tibia of young girl showing the proximal bony epi physis the cartilaginous epiphyseal plate and the shaft or diaphysis 39 t ADULT 3 epiphyseal plates lines location of ossifying cartilage prior to completion of bone growth c Medullary Marrow Cavity 1 Red Marrow 2 Yellow Marrow DI6 2 Structure of a Flat Bone a Outer Compact Bone b Inner Spongy Bone Dip1oE g Embryologic Development of Bones 1 Long Bones ENDOCHONDRAL BON FORMATION Stages in Endochondral Os szj cation ofLong Bone a Mesenchymal model b Hyaline cartilage model c Initiation of ossificationlin diaphysis d Invasion oi primary ossification center by nutrient artery e Establishment of secondary ossification centers in epiphyses f I l Hyalina l 0 cartilage x 3 V Primary l1 quot El391391t39B r 0 TEWE Collar of 5 compact bone 33 Fubrovs T it i l39PIlmlleublilw PA PA PA c icon 13 ossif39ioatio n It39lflZIE1i39quot j 7 A l ails Compact bone Spongy bone Iillaniowquot cavity 39iItIuiriant artery 611 l lends ossifia1i sen T l e on A d 2ampHpRMDNES MULALgEquotrE L 0 9 g g EPrl1ppm5EllL mares ilnRr4eNE S Q p 9 Marrow of 5 39l i g 0 T emf nating plate T 2 r Trabeculaeof 1 T T quot hypfrtrophyzins carttlage H3889 Zone of calcifying fragments cartilage k la Anteroposterior projections of normal ossi cation at the knee a Onemonthold intent The epiphyses at the knee are mostly cartilage ossi cation centers have formed for the femur and tibia The space between the ends of the bones is occupied by epiphyseal cartilage b Twoyearold child Centers of ossi cation have grown The white transverse zones marking the ends of the shafts are areas where mineral salts are deposited temporarily around the degenerating cartilage cells 3 Fiveyearold child The epiphyses have assumed the shape of adult bones The epiphyseal plates are clearty visible between the epiphyses and diaphyses of all three bones d Eight yearold child The epiphyseal plates are still distinct as ossi cation continues e Twelveyearold child The epiphyses have ossi ed almost completely The epiphyseal plates are assuming the character of epiphyseal lines Courtesy of Lester W Paul and John H Juhl Ike Essentials of Roentgen Interpretation ad ad Harper 8 Flow Publishers Inc New York 1972 1348 Page 71 2 F1atBot1es IN39I39RAMEMBRANOUS B0NE FORMATION e b0 s Primary s5i39 3ti Stages in lrttramembranous t r5 for fr ta1 Ossi cutian of Skull Bone a Mesen d0 chyme b Fibrous rnesenchymal mem brane c Initiation of ossification in primary ossi cation center in fibrous mesenchymal membrane 1 Section through developing membrane bone show ing compact and spongy bone e Root 1 e pr nary of fetal skull showing primary ossification L P T gsgjfjca on centers of skull bones 0 centers for parietal bone s c iu B Primary ossi cation center center for occipital nS E bone Dip1o39c39 trabccu1ac of spongy bone and marrow spaces it 39 gr Inner table of compact bone Periosteum 6 Hemopoietic Tissues BLOOD amp LYMPH a cells present 1 Red Blood Cells ERYTHRD g transport 02 amp C02 2 White Blood Cells LEUKOCYEES a produce antibodies amp interferon that inactivate foreign agents b phagocytize engulf foreign agents 3 Blood Platelets g produce thrombop1astin hich triggers blood clotting DH Plasma Platelets K White blood cells at Red blood cells Blood cells become packed at the bottom of the test tube when whole blood is centrifuged leaving the fluid plasma at the top of the tube Red blood cells are the most abundant of the blood celIs white blood cells and platelets form only a thin lightcolored bully coatquot at the interface between the packed red blood cells and the plasma 39 b intercellular matter pPLASMA 1 water 92 Plasma Proteins 7 most synthesized byte Liver cells so III MUSCULAR TISSUES IV EEIQVOUS TISSlJES V rumpus NEOPLASMS A Types 1 BENIGN TUMORS a increased multiplication of tissue cells M Tb5lS 13 treatment surgical removal of tissue mass b2o Page 73 39lquotissues Whose Cells Are Dividing and N ondividing in the Adult Miter 0 y none Gr nrguse disides IlZl3lilD12ilHllg and iz tissues P a rate of nail dsivrisien aha ut one dieisijon every few days ins must liss11 es latter the rist month of premanr1yt At 6s the rate slows duwina and by the and of adnlesca 39l3939ha cells of the tissues he lslasaii nd as o or nointlistitlingi In gmetali ssures wilaese W ont from tuwarzhanical ahrasgionr iiask nuel el lied ii1sells out are called upon in larger o inI emergesclsis white quotblend sells have tells nthiiclzl n theiit icell icysles N39on di39viding teller are usually pgmtests1 lI39llilEIEl h k as increase j size lhy internal s39rnt39hes is of tlrgsnslljes Maior tissues with dividing cells Maia tissues with nondividing cells Bone marrow erythroblasts Neurons red blood cells Muscle Bone manow myeloblasts Bone white blood cells Cartilage Lymphatic tissue lymphocytes Tendon Intestinal lining Skin Endothelial cells lining of blood vessels Tissue of origin for types of cancer Reproductive cells a cancer Tissue of origin 2 MALIGNANT TUMORS CANCERS Carcinomam Epithelial cells eg skin and mucous membranes of lung and gastrointestinal a Characteristics tract 1 increased multiplica l 39 tion of tissue cells Bood forming organ eg bone marrow or lymphoid tissue LEU Qlquotquot39ES 2 the abn 7quot31 C3115 Lymphoma 51 Lymphoid tissue exhibit metastasis migration Melanoma Pigmented skin cells Myeloma Bone marrow b Etreattvnent r39o2z Connective tissue eg bone cartilage 1 surgery and others 2 radiation 3 chemotherapy 1 Skin 193 is 1 I lira it 3 11 2096 Breast 14 Digestive 15 iir 15Colorectal 12 P139usateilElilE 5 M 7quot 3 i Ll saw Al K 9 Leukemia and Lymphoma39339ElE f l b22 OSTEOLOGY sr1mYoF THE SKEQIAL sysrm1 I Functions of the Skeletal System A Support B Protection C Movement contraction of the muscles attached to bones quotskeletal musclesquot causes movements at the joints between bones wm y h e 7 391quots p L insertion H D Mineral Storage of Ca and P04 E Production of Blood Cells 1 production of Red Blood Cells erythrocytes 2 production of White Blood Cells leukocytes M PRENATAL 39 POSTNATAL CELLULARITY I 1 1 I I 1 I I 1 I p i r 1 I In P OO sent 5 unseen E 80 A U 39Puquot39EH39TquotE Fi H M 1 ii 60 TETEHHUH 39 2 nmdT Ema T7 20F 1 ttFEmuH D 39 sold ion 45 h go 6 7o FETAL MONTHS AGE IN YEARS Expansion and regression of hematopoietic tissue during fetal and adult Ifo F l II Organization of the Skeletal System 206 Bones A AXIAL SKELETON 30 1 Skull 29 2 Vertebral Column 26 3 Ribcage 25 a Sternum 1 b Ribs 24 B APPENDICULAR SKELETON 126 1 Pectoral Girdle 4 2 Upper Limbs 60 3 Pelvic Girdle 2 4i Lower Limbs 60 Patelh III Regional Examination of the Skeletal System A THE SKULL l Joints of the Skull a Types 1 sutures a nonmovable joints between bones b major sutures of the skull 1 frontal suture not visible on adult skulls location where the 2 frontal bones fused together 2 sagittal suture location where the 2 parietal bones fused together 3 coronal suturev L location where the parietal bones fused with the frontal bones area of frontal suture ira ral area of coronal suture O t Vfr1ari i39altl favntarnel K p 4 lambdoidal suturel location where the parietal bones fused quot F freon elf with the rpT bone Iarnhdoidal P E p 7 2 quotquotfi39F iquot39 39 quot39quot 39 suture s V V A jL L5 Z occipital E Fontanels quotsoft spotsquot l a of the Fetal Skull T V a uncalcified angles of the Parietal Bones 5 Frontal area of h inglu E5 coronal suture 0 1 la senoidal ppnlnpp lll T 1 nasal p K lacrimal A quotT 5 lamquot bquotl 39 is 7 4 pI ma iv MquotF Iambcloidal 3 sphenoidal ngommkgpl 395 e i m asfaieaT temporal mandible 0 J 0 H 4 mastoldal YD l if 9 K suprooccipital f0I1t3I131 external acoustic meatus exoccipital squamous of temporal 3 Air sinuses cavities of the Skull Bones a garanasal Air sinuses 1 comunicate with Frontal the nasal law cavities 2 lined by a cil iated mucous membrane that functions to warm amp humidify the inhaled air Emma sinuses 39 girrtall sulfur A mastaidal Frontal Ethmoid iih henmd r a 3 includes a frontal air sinuses rn N poy aELl P Jmn1 EIIHE nu b maxillary air sinuses c ethmoidal air sinuses d sphenoidal air sinuses 11 I stoii 1 located within the mastoid pro cess of each temporal bone 5 k 39939 AnIs39 quot 39 39 p a E F 39EEI EAquot39IIL39u139I l E n 2 lined by a mucous 39 V mmmmumn p 1 membrane 39 f 3 communicate with the Eustachian canals aud itory tubes which open into the 7quotquot 7quotA39 39V throat inner eara rquot393 quotE quota39 vestibule h 4 Temporal borne Txumrtro h i i Middle Ear ossicles PLinnm 0 A pJ E f al39 A Outer Ears auditory meatus k Tympanis m jrnernbrane i Aurtor391e IuW V pl Massharynxi A if 4 Ear Ossicles a malleus quotmalletquot b incus quotanvilquot c stapes quotstirrupsquot h4 they allow equalizing of the air pressure across the tympanic membrane quotear drum ouree 661 MIDDLE am i V hens r V Malleus I stapes J l l Cochlear nerve p V 39f Hmmr External meatus P wt VH1if I LpEI1iE irl EmVbra 5 Middle oar L 1 K E Ht 39 Hound window it 5 Normal Growth of the Skull Development of the Face a eruption of the teeth b enlargement of the air sinuses W 39 E Growth of the face The newborn skull and the adult skull have been drawn so that the height of the cranial vault the distance between the planes 2 A and B is the same Notice the great relative increase in the facial skeleton 39 in the adult II DISEASES AND DISORDERS OF THE SKELETAL SYSTEM A Congenital Malformations l Achondroplastic Dwarfism 2 Cleft Lip quotharelipquot a incomplete fusion of the maxillae b frequency l1000 births Hi ct Cleft lip b Cleft palate From Ross Laboratories Columbus Ohio Educa on Aid UNI LATERAL COMPLETE A quot39 139 p J 1 1 W I 1 3939 PR 1139 I l H I BILATERAL COMPLETE SOFT PKLATE on i LY 3 Cleft Palate a partial or complete failure of palatine processes of the Maxillae to fuse together E b frequency 12500 births 3 Polydactylyj syndactyly amp Phocomelia 5 Spinal quotspinaquot Bifida a incomplete fusion of the vertebral neural arches of the vertebrae b frequency ll000 births 6 Supernumerary Rib 7 Clubfoot talipes F a sole of foot is turned inward at the ankled b 2 X more common in males 8 Congenital Hip Dislocation a acetabu1umof hip is not large enough to hold head of femure in place i 3i m 39d gm w39ii39jr 11 39 h i h b 10 X more common in females quotClubfoot in a newborn infant B Inflammatory Disease of the Skeleton Osteomyelitis C Metabolic and Endocrine Disorders of the Skeletal System 1 Ricketts a decreased calcium content in intercellular matrix of bone tissue b clinical symptoms softening of bones leading to scoliosis and bowed legs c Causes n Q mA WH AEGQJEn m VIT X 2 Osteoporosis a decreased calcium content in intercellular matrix of bone tissue b clinical symptoms brittle bones easily broken c Causes quotH12 s e 3 Opau Sa osteoarthritic if an w39o mE an A Prognathism and A acromegalic facies Hirsutism Gynecomastia and lactation 3 Acromegaly a increased thickening of bones esp mandible and hands bCause C if 9 Enlarged hands and heat Typical ndings in acromegaly D Fractures break in bone tissue 1 Simple closed I Compound open comminuied epiphyseol separation simple closed mP quotquotd Pquotml fracture fracture U hair 1 ma 2 Incomplete quotquot9139ressquot39 quotgreenstickquot Fracture 3 Comminuted 4 Impacted compression HEALING OF BONES E TUMORS OF BONES 1 Osteomas 2 Osteosarcomas The progression of acromegaly in one individual from age nine 3 sixteen b thirtythree c and ftytwo d years The coursening of features and dis gurement are evident by age thirtythree and severe at age ftytwo iii Fracture hematoma 3 b quot Fracture repair a Formation of fracture hematoma b Formation of eirtemal and intemal P c39Completely healed fracture Anteroposterior projections of the repair of a fractured femur a Immedi ately after fracture b Two weeks later a hazy sxtemal callus is visible around the margins of the fracture c About 332 weeks after the fracture the internal and external calli begin to bridge the separated frag ments d Almost 9 weeks after the fracture the bridge between fragments is fairly well developed In time remodeling will occur and the fracture will be repaired Courtesy of Flalph 0 Frank Eau Claire Wisconsin from Lester W Paul and John H Juhl The Essentials of Roentgen Interpretation 3d ed Harper 8 Row Publishers lnc New York 1972 eons maxmcs guanine A Depressions and openings 1 Fissure 2 Foramen fommen hole Aquot 8 Meatus canal 4 Paranasal sinus sin cavity 5 Groove or sulcus sufcus ditchlike groove 6 Fossa fossa basinlilte depression B Process Processes that form joints 1 Condyle 2 Head 3 Facet common SKIliL TAL sraqcruas TERMS W nsscarprron A narrow cleftlilce opening between adja cent parts of bones through which blood vessels and nerves pass A rounded opening through which blood vessels nerves and ligaments pass A tubelike passageway running within a bone An air lled cavity within a bone connected to the nasal cavity A furrow or groove that accommodates a soft structure such as a blood vessel nerve or tendon A depression in or on a bone Any prominent roughened projection A relatively large convex articular promi nence lmuclrlelike A rounded articular projection supported on the constricted portion neck of a bone A at or shallow articular surface Processes to which tendons ligaments and other connective tissues attach 1 Tubercle tuber knob 2 Tuberosity 3 Trochanter 4 Crest 5 Line 6 Spinous process spine 7 Epicondyle epi above A small rounded process A large rounded usuallyroughened pro cess A very large blunt proj e tion found only on the femur A prominent border or ridge on a bone A less prominent ridge A sharp slender process A prominence above or on a condyle Superior orbital ssure of the sphenoid bone 4 39 Infraorbital foramen of the maxilla 0 Externalrauditory meatus of the tempo ral bone 39 Frontal sinus of the frontal bone 39 intertubecular groove of the humerus anquot Mandibular fossa of the temporal bone The mastoid process of the temporal bone 39 Medial condyle of the femur Headofthefemur Articular facet for tubercle of rib on A If vertebra Greater tubercle of the humerus e tuberosity of the hipbone 1 i3reater trochanter of the femur lliac crest of the hipbone Lineaasperaofthe femur Spinous process of a vertebra Medial epicondyle of the femur III THE AXIAL SKELETON A THE SKULL 1 Frontal Bone a supraciliary arches arches that form base for the eyebrows b supraorbital iotcheg foramina openings for nerves amp blood vessels zygomatic process r portion of frontal bone that articulates with the zygomatic cheek bone d frontal sinuses hollow cavities within the frontal bone a frontal suture visible only on fetal skulls Occipital Bone a external occipital protuberance a bump at the base of the skull b occipital condyles location where the Atlas bone articulates with the occipital bone c foramen magnum large opening through which the Spinal Cord passes and also the Vertebral Arteries which conduct blood to the brain Supe rior sagi39ttal sinus C onfluens Left 39 I Right Binuum p r Hemisphere J Hemisphere Transvers I I I sinus F Transverse quot F Ma5t i process CI T ransverse process process C2 39 Ve rte tr a1 vvE139tEI F39 Calvain and large wedge of occipital bone removed Dura mater and venous sinuses in posterior dew schenla cl d internal occipital crest midsagittal ridge located within the cranial cavity EH Supe or ssg iam nus Cavernous sinus Inferior sapgilttal nus Great Sp mnopanetal celeh a Sinus Vein Supe oi quot 39 c petrosal mean 91 p c k p A g 3 V 5tmiQm Irntsrswsrnuus 391 N 1 1 p V VI l g 39 Tuntruriiuvm e y gt quotLquot p quot3939 0w 7 n 39 ii A II I quot I Iquot F 0 vein lnfraorbisai quot E P TransWrse sinus EH Venous dural sinuses of the head Super cial veins of the face empty into the cavernous sinus sinus J sinus Inferior patron From L L Langley J R Te sinus ford and I B Christensen Dynamic Anatomy and Physi ology 4th ed MccrawHill New 5York 1974 p 455 e grooves for the Sigmoid Sinuses grooves within the cranial cavity where the sigmoid Sinuses conduct blood through the jugular foramina into the internal jugular veins Parietal quotwallquot Bones Temporal Bones a b g tympanic portion the area surrounding the external auditory meatus ear mastoid quotrocklikequot process location of the mastoid air sinus styloid process the hyoid bone is attached to the styloid process via ligaments external auditory quotacousticquot meatus the ear canal mandibular fossa the socket where the condyloid process of the mandible articulates with the temporal bone forming the temporal mandibular joint TMJ zygomatic process the extension of the temporal bone that articulates with the zygomatic cheek bone jugular foramen opening through which the Glossopharyngeal Nerve IX the VAGUS NERVE X the Spinal Accessory Nerve XI and the INTERNAL JUGULAR VEIN passes through EI2 quot I an u 39v393939 o g I 1 1ilI 9 mrozm none smsuouo some rmrom ZYGOMATIC ARCHa concmouo success or MANDIBLEI coaououn success or 39i mg MAHDIBULAII NOTCH auasuna I LATERAL PTEIIYGDID HATE a molten LINE PTERYGOID HAMULUSV GIOKEN una STYLOMANDIBULAR UGAMENT PTERYGOMANDIBULAI MnIE BROKEN man I quot EXTEINM AUDITORY MEATU5 Aquot1quot 5 I 1 I I 3rLcaa Inocisy 0u M15 7 no CEIVICAI vsmasu noov I 7 LESSER comua 3 EiEA139Ei comm w Enctoms 11mono cnnnuo cmcono cmunrmE mcuua spams FORAMEN snuosun FORAMEN om R 39 7114 cznvucu venrem ST THORACIC venreau in u 151 ms P Vi Imr I39 quot1 39 I 7 0 p ISPIIENOPALATINE Ftomme t PTERYGOPALATINE FlirtEA I EHomIAE cvosrauon mass Hr LITEhla39L umlwt MEIAL LAMINA 2 HMULUE niinrntmunnt access or PALATE none V msai noom or MAXILLA HFtiIA39gtl39fEMF amp A1i FOSSA MFEDLAH PROCESS or MAXILLA h internal auditory acoustic meatus opening through which the FACIAL NERVE VII and AUDITORY NERVE VIII pass through carotid canal canal through which the INTERNAL CAROTID ARTERY passes up into the skull i 5 Maxilla upper jaw a infraorbital foramen openings below the orbits eye sockets for the passage of nerves amp blood vessels alveolar processes tooth sockets 1 incisors 2 canines 3 premolars 4 molars zygomatic process portion of maxilla that articulates with the zygomatic cheek bone frontal process the top portions of the maxilla that articulate with the frontal bone maxillary sinuses hollow cavities within the maxillary bone palatine process that portion of the maxilla that makes up part of the hard palate along with the palatine bone incisive foramen small hole just behind the incisors front teeth of the maxilla for the passage of nerves amp blood vessels Zygomatic cheek Bones a frontal process the portion of the zygomatic bone that articulates with the frontal bone together forming the cheek arches b temporal process the portion of the zygomatic bone that articulates with the temporal bone together forming the arches of the cheeks c maxillary process the portion of the zygomatic bone that articulates with the maxilla upper jaw Ethmoid quotsievelikequot Bone a orbital lamina lamina orbitalis the flat plate of bone forming the medial portion of the orbit eye socket b ethmoid air sinuses hollow cavities within the ethmoid bone c perpendicular median plate forms the superior upper portion of the nasal septum wall separating the nasal cavities E I4 om ronmsn j Amemon CLINOID PROCESS S TUBERCULUM SElLAE H 2 a H u G t quot39 Po51rERIoE CLINOID FRONTAL smusa 39 SMALl WING OF SPHENOID BONE DORSUMSELLAE n 7 R H iquot5FHEHoz1on f 3INII5i H l quot BODY OF MEDIAN PLATE 39 1 SPHENOID BONE DF ETHMDiDV 0 NAsAL mui ieh 39 l n BASILAR met or a occnpnm some 1 2 I PALATINE PLATE 7 sgs y V P L OF MAxlLLA Tl 3 p f quotfilnT391Equotquot39 39gt xs I V A Crista galli Olfactory PALATINE BONE 1 39 39a39 iquot39a P P Cribriform plate d middle nasal conchae quotshelvesquot 1 conchae is pro nounced quotKONKAYquot concha sing is pro nounced 39quotKON KAquot nasal concha s39 s Perpendicular plate 2 membranecovered portions of the ethmoid bone that project into the nasal cavities e crista galli quotrooster39s combquot superior portion of the ethmoid bone that projects into the cranial cavity f cribriform plate 1 the holefilled area on both sides of the crista galli named above 2 the holes are called olfactory foramina through which the OLFACTORY NERVES I of the nose pass up into the cranial cavity to the brain 8 Sphenoid quotwedgelikequot Bone a the sphenoid bone is a central bone within the skull located just behind the ethmoid bone b the sphenoid bone articulates with the ethmoid bone frontal bone temporal bones occipital bone and parietal bones TUBERCULUM SELLAE l raamplIl xTEii iUR CUNOID PROCESS prromiMEm ROTUNDUM c B as S ENmb39 gm j I p POSTERIOR CLINOID PROCESS E5 HovALE A FORAMEN SPINOSUM K pFORAMEN LAc RuM EJEE5 UM SELLAE l t1wu5 c greater wings the flared portions of the sphenoid bone located within the cranial cavity d lesser wings located just superior above the greater wings e sella turcica quotTurkish saddlequot 1 aconcavity in the medial region of the greater wings 2 the PITUITARY GLAND the quotmaster glandquot of the body is located in this concavity f sphenoid air sinus ho11ow cavity within the sphenoid bone located just deep to the sella turcica g optic canal openings through which the OPTIC NERVES II and OPTHALMIC ARIERIES pass through h superior orbital fissure fissures through the 0CULOMOTORNERVES III Trochlear Nerves IV Abducens Nerves VI and the OPTHALMIC BRANCH of the TRIGEMINAL NERVES V1 pass through i foramen rotundum openings through which the MAXILLABY BRANCH of the TRIGEMINAL NERVES V2 pass through u j r 5 I ue 239 39h nKE ni nauu I1a 7 39h um H l 3939 VII I 39 Trigerninal v a A Semi uunar E ganglion y e 391Bl39V9 branches Lateral p T pterygoid muscle Masseter A A 39 musde Anterior belly of diagestrucrnusole j foramen ovale openings through which the MANDIBULAR BRANCH of the TRIGEMINAL gge NERVESV pass rrria through 39 k foramen lacerum large openings through which the INTERNAL CARDTID ARIERIES enter the cranial cavity to supply the brain 1 pterygoid processes 1 pronounced quotPTERIGOYD 2 that portion of the sphenoid bone that forms the posterior back part of the hard palate roof of the mouth i 0 C K p L h p K IM Iquot gv 1i p t Q1 2 LT 109 5394 5 39s I u t u y ll v 39I 1 t q 9 Nasal Bones 2 thin bones that form the bridge of the nose l0 Lacrimal Bones a located right at the lower medial corners of the orbits eye sockets b Note the NASOLACRIMAL CANALS through which excess tears pass down to the nasal cavities thus explaining why crying can lead to a runny nose ll Palatine Bones form part of the hard palate roof of the month just between the maxilla and the pterygoid processes of the sphenoid bone 12 Inferior Nasal Concha Bones the lower quotshelflikequot structures that project into the nasal cavities 13 Vomer quotplow sharequot Bone forms the inferior lower portion of the nasal septum wall separating the nasal cavities 14 Mandible lower jaw Coronoid process e i 39 onel1v39rl7nr process t nmun of mandible Alveolar part j 7 if 139 sockets for teeth 5 H a 39539 of mandible Oblique line M V rMl7l1Bilibil llF angle jg 39 Mental ioramen E z E Iv Mental tubercle Itlentgl prouybgrancg a body of the mandible the chin region b mental foramen 4 The Mandible as seen from the Front NOTE 1 th anterior aspect of the mandible forms the bony substructure of the mentum or chin The two vertical rami of the mandible are continuous with the body of the mandible at the mandibular angle 2 the mental foramen trans mits the mental branch of the inferior alveolar nerve to the skin of the chin and lower lip on each side The mental branch of the inferior alveolar artery accompanies the mental nerve and participates in the vascular supply of the lower lip openings for the passage of nerves amp blood vessels c alveolar processes tooth sockets 1 incisors 2 canines 3 premolars 4 molars EI8 e JIMF CAPSULE TEMPOROMANDIBULAR IJGAMBJT CIATERAL UGAMENTD SPHENOMANDlIULA lGAMB39lT i39SPHENOMANDBULAR LIGAMBH IIIAHTOIE 7 ASTYLOID PROCESS STYLOMANDIIULAI UGAME39II39 d ramus quotbranchquot the angles of the jaw e condyloid process the thick rounded portion of the mandible that articulates with the mandibular fossa of the temporal bone forming the temporal mandibular joint IMJ f coronoid process the thin pointed anterior projection of the mandible for the attachment of muscles g mandibular foramen openings for the passage of nerves blood vessels located1 on the internal surface of the mandibles 15 Hyoid Bone a a U shaped bone located between the mandible and the larynx voicebox b is attached to the styloid process of the temporal bone via ligaments B The VERTEBRAL coumn DDR3XL 1 General Characteristics of the Vertebrae CPOSTERWD r p Spinous process a Body b Vertebral neural Arch e P l r l vvhelhl 1 Pedicles Tramr P lt S 2 xaminae U 1 39 P Superior articular process P l entebral P 9 E39srants c Processes 1 Spinous Process serves for the attachment of ligaments amp muscles 2 Transverse Processes a Superior Articular Process 7 VEIJTRAL EN 0R b Inferior Articular Process Superior P M g rspinous V s a quot1392 I process V w P709 I 39 nil V r 5 V 1 I Iquot F It 3quot I E3939Igt ah w i I C II I e it quot u u 39 quotruJi Le iquot 1 39 0 Spinous a process 39 W K n iLr e um process V V Suuctural features of a V P typical vertebra as shown d 1nte39rretrtlebral foramina Q t39 ed w and l the holes formed between the articulating vertebrae 2 the spinal nerves that branchoff the spinal cord emerge through these holes 39 The human spinal cord spinal nerves and sympathetic nervous system In relation to the vertebrae and the mem branesmenin esaboutthecorcI V pi 0 A h P 39 L 3m m3eS IMT39tEVER aw Eplnur nl 3 E D P 39wIi1irtematterquot 7 gray matter vertebra w PI he 4 ganglion E2o communlcans 39 3 Articular facet 2 The Intervertebral Discs p A f r tquot39b quot 39 ib a annulus fibrosus cartilage P Pad 19 1 no b nucleus pulposus gmnmEquot composed of fibro 2 39 gelatin c Herniated Disc sudden severe pressure on the disc can cause it to rupture SPm 9 process r lntervertebral disc 2 Demifaoet for head of rib 3 Types of Vertebrae TYPE a8 p HUMAN EtIBRYO j8 ADULT p Cervical T 7 7 Thoracic 12 12 13 Lumbar 5 5 7 Sacral 5 1 Sacrum 3 Coccygeal 4 l Coccyx 2125 TOTAL 33 26 50 4 Regional Differences between the Vertebrae a Cervical Vertebrae 1 Characteristics a all possess holes in the transverse processes called quotTransverse Foraminaquot through which the Vertebral Arteries pass up to the Foramen magnum of the skull Bifurcated spinous process hfsvriebrrm 0m 36 E1 b usually possess bifurcated quotbifidquot spinous pro cesses 2 ATLAS C1 a possesses no body portion b articulates superiorly with the Occcipital condyles and inferiorly with the AXIS iAILANTOOCCIPITAL JOINT iiATLANTOAXIAL JOINT E 2 quot 39 f lamp 0 A 5 pg niperiori articular facet 39V transverse process I posterior arch OF posterior tubercle 0 ramspinous process bi d 3 Axis cc2 it the characteristic Odontoid Process Dens of this bone is really the body of the Atlas which during embryonic development becomes joined with the Axis 4 Vertebra Prominens C7 possesses a spinous process that prominently extends straightout and can readily be palpated quotfeltquot as an anatomical landmark b Thoracic Vertebrae 1 the spinous processes of these vertebrae are angled strongly downwards 2 they possess facets where the head and neck of the ribs articulate Articulation of rib and vertebra Facet for 1st rib Costotransverse 3F39i39i1 3Alii3 i 39 p Demi7facets for 2nd rib C 5JiDEE iTaIf articulation quotTvpicaiquot thoracic vertebrae c Lumbar Vertebrae characterized by possessing short blunt spinous processes and lar e massive bodies E20 d SACRUM articulates superiorly with L5 inferiorly with the Coccyx and laterally with each Ilium of the pelvis quotSacro I1iacquot Joints it Flatem for the 1 1th and 12th ribs respectively E 22 5 Ligaments of the Vertebral Colum a anterior longitudinal ligaments C1 atlas b posterior longitudinal ligaments C2 axis srs s1 at e I C up 8 P111011 lgam II S 6 CURVATURES or THE VERTEBRAI I COLUMN nI 39 a Primary Curvatures G T Cervical curve concave 7 vertebrae DH 1 convex postericrly 2 include Thoracic a G P l F T T and Sacral Curves Spinous process F PYA i p O Transverse process m L l A H lntervertebral disk Thoracic curve convex 12 vertebrae quotquot39 393939 1 ntelWsnebrslquot torssn quot newquot quot quot baby o39lds hi d steadily L 34 mnths b Secondary Curvatures 1 concave posteriorly Lumbar curve csneaveji quotquotquotquot39quot 5 vertebrae 2 include Cervical and Lumbar Curves l ii Vi but 39 in quot quotquot Coccyx vi l 4 fused vertebrae The vertebral column Thin disks between the thoracic vertebrae allow great flexi bility in tbethoracic curve thick disks between the lumbar vertebrae reduce flexibility 39 Equot23 c Abnormal curvatures 1 Scoliosus lateral curvature of the spine 2 Kyphosis quothunchbackquot excessive thoracic curvature 3 Lordosis quotswaybackquot excessive lumbar curvature scouoslns KYPHOSIS LORDOSI5 Kyphois Lordosis First n39b C THE RIBCAGE Second rib 1 Types of Ribs a Vertebrosternal True ibhd m Ribs 1st7th pairs Fourth rib b Vertebrochondral Ribs 8th l0th pairs Fifth 111 C M 5 gtv sixthn7a o g 7 Seventh n b c Vertebral Floating Ribl 11th12th pairs R vEiglL1t39h rib R Ninth rib Tenth n39b c Eleventh rib Thoracic ertebrae R s Twelfth rib E 24 2 Basic Structure of a Rib tubercle S39iLIieriD r arIu ruIar process Transverse 1 ud a head of a Rib Sterna En articulates with the facet on the pedicle of 397h a thoracic vertebra bi neck of a Rib the constricted area just beyond the head of the rib c tubercle of a Rib a bump located just beyond the neck of the rib that articulates with the transverse process of a thoracic vertebra d sternal end of a Rib the end of the rib that faces the sternum 3 Intercostal Spaces between the Ribs the location of the INTERCOSTAL39MUSCLES Q The STERNUM breastbone a manubrium 1 the superior upper portion of the sternum 2 articulates with the clavicles collarbones and the 1st pair of ribs 3 Sternal Notch the notch at the superior border of the manubrium E3925 b body 1 articulates with the 2nd7th pairs of ribs 2 Sternal Angle of Louis a the ridge between the manubrium and body of the sternum b the sternal angle is used as an anatomical landmark to indicate where the 2nd pair of ribs articulate with the sternum c xiphoid process of the sternum 1 pronounced quotZY FOYDquot 2 the inferior lower portion of the sternum IV THE APPENDICULAR SKELETON A The PECTORAL GIRDLE SHOULDERS 1 attaches the arms to the axial skeleton 2 NOTE The only articulation between the pectoral girdle and the axial skeleton is the joint between the clavicles and the sternum 3 Clavicles collarbones a0 bl Co d attaches the scapula shoulderblades to the sternum breastbone NOTE If the clavicle is fractured the only attachment between the arm and the axial skeleton is lost acromial end of the clavicle articulates with the acromion process of the scapula sternal end articulates with the manubrium of the sternum 4 Scapulae shoulderblades a b C spine a ridge located on the posterior aspect backside glenoid cavity fossa 1 location where the head of the humerus articulates with the scapula 39 2 the glenoid cavity is located on the lateral aspect of the scapula NOTE Now that you have identified the spine on the back side and the glenoid cavity facing laterally orient a scapula and identify whether it is LEFT P superior border e lateral border medial border E26 i acromion process location where the acromial end of the clavicle articulates with the scapula supraspinous fossa 1 the depression located just superior above the spine of the scapula 2 the SUPRASPINATUS39MUSCLE is located in this fossa infraspinous fossa l the depression located just inferior below the spine of the scapula 2 the INFRASPINAIUS MUSCLE is located in this fossa subscapular fossa l the flattend area located on the 9 t r39IoP aspect of the scapula 2 the SUBSCAPULAREMUSCLE is located in this fossa B The UPPERLIMB ARM 1 Humerus 3 B EQIE head 1 articulates with the glenoid cavity of the scapula 2 the head of the humerus thus points medially towards the body olecranon fossa 1 a large depression located at the distal end of the humerus where the olecranon process of the ulna the elbow ar ticulates with the humerus 2 the olecranon fossa like the elbow is located on the posterior aspect backside Now that you have identified the head which faces towards the body and the olecranon fossa which is located on the back side of the humerus orient a humerus and identify whether it is a LEFT or RIGHT anatomical neck the groove that encircles the head of the humerus surgical neck the constricted area just distal below the head which is also an area more prone to fracture greater tubercle a large rough bulge on the lateral aspect of the head nutrient foramen a tiny hole on the posterior aspect of the diaphysis shaft deltoid tuberosity 1 a rough patch on the lateral aspect of the diaphysis shaft 2 location where the DELTOID MUSCLE inserts on the humerus E 2 i medial amp lateral epicondyles 1 the rounded prominences on the medial amp lateral aspects of the distal end of the humerus 2 Note You can feel these epicondyles by palpating feeling the distal end of your own humerus trochlea medial condyle 1 the rounded surface at the distal end of the humerus that articulates with the trochlear notch of the ulna 2 HINT to remember that the trochlea is located on the medial aspect think TM k capitulum lateral condyle 1 the rounded surface at the distal end of the humerus that articulates with the head of the radius 2 HINT to remember that the capitulum is located on the lateral aspect think quotCAPITULquot 1 radial fossa a slight depression located just above the capitulum that the head of the radius can jut into when the lower arm is flexed coronoid fossa a depression located just above the trochlea that the coronoid process of the ulna can jut into when the lower arm is flexed I11 Radius a the radius is located on the thumbside of the forearm HINT to remember think of where you would take a quotradial pulse the radius has a very characteristic shape head that makes it look like a nail b it has a prominent c head of the radius articulates with the capitulum of the humerus and the radial notch of the ulna neck of the radius the constricted area just distal to the head radial tuberosity a rough bulge just distal to the neck where the Biceps brachii muscle inserts onto the radius styloid process 1 a thin projection on the lateral aspect at the distal end of the radius 2 the styloid process articulates with the SCAPHOID BONE of the wrist E28 g ulnar notch 1 a distal concavity on the medial aspect of the radius 2 articulates with the head of the ulna Ulna a the ulna is located on the littlefinger side of the forearm b head of the ulna the small flattened quotheadquot at the tapered distal end of the ulna olecranon process of the ulna the quotelbowquot fits into the olecranon fossa of the humerus when the forarm is extended trochlear semilunar notch of the ulna the large notch quotpitquot that articulates with the trochlea medial condyle of the humerus coronoid process of the ulna 1 the flared ridge on the anterior front aspect of the trochlear notch 2 fits into the coronoid fossa of the humerus when the forearm is flexed radial notch of the ulna a notch on the lateral aspect of the ulna where the head of the radius fits into it rotates within this notch styloid process of the ulna 1 a distal projection of the medial aspect of the ulna 2 it articulates with the LUNATE BONE of the wrist Bones of the Wrist 8 carpal bones are arranged in 2 rows of 4 bones each Carpal the the 1 2 3 4 the 1 2 3 4 a b proximal row naming from lateral thumb side to medial scaphoid navicular quotsmall shipquot lunate quotmoonshapedquot triangular I pisiform quotpeashapedquot c distal row naming from lateral thumb side to medial trapezium quotsmall tablequot trapezoid capitate quotheadquot hamate quothookquot Dleormon PHmAiaaEs BonaoftheforearmandhandTheulnare Iembles a monkey wrench The ngers contain digital bones phalanges while the rest of the hand oontains 5 metacarpal and 8 carpalbone The carpal bones are arrangedintworowsStartingattheradiusthemale lover the carpal bones project the mnemonic 1 SCARED soaphoid 2 LOVERS lunate 3 TRY triquetrum 4 POSITIONS pisiform 5 THAT trapezium 6 THEY trapezoid 7 CANNOT mpitate is 391IANDquotLE hamate How do you remember that the trapezium com be one the trapezoid Ans They are in alphabetical order The nose of the male lover radial tuberosity is the site of insertion of the powerful biceps tendon E31 5 Metacarpal Bones a the bones comprising the palm of the hand b they are numbered 1 to 5 starting with the thumbside and moving medially c structure of each metacarpal bone 1 proximal end 2 shaft 3 distal head 6 The Phalanges digits 14 in each hand a The thumb Digit 1 consists of a proximal amp distal phalange b Each of the other fingers consists of a proximal middle and distal phalange C The PELVIC GIRDLE the Hips 1 General Characteristics a the pelvis consists of Right and Left Innominate Os coxa Bones that haved fused together at the pubic symphysis b the pelvis articulates with the sacrum and the legs and thus acts to transfer the weight of the upper body torso onto the legs c PELVIC INLET quotPelvic Brimquot 1 the space above the Pelvic Inlet is called the FALSE Greater PELVIS 2 the space below the Pelvic Inlet is called the TRUE Lesser PELVIS d PELVIC OUTLET Fuoopowm Pubic symphysis Pubic arch greater than 90 532 2 Comparison between the Male and Female Pelvis CHARACTERISTIC MALE PELVI FEMALE PELVIS Overall Structure large amp heawy light amp delicate PELVIC INLET heartshaped oval shaped Cavity of TRUE PELVIS narrow amp deep wide amp shallow PELVIC OUTLET narrow wide Angle between the Pubic Bones less than 9039 more than 9039 PUBICiARCH 1 Male 2 Female Less than 90 I V More than 90 3 Each Innominate Os coxa Bone is actually formed from the fusion of 3 bones the Ilium the lschium amp the Pubis bones a Ilium 1 iliac crest the rounded ridge of bone on the superior top surface of each ilium 2 anterior superior iliac spine the rounded lateral end of the iliac crest 3 anterior inferior iliac spine the rounded spine located just inferior below to the spine named above 4 posterior superior iliac spine the rounded medial end of the iliac crest 5 posterior inferior iliac spine the rounded spine located just inferior below to the spine named above 6 greater sciatic notch a large notch indentation located on the posterior aspect backside just below the posterior inferior iliac spine E 53 The right os coxa in lateral view Iliao crest LPosterior gluteal line I39rItjE ri39or gluteal line Posterior suoer1or iliac spine ILIUM39 Inferior gluteal line Posterior rm ferior iliac spine terior superior r liar Spin V A tmior inferior rquotilij a inf s Body Superior ramus Pubic crest 1 Epir Lesser sciatic notch Su ISCHIUM Ischial tuberosity L amus Obturator foramen 7 sacroiliac joint surface the medial surface of the ilium that articulates with the sacrum b Ischium l acetabulum a the cup shaped area that articulates with the head of the femur thigh bone i b actually the acetabulum is the location where the ilium ischium and pubis bones have all fused together 2 ischial spine located on the posterior aspect back side just below the greater sciatic notch 3 ischial tuberosity a located just inferior below the ischial spine b the weight of your body rests on theischial tuberosities of the pelvis when you are in a sitting position c Pubis 1 forms the anteriorinferior portion of the pelvis 2 pubic symphysis a the location where the 2 pubis bones articulate join with each other b they are separated from each other by fibrocartilage 3 pubic arch a the arch formed by the 2 pubis bones b the angle of the pubic arch is used to distinguish between a male pelvis angles less than 90 and a female pelvis angle more than 90 4 obturator foramen large opening through which blood vessels and nerves pass out of the pelvis D The LOWER LIMB LEG 1 The bones of the leg are much heavier than their counterparts in the arm since they not only permit movement but must be capable of supporting the weight of the whole body 2 Femur quotthighbonequot a the femur is the longest and heaviest bone in the body b head 1 articulates with the acetabulum of the pelvis 2 the head of the femur thus points medially towards the body linea aspera quotrough linequot 1 a ridge located on the posterior aspect backside of the shaft of the femur 2 it serves for the attachment of muscles d NOTE Now that you have identified the head which faces towards the body and the linea aspera which is located on the back side of the femur orient a femur and identify whether it is a LEET or RIGHT e neck 1 the constricted area just distal below the head 2 a fracture at the neck of the femur is erroneously called a i f greater trochanter the large process on the lateral aspect of the femur for the attachment of muscles g lesser trochanter the smaller process on the medial aspect of the femur for the attachment of muscles h nutrient forament a tiny hole on the posterior aspect of the shaft near the linea aspera through which a nutrient artery enters the bone i medial amp lateral condyles l the rounded prominences at the distal end of the femur that articulate with the tibia 2 NOTE While the humerus of the upper arm articulates with both the radius and ulna of the forearm the femur articulates only with the tibia of the leg T E35 3 j intercondylar fossa the notch located between the medial amp lateral condy1es Patella kneecap a has the shape of an inverted triangle b protects the knee joint the articulation between the femur and the tibia from injury Tibia quotshinbonequot a the tibia transmits the weight of the body from the femur to the foot b the tibia is the quotthickquot bone located on the medial aspect of the leg HINT to remember that the tibia is located on the medial aspect think T4M c tibial tuberosity 1 a rough bulge located on the anterior aspect front side of the tibia at the proximal end 2 the Quadriceps femoris muscle inserts onto the tibia at this point medial malleolus 1 a rounded prominence located on the medial aspect at the distal end of the tibia 2 it articulates with the talus bone of the ankle forming the medial quotbumpquot of the ankle NOTE Now that you have identified the tibial tuberosity which is located on the frontside of the tibia and the medial malleolus which is located on the medial side of the tibia orient a tibia and identify whether it is a LEFT or RIGHT f anterior crest the sharp ridge that runs along the anterior aspect of the tibia NOTE You can feel this ridge by palpating feeling the anterior aspect frontside of your own leg g medial amp lateral condyles articulate with the medial amp lateral condyles of the femur Fibula a the fibula is the quotfinequot slender bone located on the lateral aspect of the leg b head of the fibula 1 located at the proximal end of the fibula 2 the head articulates with the tibia E36 7 8 Metatarsal I c lateral malleolus l the rounded prominence at the distal end of the fibula 2 it articulates with the talus bone of the ankle forming the lateral quotbumpquot of the ankle Tarsal Bones of the Ankle 7 l talus quotankle bonequot articulates with both the tibia amp fibula 2 calcaneous quotheel bonequot the largest of the tarsal bones located inferior below the talus bone Metatarsal Bones a the bones comprising the sole of the foot b they are numbered 1 to 5 starting with the big toe and moving laterally arches of the foot 1 provide leverage for the foot when walking 2 medial longitudinal arch extends from the ball of the foot to the heel C 3 transverse metatarsal arch extends across the width of the foot The Phalanges digits 14 in each foot a The big toe Digit 1 consists of a proximal amp distal phalange b Each of the other toes consists of a proximal middle and distal phalange Nevicular Intermediate curlsifs Medial sI rinslf nrrn l39ullEElFlL LONGITUDINAL ARCH iteases LONGITUDINAL ARCH TFIANSVERS E ARCH ARCHES OF THE RIGHT FOOT IN MEDIAL VIEW See text for the component bones in each arch Footprints of right and left feet Different intensities of shading indicate different pressures on the heel head of first metatarsal and heads of lateral four metatarsal bones E3397 E38 SKIN THE INTEGUMENT I FUNCTIONS QEWEWV f A Protection mm Arrector 5 0 1 against micro pili muscle 39 organisms b Duct or d 39 sweat gland 2 against water loss 3 aga391n5l39 W B Sensory Organ C Temperature Regulation 1 sweat glands evaoorsl39wn 2 blood flow through the cutaneous blood wssels 0 V f111shec1 E 7mTro gt1 Le4T quotquotsultm I053 b pallid T t Y UTFl EDU5 V mg LPNER I 145 D u 9LoobSal1magt egsr D Synthesis of Vitamin D cialcif nl Surface area of the sltin compared with actual body size A 6foot man has about 15000 square inches of skin area Q J 4 Stratum Corneum k Y 3 hnOCyes a consists of dead flattened cells containing muchkeratin protein b acts to waterproof the skin surface 5 external pressures on the skin stimulate growth amp thickening a palms amp soles of the feet b calluses amp corns 6 Fmcwoy R IDGES B Dermis 1 much thicker layer than the epidermis 2 dense fibrous connective tissue irregularli arranged 3 differentiates from the gesoderm 4 supplied with blood vessels amp nerve fibers 391 d 7 5 papillary folds 1 IbTeit FRIWON Kmees I THE LEHEE ntrw iSH CENTER on M THE5 ilIHE5 iUHNIjFi E sBETE39HiEE 7 i N LOOP AND DELTA MUST s ow nEITgS2 H39H 39 HE z H Wags HAVE NO quotquotf5 a I 39 39 39 ncuntm mamugsdquu uuphum1upuuauur cuhnuuuuusuaunnunumeup budh nlluisl L F3 an C Subcutaneous Layer the Hypodermis l Superficial Fascia attaches the skin to the underlying tissues 2 Subdermal Fat 3 Superficial Muscles IV HAIR A Types of Hair 1 lanugo fetal hair 2 down hair lightcolored hair of child 3 terminal adult hair thicker darker hair that begins to grow B Distribution of Hair 1 at birth a head b skin 2 at puberty a pubic b axillary Ec facial amp chest C The Hair Follicle 1 associated with a sebaceous oil gland 2 associated with a visceral muscle that causes piloerection II If goose bumps COLD fzga GHT U61 at puberty Stratum b Stratum Iuoldurn 2 it Stratum Qranulosurn pt Stratum stratum 1 splmsum V GLANDS OF THE SKIN A Sebaceous Oil Glands 1 open into the necks of the hair follicles 2 secrete oil sebum 3 the sebum keeps the skin pliable 4 location of sebaceous glands 5 the secretion of oil is stimulated by the sex hormones 6 blackheads TEaSTD q aQDAME associated with sebum plugging up the duct 7 pimples amp boils infected sebaceous glands B Sudoriferous sweat glands 1 not located on lips ears or nipples 2 composition of sweat a water b NaCl c urea 3 vaporization of sweat9cooling C Scent Glands SQzV3 p 1 modified sweat glands 2 location J a axillary regions b genital region c inguinal region d perianal region D Ceruminous Wax G1ands39 located in the external auditory meatus i E Mammary Glands l areola pigmented area 2 areolar glands glands of Mont gomery lubricate the nipple during nursing 3 secretes imediately after childbirth Areolnr glands Montgomery F 5 4 secretes milk 39 E quot 39 begining the 4th day after mu g childbirth ucfggg 5 hormones stim mm Fmmm p ulate the quot h f growth amp de velopment of the Mamary Glands VI BLOOD 5 LYMHATIC gm 7 hNlm VESSELS OF THE SKIN Interior pituitary 31 A none located in posteriorpituitary the epidermis of the skin B called cutaneous blood vessels bruise ecchymosishemorrhaging of cutaneous blood vessels C Lymphatic Vessels conduct excess tissue fluid away from the region Aedema accumulation of excess tissue fluid localized swelling ls VII NERVE FIBERS 03 THE SKIN T I 4 g g V A Sensor Nerve Fibers p IILLFMM I lt BLooIgt lwVaRampu1ai5 tfF F GQMLLFFH 1 Thermoreceptors 2 Mechanoreceptors 3 Pain Fibers Noxiceptors B Motor Nerve Fibers HUTONOMIC motor nerve fibers innervate the following involuntary structures 1 glands 2 arrector pili muscles 3 cutaneous blood vessels VIII NAILS A the edges and root of the nail is embedded in a fold of the skin 1 eponychium cuticle fold 2 hyponychium B the nail is composed of the protein keratin F6 EF39d lill 1Hl Nail plate a Hyponychium Lateral M nail fold ilLunulafE NailTed Matm F Ll395 039 PU Proximal 0 hium nail fold Emuquot Nailwall Root IX PATHOLOGIES ASSOCIATED WITH THE SKIN A INFECTIONS 1 Viralilnfectionsz a examples 1 smallpox 2 chickenpox 3 measles Rubeola 4 German Measles Rubella 5 cold sores amp fever blisters Herpes simplex 6 warts b treatment 2 Bacterial It391fectlons 39rgtquotv in bi BAG LL U3 G Basic shapes of bacteria as seen under the scanning electron microscope a Spherical cocci of Streptococcus mutans are shown joined in short chains X2500 b Rodshaped bacilli of Bacillus cereus appear individually and joined end to end in this preparation x 1250 c The spirochete Treponema pallidum has spiralshaped cells x4000 F7 a examples 1 pimples amp boils are ususally associated with Staphylococcus Kamrj infections sgbat ous 3 2 acne 3 Chan T393 pronounced quotshankerquot sores 5Q VH area associated with venereal diseases viz gonorrhea amp syphilis ETs b treatment 3 Fungal Mycotic Infections a examples 1 Athlete39s foot 2 Ringworm quotJ Ock M I 4 vaginal yeast infections 3 crotch eczema caused by the yeast Qandida albicans b treatment ALLERGIC REACTIONS 1 examples quots ecssms e red crusty itching skin gb psoriasis v circular scaly patches sf skin c urticaria hives 2 treatment MDLES neyus birthmark pigmented elevation of skin KERATOSIS quotSKIN quotW65quot brownish warty growths esp in older people BEDSORES Decubitus ulcers red sores that form over bony prominences in bed ridden patients due to poor circulation SKIN QANCERS l carcinoma 2 melanoma G ALBINISM H JAUNDICE yellowing of the skin caused by hyper bi1irubinemia I CYANOSIS bluish appearance to the skin caused by hypoxemia J KELOIDS 1 dense fibrous connective tissue scar mass resulting from a traumatic injury or burn associated with abnormal collagen synthesis during healing 2 more common in darkrskinned persons 3 treatment injection of corticosteroids colchicine or penicillamine to reduce collagen protein synthesis K SCAR TISSUE Dermis l 39 Bx Epm r ig isae L scA lt 39 m ampHl F FOR4AT0N39 J L BURNS Diagnosis of burn depth Nature of I Degree burn Syrnptorns Characteristics Course at Epidermal bum First Sunburn Tingling at Reddened blanches with Complete recovery within Hyperesthesh pressure a wee Painful P 9 Soothed by T cooling i Intradem1al burn Second Scolds spills Painful 5 Blistered mottled red Recovery in 23 weeks Flash ame Hypesthesia bquot bquotquot Some scarring and Se to prlgus weeping depigmenmion cold at Feels moist soft and pliable to touch Edema V Hair stubble visible K Subdemral burn Third Fire Painless Dry pale white or Escher nonviable skin 39 Electrical Shock EL sloughs Wckn s Scams immersion Feelsohzrld and dry to Grafting necessary Scarring and loss of N0 SK chemical Contact Edema contour and function gt Ifquot i g 7 39 B8 Fri Jun 1 192 evenmo OUTLOOK I Process induces skin growth for burn victims CAMBRIDGE Mass UPI An MIT research team that de veloped an artificial skin forburn Jvictims has devised a wayto ln duce growth of a complete new layer of natural skin The method nearly eliminates scarring speeds healing and eliminates the need for grafting the researchers reported in the quotadvance Jan 8 issue of the joumal Science Although the new method has been used successfully on guinea gs the team said it could be invaluable for humans gslpnecially those suffering severe it apjpears we have lindueed regeneration at new skin where such material was availah le at that site quotSince skin is an nngan one could say we have induced organ regenerationquot 39 Yannas and Dr John F Burke chief of the bum unit and trauma services at Massachusetts General Hospital and professor at MIT and Harvard Medical School head the team which has been working on artificial skin for more than a decade After dead tissue is cleaned away the membranes are applied directly to burned areas Applied within a few hours of injury they prevent infections and loss of body fluids through the wound the two principal causes of death among victims of severe burns Normal skin is made of two layers the outer epidermis and the deeper dermis The MIT s quotThis is the most exciting part of it other than its possible use for treatment of scars which cause tremendous problems among victims of massive J burns said Ioannis Yannas an MIT professor of polymer science and engineering F 0 team s artificial skin is also two layers one a rubberlike silicone sheet which is later peeled off and the bottom a network of protein fibers 39 With artificial skin cells that remain at the base of the wound regenerate a new dermis which replaces the fiber layer during healing Surgeons then remove the silicone layer but must transplant a new epidermis to the wound from somewhere else on the victim39s body with the new method the in terface between the silicone and protein layers of artificial skin is seeded with a few cells from guisnea pig epiderrriilts The mem branes applied in in guinea pigs and ealed te39rnplates re generated hnth layers not real skin in all cases The silicone layer can be re moved after to to 14 days Arthrology G1 ARTHROLOGY I Joints articulations location where bones meet ll Types of Joints A Anatomic Classification 1 Fibrous Connective Tissue Joints 2 Cartilaginous Joints 3 Synovial Joints B Functional Classification 1 Synarthrotic Joints no movement 2 Amphiarthrotic Joints slight movement 3 Diarthrotic Joints movement Ill Fibrous Connective Tissue Joints A General Characteristics 1 dense irregular fibrous connective tissue between bones 2 nonetoslight movement between bones B 3 Types 1 Suture synarthrotic Joint no movement 2 Syndesmosis quotinterosseous igamentsquot Joint See B a fibrous CT membrane between the radius amp ulna b ligament between the distal end of the tibia amp fibula 3 Gomphosis quotdentoaIveolarquot Joint tooth periodontal ligament tooth socket of bone alveolus IV Cartilaginous Joints A General Characteristics 1 cartilage connective tissue between bones 2 nonetoslight movement between bones B 2 Types 1 Synchondrosis Joint hyaline cartilage between bones a the joint between each epiphysis 8 diaphysis in a growing long bone b sternalcostal joints G1 Dlaphyais 7 at F of humerus Epiphyeeal 39 w line Epiphysoal i Epiphysns line quot of med cqgtmum H epicondyle of humerus Oleoranon process Ulnar 39a quotquotquot diaphysis A 39 Roentgenognun 0 the Elbow Joint of 12 Year Old Male NOTE 1 an epiphyseal line containing cartilage can be identi ed in roentgenograrns at the plane of junction between the main part of a bone and independently ossifying centers the epiphyses 2 by the 17th year ossi cation of the epiphyseal centers and their coalescence to the diaphyses of the bones of the elbow joint are nearly complete 2 Sxgghzsis a fibrocartilage between bones b Examples 1 vertebral joints The intervertebral discs become thinner as we grow older arwe get shorterl 2 pubic symphysis IV SYNOVIAL JOINTS A General Characteristics 1 synovial fluidfilled cavity between bones a ends of bones are covered with hyaline articular cartilage b synovial fluid is clear viscous fluid with the consistency of raw egg white 2 bones held tgethelr7 D laments CFIBRDUS CAf5DLEquot G 395 n G4 2 l 4 f T3 pest et jeitnte Jmints tn the left at the EletI ettn39tI are arquot7 phtiertihrettc tfellightIty mevebte imrtte ebmre and taeilew the eeeieteitt ere e yrnert hrette tttinmmmreme tz intnte te thee righIt cut the ekeIetn ate dte rtthrettie tr eeI15r39 mevemet at 3yt1ChElnzdf eEJ3539E E tat ertiIegsee at the rilejt tjtttt eymphyeie tnttverventebrel dii E E at ttbreeertitiege eenneettng the trenebrexe tit e395rmpmrei39e teertilege netue pubie 5 3Jquot iI ehyetiet eenneeting the p ubitr Dcine5 en39tertier39Iyt tut Suture ti1ureue seenneetitre tteeuel eeeneeti ng the tnterleetttnug ettutli bene et tet eyncteenteete tihreue eenzneetttre tieeue eun neettng the dietel enAde et the tibia enad tti ltItetv tt eynzicwiei jetn t ttrmultteetat etheulelet jetnt gt eynwiet taint t39unti aetat eItbewi etint tht ejwtetriet ieints tbiieejel irttereergpet jetntte eat the hand 6339 MEDICINE A nyone who lives in the frenetic world of the Chicago commodities exchange can ill aiford to be laid up with a bad back And Donald McDonnell a 40yearold trader had the classic signs of a slipped disc excruciating pains shooting from his lower spine and down his left leg Without prompt treatment he might have become permanently crippled Fortunately Mc Donnell was able to undergo a simple alter native to conventional disc euf rgery recently approved by the US Food and Dnig Ad ministration His orthopedist injected eh W 0 V ain n derfivred f39rorn te ase iquot 0S shrani the ssvlle quot or ertly three New Hope for Bad Backs p0 V v A wise was in A quotospttel 39ays and baclt Y in a week and I haven t needed a painkiller sincequot he says quot Chymopapain injections promise to rev olutionize the treatment of lowback pain About 200000 Americans under o sur e ior ruptured E each year However ex perts believe halfof them could be helped by enzyme injections instead The savings to the country are going to be incrediblequot says Dr Bemard Jacobs of New York s Hospital for Special Surgery Hospitalization costs could be cut by at least 50 percent and patients could be back at work in half the lililms sea a leis 0 Veretien earl run as his h as 0 lvlellenr rte paid onljT4E P er 0 is up tou i brous pad lled t He 0 39 A 39 N r F erg A fhseee1in39t he39iimha1rI39egioen e1 i 39eloweri eon 1 take most of the stress fromthe weight of the NEWSWEEKMAY 2 1983 Annulus fibrosis portion of the Disc Nucleus pulposus portion of the Disc 2 Y UPUr A l Y nleL cquot t flll l zlEIquotD T Lyman 0 7 rntisele spaern and pain Eliienr the prehlzern resolves iltsell With bed rest or a back brace the disc HEHAFPT M u u pI In I hemmed er 39ellppee39 due the pulp a while ainel pushes the outer ee lM39I39i39 against newer vote l39mI39l eerd enuntrm pa in In back hthe and eye tn regains its normal shape and 039 I p7 heals But if the rupture threat en539pennanent nerve damage major surgery hasbeen the only reeeujree until now U 391The ene gee 39treetrnent has had a long and rat quoter eontroversial histo iy Cli1ymo39napain diseolvs rprotein and is relat an to the enzyme eetnrnenlf used as as meet erthopedist was the rst to use chymopa pain injeetiiens to reduce herniated discs in 1963 PP treatment 5lll 39t39cltlljt caught on and by 1974 at least 10000 Americans had re ceived it But many surgeons remained skeptical and the early clinical trials failed to convince the FDA of its effectiveness Finally though new trials showed that the treatment brought about improvement in 75 percent of cases about the same success rate as conventional surgery and the FDA approved it last fall In the typical operation the patient re ceives a general anesthetic Guided by a iluorosco e of the spine the surgeon inserts a sixinc hollow needle at an angle avoid ing the spinal cord He rst shoots a dye into the disc to check its shape and the place ment of the needle Then he injects the Tnurnaiorundue G394 A 1 Jee enel of enzyme reduce pulp ti welllngr U IE hlE nmsH39E iH Em 7 i391li391e t1l The procedure el more 1 an an our and the patient goes home in two or three days 39Letreetn1ent earrig one rnejer risk and mmae mmmmmeerae re an1eembia1t1e1 ihreat by giivitig anti prior to treatment and giving adrenaline should allergic signs occur A joint committee of the American Academy of Orthopaedic Surgeons and the American Academy of Neurological Surgeons is con ducting sessions around the country to see that surgeons thoroughly understand the procedure and attendant safety precautions 7 p quot 39 other develeed ihrliiaie eur j fme 39 rot dies al 2 ragth ergt M UIEif Df Lhr1 8 em egy o7 t7 o7ssesital and Medical Center in a ers n J has used one of the new enzymes in more than 170 patients and reports no allergic reac tions and no serious complications MAT CLARK with DEBORAH WITHERSPOON disA E11412 FIIIEE E 139 in in tee V eornpreesionstresseaneause the annulustowealnenand brillate allowingthe eollagenoua contents of the disc to bulge through the wall The libmeartilaginous center of the disc may also extrude 5 abductionmovement of appendage away from Body 6 adduction movement of appendage towards the body pip fiikex quotA quot 3iaabduction circumduction 7 circumductionform a circle 8 lateral rotation outward rotation mi 9 medial rotationinward rotation supinationlateral rotation of the forearm pronation medial rotation of the forearm pronationx i upination 12 eversionlateral rotation of foot 13 inversionmedial rotation of foot iquotVers19 i aversion H git V S iCj4iaiouT i 4 ELEVATIONquot Il 59 I I Hr 0Va quotFUU W VI I7 D6Pr2eSsl0N39Lowerzquot C 4 TYPES OF SYNOVIAL JOINTS 1 Limited Movement Synoyial Joints Ex quotGLIDING JOINTquot intercarpal joints AVE Uniaxia Movement Synovial Joints movement in 1 plane a quotHINGE JOINTquot mst cgmgn gyngvial joint 1 flexionextension 2 Ex elbow tulnohumeral joint knee tibiofemoral joint fingers amp toes interphalangeal joints Body 39 gnu humerus IEquot quot j E iaE ueras bers G F Medl epicondvlo A JtIquotE iilI39Iar Med epicondyle 0 39pquotquot39 4 V e Lat epicondyle 2 2 2 Elm LEE Iain aquotEquotquot K Eh p coll tara g u Fladlal annular lig AAquot quot Head of radius RadiusM A V V L hf E l1an v jE ObIiqueu4 cord Biceps m Brachial a Brachialis w x L I Iidiin cuebiimal 3 Brachinl v p Median n o 39 j quoti I 5 n J minulau capsule f lmrnnninj rburisa i Pronator tens l39I39l Palmnris longus and brevis Iquot quotin i FRONTAL sEcr1oN 19 quot summusanm V Va Tr nic nlear notch Annular lig r1E radius Tendon T llapa m H Oblique 1 Radius MIHEIFDIIIIIHUIE membtane begmaslf L lNT 0 e AA Fiaal latefalo collateral gt 39l9Ee i Radial illaterall 1 coliaterl FHQHWIEHI h Ulna R V Annular ligament I Hadilus nar eldiaill c collateral I Annuar ligament p P d Ant radloulnar lig a a Artlculer surface KL Radius with m mul carpal bones A ANTERIOR VIEW OF RIGHT ELBOW JOINT B LATERAL VIEW OF RIGHT ELBOW JOINT I Laterel I T Si w d P d i liquotl539U d m THE KNEE JOINT T Lateral ooimtereli Ii39gE1lquotlT39lETlT d Posterior cruciate ligament Fl39l39lil El39lt39lIll39 cruciate ligament meniscus I j 39 i 39 Patellar knee tlllellal ll39lquotlElquotll5CLlEl rs lrrrmlr large liiealal collateral ligament ligament cut p I Gi 0 w i Jj 3 i 39 ri U N T 3 quotline iltN E 0 52 3 mosr irli39o RN66 I9 exed slightly to allow N3WlES e Pg eli amen o s n V it W Q ly K g The a 39 cula139sclp1eeaend t t p 1 T T L P p Q the patella have been re q o R r l u p g 39 1novedbAnteropostl p r p V V H p in noX1ay of the right 0 p p p p p g p Lateral collaterllil 39 O ligament pN quot Medial collateral l ligament Figure 1lnjurfy to the collateral ligaments can be deter 39 mined by noting instability when the knee is exed 30 degrees When a valgus knockknee stress A allows opening of the medial side of the knee it means the medial collateral ligaments have been injured When a varus bowleg stress B allows opening of the lateral side of the knee the lateral ligaments have been affected Anterior drawer sign jj 1 1 A Posterior drawer sign Figure 2 When the knee is exed to 90 degrees and the tibia can be brought forward on the femur much like a drawer being pulled open the anterior drawer sign the anterior cruciate ligament has been damaged When the tibia can be pushed posteriorly on the femur like a drawer pushed back in the posterior drawer sign the posterior cruciate ligament has been iniured G l Crisin L p N EMT Eunction of the Meniscusof fibrocartilage 1 increase cushioning between femur and tibia 2 improve bony fit Function of the Cruciate Ligaments limit flexionextension movement quottorn ligamentquot wateronthekneequot accumulation of synovial fluid Vtrickknee locking of knee joint due to displacement of meniscus quottorn cartilagequot injury to meniscus b quotPIVOT JQINTquot 1 medial and lateral rotation 2 Ex atlas axis atlantoaxial joint head of the radius with the ulna proximal radialulnar joint 39 3 Biaxial Movement Synovial Joints movement in 2 planes Ex wrist jointquotradialcarpalquot ankle joint metacarpalphalangeal joints atlantooccipital joint temporomandibular joint TMJ 4 Multiaxial Movement Synovial Joints permit circumduction movement Ex quotBALLANDSOCKET JOINTSquot ECJRGUM B U CT ON shoulder gleno humeral joints hip acetabulofemoral joints Gquotl0 Figure 1 The EHHE articulating with the axis L a pivot oin t that permits ts rotatiio naI rnotarement in P azuaigs Note the diagrarnmatio repres entation Refer to quot gure 39 and deterrnrine wiiioh artieuiet ing hones not the elbow region form a pivot joint Figure 2 39 A hinge joint permits only a bending movement flexion and extension The hinge joint 0 the elbow involves the distal end of the humerus artiothting with the proximai end of the ulna Note the diagrarumtic representation of this joint l e ARTICULAII oust iiIEn CULAl TUBEIICLE P P P llili notion Trapezoid ligament H I Acromioclavicular ligament canola ligament T l Goracoclavicular ligament Goracoacromlal ligament Pectoralis minor muscle Kgsubacromialburea lll39plil llilij i A 39 5 E g j 0 5 Omohyoid muscle Deltoid muscle A A Transverse scapular ligament N V A quot Subcorecold bursa synovlel sheath of biceps tendon quote v A A 39 Biceps muscle short head Corecobrachialis muscle 6 Bursa beneath A peetoralls major muscle quotquot 0 Letisslrnus dorsl muscle and eubjacent bursa ll Triceps muscle long head Pectoralis major muscle aquot Biceps muscle long head E he Right Shoulder Joint l 70795 maltquot quotll5 and Associated Bursae and Muscles Anterior View a39 Doltold muscle A Hummus NOTE 1 that bursae which are synoviai lined clefts in connective tissue are A interposed deep to tendons and muscles These facilitate gliding movements of A A393939 133 39 39 soft structures over bony surfaces 2 how certain muscles fuse with the joint capsule and others attach in the vicin ity of the capsule A number of these muscles provide the shoulder joint with important stabilizing features which help hold the head of the humerus in the shal Brachlalis muscle low glenoid cavity origin gtquotROTAquot0R U39FFquotj the deep shoulder muscles Doltold intel completely Surround the Coracoacromialtigatnent Acromioclavicularligament i quot 39 if I Tendon ot biceps muscle long heed shoulder g1eno humera1 A joint providing strength u M amp Stability Sup asplnat a sole M Trapezoid ligament C V E Coracohumeral ligament Subclavius muscle Pectoralis major muscle V quotquotV clavioular head origin 39A quot Pectoral fascia opened AAAAAquotquots Opening in pectoral lascia tor cephalic vein Conoid ligament x quot coracoid process AAquot Subcorecold bursa P Poctoralis minor muscle pectoral lascla Biceps muscle short head Coracobrachialis muscle e quot quotA Triceps muscle long head Aquot A A y 0j 2 N p p pU subscapularls muscle The Opened Socket of the Right Shoulder Joint NOTE 1 that the head of the huments has been removed to reveal the glenoid cavity and labrurn 2 that the capsule of the joint is surrounded by muscles the bellies Of which are sectioned in this dissection K A A A A A sulbacepuler bursa G 392 ecetabular labrurn articular cartiiagfes 39 of the acetabulum and femoral head 1 39 femur the upper line is placed on the femoral the I lower on the ischial attachment ligament of head of S I 39 rquot quot 1 J Section through the hip joint show ing the acetabular labrum ligament of the head of the femur and the retinacula Mor ris V DISEASES AND DISORDERS OF JOINTS A Congenital Disorders 1 DoubleJointedness 2 Congenital Hip Dislocation B Mechanical Injugies 1 Sprain 2 Dislocation Luxation articular capsule reflected fibers of capsule superior retinaculuml quotV39 pH it spongv substance I K I compact substance px a I reflected fibers of capsule 39 39 Dislocation of the proximal interpholangeal joint of the long nger may look dramatic but reduction is usually easy 3 Bunion swelling on the modil139aIpIct of the big toe due to physical trauma GL3 C Arthritis 1 Rheumatoid Arthritis Rheumatoid Arthritis Although arthritis is generally thought to be a disease of the elderly rheumatoid arthritis commonly occurs in patients between the ages of 20 and 50 The first signs of this crippling disease are usually soreness and swelling of the joints As the disease progresses the joints enlarge and the greyish white synovial membrane becomes in amed If left untreated the disease continues to progress causing erosion of the articular cartilage In the most severe cases the articular cartilage completely erodes allowing the bones to fuse together This is visible in the second nger from the right Rheumatoid arthritis is a bilateral disease meaning that it usually affects both sides of the body not just say the right hand Although the cause of arthritis is still unlrnown there are many theories of its origin Some researchers believe it results from excessive stress of sprains or other types of joint injuries Still others believe the body produces a natural antibody stress metabolic disorders effectively with aspirin and that reacts against one39s viruses or allergies other pain and swelling own tissues Other possible Although there is no cure reducing drugs causes include psychological for arthritis it can be treated 2 Gouty Arthritis r GOUT CRYSTALS ASPIRATED FROM TOPHUS EXCESS oerosueo IN CARTILAGE5 reoun GH 3 Osteoarthritis VI BURSAE AND SYNOVIAL TENDON SHEATHS A BURSA 1 a synovial fluidfilled sac that develops at points of friction 2 they are typically located between bones and muscles bones and skin and also between muscles synovial 9 391 i i iv it membrane a T 3yn Vial 3 cavifv W 39 swwwm umm39W w cavity menisci 7 Plllg 39I39L3939Im membrane p N H 39 39 Ullna Q 5 B BURSITIS l inflammation of the synovial membrane in a bursa esp Common m mca SHOULDER 2 Examples quothousemaid39s kneequot prepatellar bursitis quottennis elbowquot olecranon bursitis quotpostman39s heelquot calcaneous bursitis C SYNOVIAL TENDON SHEATHS synovial fluid filled sac that encloses a tendon Ue Synovialjcaviw lw wr y quot39T Nb M113quot 5quotfNovAL FLUID Carpal Tunnel Syndrome U Repetitive Motion Disorder tN p 2quot 39 39 39 1 a 39 V39 quot1 d Synovial membrane 315 quadriceps femoris 39 A suprapatellar bursa i tendon of quadriceps fernoris condvle of femur medial K 39 li Is 1 I quot quot 39 7 K I 139il quot5 r I quot 7V 1 I m 5 ii a P quot 1 39 quot quot II n 39 I fatty tissue 9y nmriiaI membrane reflected off ierucsiate ligampI39TIEms T cut end of anterior cruciate Iigament posterior cruciate Iigrneni 1 v M1 quot A rtibia d i i ii ti it1395 iii J39 3 39t i L1 J5 V 39 i j 39rE i quot 1 5 f lm r 1quotii R Tquotg 39F 5quot p Sagittal section of the right knee joint The bones are drawn somewhat apart G46 MIQLOGY SIUDY OF THE SKELETAg QLE I Introduction A there are 650 skeletal muscles in the body that comprise about 40 of the Body Weight B Basic Characteristics 1 Excitability capacity to generate electrical impulses Action Potentials 2 Contractility capacity to shorten in 39 Relationship of skeletal muscles tobones ta skel length etal muscles produce movements by pulling on bones bl Bones serve as levers and loints act as fulcrums for the levers Here the leverfulorurn principle is illustrated by me movement of the forearm lifting a weight Note where the resistance and eflort are 39 applied in this example 39 E FUNCTIONS OF THE MUSCULAR SYSTEM 1 eluntary Mavens incl 5 e4 I Flesistanoeor 2 11ai39nte nace ef 39 Weishloiobiecl Pius wetghtollorearrn Bndy Feature a Effort E or 3 Heat Production 39quot 5 39a39 m E39mi quot Fulcrum as II GROSS STRUCTURE or THE SKELETAL orioint it MUSCLES A Belly of the Muscle SmquotnoNPrP1 l 1 M95quot R p llliM 39l E39 ll il39 rltjir l l l hiIl s 39 M nlbeny brachial is l W Origin insertion 7 A a m13 1 A MUSCLE F1355 S B Tendons l attach the muscle to the perigsteum of the bone 2 Tendon of 0rigins a called the head or cepsquot b attachment to the less movable structures HI i 39 clavicle ii scapula T Q Pg7 Shoulder joint pmt a nornreurosis in H p 6 Of 39DrBaTT39I39I Hine n II b Diagram illustrating the in uence oi the point of inser c biceps tion of muscles upon the movement Produced d triceps e quadriceps 3 Tendon of Insertion 39 a the quottailquot of the muscle b attachment to the more movable structure V II 39E m L l I 7 S E IL we 21 7 r 39rr I p I I I I quot J 39 RIGHT Light Microscope l i Photograph of a somatic motorneuron synapsing onto numerous skeletal muscle fibers a motor unit iquot39I NEURtMuswAR r 3NcmoN III FASCIA OF THE MUSCLE A Epimysium fibrous Connective Tissue sheath that enclose the entire belly of muscle PERIMYSIUM capzillaw NEURDMU Relationships of connec tive tissue to skeletal muscle Shown is a cross section and longitudinal section of a skeletal muscle indicating the rela tive positions of the epimysiurn perimy sium and endomysium motor B Perimysium loose Connective Tissue sheath that surrounds only a bundle fascicle of muscle fibers C Endomysium loose Connective Tissue sheath that surrounds each individual muscle fiber IV BLOOD SUPPLY AND NERVE SUPPLY INNERVAIION T0 MUSCLE A blood vessels and nerve fibers in the Connective Tissue fascia of the muscle branch to the individual muscle fibers B Innervation of Muscle Fibers 1 Proprioceptors sensory neurons that supply muscles p 2 Somatic Motorneurons a motorneurons that permit voluntary excitation of skeletal muscle fibers A Spinal b each somatic motorneuron innervates supplies several hundred skeletal muscle fibers called a MOTORUNIT V GROUP ACTIONS OF MUSCLES A AGONIST Prime Mover muscle that causes a desired action Muscles move joints Movement at joints is effected by the action oi muscles that are generally arranged in opposing pairs As one muscle contracts and shortens the other relaxes and becomes longer The biceps 1 and tie s 2 control movement of the forearm To raise the lorearm the biceps contract and act as the prime mover while the triceps the antagonist relaxes when the B elbow is straightened the reverse s SYNERGIST 39HEL9El xquot muscle that acts with an agonist C ANTAGONIST muscle that causes the opposite action of the agonist D FIXATOR Stabilizer muscle that stabilizes body position amp decreases unnecessary movement a VI MICROANATOMY CHISTOLOGY OF SKELETAL MUSCLE p a A li quotlliquotflililF39 krulgunom of I IIl39I and rnyo umorns contacted Electmn mlcrograph of skeletal Inmcle fmm a rabbit The myo brlls run diagonally across the micrograph from lower left to upper right each looks like a ribbon crossed by altemating light and dark bands The wide light bands are 1 hands there is a narrow 2 line in the middle of each The wide dark bands are A bands each has a lighter H zone across the middle 1 20000 Courtesy H E Huxley Cambridge University 2 The Sliding Filament Theory of Muscle Contraction a proposed by Andrew F Huxley of England 1963 Nobel Prize b As myosin crossbridges link with the actin they cause the actin myofilaments to slide inward 39 sflCDMERE y APPEARANCE V MYOFIBRIL RELAXED OR STRETCHED DIAGRAM APPEARANCE MYOFIBRIL CONTRACTED a hn A rough analogy to their theory is toirnagine men bent double with a pole the thick lilamentl along their backs running a long a thinner pole the thin lament I if the thick pole is xed then the thin pole will move below them As the polarity of the crossbridges at each end cl the thick laments are in opposite directions the lam ents are pulled inwards taller Huxley C THE EFFECT OF PHYSICAL TRAINING ON MUSCLE FIBERS Identical Twins One a LongDistance Runner the other a Weight Litter The muscles of the weight lifter are larger because they have developed larger fibers containing more filaments The muscles of the runner are smaller because they have developed more mitochondria myo globin and capillaries but fewer filaments From J Keul Med Sci Sports 5 1973218 ll P a 1 Brief MaximalType Training a Examples 1 weightlifting 2 sprinting 3 jumping b muscle fiber characteristics 1 large diameter muscle fibers a fast rate of contraction b high power development H3 If I la 5 moss gmbees 3 0 H e mosN 2 low myoglobin content a minimal storage of 0 within the muscle fibers b quotwhitequot coloration of muscle fibers ENDURANCE 3seRoegtcsquot 2 Sustained Sub Maximal Type Training a Examples 1 longdistance running 2 swiming 3 CquotlCLlNG39 b muscle fiber characteristics 1 small diameter muscle fibers a slow rate of contraction b high endurance 2 high myoglobin content a permits storage of 0 within the muscle fibers b quotredquot coloration of muscle fibers 2 A Plantaris muscle of a normal control guinea pig B The same muscle of an animal after 8 weeks of running on a treadmill The ber population of the exercised muscle is more homo geneous and nearly all bers are small and rich in mitochondria Photornicrograph courtesy of J A Faulkner From Podolsky R 1 ed Contracrility of Muscle Cells and Related Processes Englewood Cliffs N j PrenticeHall Inc 1941 VII EMBRYONICDEVELOPMNT OF THE SKELETAL MUSCLES A Principle Myotomes of the Embryo develop during the 4th week from the segmented Paraxial Mesoderm quotsomitesquot Diagram of embryonic myotomes at about four weeks development occipital myotomes cervical rnyotomes thoracic myotomes lumbar myotomes 4 regressing caudal myotomes cral myotomes MB Development of the Extrinsic Muscles of the Eyes 1 develop from the quotPreotic Myotomesquot 2 innervated by the OCULOMDTOR NERVES III C Development of the Muscles of the Tongue 1 develop from the Occipital Myotomes 2 innervated by the Hypoglossal Nerves XII D Develo ment ofthe Muscles of Facial Expression Mastication and Ph I mostmseles of the Head ampThreat 1 develop from the Branchial pharyngeal Arches 2 innervated by the Facial Nerves VII Trigeminal Nerves V amp Glossopharyngeal Nerves IX HI0 THE BRANCHIAL ARCHES STRUCTURES DERIVED FROM BRANCHIAL ARCH COMPONENTS AND INNERVATION OF THE BRANCHIAL ARCHES Arch Nerve Muscles Skeletal Structures Ligament First Tn39geminalquotquot V Muscles of rnastication Malleus Anterior ligament Mandibular Mylohyoid and anterior lncus of malleus belly of digastric Sphenomandibular Tensor tympani ligament Tensor veli palatini Second Facial VII Muscles of facial 39 Stylohyoid Hyoid expressionquot quotquot Styloid process ligament Stapedius Lesser comu of hyoid Stylohyoid Upper part of body of Posterior belly of the hyoid bone digastric 39 Third Glossopharyngcal Stylopharyngeus Greater cornu of hyoid IX Lower art of bod of m Fourth and Superior laryngeal Pharyngeal and Sixthquotquot branch of vagus laryngeal and recurrent laryngeal branch Comiculate ear39Iilage of vagus respec Cuneiform cartilage tively X quot The ephtllalmerlivisien ees not supply any brancluat components Tempevralis maeseterx rnedial and lateral pterygoids Euecinator aurieuliariisi ErentaJis platysma orbicularis oris and oculi quot39quot39 quotT39he fth branchial arch is sometimes absent When present it is rudimentary like the sixth arch and usually l has no recognizable cartilage bar orbicularis irculi K V 39 temperelis occipital rnyotamu ff nmm l Aoccipitalis l 1U39E39liE 39l3lEtF e v auricularis orbicularis If OHS styI ohye il 39 J Iquot 39 r quot lg i mm Er plats L stylopharyngeus mylohyoid T T if quotE if h anterior and T posterior bellies V T 39 g r of digastric A bronchial tpharyngeal Bquot T muscles T mus e iturnerelFniiemniiai39eI eauielu T T plutysmlr D First arch second arch third arch lourth and sixth muscles muscles muscles i arch muscles A sketch of lateral view of the head and neck region of a fourweek embryo showing the branchial muscles The arrow shows the pathway taken by myoblasts from the occipital myotomes to form the tongue muscula ture B sketch of the head and neck of a 20week fetus dissected to show the muscles derived from the branchial arches Parts of the platysma39and sternocleiodomastoid muscles have been remeued to show the deeper muscles Note that myoblasts from the second branchial arch migrate from the neck region to the head and give rise to the mus cles of facial expression Thus these muscles are supplied by the facial nenre the newe ofltl1eseeend hranehjall relL Hll E Development of the Muscles of the Neck amp Trunk quot39Zquotquot i a muscle derived from a single myotorne A re TH I eeictemal oblique Pm 5 Development of a simple muscle from several myotornes 1 the segmented stage of differentiation gt in muscle after the fusion ol 5 muscle slips 1 during the 5th week of development the myotomes divide into prevertebral hypoaxial amp postvertebral epaxial portions P P l39lrseI primary ramus Outer intermediate and inner muscular 5 Iayersal t a muscle asfound A A g in wall 39 of thorax and abdomen 1aquotl1i39 quot 7 s ursi A lT39r39an5ver5e Setion l39IT LIgWquotI the tl1rer39erll region of a fiveweek ernbrwo The tlorsal portion of thee eddy wall museualature ejpirnere and the ue tiral pertrien h39ypom erel are vinneruated by a dorsal primary rarrrntus and a vyentrrel priimary Iramu5 re5pett39iue39Ify E Siirnailar settiene as in A at a 39letelr staged of Ideueioepaamentm The hypomeree has formed three separate l39lquotllJr i ElIE39 layers and El ventral longitudinal muscle HI2 posterior spina cord vertebrgi muscies i n573 h externa1 7 Ti ob1ique 1 M TVposterior primary ramus anterior primary ramus L tb 1 1 H 8 ever e ra mus es b kinternan f oblique rectus shampath IT f 5eM quot 39 T I I F V nF39 1umaawar gaarF f ifiictus abdominis Transverse sections of the abdominal region showing the formation of the muscles and the distri bution of the spinal nerves to them hinnuueuccnnnsheuanutunltmnnnleoy TIl39 I lUIIIIllI39Ah Ign H1 4 5 a prevertebral muscles 1 cause flexion of the spine vertebral column 2 innervated by the anterior primary ramus branch of the Spinal Nerves b postvertebral mscles 1 cause extension of the spine vertebral column 2 innervated by the posterior primary ramus branch of the Spinal Nerves 2 the myotomes fuse together to form large broad muscle sheets F Development of the Muscles of the Limbs tpusteriur vertebral muscles spinal enrtl L 7 rpnstarior primary ramus z 4 c7 ftprevertebral muscles it A anterior primary rarnus W anterior muscles of infrahyoid muscles glrdle Section through the lower cervical region showing the primorclia of the muscle groups in the neck and upper limb The muscles of the limb are derived from somatopleuric mesenchyme and the muscles of the girdle from the hyporneres and local mesenchyme Drawings illustrating positional changes of the developing limbs A during stage 19 about 48 days showing the limbs extending ventrally and the hand and foot plates facing each other B during stage 20 about5l days showing the arms bent at the elbows and the hands curved over the thorax C during stage 22 about 54 days showing the soles of the feet facing each other D about 56 days Note that the elbows now point caudally and the knees cranially H 4 VIII SKELETAL4MUSCULAR DISORDERS AND DISEASES quot A SKELETALMDSCULAR DISORDERS 1 Muscle Agenesis congenital failure of muscle development esp the Pectoralis major 2 Hernia a protrusion of the abdominal viscera through a weakened area of the abdominal musculature b examples 1 inguinal hernia 2 diaphragmatic hernia 3 umbilical hernia P c factors c 0 ES 1 congenital iJ py CHE T1Qlr n o wrRnPr6bomwAL P essuke 3 1 3 r is 2 2 lifting heavy weight 3 coughingdefecation 3 Use amp Disuse of Muscles la Use 9 protein synthesis muscular hypertrophy v Use protein synthesis muscular atrophy anquotl39 4pa b factors nutrition BQ SKELETALMUSCULAR PATHOLOGIES MYOPAIHIES 1 Myositis a inflamation caused by a microbial infection or physical trauma 1 quotlumbagoquot myositis in lumbar region 2 quotcharley horsequot myositis in thigh region b symptoms pain stiffness amp soreness c treatment p O PA 39pW 3 0X heat massage amp rest HI5 2 Muscle Spasms a involuntary contractions caused by physical trauma muscular ischemia or hyponatremia poor pasiure b 2 Types of Spasms 1 Cramps persistent sustained spasm A 2 Clonus intermittent quotjerkyquot quotticsquot spasm c Ex Low Back Pain caused by spasm of the Erector spinae muscles 3 Muscular Strainquotpulled musclequot over stretched or torn muscle fibers A Normal back viewed from be 4 Tetanus quotlockjawquot hind B Muscle spasm of the erector spinae state of muscular contraction 39m d caused by a toxin released by Clostridium tetani bacillus 5 Muscular Dystrophy a progressive degeneration muscle wasting of skeletal muscles and replacement by scar tissue fibrosis b Cause 6 Convulsions gross involuntary contractions as occurs during epileptic seizures 7 Fibromyalgia pain tenderness amp stiffness C Treating Muscle Injuries quotRICEquot Rest Ice Compression Elevation I GENERAL CHARACTERISTICS OF VISCERAL SMOOTH MUSCLE TISSUE A Location in the body usually located in the walls of internal organs inc1 alimentary canal blood vessels bronchioles urinary bladder uterus iris of the eye arector pili muscles in B Microscopic Appearance 1 there areEg striations apparent within the cells 2 the cells are electrically joined together by gap junctions intercalated discs C visceral muscle cells are innervated by autonomic motorneurons Ii II GENERAL CHARACTERISTICS OF CARDIAC HEART MUSCLE TISSUE A Microscopic Appearance 1 faint striations lniercolcted discs 1 2 the cells are electrically joined together by gap junctions intercaItEd discs 3 cardiac muscle cells are innervated by autonomic motorneurons HI Classes of levers Each is defined on the basis of the placement of the fulcrum F effort E and resistance R a Firstclass lever b Secondclass lever c Thirdclass lever H I8 MCSCLEGROUPS or THE BODY I MUSCLES OF THE FACE A General Characteristics 1 all are superficial cutaneous muscles 2 they 3 4 insert into the overlying skin they develop from the Branchial Arches they are all innervated by the FACIAL NERVE VII rhieculagl 7 I Levator labiie C snperioris Levator nnguli oris N Elllnteil Risorius Depressor anguli oris i u risori V A Depressor labii inferioris B Muscles 1 Frontalis Seer 0 ORIGIN frontal bone INSERTION skin of eyebrows ACTION raises eyebrows wrinkles forehead Orbicularis ocnli 539 Zyg39 omaticus ORIGIN bony orbit 916 5 c39KEO ORIGIN quotzygomatic bone INSERTION eyelids INSERTION skin at corners ACTION closes the eyelids f m th ACTION smiling 0rbiCu1aI Gris raises corners of ORIGIN maxilla and mandible m th INSERTION lips ACTION puckers the lips Buccinator quottrumpeterquot viz quotbuccalquot ORIGIN molar regions of the maxilla and mandible INSERTION cheek ACTION compresses the cheek as when blowing II rauamaTLu5 um suvsmonus uuscm LEVATOR IAIII SLPERIDHIS AIAEOUE NASI LEVATOI LABII SUPEIIORIS AND ZYGOMATICUS MINOI MUSCLES if iEPomI uso mssmn MUSCLE DEEIoImoN39I I IquotE JMA11ELI5 MUSCLE ETEDHATEQJS K Vmssmsa muagls LItImyn7 4aIuLuIDEi u w 2 TITEIAHGULAHIE MUSCLE IDEPRESSOR ANGULI ORI5 cJINuNus MUSCLE uewuoa mouu onus ougolmus man mrealonns MUSCLE CDEPIIESSOR uau INFEIIDRIS NCISIVUS LABII suremoms mo INCISIVUS usu INFERIORI5 MUSCLES ENTALIS MUSCLE IV MUSCLES OF THE TONGUE A General Characteristics 1 they develop from the Occipital Somites 2 they are all innervated by the Hypoglossal Nerve XI B Muscles 1 INTRINSIC MUSCLE a located entirely within the tongue b include longitudinal muscle fibers vertical muscle fibers transverse muscle fibers I4 Tongue 0 lening uassuzsl Ia I I I StY10id P706955 P F C e of temporal bone Mandibular 39 symphysis Geniohyoid V Hyoglossus AA Thyrohyoid 39 I 2 EX39I39 NSIC 11UscLEs a their Origin is outside the tongue Insert into tongue b examples 1 Genioglossus A Prom 2 Styloglossus a gfEKdh5 V MUSCLES OF THE PHARYNX THROAT A General Characteristics Cl they develop from the Branchial Arches 2 they are all innervated by the Glossopharyngeal Nerve IX B Muscles I 1 Thick Outer Layer of Constrictor Muscles 4 force food into the esophagus ex Constrictor pharyngisu C R2 ZJ 6 H 2 Thin Inner Layer of Longitudinal Muscles elevate the soft palate closingoff the nasopharynx fromthe oropharynx during deglutition VI mm surmnrom MUSCLES G A General Characteristics 1 ORIGIN mandible 2 INSERTION hyoid bone 3 ACTION elevates the hyoid bone and base of tongue during swallowing 4 they are all innervated by the Trigeminal Nerve V I5 tensor veli polofini levotor veli palofini shrlrsglnssu s constrictor Spfenrgephrgrngeu N Ph 39Yquot 9i5 p p j1 at N pb P nbuccinofor ape9 lbuccopharyngeus V I 0 p sffltitphnryngel W A sryloglossus l5fquoti 39 V mylophoryngeus a phoryngis r x superior p u glossophoryngeus pX rnoclius quot hyoglossus cut i r r 39i thrraphafrngeus pv MIw m carmuge constrictor 0 u V J iu phoryngis R iquotf quoti quot Ke 397 39 39riIcnihsfreideus criocophoryngeus v v a W J Buccinator and pharyngeal muscles jw quot V B Muscles 1 Mglohgoid VII MUSCLES OF THE VERTEBRAL COLUMN A General Characteristics 1 permit movement of the spine 2 stabilize fixate spine when moving limbs B PREVERTEBRAI QIYPOAXIAL MUSCLES 1 AQTIONS flexion of spine when muscles on both sides constract together I pulls spine to one side when the muscles on only one side contract 2 Examples a SteiT0c1eidomastoid 7Z We hm b External Oblique c Internal Oblique d Transversus abdominus e Rectus abdominus f Quadratus lumborum ghlligpsoas T EELTEJD 1 BICEPS 1EFramp H39lIquoti FIEE I EE3939ll9i I N Tammwnu iEr I 5asF 1w139sEE1r1sw SnnTnnIu SPEHMATIC cono Terusoa FASCIAEA LATAE 1quot FAE CM LATA tjfu39 AiPu z LuruwaLmaruI 3 FnJruFTaHm mnem or GREAT snmnsuous w s 39 5 5 PE 39quotG 0 Super cial muscles of from of neck and trunk 39 P H quot ATquotquot39e quotH 39 1 A A quot395 39 quotquot39 a a 39139 a A I lnuwnd p abwmnmal ioh que p nFEXTO Ll Pecuram The free lower border of the External Abdominal Oblique ro1ls up upon itself to form the inguinal391igament which extends from the STERNOCLEIDQ ASIOID in the cat this muscle appears as 2 muscles the sternomastoid amp the cleidomastoid ORIGIN INSERTION mastoid process of the Temporal Bone sternum amp clavicle ACTION whenthemusc1eon only 1 side contracts the neck bends laterally to that side when the muscles on both sides contract together the head is flexed downwards rquot mom son quot393 anterior superior iliac spine to the pubic symphysis INFERIOR EE1lgtquotPquot3933 39 quotquot 3quot 39 PlaIHlI39i39E39rf 39 IquotElI T5H 14L5 rmvfEI i aquot i lh I uhmnjEihEEp5 I 39 E gh il I 15v iV i gt quot quot39 EFr2I3939aJEiIImg 393 quot l l quotLiT39I55lMlJE Dons 7 H HAEEiLU39J39EJH FASCIA quot B POSTVERTEBRAL EPAXIAL MUSCLES EACKSDE OF THE SPME 1 ACTIONS extension of spine when muscles on both sides contract together pulls spine to one side when the muscles on only one side contract 2 Examples a SPLENIUS CAPITIS ORIGIN thoracic vertebrae INSERTION occipital bone ACTION extends the neck CANTAGONIST OF STERNO CLEIDOMASTOID b Eascgon SPINAE MUSCLES l Spinalis dorsi 2 Longissimns dorsi 3 Iliocostalis dorsi VIII MUSCLES OF THE SHOULDER A MUSCLES THAI MOVE THE SHOULDERS 1 INSERTION scapula ACROMION f U 39ltig39ia m A k EnnmLs 39 p smsnnon I Muscles raising and rotating scapula Semispinalis Copitis Longissimus Copi s c llio Costolls pY U xi E Longissimt Erector spinae and semispinalis capitis After Cun Iungham s Anatomy From Granfs Method of Anatomy 2 Examples 51 L This large muscle of the upper back consists of 3 portions the clavotrapezius spinotrapezius amp acromiotrapezius In the cat these 3 portions should be dissected apart in man they have essentially fused together ORIGIN occipital bone amp the spinous processes of the cervical amp thoracic vertebrae INSERTION clavicle amp the spine amp acromion processes of the scapula ACTION pulls the shoulders towards the midline can also elevate the shoulders as when one quotshrugsquot his shoulders tightness in the Trapezius is often perceived as a quotstiffquot neck b since this muscle is located below the Trapezius you should transect cut through the Trapezius on one side only ORIGIN spinous processes of the thoracic vertebrae INSERTION medial border of the scapula ACTION pulls the shoulders towards the midline SYNERGIST WITH TRAPEZIUS c SERRATUSTANTERIOR ventralis ORIGIN ribs INSERTION medial border of the scapula ACTION pulls the shoulder downwards toward the ribs can also aid in forced inhalation by pulling the rib cage upwards when the scapula is fixed in position MUSCLES THAT ABDUCT THE UPPER HRM 1 INSERTION humerus 2 Examples a DELTOID 6322 7 This muscle of the shoulder also consists of 3 portions the clavodeltoid acromiodeltoid amp spinodeltoid In the cat these 3 portions should be dissected apart in man they have essentially fused together ORIGIN clavicle amp the spine amp acromion processes of the scapula The 3 portions of the Deltoid essentially originate at the same points where the 3 portions of the Trapezius insert INSERTION deltoid tuberosity of the humerus ACTION abducts the arm b SU39PRASPINATJS 399 Irll ORIGIN supraspinous fossa of the scapula INSERTION greater tubercle of the humerus ACTION abducts the arm SYNERGIST WITH DELTOID IIO C MUSCLES THAT ADDUCT THE ARM 1 INSERTION humerus 2 Examples a PECTQRALIS MAJOR 86 ORIGIN clavicle amp sternum INSERTION humerus ACTION adducts the arm an ANTAGONIST OF THE DELTOID b LATTISSIMUS DOESI ORIGIN thoracolumbar fascia lumbar V9139i bT3953 INSERTION humerus ACTION adducts amp rotates the arm medially viz over hand breast stroke in swiming or paddling a canoe c mass HIQAJOR ORIGIN inferior angle of the scapula INSERTION humerus ACTION adducts amp rotates the armmedially SYNERGIST WITH THE mrrlssng 1301251 quot 39dis f Lomaneao or renters amcnn d INFRASPINATUS ORIGIN in raspinousifossa of the scapula INSERTION humerus ACTION rotTtes the arm Ska 3 3139 40F LATTISSIMUS DORSI e NB CAPULARIS ORIGIN scapula INSERTION lesser tubercle R 3 quot iiDquot EA39 of humerus Some muscles acting on shoulder joint posterior aspcct E E nmtm Um m FAt1n ACTION rotates the armmedially SYNERGIST WITH THE LAITISSIMUS DORSI amp TERES MAJOR ANTAGONIST OF INFRASPINAIUS quotRDTATOR CUEEquot the deep shoulder muscles incl Subscapularis Supraspinatus amp Infraepinatus amp Teres completely surround the shoulder glenohumeral joint providing strength amp stability IE39 tqnnALocu1rraurnomuEnAnc oomnmL nsu39v or occvntornomnus s139 nuocLmoouAsfoo EXTERNAL DBLIEKEILiEquot quot 39 IX MUSCLES THAT MOVE TIIE FOREARM A ANTERIOR FLEXOR MUSCLES 1 BICEPS BRACHII ORIGIN both heads originate on the quot scapula INSERIION radial tuberosity of the radius ACTIONS 1 flexes the forearm 2 supinates the hand V 5HornT HEAD or a i9 39 ancsps anncum 7 43 39 oH e HERE or FEquotlEEE5 EIF I AzHi I 39 q39 iIquotI39quot39Elquot3M HEAD OF 1 I 1 mwEu5 anncnus 2 BRAC1IIALIS ORIGIN distal end of the humerus INSERTION coronoid process of the ulna ACTION flexes the forearm SYNERGIST WITH THE BICEPS BRACHII1 I BI39IampdI2III On the cat the Brachialis begins at Flexors and extensors of forearm at elbow joint about the same point where the Biceps brachii ends II2 igagherlor caW3rTM939 3 BRACHIORADIALIS ORIGIN distal end of the humerus On the cat the Brachioradialis begins at about the same point where the Brachialis ends INSERIION styloid process of the radius at the far distal end ACTION flexes the forearm SYNERGIST ITH THE BICEPS BRACHII B POSTERIOR EXTENSOR MUSCLES 1 TRICEPS BRACHII ORIGIN there are 3 heads of origin long head scapula 391atera1 amp medial heads humerus You should identify all 3 heads on the cat long lateral amp medial heads INSERTION olecranon process of the ulna elbow ACTION extends the forearm AH G NI T OF THE BICEPS BRACHII 39IeaHTERIOE FLEXORS E dk hlki fOETEEIDE EXTENSORS X 5 Hquot quot5 RT Am I1 3 V II 1umnw mum V rquotiELl i39lquotEiuIuIo E I ie E lI i pecroruus ImI n Pz DELTIUIE PECTOHALIS MAJOR 1 E1rEHH cu5rAL HEAD mmmaimmauums V J SHORT HEAD OF mcEPs anAcnu A E LONG HEAD OF BICEPS ElHhE39HlI39 A Vums5mLIs DOES RES HMOquot f flsr seu1rnr5 ANTERIOR idquotFlrIt EFE anacnn s nsuoou or BICEPS l nlnah F HEDM1 EPICWDYLE F EXTENSOR cam IIADIAUS IDH LlE N BlE1PlTlsL APOHEUROSIS Vgig H 0X 8W emnson camp V T runmus aa vrs T A i quot55 ED39LlCTEiiH FEFLLIIEIE LHNGU539 quotquotFLEaH msnonuu surenncuus Ihouxar u QWIHWQ5 ADDUCTOR ponucnsq xai rlit TENDON OF FLEXOR nsxoa Pomcas Lrre us ousnonum supsnncmus rEr4an MUSC a H PATH Li39quot LE Fih1EER II4 X MUSCLES THAT MOVE THE BAND A EXTRINSIC MUSCLES OF THE HAND 1 ANTERIOR FLEXOE PRQEaIQB GEOUP a General Characteristics 1 ORIGIN medial epicondyle of the humerus 2 INSERIION metacarpal bones amp phalanges b Examples 1 ELEXQR CARPI RADIALIS f1exes amp abducts the hand 2 PALMARIS LONGUS flexes the hand 3 FLEXOR CARPI ULNARIS flexes amp adducts the hand PRDNATOR TERES pronates the hand quotENTEEDHIST QE THE BICEPS BRGHII FLEXOR RETINACULUM fibrous band on ant aspect of wrist 2 P0 TERIQR EXTENSOE UPINAIQR GROUP a General Characteristics 1 ORIGIN lateral epicondyle of the humerus 2 INSERTION metacarpal bones amp phalanges b Examples 1 EXTENSORpCgRPI RADIALIS extends amp abducts the hand 2 EXTENSOR DIGIIORUM extends the phalanges 3 EXIENSOR CARPI ULNARIS extends amp adducts the hand EXTENSOR RETINACULUM fibrous band on post aspect of wrist B INTRINSIC MUSCLES OF THE HAND permit precise movements of the fingers 1 PALMAR FLEXORS n a Thenar Group MW QWWJM v b Intermediate Group c Hypothenar Group 2 DORSAL EXTENSQRS a Thenar Group b Intermediate Group c Hypothenar Group I I5 XI MUSCLES OF THE PERINEUM A Levator Ani velvndiqolw pubic arches Origin Insertion coccyx bone Action supports the pelvic organs B Bulbocavernosus constricts vaginal opening contracts during orgasm incl spurts semen C Egternal Urethral Sphincter constricts urethral opening D External Anal Pehric 9 Ischialtuberosity i T b T diaphragm l Obturator it it 39 internus u Iliococcygeus A hr Pubococcygeus V I UrogenitaIi giaphragmj Hwernvucum a Ischiocavernosus K Super cial a transverse perineus a Levator ani iGlu1eus rnaximus quot i A Urogenital diaphragm eiep t aT1sverse 7 T T F mneus T Spiipacra r rIo 539J1quot 1f n E pubis Gliiteris XII MUSCLES OF THE HIP A ANTERIOR FLEXOR PREVERTEBRAL MUSCLES OF THE HIP 1 General Characteristics a ORIGIN ilium b INSERTION femur c ACTION flex the thigh 2 Examples a IQIOPSOAS Psoas major Iliacus ORIGIN lumbar verte brae amp anterior surface of the ilium lesser tro chanter of the femur INSERIION flexes amp ro tates the thigh laterally ACTION when the thigh is fixed in place the Iliopsoas causes flexion at the waist prevertebral muscle b IENSOR FASCIA LATA ORIGIN 1 A s39rgHrauucL EEn ma A5TEED V m 1quot Fl I Hvolo BONE HF mrsmon aELur uar 0 0 3 V G iu a a p quot39 g r P 39iI39EL39ff3Ilia Pscronmus p wuon 0 0 g 0 7 I 1 f quotI T HdE Fquot5 3 9 0k EFi EHI1 senmrrus FE R quot quot39 539 quot quotquot 39 r x J 2 he gggegs 1 E A H F j V L V 7 I P quot395 39 1i F r quot ih 0 I L quot sm1cHwI5 RECTUS H a39fH quot quota g quotquot39 Nquot3 quot quot F V HATnSEI39MU5 Dons IrF39 F EXTERNAL DELIUUEI fl quotquot39jcnesswr or mum slLL us 7hahs1hius I H quotquotL5 lEa i 7 E Fi TROCHANTER cSuper cial muscles of side of neck trunk and upper part of thigh iliac crests uia a broad sheet of fascia called the fascia lata quotbroad fasciaquot INSERTION lateral condyle of the tibia via a broad sheet of fascia called the iliotibial band ACTION abducfs the thigh B POSTERIOR EXTENSOR MUSCLES OF THE HIP 1 General Characteristics a ORIGIN b INSERTION c ACTION 2 Examples a GLUIEUS MAXIMUG ilium femur extend the thigh 1 this muscle forms much of the mass of the buttocks in man appears much smaller in the cat 2 ACTION extends amp rotates the thigh laterally viz rising from a chair walking FASCIA LATA ANTAGONIST OF THE TENSOR I139 3 the upper lateral quadrant of this muscle is a commonly used site for intra muscular QIM injections srres son INTRAMUSCULAR INJECTION 39 I About 2 cm 0 I below earnminn 3 process B Posterior View I A M I I y About 6 cm below iliac crest t 3quot rquot Greater I H trochanter l of femur ElUTEUE 39 MEDIUS Gliuteait blood r 0D 2 V 1 ii vessels 39 e pr quot quotquotquot 39 EsiratEj c 3 quot7 v newe Z I quot About 10 cm I 39 I f quotFe below greater trochanter Lateral View I Greater 39 trochanter I of femur U K Posterior View b GLUTEUS MEDIUS 319 of In n39yc39l1oy tn upper outer iuaalren XIII MUSCLES OF THE THIGH A ANTERIORJEXTENSOR GRQUP THE QUADRICEPS FIEMORIS 1 General Characteristics a ORIGIN femur there are 4 heads of origin b INSERIION tibial tuberosity via the patellar tendon c ACTION extends the lower leg d innervated by branches of the FEMDRAL NERVE Il8 2 3 SARIORIUS includes a RECTUS FEMORIS located on the midportion of the thigh b VASTUS LAIERALIS this muscle is a commonly used site for intra muscular IM injections movsons ANTERIOFI 0 uuon c VASTUS MEDIALIS d VASTUS INTERMEDIUS this muscle is located just below the Rectus femoris but is often difficult to separate from the other 3 parts of the Quadriceps i yrssrus LusLus L o iquot r Tu rs a the Sartorius is a straplike mus cle that extends diagonally across the anterior aspect of the thigh it is the longest muscle in the body although it is not very strong b ORIGIN INSERTION d this muscle pulls the entire thigh up towards the hip thus it flexes the thigh like the anterior muscles of the thigh viz the Iliopsoas amp Tensor Fascia Lata anterior iliac spine c tibia Super cial muscles of anterior aspect of right thigh B MIEQIAL Am3UcIoR GROUP or 0 THIGH 1 General Characteristics a ORIGIN pubic symphysis b INSERIION linea aspera of the femur c ACTION adducts amp flexes the thigh viz quotdiggingquot your thighs into the sides of a horse while horse back riding includes arGRACIl this appears as a very broad muscle in the cat that almost quotcrossesquot with the Sartorius muscle IH b ADDUCTOR MAGNUS Femoris this muscle is located just deep to below the Gracilis c ADDUCTOR LONGUS this muscle is located just superior to the Adductor Magnus l E EI EEE 1 quot this muscle is located just superior to the Adductor Longus fWHHE3Ho fu5x0Rsy CROSSSECTION THROUGH THE RIGHT EEIGH as viewed from belowthe distal end C PQSTERIOR FLEXOR HAMSIRINGquot GROUP 9F THE THIGH 1 General Characteristics a ORIGIN ischial tuberosities b INSERTION proximal end of the Eihia c ACTION flexes the leg TAenh1sr BF THE QUADRIEEPB EEMORIS also extends the thigh d each of the 3 muscles in this group is innervated by branches of the SCIATIC NERVE I20 2 includes a BICEPS FEMQRLS this muscle is broader in the cat than it is in man b sEMITEgDINosUs c SEMIMEMRANOSUS quotpulled hamstrings muscle strain 39 XIV MUSCLES THAT MOVE THE FOOT ttersquot 39 s 3 A fc A EXTRINSIC MUSCLES or THE i gt FOOT 1 ANTERIOR CRURAL GROUP a General Character istics 1 ORIGIN tibia 2 INSERTION metatarsal bones amp phalanges Dorsi exion flexion llntar Hexion Human leg and thigh musculature The EJ080550 massive quadriceps muscles on the front of the thigh and hamstring muscles on the hack of the thigh extend and ex 39NVER5 oN the lower leg in man s unusual striding gait 3 ACTION inverts the foot dorsiflexes the foot and extends the toes vizz prevents stubbing of the toesas the foot swings forward in walking b includes g l TIBIALIS ANTERIOR this muscle is located just lateral to the anterior crest a sharp ridge on the front side of the tibia quotshinsplintsquot tendinitis of Tibialis anterior 2 EXTENSOR DIGITQRUM LONGUS located on the lateral aspect of the leg 3 Extensor Hallucis Longus I2 2UPERFICIALkPOSTERIOR CRURAL GROUP quotCALF MUSGLESZLE a General Characteristics 1 ORIGIN tibia 2 INSERTION calcaneous bone via the Achilles tendon 3 ACTION plantarflexes the foot ANTAGONISTS OF THE TIBIALIS ANTERIOR 4 each of the muscles in this group is innervated by branches of the TIBIAL NERVE b includes 1 GASTROCNEMIUS this muscle possesses 2 large heads situated lateral to the midline of the calf 2 SOLEUS 3 DEEPOSTERIOR CRQRAL GROUP a General Characteristics 1 ORIGIN tibia 2 INSERTION metatarsal bones amp phalanges 3 ACTION plantarflexes the foot amp flexes the toes b includes 1 ELEXOR DIGITORUM LONGUS a deep muscle located on the posteromedial aspect of the leg 2 Flexor Hallucis Longus I saAl Y b I A tibia 4 LATERAL QRURAL PERCNEAL GROUP a General Characteristics 1 ORIGIN fibula 2 INSERTION metatarsal bones via a long ten don running on the underside of the foot 3 ACTION everts the foot plantarflexes the foot ANTACONIST OF THETIBIALIS ANTe ERIOR 4 innervated by branches of the PERONEAL NERVE tendon of pgr msui N iu l7 b PERONEUS LONGUS F1BULARs Lateral muscles of the right leg I22 B INTRINSIC MUSCLES OF THE FOOT permit more precise movements of the toes 1 PLANIAR FLEXORS 15 Flexor digitorum brevis 2 DORSAI EXTEHSORS ACHILLES TENDONV ex Extensor digitorum brevis GLUTEUS MAXIMUS I E1 necrus it t39o 7 sFFEM0FllS ADDUCTOR MAGNUS 0l i SEMITENDINOSUS A it I r iffrjgf I 0 hquot39V I quot3 I ll V l I 1 VASTUS LATERALIS I8IcPS FEMORIS m 7 gt GAS139 cmEMuu5 i 39 quot 539 TIBIALIS ANTERIOR F Hnw hL1 sousus A ANATOMY OF THE HUMAN LEG is shown in rear and side view The two main If mus cles are the soleus and the gastrocnemius In the normal standing position the sound emitted by the soleus is nearly 10 times as intense as the sound emitted by the gastrocnemins The soleus is the muscle responsible for maintaining the angle between the leg and the foot It consists mainly of what are called slowtwitch bers which can contract many times without fatigue TQ3 3 IIGESTIVE39 d parotid s livarf lan or39aI39cAavity y phawm H a tongde T subinaxillary and suhmandibular salivary gtands es phagusF 1 x x I A quot 39 quot ll laI 3953939 E Y E dia hta m C to J gallmadder 39 S gamyms age T V 1 l l 2 pa 8 raIB575IETIlllIg polon F p V sIanbIocpum 6 rectum appendix The Digestive System The Digestive System I Introduction A Organs of the Digestive System 1 Alimentary Canal J1 The Digestive System 2 Accessory Exocrine Glands a secrete enzymes and other substances into the alimentary canal b including B Definitions ingestLon gt FOOD dquot9estquot quot r FOOD RESIDUESegestion it HVTTE 1 39 t w pm inges 1011 a sarp 2 digestion 3 absorption 4 egestion defecation C Overall Emhryological Development of the Digestive System 1 during the 4th Week the mouth and anus develop forming a continuous tube the alimentary canal 2 during the 5th Week a the yolk sac constricts off from the midgut b endodermal buds begin to develop from the alimentary canal and project intothe surrounding mesoderm at certain locations I2 mam J39Fa ilE z Sggiitmi S c thmug the cgphai iicr and sf 1 uewweek Embrjm approximately E mmJ siimiJ39ing Eii npgenimzgs Hf the p5iarjH39ngeat paihes u ung the lateral wall of H12 phuryngei gun mken Einei repmsexntsi uppmximzcie isiite uf attachment of the amp wcupharjngm 39 mvemEiriine B 0 ph 1rwigEuE amiiaa and ci s in a fiveweek embryo gt breaking i V through il l1lquot g3il39lII39I39iV l397lIi x zdigesIiw tube Schematic drawing to show origin of gill slits 3393 Thrid dua ri u1umT 39 gt I quot IEn Ia hE luucl 7 v N M Esophagus V Li ver V Notochord region or 7 quot future spinai column ElamE gt H future mnm1nj pharyngoiyrnpanic tube and tympanic cavity pouch I forumen tonsillar fossu upu ung 1rI1 39iA EmTu nh quotII puurm39fIw39asi i dlqnds uviirnl fnn l1ia I E 1 body pouc1lV lhymu pouch Ill Schematic s 1in n of a 20week fetal head shgwingi mg adult durivativves of the pharyn geal pouches dEEE39EiI1l at this thyrui gland The Digestive System II Regions of the Alimentary Canal P A Divisions Mouth 1 Pharynx Esophagus Stomach Small Intestine Large Intestine Colon Anus B MOUTH i1Vi lti urn a 5m M 2 n3 39 g arch B H P orUg39 1 f UC2E E pulatine arch quot buccinator Anterior View of the mouth cavity 1 Oral Cavity a Lips 1 superior labial frenulum quotbridlequot 2 inferior labial frenulum b Cheeks Buccinator Muscles c Gingivae gums consists of the oral mucosa nonkeratinizing epidermis and underlying dermis 3395 The Digestive System 1 TEETH 1 Parts of the Tooth Molar Tooth Gross Anat 39 omy39 Each tooth consists of three regions Occlusal mrtmv crown which projects above the gum root which is embedded in the alveolar process of jawbone and neck which is constricted area between crown and root Crown has several surfaces surface that contacts op posing teeth is known as occlusal surface surface that faces lips or cheek is known as labial or buccal surface and surface that touches a neighboring tooth is known as contact surface quot 3s Jttllilil Site of A odontoblasts i 39 s IIF lTI l39l Ii l mnmhmn E i iiivnvulalt Lpu eslmrm39lt i u 2 l A r VI VF V I Ill 3 ll I P 4 Longitudinal section of human canine both 5 a Crown E i anatomical crown the superior portion of the tooth that is covered by enamel that portion of the anatomical crown visible above the gingiva ii clinical crown CYG The Digestive System iii occlusal surface of the crown the portion of the crown that contacts opposing teeth iv cusps the elevations present on the occlusal surface of the crown b Root the inferior portion of the tooth that is embedded in the alveolar process of the maxilla or mandible which is covered by periosteum called the periodontal Co 39 Aveaar In 139 C Neck MP 03 5 g w n the constricted region between the crown and the root of the tooth 2 Classification of Teeth M2 p Permanent teeth of upper dental arch as seen from below and from the right side 1M medial incisor IL lateral incisor P1 first premolar P2 second premolar M1 first molar M2 second molar M3 third molar wisdom tooth a Incisors i chiselshaped teeth used for biting ii crown is chiselshaped iii there is 1 root b Canines cuspids i pointed teeth used for tearing ii crown has 1 cusp iii there is 1 root cl Premolars bicuspids i broad teeth used for grinding ii crown has 2 cusps iii there is l or 2 roots d Molars multicuspids i broad teeth used for grinding and crushing ii crown has 35 cusps iii there is 2 or 3 roots 3 The Digestive System s v incisors E ni i premolars incisive foreman v polotine 3 process of maxilla P a greater pulatinequot foramen in A 9 0pS horizontal port of quot 15 polotine bone Permanent teeth A Superior dental arch B Inferior dental arch 3 Deciduous Milk Teeth a begin to erupt about 6 months after birth b dental formula 2 1 0 2 x 20 teeth I 0 P M nstetnnnua lval39Ea39tv l Ill1lE539 quot M quotJ mxi I I f 391 gt 39I K oeonuous etmm mctsoll 0 v 72 t V 4 p o E f 11 IST PREIIOLAH maEquotquotquot E 39 gr H muuuenr urEuLiHIienIt 39 hf V Irnuauenr GAIIIIIE it it 39 39 IlIlEiIFr39I L 394ltftiIiE lwquot 39 K we FIJEHQIJH vennaueur ts noun vT qR R Eiill1 Lateral view of the facial skeleton to show the arrangement of the teeth in a child aged 6 years The bone on the lateral aspect of the alveolar portion of the mandible and maxilla has been removed to show the position of the permanent teeth 4 Permanent Teeth a begin to erupt about 6 years of age b dental formula I C 2 1 2 3 x 32 teeth I8 the last set of permanent molars are called quotwisdom teethquot The Digestive System 5 Histology of the Tooth aEnamel i covers the surface of the crown ii hardest substance in the body composed of calcium phosphate Ca3P042 b Dentin i composed of calcium phosphate and calcium carbonate salts much like bone ii produced by cells called odontoblasts c Cementum i covers the surface of the root ii much like bone in consistency d Pulp Cavity i consists of highly vascularized loose Connective Tissue containing many sensory nerve fibers ii the teeth are innervated by maxillary and mandibular branches of the Trigeminal Nerve Cranial Nerve V iii the distal portion of the pulp cavity is called the iIn39l1tliIf midi i d e l f IiFl39 ilil Sarnlluner pngllnn rquot F v l 5 0 il5E N L i Trim E e Nerves of the Upper and Lower Teeth NOTE the upper teeth are innervated by the maxillary nerve 7 through the anterior middle and posterior superior alveolar nrnm iraennunuema nerves The anterior superior alveolar nerve branches from the infraorbital nerve while the middle and posterior come off directly from the maxillary The lower teeth are innervated by the inferior alveolar branch of the mandibular nerve after it enters the mandibular foramen I The Digestive System I393939 6 Tooth Embryology enamel cuticle Tg g EnamE1 rootv heat uquot39quotquot39J quotrquot g39 39if e mentgblast fg V 7 Diseases of the Teeth a dental caries b gingivitis c oyorrhea PER0DONTH 3 bone cut away dquotimpacted wisdom toothquoti It is be ieved that we have four taste sensations sweet sour39saIty and bitter and that these are located on the tongue as shown e Tongue 1 functions a mastioation b deglutition c speaking d taste buds chemoreceptors T 59quot 3no b ter P R0b0NTAL bsaAse quot Gt393tvIIs P CALCULUS EHGsl39HquotA1 CREST nscsnsn CA AIaHHumu1aiv mFuLm11nH AUEEIHGWAL cucuws VF nE5anP11mI or none 1055 or EPITIIELIAL ATIACHMENT spam ngcmmnou or PERIDENTAI MEMBRANE DEFquot I39H OF POCKET F v 31 WiFquot pi Us Pi quotIs py I e 2 3 li gt 1 FUFAPF FD FQJIQWC I JD IMPACTION g A 1 p p L j F PERIDENTAL MEMBRANE 39g WIDENED AT H rarsw or LATERAL 1mEss quotD 39 FACET5 OF V 1 AHELAEIJGH 39 Ha EFFECT OF MISSING TEEITH EFFECTS OF OCCLUSAI TRAUMA ADVANCED PERIODONTITIS MIGRAHON OF TEETH GINGIVAL COLOR CHANGES AND HYPERPLASIA CALCULUS HIGH FRENUM ATTACHMENT The Digestive System 2 tongue muscles mmwsuc see l4 EXTRNSQ gee IS 3 lingual frenulum 4 the root of the tongue is attached to the epiglottis p pharyngapala ne arch w root of tongue g P i siii Os 1339 39 a nguaansngj I I if 3939 394 2 quot V foraman caculn sulcus terminalis quot 7 139 V quot j quot p i glossonalatine arch 39 p lvallate papillae e a fungifarm papillae lifarln papillae L The dorsutn of the tongu and related structures 5 lingual tonsil JI2 The Digestive System f Salivary Glands fl Buccinator muscle N quotTongue injl i f 551WEu7quot V e gliandsi s right side of Sublingual f has been ducts 139 Em 3939393939Ed gand T Masseter G G A Submandibuar muscle duct Mandible Submandibular Sgbliiguail Wwm Hyoid bone E 39E E 1 Parotid Salivary Glands located just in front and below antero inferior the ears MUMPS 2 Submandibular Salivary Glands located within the lower jaw mandible the duct opens just beside the lingual frenulum 3 Sublingual Salivary Gland 4 quotall about salivaquot 2 sthmus og Fggggs C PHARYNX 1 The Digestive System roof of oral cavity 1 permits breathing amp chewing at the same time g Palate 2 anterior hard palate 3 posterior soft palate a palatine rugae Gransverse P93 lfB p H b uvula aa n39ne uvua the opening between the oral cavity and the oropharynx throat Nasopharynx a lined by a ciliated mucous membrane b choanae c Eustachian canals quotauditory tubesquot SE51 E 5 pharyngeal tonsil See K3 Oropharynx a lined by a nonkeratinizing stratified squamous epithelium b isthmus of Fauces the oropharynx extends from the palate down to the hyoid bone palatine tonsils The Digestive System 2 gt Ifyhh amp uIquot arci palate r A wrwx A H WEaLmRh 3 Laryngopharynx a391ined by a nonkeratinizing stratified squamous epithelium b laryngeal aperture CH5 goNm1 coaoNAL seamen use or SKULL quot393quotF 39T39L E 5 gtv HiR ifHGEM 39TQ39H IL ronus TUBARIUS eJIHG as p m AEUSTACHIAN TUBE l lquot PHAJIYNGEAJ RECESS FIU39IB GLAND LEVATOI CUSHION NASAI j 39 PHARYNX I L T L 1HGLD EHbIBiE j I 0k T ab 39 H Pl T5uanuHn1wLuvGm39m PALATlllE TONSII ORAIlt Taoor or mucus PHARYNX T FJJLJLTEIPPQAMFNEEAL row momma ca cmsso av enema coauu o HYOID some MI HtE nA39Iv5E Eff 3 JPEIlJL fE E HORN or nmom cunuxoe T A1WEPlELDT39EiE FOLD T Euuiwonm wanna gt T PIRIFORM aecess jtcmmmimg TUBEIICLE l row over summon LARYNGEAL NERVE 3939quotLEE V p Go 0 A quotINTERARYTENOIDINCISUIIE rnommauce oven cmcom CARTILAGE MHWIGEAL V rHAmrNx I1 rrm1Prwt39rH1 I E5 PHAEUS W The Digestive System c the laryngopharynx extends from the hyoid bone down to the level of the esophagus The wal1owing Deg1utition Ref1exL 1 the tongue pushes the bolus of food to the back of the mouth 2 the nasopharynx becomes blocked by the uvula dC H39 50F139 1 H375 1 amphe suprahyoid muscles pull the larynx up toward the epiglottisD C3 H N EPIGLOTWS b nti clown 23 pvrewmji Fram ve rin3 quot v LARW3L 4 the pharyngeal constrictor muscles push the bolus of food down the esophagus C ESOPHAGUS 1 a 10inch long muscular tube that extends from the larynge pharynx C6 down to the stomach T l0 2 the bolus of food moves down the esophagus byaperistaltic wave of contraction and by gravity p a 39 1 u v P0 Y of 0 along aft 1 p of 3 3 quot g int etemaeh i hugu r mru ln relaxed muscles constricted bolus muIsles mncnricmrgl A bolus J I The Digestive System 3 Histological appearance of the Alimentary Canal a the MUCOSA l epithelial lining 2 lamina propria 3 muscularis mucosa b the SUBMUCOSA c the MUSCULARIS d the SEROSA D THE STOMACH l the stomach is a J shaped muscular organ located in the Left Upper Quadrant of the abdominal cavity mwWwhu L A Q ragga V A 2 T T r L x 3 1 T w E u 1 K L n Q m rd mu 1 J haw E 4 T w u u up 2 2 gt 1 H A L Hp H Y 1 1 1 Z 1 U P N 2 0 11 L 1 w Q7 u 2 2 L L n m Mu3cLE 39 tmcuLAH MUSGLE quot 7SUEMUD 3 I1 aLaTw A LA F9331 LEN39EfTU NAL MU3CLE wuus LYMPH NODULES M M7USEuLA1 IS LUCU7SAE gt 1 numum mag BF uvelt NN quotquot39Equot m E39 517quotquot 393quot 39 quotquot 39 quotquot I pON FLEEE an we 0 Z T 39g 39anurrj3939 39ampmlw39j I H 3quotv39 quot 39quot quotI r 39 The Digestive System 2 Gross Anatomy of the Stomach ESDPHAGEHL EIATUS through Diaphragm lesser curvature quot greater A curvature 51 gasi39ro esophagea1 quotcardiacquot sphincter valve b fundus of stomach c body of stomach d pylorus of stomach e pyloric sphincter va1ve f greater curvature 39quot g lesser curvature Functions of the GRm EBm mM 1 cushions underlying viscera 2 protects underlying viscera from the spread of infection 3 stores fat S A sigmoid Eenielff J2 The Digestive System h SELL rugae prominent folds of the mucosal lining 3 the stomach functions to churn mix and hold the partially digested food called CHME a Gastric Glands located in the lamina propria of the Mucosa secrete gastric juice 1 HCl Eparueia c25 2 pepsinogen pril IP3JD0 e a pepsinogen Hcl apepsin inactive active pepsin b protein peptide chains b substances normally absorbed across the stomach c the contents of the stomach are normally emptied within 14 hours I 4 Disorders associated with the Stomach a Gastric Irritation b Esophagitis quotheartburnquot gastric reflux c Gastric Ulcer yf sre uri mo Etovmach coentenE J55 nphagus it i in d Gastritis e Flatulence W fa ii The Digestive System f Cancer of the Stomach g Pyloric Stenosis CDMSTp TioN O7 gm iairiiis Q 3 ymo births h Vomiting 5 Embryologic Development of the Stomach and associated structures dorsal rnesentery pverritomea cqw r V sieinitrai mesentverr rg V stomach region hepa c i diverticuium e ventrals i mesentery i e a F regut maociL 3 hepatic iordsV gall bladder foregut 39 midgu dorsal pancreas stomach E fl Il39i39rI 39 lime on stomach cystic duct T i sgzpaiii biauzlderv I I gt P A E 3 39 N orsal Pancreas it o d rmh i we r39i39l39razi n miwt H ii duodenal loop V i 9 pancreas i 11 g A ventroi common bile s vuct E P dmttm E guct pancreas 39 39 quot Drawings illustrating progressive stages in the development of the duodenum liver pancreas and extrahepatic biliary apparatus A 4 weeks 8 and C 5 weeks 0 8 weeks J23 39wmmm duct Allantois A The Digestive System 39 Esarnfhaaeus i quot Diaphragm is N 3 quot V V vsaphtaguts E p p P Greater curvature 39 39 of stomach V 5 Etascantling colon 4 it iasaendlng es astrium tmmn fused with EllSPtIl viral Dorsal mesoduodenum v Ereater curvature dei uinaeillaali loops ll5aendi39ngV P dorsal 39 mesentery with 5 quot 3 Iiiver spleen ventral rnesenlaryr stomach dorsal mesentery P T a right gym kidney 7 VITIIELEEHEquot aorta 0 phric i 39 kidney l t level of r 0 r spleen dorsal rnesentery vppgastrosplenic 39 eeliac ligament I a cry Itenorenal ligament liiform ligament h p p 0Y area of Fusion venalirail and dorsal pancreas umbilical vein Falciiarm liigarnenti ventral mesentery gastrohepatic ligament PS A drawing of the left side of the stomach and associated structures at that the pancreas spleen and celiac artery are between the layers of the dorsal erg B transverse section through the liver stomach and spleen at the level shown in A to show their relationship to the dorsal and ventral mesenteries C transverse section through a fetus showing fusion of the dorsal J with the peritoneum of the posterior abdominal wall The Digestive System Parietal V peritoneum x Body wall Anterior Visceral peritoneum Muscre Posterior The Digestive System E THE SMALL INTESTINE l the small intestine is about a 20foot long muscular tube extending from the pyloric sphincter to the ileo cecal isphincter at lgtl6esTnoN 6 vuodenum Root of mesentery Ascending colon Cecum Appendix 2 the small intestine is divided into 3 sections apduodenum b jejunum c ileum 3 the Mucosal Lining of the Small Intestine 1 micron 39 pp p J39393a quotNquot is m Fr 3 H F 4 If I H Barrier my s J lumen goblet cell cell border g pJ mI irmljlr 39ne columnar i tell 39 HuiIlau l 7 mllachondrla basement El39iEl pll5 quotIlI mernbrone ret39i Igulum lamina proprio Electron micrograph of the surface epithelium of the small intestine A Iejunum about 1250 X J 2 B Duodenum about 7500 The Digestive System a the lining of thesmall intestine is folded into C artgt1B fingerlike extensions called villi the simple columnar epithelial cells possess a 39Tmud1 borderquot called microvilli 4 Enzymatic Digestion of Chyme a occurs primarily in the duodenum Neck of gallbladder A 0 g ir ifgnr una1err I IEpu r i39af s E b E Win an Vhep1i7 7 9 Corpus body of F 0 i N gaubmdaerr LI lCrnmgrjb39i39le duel it W s I sccessary duct 1 Fmnrzreas Fundus 13939 1 P 0 39 gallbladder 1 0 Minor quot 3939 39 E V Superior mesenferic F 39 artery and vein b bile 1 contains mucin bilirubin cholesterol lecithin a phospholipid fatty acids and bile salts steroids 2 bile acts like a detergent to emulsify dissolve fats in water 332 The Digestive System 3 bile is produced by the Liver cells and stored within the Gallbladder X common hepatic LIVER duvet common bile HEPFI l39D P cystic pT duct pub EPHIHETEE GALLBLADDERX 5r e F 013011 c pancreatic juice 1 contains digestive enzymes plus NaHC03 pH85 to neutralize acid chyme ancreatic amylase a STARC1I P MALTOSE u I I trypsin b PROTEIE 3 PEPTIDE CHAINS c NEUTRAL PM5 Pancreatic lipase 1 FATTY ACIDS incl triglycerides GLYCEROL a pancreatic d NUCLEIC ACID nucleases NUCLEOTIDES ii 2 n I hi 5 2 pancreatic juice 15 produced by the Exocrine Pancreas IEPFFl390 P NOReA11C PANCREAS Pang iitlc SPHINQTER OF QDDI ipuodenugl d intestinal juice 1 intestinal juice is secreted by Intestinal Glands located in the lamina propria of the Mucosa 2 intestinal juice contains digestive enzymes a MALTOSE maltase gt GLUCOSE GLUCOSE sucrase b SUCROSE GLUCOSE FRUCTOSE c LACTOSE lactase A GLUCOSE GALACTOSE CT28 The Digestive System a d PEPTIDE CHAINS Peptidases 2AMINO ACIDS el HUELEOTIDE5 n 91e tidaseE PURINE amp PYRIMIDINE BASES PENTOSE PHOSPHATES 5 Absorption of Nutrients a occurs primarily in the jejunum amp ileum b sugars amp amino acids are activ transported across the mucosal lining ig Ih rmwll PRQFRIH 1 Hiiiil V T l pg urterioIe of 5 fr villus quot 1 esnsalvmgv 522111 iiii iiiiiF1lti1iliii A we l I 0 w v39t I 7 pJp p ppltlil 1A39w vein A t I P r urterf Schematic section of mucosa and submucosa of the small intestine to show the blood and lymph circulation in the villi The villus to the left shows only the blood vessels the villus in the center shows only the lymph vessel the one on the right has both which is the normal condition for all villi c nutrients are conveyed to the Liver H Osoluble nutrients hegat gigortal 3LIVER 2 wool capillaries J392 39 stnrsrAaY or PROTEIN crmnorrvnrurre AND FAT nrossnon u Digestion of Protein T p Mouth 39 protein L no acttion Stomach acidic PH proteoses and peptones Sinall Intestine tnrpsinPancreas bask PH small polypep des I peptidasesPancreas and intestinal glands amino acids Digestion of Carbohydrate Mouth r dietary starch and disaccharides salivaSalivary glands P s o amylase stomach bM slight action acidic pH 1 Small Intestine H q amyas Pammas basic pH 1 maltose sucrose lactose 4maltase 4 sucrase Intestinal glands lactase glucose fructose galactose Digestion of For T l Mouth dietary fat no action Stomach W acidic pH Small Intestine L bile salts Liver and gallbladder basic pH grnulsi ed fat 1 lipasePancreas fatty acids glycerol 3 glycuides The Digestive System STOMACH i 0 I pulagra E ikey mule n1damri ing ingested snfhslancas a 39I1sr they laws the sham mzh and intss insn and hoists Ehaw remh libs reaiti of the hHindi Many drugs taken to nanuha diS39E EE are rdestrnyeti by ems liver ihecanss their re hemica1 atriatzture is tsimfilar m B of 2I1E39EI I H 39 ums11rrrinng quottaxi E E 51Hi 39EEE s The liner alsn emnivsrts nu I1ienta absnrlasd from the rdigas vs usgit into forms that are easier for the rest of the EquotimEl tn EalertE and mij1iet 2 lipidsoluble nutrients 1actea Sgt general circulation lgmpba e ygs239 S LIVER 6 Disorders associated with the Small Intestine a Duodenal Ulcer b Enteritis Jquot5l The Digestive System F THE LARGE INTESTINE COLON l the large intestine is a 4foot long tube extending from the ileo cecal sphincter to the anus m m Right V C T hepatic t 3quot 0 exura DEHCTEBS 0tT Mesocolon ASCBIquotdiI391g Transverse GOIOH colon w p c p K Left 39 1Pi P iW spienic quot flexure K Vh valve i V Descending colon A iv Cuiedyes of mesentery C Taeniae coii 2 subdivisions of the large intestineltEkKSrt a Cecum b Ascending Colon c Transverse Colon d Descending Colon e Sigmoid Colon f Rectum g Anus the large intestine exhibits sacculations called haustra functions of the Large Intestine a water storage J32 The Digestive System b bacterial digestion of remaining chyme to food residues 5 the APPENDIX a the appendix is a 3inch long quottonsil of the abdomenquot tueniu coli n n r at meserltery b Disorders associated with the Appendix 6 the ANAL CANAL a the anal canal is the terminal 12inch long portion of the alimentary canal b defecation l ingoluntary internal anal sphincter 2 yoluntary external anal sphincter The Digestive System Supmirr 2 Win Inferior Vesical Vein Levator Ani Muscle Internal Rectal c hisorders assdciated with the Anal Canal hemorrhoids pi1es A F 8B hem arr mg s VG Y S The Digestive System 7 Disorders associated with the Large Intestine Colon a Diarrhea Irritable Bowel Syndrome b Constipation J PampR513L 1C comac37o 8gt w c Ulcerative Colitis d Diverticulosisj D1ert1cu11tis 4138 33936 formation of pouchlike weak spots in the intestinal wall e Cancer of the Colon co1csrec1a1 cancer 1 2nd most common cause of cancer death in the US 2 surgical removal of the colon and the formation of an artifioiag anus through the abdominal wall CDLDEsfE39DiMY39 58 39315 III ACCESSORY ORGANS OF THE ALIMENTARY CANAL A THE LIVER 1 the liver is the largest organ in the body about 3 pounds in weight and located in the Right Upper Quadrant of the abdominal cavity 2 the liver consists of major lobes separated by the Falciform Ligament See J3391 a large Right Lobe I71 Inferior Quadrate Lobe 2 PORTA HEPATIS See ZY4390 a hepatic artery O1e1sATEb BLOOD Tb LWER 39 39 TH N UDQIENTS hePta5 eV332L a AT ngt me c common hepatic bile duct BHE CGNBUCKB TD bUob NUM UN bERSb or LweR 3 Superior Caudate Lobe b smaller Left Lobe The Digestive System Xray photograph of a raounal colon in an adult evacuation of the enema Courtesy of F J Hodges and person Lott colon filled with a bariurrj enejma Right after J N Glorreaql Transverse colon J5l5EE 39lIiIl1g colon i o De5cendlmgoo Io n T r Sigrnoid colon V l acurn GOLOSTOMY A diuartlculum ls 39 FTl ljE39l3939H by the Fecal matter accomulates harnla tlo o he iinst i run I1Izooa withm the dwertnculum through the eweokonlad rrlusoular yaralI usuallhr at site 39Efa39i1E39rilE l paarmtratiom1 on lrlla m39nE EAn39lrEll39il borda ro1ltl e oollolnr lvertlcula are r39rrosl common fn the slgmmd rol39Ion they ujlmlnlsh in lfluml laer and mtze as the calm Hillquot preaches the cecum Dllren39roula re rar ly found m lhe rec lumen 361 I F r The Digestivesystem Coronary ligament of ll 1 Diaphragm H I V 1 Right triangular quot 393939F 39 ligament Jrquot 1 Left triangular ligament Irlf Diaphragmatic E surface 39 Ii ii 39h FaiF39 m Round ligament ligarnenut 9 Iv I quotquotquotE quots39 quotquotquot T Inferior margin Flight lobe Gall bladder 39 Anterior Surface of the Liver with Diaphragmatic Attachment NOTEf 1 the falciform ligament derived from the ventral mesogast um separates the large right from the tisrnaller left lobe of the liver It contains the brous cord called the round ligament of the liver which is the resultant structure from the obliteration of the umbilical vein 2 the fundus of the gall bladder extending below the sharply angled hepatic interior margin H Ifosterior Visceral Surface of Liver and the Gall Bladder NOTE 1 the impressions made by the esophagus and stomach on the left lobe of the liver and the right kidney right suprarenal gland duodenum and transverse colon on the right lobe 2 the sulcus formed by the inferior vena cava which subdivides the caudate lobe from the right lobe The gall bladder along with the portal vein hepatic artery and common bile duct bound the quadrate lobe 3 the continuity of the round ligament umbilical vein with the ligamentum venosum ductus venosus 07 Appendix brosa hepatls 39 Ligament Bare area of liver Diaphragmatic surface M of vena cava p g s 08 Coronary ligament of liver 39 ant and post folds Esophageal impression Suprarenal P Impression Gastric Impression 39 I v I 39I ll I 3 l 39 Hana E i lmpraanion i l IE39ILrnilenali ffquot Impression J 39 39 p 9 pD Colic 2 impression 1 39quotquot F 6 n 9 39 F gt 9 The Digestive System 3 FUNCTIONS OF THE LIVER a Carbohydrate Metabolism I M 9l C03eneSiS lg llCltgt Je39rltPa n 9395 0 1quot quot0 33 5 b Lipid Metabolism 1 synthesis of phospholipids 2 synthesis of cholesterol from saturated fatty acids c Protein Metabolism 1 synthesis of plasma proteins 2 urea formation 0A protein amino acids quot urea d Storage of Vitamins amp Minerals e Break down of old erythrocytes by macrophages globin 9 amino acids hemoglobinlt 39 heme gt bilirubin z PKx f Production of Bile l the liver produces about 700 mlday of the greenish yellow bile 2 contains mucin bilirubin cholesterol lecithin a phospholipid fatty acids and bile salts steroids quotg Catabolism of Hormones Toxins Alcohol amp Drugs 333 4 The Digestive System Disorders associated with the Liver a Hepatitis b Hepatoma c Cirrhosis d Jaundice 1 hyperbilirubinemia ayellowing of the cornea I of the eyes amp the skin 2 causes a mac de strh fcioxia a mom Jaw e 139 b infectious hepatitis c obstruction of the bile ducts B THE GALLBLADDER l 2 3 the gallbladder is a pearshaped organ located on the underside of the quadrate lobe of the liver j13939F 39dT the gallbladder functions to store up to 50 m1 of bile Disorders associated with the Gallbladder a Cholecystitis b Gallstones Cholelithiasis J 3 The Digestive System j Tfepatic vein u 39 A t central V E IEPATIIS Epalie artery H emrnc PORTAL VE IN E mmnn bile duct rine Fecal COMPLETE nrobilinogen Ilbbiinf Tuna Sttictun Alarm Tun to shunt some hepatitis Indy u Island INTERHITIENT Eh r39qI39 a gljuni Stone Fluctuates Hl tl i Biliruhinurobilinupen cycle Solid arrows bilirubin glucuronide dotted arrow urobilinogem ieptoduced with pormiuion from Krupp MA 8 others Physician Handbook 18th ed Langa 1976 J 40 The Digestive System C THE PANCREAS 1 the pancreas is a 6inch long organ located in the loop formed by the duodenum Common bile duct 1 I P rNCREPsTC39 p rs LET 39 E I w J u 39 8 4 it A rIrLa I v J 39I1 quot V iquot4 Pn 39 quotquotPanierea 139 acini exocrine structures 2 Gross Anatomy of the Pancreas a Head b Body c Tail d Pancreatic Duct 1 accessory duct 2 empties into the duodenum at the sphincter of Oddi 3 Microanatomy of the Pancreas a Exocrine Pancreas IlCR AT C CTUICE z Endolcrihnne Pancreas Islets of Langerhans quot Pancreatic EM INSULW quotB5773 CELLS 2 GLUEHGDN PH CELLS 4 Disorders associated with the Pancreas a Pancreatitis b DIABETES MELLITUS 3394 34 THE RESPIRATORY SYSTEM I FUNCTIONS OF THE RESPIRATORY SYSTEM A Uptake of 02 into the blood amp the elimination of CO out of the blood PULMONARY VENTILATTOH External Respiration T39 2 B vocalization c Olfaction II REGIONS OF THE RESPIRATORY SYSTEM A Nasal Cavities B Pharynx C Larynx D Trachea E Lungs III The NASAL CAVITIES 1 W p1ates ef the ef theRku1l 5l1uwing thg A Nasal Cartilages Ruse bji Iv daagittal Nasal bone WU W n Perpendicular plate of ethrnoid bone O gt V 393eputaI y E EeltaI S A Q vY I 5Eli quot 7Ziilag M camage A h P Y Lesser alar i 1 9W cartilage Lateral nasal h 1 0 R cartilage VRhEMmWwy i Greater in bone cartilage B Anterior Nares nostrils F V Palatine bone Y RHINImIse C Olfactory Receptors D Cribriform Plate of the Ethmoid Bone The Lateral Wall of the Leit Nasal Cavity NOTE the mucous membrane overlying the lateral olfactory nerves has been removed The lateral wall of the nasal cavity is marked by the superior middle and inferior nasal conchae Beneath each ooncha courses its corresponding nasal passage or meatus Frontal sinus ii Middle nasal canalta 11quot39Ilquotl EEx f39lrlII nasal aancha Sphenoid sinusnNdor Limen nasi Pharyngeal tasnslll 2 Vestibule of nose F39l11 u1rngeaIl arl lza at aziia illary nmhe quot d3 t rsarl glands in lighter areas as seen through coniunctiva apeniings of ducts of tarsal glands superior lacrimal la of lacrimal ducts an s gampu inferior Iacrimal if 0 p 7 37 FA nasal bone J fa t 39 3955 aer39irnal bone r F arn i3939 of lacrimal sac gland 3 l E quot p l i39l iI39l39ln ll duct h l 8 1 lanrimael papilla laerimal sac 1 39quot nasal cavity 5 9 middle nasal concha ijLat ine afnose on ski surface P 39u gan39g r39i at r K 39 vtari ea of nasalacrirnal duct excretory ducts of 1quot39 laerirnal glands 13 jg a posterior palpebral EH anterior palpebral m 39 limbus ii 39 i7ii P11quot 7 39 n 3 llaerlnnall i 1 is c it quot 39 39 a l inferior nasal concha inleriar nasal meatus F Nasal Septum G Nasal Conchae quotshelvesquot See lltI0 H Paranasal Air Sinuses See E3 E4 SINUSITI I Choanae Posterior Nares Lhu n eihrnoidalis 1 in l la nasal concha cut edge sfpsha naidali sinus H 39 6 1 5Pquot N0b BONE nasal bane A arrow into iquotrsari391Ilfsnquot L sinus A 3 5uaeer39iar nasal concha ipharyngeal ori ce of A n nasalaatrfimal 0 dui39 39 napernirflg V Hi IquotErrIaI narii 39 39 ta IeIrIi39l39 39I39yquota a tube T Ainfiar nasag concha cut edge E 2 H UH oral cavity nasopharynx ft lat vestibule D pa e K T Paras39agitta1 section of nasal passageways and pharynx IV The PHARYNXI A Nasopharynx SQQ 3 1 Eustachian Canals Auditory Tubes 899 94 1355 J14 EARACHE 2 Pharyngeal Tonsil Adenoids B Oropharynx PHARYN ITIE C Laryngopharynx spihnenaidal sinus K sells turcica 9 j pharyngeal tonsil IA hard palate quot b 39 syperior nasal concha 39 middle nasab 1 cancha k inferior nanEaquot j y concha inferior meaius q q oral cavuy I V rt 39I39K I 1rquotamplquotI IhquotllIu tongue T I blragplwr jrnj 2 L P5n aryrngapiharwjr a a re fia i T e1 ff L Am hyoid bone gti7 iFriH lar is p gquot 39 gr K4 Median section of head and neck showing relationships of ugper digestive and respiratory systems The Respiratory System ljl IIll39iFI I Q gnzl In I turn ail cuneiform cudilage 5 U enqnniieulafie ear lvelge Ianmgophurynx piriform recess esophagus r trachea Pharynx Posterior wall cut and reflected laterally to reveal the ori ces and structures of the anterior wall J v39 v 3939392 a 39u39i 1 14393953939J quot V LARYNX quotvoiceboxquot A projects outwards as the quotAdam39s apple B lined by nonkeratinizing stratified squamous epithelium C Laryngeal Aperture D Ventricle 7 I Ch miver Wire a E me yam cams l t 08 m foramen caecurn 9 39 as tongue d lateral glossoepiglo ic me nan Id glossoepiglo ic fold a 5TT7 L3F 39 IurrngE I39 uperiuire 39quotquotquoti39i393939F 7 nun ph aryepiglo ic fold ventricular folds at piriforrn recess 0v A wall of Iamynga T 39 quot39 pharynx esophagus a E Posterior view of laryngopharynx and laryngeal cavity E Vocal Cords 9 F Glottis G Laryngeal Cartilages l 3 large single cartilages EPIGLOTTIS THYROID CARTILAGE The Respiratory System Greater cornu H Hyoid bone i Lesser oornu 39 Tmgue 39 A muscle of 09 V g g 0 v i i pharynx 39 39 sV 39E39HIlIl 39I Bod W t 397 Greater comu fl4 Wold b39 quot9 of hyoid bone l l Thyrohyoid Ventricular fold a e false vocal cord lcorniculate T A cartilage Vmml l 1 c el r 39 39 quot l J a i h cartilage at aVmwme Cricotracheal 3n39qa ligament quot Tracheal T cartilages V Tracheal VI cartilages Structure of the larynx a anterior view D sagittal section CRICOID CARTILAGE 2 3 pairs of small elastic cartilages a arytenoids b corniculates c cunei forms H Muscles of the Larynx 1 Extrinsic Muscles ci fular constrictor muscles lnc3 Consfnclur pllarjngns The Respiratory System greater horn of P7 hyoid bone superior horn of thyroid cart N H eplglofflcus membranes 39 l arytenoideus pg wb A is aryepiglotticus thyroid cartilage cricoarytenoideus P 5l quoti 39 Ihyroarytenoideus cricoarytenoideus Iateralis articular facet y for inferior harm of thyroid cartilage 9 9 Muscles of the larynx 2 Intrinsic Muscles open amp close the glottis by changing the tension on the vocal cords innervated by the Laryngeal Nerve LAR NGOSPASM spasmodic contraction of the laryngeal muscles Use Heimlich Maneuver form AlJlOM39n Tl lT lS39l39 Cl bearhug around the victim and then Man euwar press fist against the victim39s abdomen just below his xiphoid process causes reflex exhalation I Irritation Receptors of the Larynx LARY39llGI39I39IS CARCINOMA OFMTHE LARYNX associated with heavy smoking amp heavy drinking after a laryngectomy train patient to use 1 esophageal speech 2 electric voicebox or 3 artificial voicebox K8 The Respiratory System VI The TRACHEA quotwindpipequot A the Trachea is a 4inch long tube extending from the cricoid cartilage of the Larynx to the Rt amp Lt Primary Bronchi Larynx 4gtPrimary Bronchi C6 T5 B the Trachea is located anterior to the Esophagus C it is reinforced with Cshaped hyaline cartilaginous rings I D it is lined by a quotciliated mucous membranefampg TRACHEOTOMY surgical opening of the trachea TRACHEOSTOMYan opening in the trachea 2 a ii i 39 V i g Fir ii If I u rn ii 1quot Thyroid 39iquotquotsirquot39g 3quot39 a quot quotquot I Tracheotomy A diagram slitwiiag tlis position cf the ngers of quotl139lI39 le i 139 hand grasping the P and the indent i39mgs fama 1tlr palpation of Il1E midl ileg in TEmsrrgeznrsies the lung incision w illustrated is used 139nrmsrre mmplete E h39p39Er L1l39E H tlis thy in mid isthmus lms been and winclmnr made Fmm Proctor D F Anesthesia and Otolaryngology The Williams amp Wilkins Co Baltimore 1957 E H r VII The LUNGS A The Lungs extend from just above the clavicles down to the Diaphragm Muscle l apex of Lung 2 base of Lung 3 root hilutn of Lung location where Primary Bronchus Bronchial Artery Pulmonary Artery Pulmonary VeinLymphatic Vessels and nerves enter amp leave the Lung K l The Respiratory System a21Ii jW39E3 T a nasal passageways V V H superior nasal canclaaa Vff D middle nasal concha 39 E L inferior nasal concha 3 external nurls P V v quot H F c lfh Iquot T AL e 2 res1 us If mouth Aquot 0 I so pal 39 quotwarpFrni E a quotngl1arjr n right prirnry bronchus e I F O nfli l fl primary bronchus xl secondary bronchi 39 o superior lobe of leir lung r H X if pericardial sac ah rib clialihr alig J 4 I rlrl39Ee ior hren E lzllf e 5 u 1 n E 5 n D 3 O F L 3 390Wquot 5 quot3 e Blwhra m 0Y asrphaa gTiQ e General view of respiratory system Anterior walls of lungs partially removed to show branching of bronchi and bronchioles E px 4 color of Lungs KI0 The Respiratory System 5 mediastinum RT mm LT SIID9quot T 39 b S 39 a V 0 bronchi 1 S Superior lobe bronehieies 7 M I 3957l f gquotT I 3ly edquot a mmmmvunmmi ffhy i l 4 y I a Hsspiramury P I quot Hg I I l 7 Tammy bronchi s quot veolar sac Ernrrehialell K F nhiddlg T I lobe P P Inferior iobe 0 Inferior lobe B The RIGHT LUNG is larger than the LEFT LUNG 1 RIGHT LUNG a the Rt Lung is a little shorter but broader than the Lt Lung quotb the Rt PRIMARY BRONCHUS divides into 3 Secondary Lobar Bronchi lhorizontal fissure divides the superior amp middle lobes 2 oblique fissure divides the middle amp inferior lobes 392 LEFT LUNG a the Lt Lung is a little taller but more narrow than the Rt Lung b the Lt PRIMARY BRONCHUS divides into 2 Secondary Lobar Bronchi c Oblique Fissure divides the superior amp inferior lobes The Respiratory System C The Respiratory Pulmonary Tree Primary Bronchus Bronchioles Alveolar Ducts with Alveoli 1 with each subdivision there is progressively F Mare W5 2 the bronchioles are innervated by autonomic motorneurons a bronchoconstriction b bronchodilation 3 there are about 300 million alveoli quotair sacsquot in each Lung terminal hranchimle respiratory hrrlenciIi ules n l alveolar duct Schematic representation of respiratory units of the lungs K I2 i 5 The Respiratory System Red blood nails 39 E Extracellular fluid i 39 39 Connectiye asue fibers weesl g u ill l lgtau I lvrn IiI39rquot r nVquot39 I gtJ1 7 in Y 0 O i 2 c quotI AWGOIUS quot M 1 Capillary 39 enr1oiheiiurn Basement membrane of capillary endothelium Alveolar epithelium Basement membrane of alveolar epithelium Connectivetissue p 0 g 6 Camry i a An alveolus sur bers Men T pillari Connective tissue cell i WW3 H f i gnvfgg endoiheiium a membrane that separates 39 the air in the alveolus from the blood in the capillaries b The respi ratory membrane of the lungs 39 3 a alveoli begin to develop in the embryo during the 6th month and continue to form through childhood b alveoli are composed of simple squamous epithelium c alveoli are surrounded by pulmonary capillaries d Microanatomy of the Respiratory Membrane S weomacws r e SfErlp11IE1n Er1 r e urfactant 0 PY VQzVCquot 3V 0quot x vom coiiapswng f Macrophage Cells engu1f dust and foreign matter K13 3 u gunm 2 I n The Respiratory System D The PLEURAL MEMBRANES H I Tracheobronchial tree Right lung p aritalv a i pleura ix Mediastinum Lung collpsa caused by a stab wound pierc lng the thoraclc cage Note that the air in the pleural space did not come from the lungs since the lung wall is still Intact l the pleural membranes consist of a simple squamous epi thelium that secrete a slippery serous fluid ha visceral pleural membrane covers the surface of each Lung b parietal pleural membrane covers the inner wall of the Thorax c pleural cavityefluid filled space between the pleural membranes 2 Embryological Development a endodermal lung buds pushout into surrounding double layered mesodermal sac b somatic mesoderm parietal pleura splanchnic mesoderm 939visceral pleura KH The Respiratory System 1 aryngo Eachaal tube coelolnic cavity C0Bl f quotlC CiV 5tY 5 1aytal pleura parietal pl eura 1 visceral pleura visceral pleura Z I root of lung lungg A avisceral pleura thoracic wall a up aural ca 13 parietal pleura costodiaphragrnatic recess Formation of lungs Note that each lung bud invaginates wall of coelomic cavity and then grows to ll greater part of cavity Note also that lung is covered with visceral pleura and thoracic wall lined with Parietal pleura Original coelomic cavity is reduced to a slitlike space called the pleural cavity as the result of growth of lung KI5 The Respiratory System Kpa eml pleura visceral pleura phrenic nerve quotlmgu par mrdiirrm wd Drawing through the thorax after fusion of the pleumpericardial folds with each other and with the root of the lungs Note the position of the phrenic nerve which is now in the brous pericard VlseoraI nlmIrI I Coltnlporllnnxn Parietal pleura Modlutlnal portion N A A Pleural nevi d quotV Vr g T t V V K l l cartilage mad lnntlnill nous nighutriurn Slerhum 39g Anterior mediaatlnum II6 The Respiratory System shoulder H muscles VL abdnnnnaI my muscles Exuamou INSPIRATION E PULMONARY VENTILATION 1 Inspiration Inhalation DIHPHRBGM lNTTZ C0S179L 9 rCHEST 5 AJR S S KLEUI GS Ml301E3 C0W T VOL mm a Diaphragm Muscle 1 is attached to the sternum edges of the ribs and the vertebral column 2 is innervated by the Phrenic Nerve b External Intercostal Muscles 2 Expiration Exhalatien L J1 KI7 The Respiratory System VIII RESPIRATORY DISORDERS AND PATHOLOGIES A Respiratory Distress Syndrome of the Newborn Hyaline Membrane Disease B Pleurisy Pleuritis C Pneumothorax formation of an air pocket between the pleural membranes D Cold coryza catarrh viral infection of the upper respiratory tract results in reddening amp swelling of the mucous membranes swelling of tonsils and lymph nodes HE Influenza F Bronchitis viral or bacterial infection of the bronchi G Pneumonia general inflammation of the the Lungs H Tuberculosis bacterialinfection of the Lungs resulting in the 1 formation of fibrdtic nodules around the infected areas I Bronchial Asthma allergic reaction resulting in bronchospasm and bronchial edema Cbronchacon 57 IGIWOTI KI8 The Respiratory System J Lff vytsiyiua gaa iE l 5 Redness SKIN due tn dilated capillaries Z N 5 l Diarrhea Nor iay Mucous GUT airway constricted by smooth MEMBRANES muscle contraction LUNG Allergic responses When allergen binds to its speci c IgE antibody histamine is released from the tissue mast cell to which the antibody is attached Histamine causes capillary dilation 101311 Swelling 81110015 muscle contraction and mucus secretion 39 J Emphysema a chronic progressive degeneration of the Lungs associated with fibrosis of the lungs and atelectasis Confluent ulveoli NORMAL EMPHYSEMA K Carcinoma of the Lungs L CLINICAL TERMS ix i a Section of the lung lb Enlarged alveoli 2 Section of alveoli showing blood cells Alveoli a A section of the lung shows a small bronchiole its branches and numerous bubblelike alveoli b and c Enlarged views of the alveoli show multitudes of capillaries sandwiched beween thin alveolar walls in life red blood cells circulate through the capillaries Micrograph a of a rat lung from F M Anclraaws in1uiicro grap39qb gf a rat lung 5D lrorn R G Kessel and Fl HKardon Tissues and liirgains A TEril39f ll39i39fEE of Scanning El eetran Microscopjr San Francisco W H Freeman and Co 1979 p 212 miicrograph o of a Ilog lun K l from Waibeil F39h391fsioi Rev 53 1973424 20 2 THE URINARY SYSTEM I FUNCTIONS OF THE URINARY SYSTEM A Maintain Water Balance 3 Maintain Salt Balance 1 C Maintain pH D Excretion of metabolic waste products vena BOVZ urinary bladder II REGIONS OF THE URINARY SYSTEM A Kidneys B Ureters C Urinary Bladder D Urethral Canal urethra I it 5 iai rirf I Left Kidney Grass Anatomy 1ntemal Longitudinal section shows capsule cortex medulla fnedullary pyra mids renal sinus and proximal part of uretel Nate H9 rehs ve size 0 the Nevunmi I K 8Hbbs III The KIDNEYS HA reddish brown organs located retroperitonealgg the reddish color is due to the high vascularity of the kidneys B the Kidneys extend from about T12 to L3 with the Right Kidney located slightly lowerthan the Left Kidney C the Kidneys are surrounded by Tthal G3 pSU39 Penmna Fat D ENAL CORTEX Note interlobar arteries and veins extend through the renal columns of the cortex dividing the kidney into lobes D RENAL MEDULLAMedullary Pyramids Note the urine collecting ducts pass downward through the Renal Medulla pyramids and open into the renal calyces of the Ureter E The Hiluu of the Kidney P Each l39irlneyr rec aims a renal ariter that dhriiles intn El 139EEI iIEJIE5 WH3911i1 l tihae kidney Venules leaving the jnin in farm the renal Thig drawingaIsn shuws thE p1auemnt Hf sane nephrurL p P V teams were renal pelvis quot P P gt f H ifenal vein I J E arteIy1 Ium I 39 T MFEIEZI IV BLOOD SUPPLY TO THE KIDNEY T e blood flow thrqugh the Kidney involves a portal system RENAi ARTERY gt Interlobar Artery V5 ArcuatJe Artery Inter Artery V Afferent G1nmer111iarArte39rio1 V A lomerular CapL11aries GIOMBPIJU5 Efferegnr Arterial PM h 39 5 I T j 39 FPenrtitubular Capi11aries Interlebularrveirnxsti T gyasa reda Arcuat Vein Interloiar Vein Renal Vein L3 Each kidney contains over one million microscopic nephrons one of which is shown here 0 c T istamnTIute tnmlgz Equotquot K39 39r39n1all quot 39E il15lilIl s h X h T Y 39 e fe1 em glomerular arteriole i p 0 P h pI 39 s afferent glomer lar i Vi I E 391 i I aI p 7 39 V q AT proximal cnnvo iLIrte tubule Dill016 V MICROANATOMY OF THE KIDNEY A The Nephrons Renal Tubules quot39CVb0A3Q ap he3039 C9 S wrm mmvw 1 Glomerular Bowman39s Capsule Temencosesthe glomerular capillaries Ens GLUHERULAE FILTRATIGM BF BLGGD 39 P y F M It 7194 Hi M 2 Proximal convoluted Tubule hh 5ileeation for TUBULAR ii A S RPTI N in v v reabsbr no t c hm L4 VA Juxlaglomerular cells EnduiE1eHum D Prox39mc lV convoluted tubule I P 3 Loop of Henlec Nephmn K a located in the Renal Medulla b consists o a descending portion and an ascending portion Mb 4 Distal convoluted Tubule quotnW l location for TUEU Q EECEETIUH n aR TUULE B The Urine Collecting Ducts PampP3Vquot hidquot the nephrons empty into the urine collecting ducts which conduct the urine down to the renal calyces of the ureter 3 VI THE URETERS A the Ureters are 10inch long mbscular tubes that conduct urine from the Kidneys to the Urinary Bladder by peristalsis B Pelvis of the Ureter VII THE URINARY BLADDER A the Urinary Bladder is a hollow muscular organ located just behind the pubic symphysis in the True Pelvis B the Urinary Bladder is lined by transitional epithelium which flattens as the urinary bladder becomes filled C Micturition urination l the Detrussor muscle in the wall of the Urinary Bladder contracts 2 the Internal and External Urethral sphincters relax L6 urethral ori ce nternal V5cQv a S30 M 5 la L T lntemal sphincter GWW T T ura ra p E Eieiailed structuare at M13 lIjaddEr f4JltELem139 NE VP39THiJeuRaN gig S f JPITlC MWR if Alr7Ij1AIm x W 1 F J 39 f 39 39u39 I13 duchn gt A V p urefhrd crust V u 39v39s v V 7 gpunlin jyg f u139I39i 390 Q Prgratin uI39lquot39 7 pA q gtAIFmquot 39 39 T Z u arani11uidm rauImA P 394 3 TL A 4 uelhwnahmz 39 Fnhmhrnmm urilhru 0 pl quot 5 T5i39 quotE 39 quot 1 up E Shulhwu39ihm T v s 39 ILula wl w urHmA Z T crusof penis I my 0 r V I I P u IJ 53 Q 3 quot j L quot3939wI 393 mdi H I a 393 3 5 E coipos sponglowurn 1 I7 p E 3 7lLlquot w39H 7 P4 5a iE5mr 1 I39Egi 39q 1 W lia 5 0 quot Anterior View of some urogenital relationships in the human male VIII THE URETHRAL CANAL A the Urethral Canal conducts urine from the Urinary Bladder to the body surface B In the Female 1 the Urethral Canal is only about 1inches long 2 it opens just anterior to the Vaginal Canal C III the MaJe l the Urethral Canal conveys both urine and semen 2 it is about 8inches long it is divided into 3 regions a Prostatic Urethra b Membranous Urethra vernous Ur thra spongg pad URET HRT 8 IX DISEASES amp DISORDERS OF THE URINARX SYSTEM A Kidney Agenesis B Glomerulonephritis C Kidney Stones QuRNML 1 STONESquot D Kidney Failure Uiemla E Cystitis F Ureteral Stenosis stricture G Urethral Stenosis stricture dysuria painful urination X EMBRYOLOGICAL DEVELOPMENT OF THE URINARY SYSTEM lesser omentum I V i j I1 duodenolweptit ligarnet gaatr39al1epa39tn ligament dorsal mesentery bare area of the liver r 0Z J V dorsal diaphragm T 0 d ii i 39Wm A l A a pancreatic bud t 0N t 311 if i quot ti Falciform ligament celiac artery VOLKite L AuAmnms EKlF39 Ei39i IbI39YOl391iC P coelam H superior mesenteric artery F H ll It T i gall bladder free edge of ventral mesentery peritoneal cavity aoA ie Hi i l l 39 V O 0 l quotinferior mesenlerlc artery Sketch of the caudal half of an embryo at the end of the fth week showing the liver and its associated ligaments viewed from the left The arrow indicates the communication of the peritoneal cavity with the extraembry onic eoelom Lr9 Degenerating pronephros Mesonephros Mesonephric duct quot J Mesonephros J A Mesonephric uIum A J R Metane hm Ureteric bu D KIDNEY S a Fmh week hiuIIafa ephric 3 Sixth week mm Degenerating mesonephros f Kidney Developing Gonad T urinary Bladder Metanephric duct Urete G Seventh week an Eighth week HEMATOLOGY THE STUDY OF BLOOD I General Characteristics of Whole Blood A special type of Connective Tissue 1 madeup of cells and an intercellular fluid matrix 2 like all CT s it is of mesodermal origin A Platelets it i White blood cells v Red blood cells as Blood cells become packed at the bottom of the test tube when whole blood is centrifuged leaving the uid plasma at the top of the tube Red blood cells are the most abundant of the blood ceIls white blood cells and platelets form only a thin lightcolored quotbuffy coatquot at the interface between the packed red blood cells and the plasma p 3 3 B Functions of Blood 1 Transport of O2 and C02 2 Transport of Nutrients and Metabolic Wastes 3 Transport of Hormones 4 Transport of phagocytic WBC39s imunological1y active WBC39s amp antibodies 5 Contains Buffers such as NaHCO3 to help maintain pH constant lll C TOTAL BLOOD VOLUME 1 normal 56 L 2 hypervolemia hypovolemia D PRIMARY COMPONENTS OF WHOLE BLOOD 1 Plasma 55 TBV 2 Blood Cells 45 TBV II CHARACTERISTICS OF BLOOD PLASMA A yellowishcolored fluid pH 74 B Chemical Composition 1 H20 92 2 Plasma Proteins 7 a most synthesized by Liver cells b Albuminf accounts for 60 of Plasma Proteins osmotically inhibits H20 in the blood from diffusing out of the capillaries c Globulins accounts for 35 of Plasma Protein 13 cg1 bu1ins O Transport lipid soluble nutrients in the 2 f3 globulins blood 3 if globulins TmunoglobulinsAntibodies a synthesized by Lymphocytes b inactivate foreign agents d Blood Clotting Proteins accounts for 5 of Plasma Proteins 1 includes Prothrombin and Fibrinogen 2 SERUM blood plasma without the clotting proteins 3 Hemophilia genetic inability to manufacture blood clotting proteins 3 Other Organic Molecules 1 a Nutrients 1 glucose 2 amino acids 3 fatty acids 4 cholesterol wuouaa moon 7 FORMED ELEMENTS 39 45 i 11 000mm quot 93 gmI10O ml FIBC 4 6 million mm b Waste Products 1 urea 2 uric acid 3 ammonia NH4 U Sk Proteins 678 gml100 ml rthar inorganic ions salts lipids carbohydrates hormones etc 39 4 Inorganic Ions MineralsElectrolytes 3 b cations 1 N lt2 1539 3 C 4 Mg anions 1 c1quot 2 HCO 3 COMPOSITION OF WHOLE BLOOD WITH THE VALUES NORMAL RANGE OF E Monocytes 2 10 E 1 Eosinophiis 1 6 39 quot Basophils 0 1 32 symwomn FEarucrnj globulin alpha beta gamma 23 35 gm100 ml Fibrinogen 300 400 rngnoo ml 39A Prothrombin 1o 15 rng100 ml III CHARACTERISTICS OF RBC39s CERYTHROCYTES i W A Appearance biconcave discs 5 P H P 120 microns Tmpwew 8 pm in diameter with no nucleus B normal RBC Count 5 millionmm3 C Function transport 02 amp CO2 by binding to hemoglobin o 75 miomns D Origin 1 produced in red bone marrow esp in vertebrae ribs amp sternum 2 about 2 million RBC39s formedsec L PRENATAL POSTNATAL CELLULARITY W n m u 1 17 17 39 4 I F I 391 l 39 uoo sous gt YOLK sac ARRoAr i pk i eo i IJVER E vssrssss V I I j I so E wETE HUM E 40 A SPLEEN A I A H TI E iE A 0p e R II FEMUH E I 1 I Iquot ii I I Pi 39 39 39 39 39 234ss7e9o 20 so 40 so so 70 amrn FETAL MONTHS AGEINYEARS Expansion and regression of hematopoietic tissue during fetal and adult Ito E LifeSpan 1 about 4 months 2 phagocytic cells in the Liver amp Spleen engulf old R2BC39s F Clinical Considerations 1 Anemia a 4 no of normal RBC39sTgt capacity to carry 02 in blood b Types 1 Fe Deficiency Anemia 2 Vitamin B12 Deficiency quotPerniciousquot Anemia 3 SickleCell Anemia abnorma1 hemoglobin 14 Erythropoiesis lt Iron x r 5 1 lt Iron V E7 I Bone marrow lt Iron T l Erythrocytes Iron transferrin 8 E h v KgA d quotabnnArma cur M mcytes lquot 39tda rnagetl erythmne391ftes Aged abnormal or damaged erythrocytes are dis may be either stored or reused in the synthesis of new posed of by macrophages The iron that is released hemoglobin IV WHITE BLOOD CELLS LEUKOCYTES A General Characteristics Ag uvlafllgukQEFEVEE 1 nucleated cells that behave 39 7f like amebae 2 normal WBC Count 7000mm3 3 normal LifeSpan only a few days B GRANULAR LEUKOCYTES GRANULOCYTES PMN s 1 contain cytoplasmic granules vacuoles 2 contain multi 1obed nucleus 3 all formed in the red bone marrow 4 Types a NEUTRDPHILS 65 of WBC39s 1 very small light purple staining granules 2 phagocytize foreign agents b EOSINOPHILS 3 of WBC39s 1 many large redstaining granules 2 phagocytize antigenantibody complexes in allergic reactions c BASOPHILS 5ZXof WBC39s 1 many large dark bluestaining granules VaCU01eS C nt3ini 3 histamine and heparin 2 the basophils that migrate to loose CT in the body are called mast cells 3 actions of Histamine a causes local vasodi1atiamp lt 39 swelling redness INFLAMATION b causes bronchospasm 4 actions of Heparin prevents blood clotting C NONGRANULAR LEUKOCYTES Agranulocytes l Lymphocytes 25 of WBC39s a round purplestaining nucleus with just a rim of cytoplasm b there are 2 Types of Lymphocytes 1 B small LYMPHOCYTES Plasma Cells a originate in the Bone marrow b produce antibodies esp against bacteria HUMDRAL IMMUNE RESPONSE 2 T large LYMPHOCYTES a originate in the thymus gland b produce interferon which interferes with viral multiplication c also release chemicals called lymphokines that stimulate phagocytes to engulf viruses fungi cancer cells and organ transplants CELLULAR IMUNE RESPONSE VI6 AILEFT blood smear showing erythrocytes a small lymn phocyte a monocyte and a neutrophil ABOVE Scanning Electron Micro graph of a macrophage monocyte engulfing a staphylococcus bacteria 2 Monocytes 5 of WBC39s a largest type of WBC containing a large horseshoe shaped purple staining nucleus b formed in the red bone marrow c phagocytize foreign agents d the monocytes that migrate to other tissues are called macrophages e Mononucleosis viral infection associated with increased modocyte count V BLOOD PLATELETS Thrombocytes A consist of cell fragments containing purplestaining granules vacuoles 3 normal Blood Platelet Count 250000mm3 C formed in the red bone marrow from cytoplasmic fragments of megakaryocytes D Blood Platelets adhere to injured blood vessel walls and release 2 Chemical Substances 1 Serotonin D local vasoconstriction 2 Thombop1astin gt f blood clotting M H H l 5 p M H Pl I I t Fi Tl Clot starts f Rt quot 2N f3939La t to form fibers and plug hole 139 IE 39 K 1quot quot 39 I 39 392nu V quot 1 H I I39 we 39 quot aI s1 392 V n s 39 R 1 l 7 1quot quot33 H I n E 39 7 I P V l V T V W T 1395lt cl Function of platelets in closure of a hole in a damaged vessel A Movement of blood through tissue wound B Platelets adhere to collagen fibers and start to plug D 39 Cllnlcal Considerations hole C Platelets adhere to each other to close the gap in 1 Thrombocytopenia the damaged vessel wall while blood clot forms to rein force the platelet plug a Blood Platelet Count b results in t blood clotting capacity 2 Intravascular Thrombosis atherosclerotic i triggers blood clot formation plaque r g MiIsrua39hesE iw39ade c n T 1 39gs 1 39 pv B lymphocytes are mnwertsd inte la fla eellls p Hquot 53 39 II 09 MastrIeIlsand thasophils I S quot 0 39 39 39fT IIymphoe1rtEsr are converted into lltiers 3939 quot E i uIn39 3939 quot quot39n r4 39 r IHalI 39 II II39 2 ar39i ta39 1 a ea am vr39a39s2 N lijiflllgr Iquoty39rrlI 39vi1Ii39lB 39 p load vessels tl1Il atae and 3PIasma EiElI5 W 06 l 0 P P 391 IIaCue 1quot 395 HT quot39ui39 Ii39VquotquotquotJ quot u39 39 It WP WP trophils and mvunoeytes A hnt b dl Hind U iii eompilement attaslk M team si3ta39g gut lnuasiom 9 Q glsrnlbesr r 39f lt P r 39I I39Jurlquot39F ELI r i IuJI 139 quotmeme flquotlI Illlrgl7I vessel walls l 1 39 E gt7fFPquot339H V NeutrephiIs rn fiend tissue phagocytes i f d t 1eiuiEdl but anti nodies Ends 739aompesmentl 0 n139i1vrcrlnesn 5 p I 93939 3939j il I3I Eh I 3 L P p s 0 2 l M3 ii Bu an 39139 THE CIRCULATOBI SYSTEM I GENERAL FUNCTIONS A distribute O2C02 nutrientswaste products hormones and heat to and from the body tissues B defense against foreign agents II GENERAL ORGANIZATION A Cardiovascular CV System 1 Heart 2 Blood Vessels B Lymphatic System 1 Lymphatic Vessels 2 Associated Organs L Diagram to show the circulation of tissue uid from blood capillaries to tissue cells and back into b1oodcapi1laries or into lymph capillaries III THE CARDIOVASCULAR CV SYSTEM A Definitions 1 arterx 2 vein 3 capillary bed an anastomotic interconnectihg network of capillaries where the exchange of sub stances between the bloodstream and tis sue fluid occurs 4 naming of vessels arteries gt arte171oZes cczp11ZZary venulese veins lads only the arteries amp veins are usually given names 3 1 the heart begins beating 3 weeks after fertilization 2 the heart consists of 2 PUMPS a RIGHT PUMP pumps blood through the Pulmonary Circuit b LEFT PUMP pumps blood through the gystemic Circuit W Rm A h5 P P Svircmvrrew i A r Ar1eriesto 739 upper body 1 Puimorngaeiesl ig I Veins from upper body p L PulrnoncIquotY I A i 9 I 39 Righterium A P 39 0 mg i bV Veins T Aau e ventricle CELMC HRTGKV m 3939f 39 P a SUP mesenremc k f bodY s I P mp veslt TeRcA gostromteshno T trod 39 Kidneys Trunk lower limbs N2 3 both pumps normally contract at the same rate 4 both pumps normally pump the same volume of blood 5 SIZEAND LOCATION a a person39s heart is about the size of his clenched fist b the heart is located within the mediastinum of the thoracic cavity 1 anterior sternocostal surface 2 inferior diaphragmatic surface heart rests on the Diaphragm muscle c the heart is situated obliquely between 2nd gt6th ribs BASE pI XIS OF THE HEART line drawn from the center of the base down to the apex SECOND THORACIC SPINOUS PROCESS SUPERIOR VENA PULMONARY VA ARTERY AND LEN ATFIIUM I AIR IN FUNDUS OF STOMACH CUT EDGE OF PERICARDIUM AT SITE BRAEH C39EFHA1IlC TRUNK IINNOMINATE ARTERY OF REFLECTION FROM GREAT quot E5 EE39L 1 BRACHIOCEPHALIC CINNOMINATET VEIN R BRACHIOCEPHALIC INNOMINATH VET A COMMON CAROTID ARTERY R PlIRENIC HEW E N 2 A M H X INTERNAL JUGULAR VEIN R SUBCLAVIAN J Gus NERVE ARTERY AND W39EiIH A LiAMENTUM ARTERnT5uM R PHRENIC NERVE AND PERICARDIACOPHRENIC ARTERY AND VEI TRANSVERSE SINUS lRuimDNArRTA TRUNK L PULMONARY ARTERY F E 39C 39 739 TRANETTEREE sINus 3 quotULM N c T A A A J U Z p A 0 h i F PEMARDIUM Tquot EquotEquotquot39 P Z A n A p s suremon P Y t A n n Y P n 0 X p P A J r 07o V ma 391 Tfillqi E T A v quot n lt H I p row or T quot HINEDFLEIEEEH e i A x 5 R SUPERIOR T PULMONARY x VEN pf k v 41 Pt j j A 4 A i 39 A 39 m 4 39 4 A H 4quot 39 Irquot p PB lt A r u 39 39 39 quot 39 g 1 Lu391EI2wi39I VZ EQRDNART SULCUS R TrENTRTKvL1 A L AUElCIl CONU5 ARTEEFID5li39 L quotHquotEI395quotquotRIACFL H39lquotTLl395E A MARGIN ANTERIOR N4 INTERVENTRICULAR hZ P ECU EGEE 3Fi SUECUEAA MARGTN APEX PllI MMl Topographic anatomy of heart RA Right atrium RV T59 Vequot 39iC39e3 LAI left atrium LV left ventricle 6 The WALL of the HEART a Endocardium b Myocardium See HFl c Epicardium Visceral Pericardiumf quott E h Intercoted discs 1 l a ii y J quot391quot A 1zeal pg Ii t ti ieae t tr u t I L 39 tumwy t q P pC up Ha mWrrai 3 tj E i t V 3 E t q q 39t 1 4 J3 er serous membrane covering the sufface of the heart 7 The EhIcARoI al Parietal Pericardium 1 a 2layered sac that encloses the heart a serous membrane continuous with the Visceral Pericardium Epicardium SIMPLE SQUAMOUS eIgtmeLwM we seam FeS SEROUS FLU I b separated by a pericardium cavity filled with serous fluid 2 Fibrous Pericardium fibrous Connective Tissue attached to base of heart Diaphragm 13 N5 anterior thoracic wall amp the El viscera pericardium pericardium Pericardial uid D Membrane relationships in the ventral body cav 39 ities a Schematic repre sentation using a fist thrust into a balloon b Membranes surrounding the heart 39 8 INTERNAL ANATOMY OF THE HEART Fibrous A pericardium iViscera1 peiticagr iiam seriius Atrial quotquot V cavity Pericardial H T cavity Endocardium Myocardium b Figure 86 Structure of Heart Wall a Schematic section through heart wall in dicates relative thicknesses of endocardium white myocardium light gray and epicardium dark gray 3 Schematic diagram of heart with coats of heart wall and pericardial sac indicated groove a Atrioventricular Coronary Su1cus band of fibrous CT oatieu vigiii or L Atrium iiiuunsi irtit GREAT CARDIAC iiquotFJ 39 CIRCUMFIEX BRANCH LT V55 i39Nquot5i gvfg 2 RT PuLmovihQ t VEINS or 1 coaomav inrEmr agt 3 I rostrruoaquot VEIN or L quotiiEr t1itiCLE MIDDLE CARDIAC VEIN 39El339HEiH ET AF Ti39ElE lNiTEEtquoti39 EHTHIElJUaEl CPOSTERIOR DESCENDING BRANCH OF It CORONARY ARTERY b Interatrial Septum 1 partition between the Rt amp Lt Atria 2 FOSSA OVALIS depression in interatrial septum Fmrrmew OVALE 39 39 S 7 3 gt F055 0VALS t Peru 5 39 c Interventricular septum left subclavian artery 7 gt 3 quotav quotquot superior vena T cava V it left common carotid artery r X it r quot39 i Pm aortic valve it i ii i lerrIiIunar 7 P u l pulmonary valve i I M pserJniuna p rifghti I39AtriII39Ii1 3 3 o L tricuspid valve 1 anterior vtmp chordae tendineae ventricle h trabeculae papillary muscle it carneae E inferior vena p COVE FIG 184 39 of opened heart to show its chambers and valves The arrows indicate the direction of How of blood through the heart and to and from its major vessels d CHAMBERS OF THE HEART atria receiving chambers ventricles ejecting chambers 1 RIGHT ATRIUM a receives blood from i Superior Vena Cava SVC ii Inferior Vena Cava IVC iii Coronary Sinus N F m0Ezmgt A sE lt5uzmA2mA AA 3032 sltlt A gAuAEA AAAuA mAum5A A 5E AAm0AMwAhAuA Am 0 50 A p A pz AAA A WA A AA Aw AmAAAumAAA gt ltlt 0mm0 zo 0 uzlt 7 AA uEEzEA AA A AA 20 0w50 A 3 30 2 H 53 A AAAmAAH 532 AA aEultAm Eum ltlt 0Ezlt AA nmu euEzmgt 522 A ozltn ikmLw A EAA A 2 A 03 au no 55 ltEquotm 0 zmzulttlt 0 mz 2092 mz 2305 ozltn AA Au0EA n0A A Ed 3032 ampltlt 0Ezlt AA A 2 A 0529 AA 152 A A mAAnm muEzugt m 3032 ltlt ltZOU Enm A A E A lt5uEzmgt 0EltA mm EmEA AA E200 A 530 ltzugt 0Es 22 242022 AAAA 9 3050 uA czltz00uz0z E 05o AAEMA R mmuA 8 520 SumAmAiEAmA A 30 AA 04 ozozuumlt 1 2 AAAAwz P AAAAAAmA PQ u0lt 4 gt ltz0s AA AA ltz0 AdAq A 0 32 u0lt AA A nu 0205 0 zlt E A A AA A A A mA AA lt 0 ltolt wzAnz mqAA 22 AA z0 AnAA 250 0505 oEzlt AAmuA oE8 5 mmmAA AAEAx 42900 A0 AA0AmAW N3 3 G Blood ow through the heart during a single cardiac into the ventricles c39i39IE he ventricles contract forc cycle a Blood lls both atria and enters both ventri ing blood into the aorta andthe pulmonary trunk cles b The atria contract squeezing more blood b Rt AtrioVentricular A V TRICUSPID Valve i consists of 3 endocardial folds reinforced with dense fibrous CT ii prevents the backflow regurgitation of blood from the Rt Ventricle 2 RIGHT VENTRICLE a present on the anterior sternocostal surface b chordae tendinae i dense fibrous CT cords that anchor the AV Valve cusps to papillary muscle ii prevent the valve cusps from turning insideout c the Rt Ventricle ejects blood into the PULMONARY ARTERY TRUNK d PULMONARY VALVE i consists of 3 semilunar cusps ii prevents the backflow regurgitation of blood from the Pulmonary Artery Trunk 3 LEFT ATRIUM a receives blood from 2 RIGHT PULMONARY VEINS 2 LEFT PULMONARY VEINS b Lt AV Bicuspid MITRAL Valve i consists of 2 endocardial folds reinforced with dense fibrous CT ii prevents the regurgitation of blood from the Lt Ventricle N i HEGWE so mam FENTER 5 QT AV S S S 1W0 srgtIAb t LiEH Sp J N LT PW VA LVE The base of the ventricles exposed by removing the atria Artery is the branch of right coronary artery to the atrioventricular node 4 LEFT VENTRICLE a present on the posterior diaphragmatic surface b chordae tendinae anchor the AV Valve cusps c the Lt ventricle ejects blood into the AORTA d AORTIC VALVE i consists of 3 semilunar cusps ii prevents the regurgitation of blood from the AORTA 9 ELECTRICAL CONDUCTION SYSTEM OF THE HEART a consists of cardiac muscle fibers s ecialized to g nerate and conduct electrical impulses CTION POTENTI S 1 Sino Atrial SA Node 2 AtrioVentricular AV Node 3 Common AV Bundle of His 4 Rt amp Lt Bundle Branches 5 Purkinje Fibers 665 VENTNOLES b Autonomic Motorneurons 1 innervate the SA amp AV NODES 2 act to modulate the Heart Rate NI0 Baclumann39s bundle FumnaW Veins Superior vena cavavjf ti 1 u pacemmap Anterior internodai tmme Middle intemodal ii HOG Mitral valve i L bundle Irnz i Posterior papillary muscle i RightiLindI quot an ilnterventricular septum rranhn i 3 10 BLOOD SUPPLY TO THE MYOCARDIUM a Rt amp Lt Coronary quotcrownquot Arteries I 1 branchoff the Aorta just behind the cusps of the Aortic Valve 2 encircle the heart along the atrioventricular coronary sulcus aorta V L righf coronary artery coronary aery right coronary artery rendineoe of w T bicuspid valve quotquotquot39 A i B The aortic semilunar valve A Aortic ori ce cut and spread out to show semilunar and bicuspid rnitral valves B Aortic valve in closed condition as seen from above NH osuoue van or V 39 L ATRIUM IllMAJ5 HA39 W GREAT CARMAC nuMFVm EIEalil l I L IE39t DHAE 139 H152 z V 1ciuo ET VflHi39aI5quot POSTERIOR VEIN or L quot39H39EHTEIEL39 J I CORONAquot ARTERY MIDDIE naED lAC quot e 39E H T LEFT FD5139EnIaD VV HTEwEHmiEUME V p IFEi5TEEEiE oesaemmna quot 39EHAH H DP E coaoumr ARTERY 9 K II H subclcwian artery T ileft common coroticl artery o brhisoA eph li artery puiiimnnuryr r1 V l aortic I L A 0 mernivunorI pulmonary valve C D gt quotV V 39 Into rare ffi iji rf A NI septum I U I 39 on enor zusp left ventricle I1 cl F4 c arnlIieoem quotgm ventricle 39Hquot39Piquotquot397 quot quot 39 troboculue CRITIQUE of How of blood through the heart and to and from its major vessels N4l Section of pulmonary y y i dw trunk wall Left coronary artsryr p iallirucl cardiac vein Right coronary anew Anterior cardiac veins 39 Fnsterirnr39 vein left I ventrivele lAh Right marginal V branch Great cardiac vein Transverse branch r MIddle cardiac vein right coronary 39esterrier descending hzraci interventricular branch j R rizht curnna 1 W r39i7tarnhrl ndig jinrienrentricuarl r Eranc1left coronary V v Schema of usual disposition of A coronary arteries and B cardiac veins in the transparent heart s posterior structures crosshatched In A a piece of the pulmonary trunk wall was left in place to show tha rior vessels solid the left coronary artery crosses behind that vessel r I 3 they form many anastomoses with each other collateral circulation 4 RIGHT CORONARY ARTERY a Marginal Branch supplies the SA Node b Posterior Interventricular Descending Branch 5 LEFT CORONARY ARTERY a Circumflex Branch kb Anterior Interventricular Descending Branch b Coronary Sinus 3 1 located in the atrioventric surface R s 2 receives blood from cardiac veins anterior interventricular vein 3 empties into the RT ATRIUM near opening of the IVC ular sulcus on the posterior 11 PATHOLOGIES amp DISORDERS OF THE HEART a Rheumatic Heart Disease 1 an auto immune disease triggered by Streptococcus viridans 2 can result in a endocarditis b valvular disease b Coronary Artery Disease 1 caused by atherosclerosis of the coronary arteries 2 can result in a Angina pectoris CAb gt g39eJggg1 JPfLl0f lgt iMwocA bmL ISCHEMM 4 1 lumen oHe 239 J 3 muCLE 1 1 CA b Coronary Thrombosis c quot naTV Artery BYPEISS D gt W Pr 0 l M 1 u u u W39 N mow c Conduction Blocks 1 ex SA Nodal Block AV Nodal Block Bundle Branch Block 2 results in abnormal rhythmns NI4 Blood vessel Blood vessel pb r39 5 la V quot Y 39 quotINJ quotl llllr 0 oL l E L Z gjslslallwla lSlS w Blood vessel d Heart Murmurs A6tic Valve Normal Stenotic Insufficient Open closed Open Closed Fig 23 Le A prosthetic valve used for trepllaazase men of di5ease39l aortic vaim j de ne is in serted into the valve ring move ment of the caged ball substi tutes for action of valve cusps Right Lateral chest xray of a patient in whom both aortic and mitral valves have been re placed with prosthetic devices such as are shown on the left Courtesy of Dr Albert Starr C BLOOD VESSELS 1 Histology a Terms lumen 1 cavity Tunica intima 2 Qquot m w 0 W S k or W S 13 Tunica media elastic CT 1 Tu vi a amp smooth ltEEETlquotIETT muscle 4 Tunica externa adventitia fibrous C T 5 Vasa vasorum uimian n JHHE139iDE E HEI9D39I39H U hIiquotl39II39Ii39 hwi T jg xsaxm iztc a5 d p P 0t K V P 1 g p n T zone A T IrI3EULii AVASCUIAI A L Endotheliurn Endmheiquotu2ma Tumca ii ii Basement intima 0 Z R B 039 membran IIf3aeeEnent 0 M 9 up rj 7 z y S 4 Circular internal L E quot0 0 00 elastic bers P H iv 2 n Tunica media 0 e 0G V P lL39 quot53 TunIca media W vy wanEEl VT E ema ff l j adven a 3939 W 4 quot7quot d Capillary I quot 1 Tunica extema 0 0 1 3 adventitia quot 139 I 3 Vein Cb Elastic arteryy 939 r 5 b Types of Blood Vessels E Q 1 Elastic Arteries a contain much elastic CT in walls b act to smooth out Blood Flow 2 Muscular Arterioles a contain much smooth muscle in walls b innervated by autonomic motorneurons c act to divert blood flow from inactive tissues to active tissues 3 Capillary Bed a there are about 60000 miles of capillaries in the body b nutrients diffuse out of capillaries while tissue wasteproducts diffuse into capillaries c Metarteriole capillary bed bypass vessel that shunts blood from an arteriole directly to a venule d Precapillary Sphincters muscular valves that regulate blood flow 4 Venules small veins NH V mm pyI V amp ear P 435 Schematic representation of a capillary bed Insert A shows some of the muscle bers of the proximal part of a thoroughfare channel Insert B shows part of a true capillary 5 Veins a thinnerwalled than arteries b no elastic CT in walls c innervated by autonomic motorneurons d possess semilunar valves to prevent the backflow of blood NI8 Toward the heart L pE smusono 39I I H quot 39vquotIquot 39di39eEquot39I L I Valves of a vein The ar rows indicate that the valves are forced open by pressure from below and shut by pressure from above This allows blood to move in only one direction toward the man K t quotValve open 6 Venous sinuses A no a veins with no elastic CT or smooth muscle T media b Examples cranial venous sinuses Coronary Sinus hepatic sinuses 2 PATHOLOGIES amp DISORDERS OF BLOOD VESSELS a Arteriosclerosis b Atherosclerosis l plaque formation 2 results in a coronary artery disease b hypertension o Aneurysm 1 weak spot in wall of vessel Progressite Atherosclerotic Buildup on Arierg Walls 2 diagnosed with angiogram NH To illustrate the way in which after occlusion of a main artery the ow of blood ican be maintained through a collateral circulation ANGIOGRAM or cnlzonb mew EM 5M d Phlebitis l inflammation of veins 2 thrombophlebitis 3 e Embolism 1 dislodged blood clot 2 Examples cerebral embolism pulmonary embolism f Varicose Veins 1 veins distended with blood due to deficient valves 2 Examples Great Saphenous Vein Hemorrhoidal Veins 3lfactors JU d posivm Pregnanajokgsnlj Valve incompetence develops as dilatation of a vessel prevents effective approximation of the valve cusps N 20 Steven A Fink Instructor ANATOMY I REVIEW OF CIFCULATORY SYSTEM Left Atrium Left AV Valve Left Ventricle Aorticvvalve Ascending Aorta i Aortic Arch Rt amp Left Coronary Arteries 9V3910C9RNUV1 oF H fm Located in the aortic arch are the aortic sinus nerve fibers that detect changes in blood pressure and the aortic body nerve fibers that detect changes in oxygen in the blood AORT ICi ARCH Aortic Arch 1 Common Carotid Arteries i Right Common Carotid A Brachiocephalic Artery 39 Right Subclavian A Left Common Carotid A a Left Subclavian A A Located at the bifurcationrof the Common Carotid Arteries are the Carotid Sinus nerve fibers that detect changes in blood pressure and the Carotid Body nerve fibers that detect changes in oxygen in the blood B External Carotid A e upplie bl9od to fac neck and thyroid gland CEREBRAL ARTERIAL CIRCLE bou 33 2 T22 352 328 858 2 S TEaT uTETTuET TE 5 TTTTTT1TTTT u uEEE3 TTTTTT n n TaE TT TTEuu EuE TTTT Ea T u E95 8 nT TE TnmT um 0 TEETH mT TEEE hTnwwTnMTuTT m o Thorn nua 2 E3 mutate 2030 uE8 2 T T EST 33 ogt8oT 92 ugt 3 uuu 2 932 TT 52 9 ouuu ut4 2F jf ETmEnTTTuTETT wE T TT TmTmm TTm wTHnTmEmTT TT T gtuo EETTuTTTTT T 2 ES T T Tfm mm Tao TmETTmET TT 8z 2 two 05 nutult 32 Beta iota uo8 uuuxo T v z T T T T a T n2oou T a T T g V U B y T P T Q EETmTnT ou T 0 T p L p T I T V T k T MTTT TT TTuiTTTEauEmT b T t p d Py TiTaunTw mTT T ETTmTE T n TuTTgEuunEE3E T 0 y b P v x uEEE T pg pg tutu k 3w T T m METET TTTT T ou g T TET Tu T TT TT T hampTmna n TunuT T TT T T T u y w T TT T TTTaTTT 5 5Z quotCircle of Willisquot m P p v T T k w TT T T T w TT23 TT w T T T w t T T A mlTm Tm TT 0f T 2 T TT Ta nTTT TT TT TT v m u T a v T B NV T T T T v w PN e T T T T T TNT v y T T T T Z TT TT p x PJu w TT T H TTT pyA 3 T TT T T i t T T T T T TT 0 v mX t T TT T TTTTTTTETa N uT N TTT T 1 Z T Z j TTTT Th A T T T T T 5V mTT TTTT 0V pnm V TTTTT p TT xt T T T V 3 rsa T Pt TT TT m T T T T T T 1 TT pt ra T T t T T T T EI T TT T T T nTTTaTnETuTTuotonm T T T uTETmuPMTTnDT pv T u5eooTn TTTTT V H RT K T L T T O O TTEuEn h T 9533 uauE 3 H 22 Fink CIRCULATORX SYSTEM C Internal Carotid A 1 passes through carotid canal in the temporal bone 2 opthalmic artery 3 anterior amp middle cerebral arteries CIRCLE OF WILLIS IISubclavian Arteries A VertebraI Artery 1 passes up the transverse foramina of the cervical vertebrae through the foramen magnum of the skull 39BRAIN 2 Basilar Artery 5 cerebellar arteries bCposterior cerebral arter CIRCLE OF WILLIS I B Internal Thoracic A supply blood to pectoral muscles mammary glands amp thymus C Ihyrocervical A supply blood to thyroid gland and shoulder muscles D Lsee o lBrachial A you can feel the pulse of the brachial arteries between the epicondyles of the humerus a Radial A runs along the thumb side of forearm radial pulse can be felt at wrist b ulnar A Note The radial and ulnar arteries terminate in anastomosing interconnecting branches to form two arches the superficial amp deep palmar arches from which arise tiny digital arteries 39 down each side of the finger A 03 Fink CIRCULATORY SYSTEM THORACIC AORTA AND ABDOMINAL AOBTA Thoracic Aorta Agdominal Aorta Intercostal A parietal supplies blood to the intercostal muscles amp skin of thorax Bronchial A visceral supplies blood to lungs Esophageal Artery visceral Superior parietal D muscle aortic hiatus of Diaphragm T12 Inferior Phrenic Artery parietal gwrgiac Arter visceral Lef1 Gastric A lesser curvature of stomach enic lienal Aw len astroepiploic AJgreater curvature of stomach Duodenal Au yEuerio Mesenteric A visceral supplies blood to small intestine excepg duodenum amp ascending colon of large intestine Adrenal A Suprarenal visceral supplies blood to adrenal gland Renal A visceral supplies blood to kidney Testicular Spermatic or Ovarian Arteries visceral gnferior Mesenteric Artery visceral supplies most of large intestine Lumbar A parietal Common Iliac Arteries parietal Middle Sacral A parietal terminal branch of aorta supplies blood to sacrum amp coccyx 04 Rig quot39quot quot quot d quot9quot i up 5 A 39 r Left common carotid artery Right subclavian ltartIrf P p i 39 11 Left subclavian artery tilagrdtiac i hiaiie arttti T p T P i T i O i PW I J Left intercostal arteries p5Mb1uG Aorta A 1 it car1r1ltar3r art a Eranrihiai arteries T omctc ncmn re 4 2 Elaphagegait arteries Opening for aorta i A E Superior phrenic artery through diaphragm 4 quot i nferisar39 phrenic I artery Hepatic artery i e sling artery Right gastric arteqr g Right renal artery 2 g tPRENF W v rena a ery 39 Superior mesenteriocl at inferior mesenteric artery Left common iliac artery Middle sacral artery ie39Ft internal iliac artery Leh external iliac artery Clmental branches Left gastroepiploic artery L h at rt 52 t39 d 393L Right hepatic artery m U 4 ah i right branches V 7 Eamman hepatic l1El39 Iquot A g hegtic Karte vi p Gustraduadienai artery Right gastroepiploic rtergtr Py Superior panicreati cad uace taIt artery Interior pancreaticoduodenal artery Superior mesenteric artery Fink CIRCULATORY SYSTEM I Common Iliac Arteries A Internal Iliac A sssupplies blood to rectum Rectal or HemorrhoidalpA urinary bladder uterus pelvis buttocks amp external genitalia Umbilical Al branches off Int Iliac A in fetus BExternal Iliac A passes underneath inguinal ligament 1 Egmoral A The External Iliac continues through leg as the Femoral Artery which passes under Sartorius muscle then between the Quadriceps femoris and Adductor group It then passes through the tendon of the Adductor magnus to the back of the knee a Popliteal A passes down through popliteal space behind knee where it forms an anastomoses 1 Anterior Tibial A a passes down front of leg b Dorsalis Pedis A supplies blood to foot 2 Posterior Tibial A supplies back of leg a Peroneal A supplies blood to lateral side of leg b Plantar A supplies blood to sole of foot Note The Dorsalis pedis A amp Plantar A terminate in an anas tomosing branch the Plantar Arch fromwhich arise the tiny Digital Arteries Interior vena cava Emrnaru iac hi l V mj 39hdalal gs Middle sacral artery A quotExternal iliac atrte i y V pX 6 T 39 A quot at e L A r 0 p re A lmar lHE Wart Superior gluteal artery A L 9 P yyljexinferior GPigasmc angry Deep cirfum u mac emery 7 D Lateral sacral artery Interior gluteal artery T E p J N 1 T Internal pudendal artery l 39 Cl39b39tquotutr39riter artery Descending branch Equot l W Lateral femoral circumflex artery Medial femoral circum ex artery Deep femoral artery 39 Femoral rjrter K A Descending genicular artery A l eraneal artery P Pasteriar tiliialirter3r l f nferiiarjihlalt artr Y T Arcuate artery of plantar arterial arch Dorsal digital arteries Circulation through the Body 0 9 Circulation through the Veins II THE VEINS A Terms 1 Superficial cutaneous Veins return blood from skin and subcutaneous structures by anastomosing interconnecting with deep veins 2 Deep Veins a accompany the principal arteries 8 usually have the same name b they are larger amp more numerous than the accompanying arteries called quotvenae comitantesquot c form many anastomoses with other veins p d possess more valves than super cial veins 3 Venous Sinuses a refers to relatively large thinwalled veins that are found only in certain locations b include 1 Venous Sinuses in the dura mater of the brain 2 Coronary Sinus of Heart C 0 R Veins ofwthe Head amp Neck Cranial Venous Sinuses Transverse Sinus Sigmoid Sinus AXILLARY EXTERNAL JUGULAR VEFITEBRAL 1 jugularforamen VEIN P 6 3Ll gE1lZ3L lVlAN vain lNTEFlN l39LlJUGU LAH1 EI39N tEHACHlDCEElHlLlC VEVIN NOTES the Internal Jugular Veins drain the head ie areas supplied by the Internal Carotid Arteries the External Jugular Veins drain the face amp neck ie areas supplied by the External Carotid Arteries o9 Superior sagittal sinus Inferior sagittal sinus Great vein of Earlene Cerebral faic Supraorbital and supratrochlear vein piht haI39mii vein Con uence I of sinuses T Aniteriuir Torcular facial vein Herophiii Occipital sinus V 5UD8I39i0f Detrosal sinus Inferior petrosal sinus 39iritErin1aI i Lggigiar iseiiij 39 OIO Circulation through the Body H 0 I I B Veins of the Upper Extremiy includes both superficial veins and deep veins with many anastomoses between them Superficial 8 Deep Palmar tiquotiea puts Arches H g LVEIN tBAsILoivEIN ieoaiiaio1L VEIM irnedjiaili 1 A I I s 1 J MEDiAN I Lorsall Venous CUEITIKL I Arches VEIN I i 1 CEPHALIC VEIN pAxILLARY VEIN lateral I I I Ex1EnNAL 1 55 I I I I LYMPHATJE is ih or cicpif UCT i L I BRACHIOCEPHALIC VEIN N e the Lymphatic Thoracic Ducts passup through the Aortic hiatus of the Diaphragm 0 ii amgt umn 8 w onuu2oE N uo oogt uEon out2m 20 309 nEun muu A 0 X mi EE uuEm mT u9noU mm wn aw u u A W Em Tu um Eu oEuanoa ouoltlt 0 uuum Icogt 233 uuET H m cuxlt ogt uzusnou A A Conouult UgtU U W 2 1oc unm ogt um E um oEoxm agt ono oo m uEoc Coxoltlt ugt ono LET n m ouu o2mo 50gt OUDn 012 2852 ouoow 50gt o 3 am gt 5 oonE2uuultlt 2 VmJL 3 G V anTEunj m 552 p G Fink THE VEINS 2 Superficial Veins a Basilic vein 1 drains blood from the medial side of the arm 2 empties into the Brachial Vein b Cephalic Vein T 1 drains blood from the lateral side of the arm 2 receives blood from the Median Cubital Vein 3 empties into the Axillary Vein just below the clavicle c Median Cubital Vein an anastomotic vessel between the Cephalic Vein and Basilic Vein at the antecubital fossa bend of the elbow This vein is commonly used for drawing blood or for intravenous IV injections D Veins of the Thoraxp Rt Brachiocephalic Left Brachiocephalic vein a Vein Azygos Vein p Superior Vena Cava l Coronary p RIGHT ATRIUM Sinus Inferior Vena Cava NOTES AZYGOSVEINi located anterior to the vertebral column drains blood from the abdomen thorax mediastinum amp lungs passes up through the Aortic hiatus of Diaphragm empties into the Superior Vena Cava at T4 serves as a link anastomosis between the Superior Vena Cava and the inferior Vena Cava analternateroute of venous return to the heart 0I3 w jugs o2 uET 8 uoouo V L CuooU ogtuu ace o uu T Ea 7 oogt 2 3o2 Hanna v g za39 asE F 1 39 39 I 7quot 39l 9 03 ooElt ogt un ot2mom J pq wnhmmu uE agt aooom lll u V mgt 003 2 0 ogt Emma E npmmu T V E 0523 moon cogt ooE xoEuu uo3 cogt on3O ogt uomno uuomm cogt uom E ogt nuu ooo M 0 ua E2 950 ou12 xoEuu ouom mogt uc a2 ogt uom oonm 1 P6 B uE uu oEEoU ogtau uogt o OI4 F ink THE VEINS E Veins o pthe Lower Extremity includes both superficial veins and deep veins with many anastomoses between them 1 Deep Veins Dorsal Venous Plantar Venous Arch Network 1 P L medial lateral peroneal Dorsalis Pedis Vein plantar plantar vein vein 39 vein 9 Anterior Tibial V Posterior Tibial Vein lateral aspect of foot 77 L gtSmall Saphenous Veingp Popliteal Vein lateral 39 medial aspect of foot IGreat Saphenous Vein 0 Femoral Vein medial External Iliac Vein 2 Superficial Veins a Great Saphenous Vein longest vein in body 1 drains blood from the medial aspect of the leg 2 empties intb the Femoral Vein i b Small Saphenous Vein 1 drainsfblood from the lateral aspect of the leg 2 empties into the Popliteal Vein F Veins of the Pelyis External Iliac V Internal Iliac V Comon Iliac Vein 8 I Inferior Vena Cava OI5 Fink THE VEINS G Veins of the Abdomen Middle Sacral l Common Iliac Veins Lumbar Veins Testicular or Ovarian Veins Inferior Vena Cava Renal Veins Adrenal Suprarenal Veins Hepatic veins 391 NOTES INFERIOR VENA CAVA IVC ascends on right side of vertebral column just to the right of the Abdominal Aorta behind the parietal peritoneum because the IVC is located on the right side of the vertebral column the Left Testicular or Ovarian amp Left Adrenal Supra renal Veins enter the Left Renal Vein rather than the IVC directly Veins from the GI Tract do not drain directly into the IVC H Hepatic Portal System 1 Blood from the abdominal GI Tract amp accessory organs drains directly into the Hepatic Portal Vein at L 2 Superior Mesenteric Vein Splenic lienal Vein Gastric Vein PancreaticVein Inferior Mesenteric Vein Hepatic Portal Vein 2 Superior s s Mesenteric Veij l plenic Vein is Hepatic PortalVein1 M V L LIVER processes amp stores nutrients Hepatic Vein 3 The liver thus receives blood from two sources the Hepatic Artery oxygenated blood and the Hepatic Portal Vein high in nutrients absorbed from the GITract 0I6 Fink THE VEINS I Pulmonary Circuit Superior Vena Cava Inferior l Vena Cava V RIGHT ATRIUM 4 Coronary Sinus Rig t AV Valve Icvsmb RIGHT VENTRICLE Pumounnw VALVE Pulmonary p Right Pulmonary Artery Left Pulmonary Artery Right LUNG Left LUNG 2 Right Pulmonary Veins 2 Left Pulmonary Veins in LEFT ATRIUM 0I7 Steven A Fink Instructor ANATOMY 1 THE CIRCULATORY SYSTEM TRACE THE PATH OF BLOOD I39 0 N I OkODlOUquotrlLid O0 is I39 E39 12 13a RT DORSALIS PEDIS VEIN 14 g15 16 17 18 19 20 LEFT VENTRICLE gt DORSUM OF RIGHT ATRIUM RIGHT FOOT LEFT VENTRICLE ASCENDING AORTA AORTIC ARCH THORACIC AORTA ABDOMINAL AORTA RT RT RT RT RT common ILIAC ARTERY FEMORAL ARTERY POPLITEAL ARTERY ANTERIOR TIBIAL ARTERY DORSALIS PEDIS ARTERY CARILLARY BRD OF pQRUMaOFjRIGHT FOOT RT RT RT RT RT RT DORSAL VENOUS NETWORK 393 f3b RT SMALL SAPHENOUS VEIN ANTERIOR TIBIAL VEIN POPLITEAL VEIN y A FEMORAL VEIN A 136 RT GREAT SAPHENOUS VEIN EXTERNAL ILIAC VEIN COMMON ILIAC VEIN INFERIOR VENA CAVA RIGHT ATRIUM OI TRACE THE PATH OF BLOOD 1C 2 3 4a RIGHT PULMONARY ARTERY 5a CAPILLARY BED OF 6 a RIGHT PULMONARY VEIN 7 8 9 10 11 12 13 14a SPLENIC ARTERY 15 15 17 18 19 2o 21 22 23 RIGHT ATRIUM gt STOMACH RIGHT ATRIUM RIGHT ATRIUM RIGHT VENTRICLE PULMONARY ARTERY 41 LEFT PULMONARY ARTERY 5b CAPILLARY BED OF LEFT LU Qgt RIGHT LUNGT 6b LEFT PHLHOHARY VEIN LEFT ATRIUM 6 LEFT VENTRICLE ASCENDING AORTA AORTIC ARCH THORACIC AORTA ABDOMINAL AORTA COELIAC ARTERY 14b LEFT GASTRIC ARTERY GASTROEPIPLOIC ARTERY CAPILLARY BED OF sTOMACHg GASTRIC VEIN SPLENIC VEIN HEPATIC PORTAL VEIN CAPILLARY BED OF LIVER HEPATIC VEIN INFERIOR VENA CAVA RIGHT ATRIUM OH Steven A Fink Instructor ANATOMY 1 THE CIRCQLATORY SYSTEM TRACE THE PATH OF BLOOD LEFT VENTRICLE 45 BRAIN RIGHT ATRIUM 1 LEFT VENTRICLE 2 ASCENDING AORTA 3 AORTIC ARCH 4a BRACHIOCEPHALIC ARTERT ARTERY 5a RIGET 5b FIGHT COMMON SUBCLAVIAN CAROTID ARTERT ARTERY V 6a RTVERTEBRAL ARTEEE 7a RIGHT INTERNAL CARDTID ARTERY 8 cIRcLE OF WILLIS39 9 cARILLARY BED OF BRAIN 10 CRANIAL VENOUS SINUSES 11 TRANSVERSE SINUS 12 SIGMOID SINUS 13 INTERNAL JUGULAR VEINS 14 SUECLAVIAN vEINs 15 ERACHIOCEPHALIC VEINS 16 SUPERIOR VENA cAvA 17 RIGHT ATRIUM O 20 7th EAEILAR ARTERY 4b LEFT SUBCLAVIAN 6b LT VERTEBRAL ARTERE c LEFT COMMON cARoTID ARTERY 7c LEET INTERNAL cARoTIn ARTERT I THE LYMPHATlC TE A General Functions 1 conduct excess fluid that filteredout of the capillaries from the tissues back to the Cardiovascular System 2 filtration amp phagocytosis of foreign agents 3 production of lymphocytes p39CE lE llTiI5l39aIl lymph nodes left thoracic duct f inginal lymph nodes plimlit al1 lymph nodes periplhra l lymphatics 1 J 4 393 B The Lymphatfzp essels 391 Lymph Flow Right 3 PHFITIO Duct mm SUBCLAVIAN VEIN n b cw Zynlgfhatzcf Zymphat1c LEFT capzllarzes eollectzng Vi vessels Clstemm LLIMPHATIQ LT SUBCLAVIAN VEIN C39hyZ7l DUCT 39 PI LEFT JUGULAR TRUNK mam JuGuLAn E 393939 In THOHACIC DUCT RIGHT BHONCHO MEDIASTINAL TRUNK quotquot quoti 15 J39F E 39lBi VENA 39EhfiaI39A POSTERIOR quotas JHTE EZE5T L VESSELS AND NODES I39l aI39l F iIn Irquotquotquot39 quot RENAL LYMPVH 11 rfE55ELhH i CISTEHNA 2Hquotn39g LUMBAR mum Am LATEHALI T Aonnc H E EEquotquot T1 T INTESTNAL EHLYMPH mum H EJCFEHNAL ILIAC VESSELS mo NODES INTERNAL ILIAC VESSELS AND NODES a Right Lymphatic Duct drains upper Right quadrant of body b urr Lvmpn rlc mom clc WT drains remaining 34 of body PhotopI dnvnlvehulynrhvxel 92 submandibular nodes cevicul lymph I39I39Dl B axillary lymph P v i hp n nodes lymphatics of mrumzmu mtercostcul nles r thoracic lI E 39 O r39 j p g39 39ms F diaphragm X right ikidnev v H chyle cistern ureter i p H p o 0w inferior at Ev H quot I ZY common iliac n e ggr uterine tube e v39Irj e 39 LI EfE7FU 5 c lymphatic vessels ye 1 have very thin walls 2 possess semilunar valves to prevent back flow of lymph 9 2 Lacteals lymphatic capillaries specialized to absorb lipidsoluble nutrients from the intestinal tract EU LYMPH NODES 1 small round or beanshaped organs containing macrophages and lymphocytes 2 distribution of Lymph Nodes in Body Medullcn ry cords it 39 Lymph sing h A Efferent lymphatic e3 39 vessel Artery and vin Lymph node Conical and medullaxy areas contain both lymphocytes and macrophages Arrows indicate direction of lymph ow Note valves in afferent and efferent vessels 3 swelling of Lymph Nodes D SPLEEN quotlienquot 1 located in upper left quadrant of the abdomen 2 composed of a White Bulp Tissue L lMPHocMTes Vmoeo PHJGEIS b Bed Pulp Tissuem l r e varmus smvseS tvag39 ma M n A quot7quot ii7IquotiI quot 39l39quot3quotE 39 pn E L V M uilp TI 53Ul V irgnous sinuses Figure 216 The functional structures of the spleen Modi ed from Bloom and Fawcett Textbook of Histology Philadelphia W B Saunders Company 1975 3 Add39t39 1 F t39 quotF J a lltaresoin 80Ya3 L OT M M6 p 66 39 66 I68 b destruction of worn out Erythrocytes macrophages cproduction of Erythrocytes in the Fetus E THYMUS 1 located in the lower neck and mediastinum 2 atrophies after puberty F TONSILAR TISSUE 1 Pharyngeal Tonsil Adenoid 2 Palatine Tonsils 3 Lingual Tonsil 4 Lymphatic Nodules of the Intestine Peyer39s Patches 5 Appendix G DISEASES AND DISORDERS OF THE LYMPHATIC SYSTEM 1 Lymphangitis 2 Lymphedema a obstruction of lymphatic vessels 9edema b causes agis GL6 raAc39aQ masiedbmg 3 AutoImmune Diseases a disorder of the Thymus b Examples Lupus erythematosus Rheumatoid Arthritis Rheumatic Heart Disease Myasthenia gravis Multiple sclerosis Ulcerative colitis JUVeNLE oNsET DIAEETES Ps Endocrine System Endocrine System A Gland Hormone Functions Disorders Thyroid Gland Thyroxin Increases metabolic Hypothyroidism reactions associated or Cretinism with Energy def production Growth amp Development H3 39d39Sm 7 Calcitonin Lowers blood Calcium amp Phosphate levels Parathyroid Parathyroid Increases blood Hyocalcemia Gand Hormone PTH Calcium levels amp def lowers blood Decalcification Phosphorus levels excess Adrenal Gland Medulla Epinephrine Increases Metabolic Adrenalin Flate Heart Rate Breathing amp Blood Flow to Muscles during Exercise Cortex Mineralocorticoids Causes Kidneys to I Aldosterone Eztja nefgg Water STQQOEIEE Potassium into the W2 urine C Glucocorticoids Raises blood Sugar Addison39s Cortisol level Disease def 5TeR quotgt i 239 HORMONE excess Uterus womb during Pregnancy Endocrine System Q2 P 0 Pquot B i P P Gland Hormone Functions Disorders Pancreas Insulin i Lowers blood Sugar A Diabetes Pancreatic Islets level mellitus def quotIslets of Langerhansquot Glucagon Raises blood Sugar level A Testes Testosterone Masculinizing Hcnnone Ovaries Estrogen Feminizing Hormone Progesterone Increases vascularization of Uterus womb placenta Chorionic Maintain Gonadotropin vascularization of Q3 Endocrine System Q3 Gland Hormone Functions 5 Disorders Pituitary Gland Neurohypophysis Antidiuretic Causes Kidneys to Hormone ADH retain water amp Posterior Pituita Gland excrete small W volumes of urine Oxytocin W Sjtirnulates laoor S contractions amp milk letdown during nursing Pituitary Gland A Adenohypophysis A Thyrotropin Stimultes Thyroid T SH Gland to secrete Anterior Th roxin Pituitary Gland V S i Adrenooorticotropin 9 Stimulates 139 P ACTH Adrenal Cortex to A 5 secrete it 39 glucocorticoids cortisol A S i a S p Folliclestimulating Stimulates Gonads to Hormone FSH secrete gametes amp Luteinizing and sex hormones Hormone LH T Sarowthl Honnone Stimulates growth in S Dwarfism def EH body esp Skeletal l rt system Gi r392 2 2i l y t g E quot 9 Y See E4 E6 excess i i Prolactin S SStimuatSesMammary A Glands to produce i l milk Endocrine System u I i 39 39 3 I g 1111 W P 1 V ahi quot14 39 fr r 45 F45luHE39aTHquotFHlUID Q4 TTTIIE REPRODUCTIVE SYSTEM I Regulation of the Reproductiye Organs A Definitions 1 Endocrine Gland a ductless gland that secretes hormones directly into the bloodstream 2 Hormones quotto arousequot chemicals secreted by endocrine glands that are carried in the bloodstream and cause changes in cell and organ function B Role of the Pituitary Gland 1 Location u l i39li IquotIE39E iij s 1 eerebrum p r P r ms eaZ atera G Ti ventricle l39i p q 3rd ventricle 1 up 3 am i i Pq j thalamus rnidhrairi ip quotA p G I quot I pituitary glarnrliyr n 39 iierlulla lt d I G 4 cerebellum lth ventricle La Diagram showing the major areas of the brain encases within the skull Note the location of the Hypothalamus and the Pituitary Gland 2 Action releases hormones in response to chemical factors produced by neurons in the Hypothalamus of the brain 3 the Pituitary Gland secretes 2 Gonadotropic Hormones Diagram iliustrating the hypothalamic pituitary gonad system as it functions in the male hypothatsntus ems us it anterior E pituitary testosterone i substance u re Page 2 Simpli ed diagram of the hypothalamic pituitarygonad system as it tunctiorts in the tomato hypothalamus A s m anterior t y pituitary estrogen progesterone A V a Follicle Stimulating Hormone FSH 1 MALE 2 FEMALE b Luteinizing Hormone LH 1 MALE 2 FEMALE I I PUBERTY A period of sexual development B Timing of Puberty C Physical Changes FElAAI Higher oerebrel a center quottriggerquot M Idinbhvnophvii pl The effects of the sex hormones on development at puberty rsyn dreams inu Ind rtean hormone Adrenal cortices i hormorreeprogyand We Page 3 Hlir line Adrenel P P ondrogenequot39quoti zl ulgnld Hiiiulrone enlarges mi 0 HHMIEU Hill Estrogen nr dyud l lf lltimuleted by ICSII eerniniferoul tubule proliferate due to FSH end testosterone Itlmuletlon The releas ht39lI39I39lv vee r iwpun Flquotzlill heir P0ll Llrynx 3939I vImere union Ii 39I 39r iI it Wllulculmu develops 39 Some hreen quot miilzrniemerui WIIV OGCIl39 Axillary heir appears c rubs heir XIII hpsmmnm union hemned e of of Follicle Stimulating Homrone FSH and Luteinizing Hormone LH from the Pituitary Gland stimulates the gonads testesovaries to produce gametes sex cells and secrete sex hormones testosteroneestrogen amp progesterone These sex hormones cause the development of the secondary sex characteristics at puberty IFENUELE breast development fat deposition in buttocks menstruation increased growth of genitals growth of pubic amp axillary hair MALE facial amp chest hair increased size of larynx increased muscle development increased secretion by sweat amp scent glands development of acne ADOLESCENCEr period of emotional amp mental development F23 III THE MALE REPRODUCTIVE SYSTEM A External Genitalia l Penis unmnlqm me a glans b urethra orifice quot cprepuce foreskin lt CIRCUMCISION Gquotquot Ewes W do haft I sni39 c Penascrotal 0H rphe39 em quot wmum Prince nphe39 ll Ftenulne M Ferienal tissues including Iltlf ll S ili llf 2 Scrotum a located just below the penis b the Testes are enclosed within the scrotum the scrotum acts as a heatregulating container for the Testes in a cold environment the scrotum contracts elevating the testes and in a warm environment the scrotum relaxes lowering the testes In this way the Testes are normally 339 lower than the core body temperature 3 Erection of the Penis during sexual arousal YASOCONGESTION as the venous sinuses within the penis become engorged with blood the penis becomes erect 39g5 nuetus daf ml versatile tissue pubic bone Ieminal vesicle am e preltnte rectum a d yrnis quottestis I S Cowper gland 39 scrotum Glens penis Corpus nmrarnnsum penis h P y V Cerpus sponglosum K 1 quot Ir a penis I 5 Ti i V A Artry lschiocavernosus muscle g q z 39 j u Gluteus rnaximus muscle j Urethra a Venous Sinuses 1 Corpus spongiosum located on the ventral aspect of the penis surrounds the urethral canal 2 Corpora cavernosa b Changes in penile size Flaccid g g Erect g Length 2345 inches 4792 inches Circumference 338 in avg 438 in avg Diameter 1 in avg 1 in avg Reference H Katchadourian amp D Lunde Fundamentals qf Human Sexuality 1975 2nd ed B Internal Genitaliaz urinaty 0 a bladder rectum iunctn eferens s a it pain i 39 quot 39ampulla Cowper erectile gland ussue hnl t g a ipididyn39 i PW scrmul ac 5 a Page 6 u u vnsicle p7rn7rsftlnat gIa7n1li 1 se lnwpafs gland V65 d uctu3Jdaltl Irens 9r n gamma cam location of u39 l 0 p l o plmm i 13 e for vasectomy age o T sominiierus tubule penis T V i aminiT eiuus interstitial call gt 1 Testes quotto witnessquot a Size 2quot x 1quot x 1quot b Functions 1 Spermatogenesis a occurs in the seminiferous tubules of the Testes b maturation of sperm takes about 64 days c stimulated by FSH produced by the Pituitary Gland 2 Secretion of Testosterone a secreted into the bloodstream ay the Leydig cells b stimulated by LH produced by the Pituitary Gland c Actions of Testosterone stimulates masculinization stimulates sperm production stimulates anabolic biochemical reactions ex growth stimulates libido 2 Epididymis 20foot long highly coiled tube for the storage of spermp 3 Vas Ductus Deferens a an 18inch long muscular tube that passesup the inguinal canal into the abdominal cavity b each Vas Deferens unites with a Seminal Vesicle to form an Ejaculatory Duct that opens into the prostatic urethra R6 Page 7 c Vasectomy YEV6n rS Sfbrm Rom Comms0U H12 0 4 Seminal Vesicles 2inch long glands that secrete about 70 of the semen 5 Prostate Gland a located just beneath the urinary bladder b the urethral canal passes right through the Prostate Gland c it secretes about 30 of the semen d Disorders of the Prostate Gland 1 Prostatitis 2 Benign Prostatic Hypertrophy causes narrowing of the urethral canal occurs in about 13 of all men over 60 yrs 3 Carcinoma of the Prostate Gland 6 Urethral Canal tube that conveys urine and semen to the outside quotmundane prosfdoemnele bnlbowotlucl uiend nt 39UI U f9hOIl39IIll39l enuofpall P A FfTquot WihFrvquot IV 0 in pB yl P u l in j I nr Fi r1lquotl39 lieMe4gnmas nan v rwe ii zt JJ39aa39i12 1 E e vg 2 a P g uh h il 4 v Pd p L Cp p Q5Q 0 0 ye r F rg 39v m 39 9quot 39Fquotquotquot1quotr 5 I quot y v in quot b39 fy ampK naggwg l7s x 39I5u3939Lquot Nahquot I 39 ne If i i w Anterior view of some urogenital relationships in thequot human male R7 Page 8 7 Cowper39s Bulbourethral Glands 2 small glands that secrete a clear sticky alkaline fluid into the urethral canal during the begining of sexual arousal E SEMEN l seminal fluid is creamy in texture gray to yellow in color 2 Average Volume ejaculated 2 3 ml 2 tsp after 3 days abstinence 3 Sperm Count 120 millionml about 360 million spermejaculate less than 20 million spermml sterility 4 Chemical Composition of Semen a water b alkaline buffers pH 74 ex NaHCO3 c salts amp minerals ex zinc d ascorbic acid Vit C e mucus for lubrication 4 f fructose sugar energy for sperm Pf g enzymes ex acid phosphatase h pro staglandins DCEitus Sexual Intercourse 1 during sexual arousal there is a general increase in muscle tension throughout the body MYOTONIA 2 EMISSION OF SPERMAND SEMINALFLUID quotimminent comingquot sensation a as the level of sexual excitement approaches its peak sperm from the Vas Deferens and seminal fluid from the Seminal Vesicles and Prostate Gland are released into the Ejaculatory Ducts of the Prostate Gland L 39 I b this process is mediated by parasympathetic motorneurons 3 THE ORGASM the quotclimaxquot a the Orgasm is associat d with involuntary rhythmic contractions of muscles throughout the body b EJACULAIION OF SPERM AND SEMINAL FLUID 1 rhythmic contractions of the Ejaculatory Ducts and the Urethral Canal cause the semen to be spurtedout the penis 2 this process is mediated by sympathetic motorneurons c this over all decrease in muscle tensions is followed by a state of profound relaxation R8 Page 9 rectum of mole ureter seminal sperms in ductus deferens 8MEI female urethra prostate gland UIPQS Gland 39C39 39 urinary bodder epididym V seminiferous tubules of testis site of sperm formation sperm fertilizing ovum penb ovary mole urethra see we The diagram above shows a sagittal section of the male and female pelvis during coitus the penis of the male inserted in the vagina of the female The sperm are produced in the seminiferous tubules of the Testes and stored in the epididymis During emission the sperm are expelled up through the Vas Deferens into the Ejaculatory Ducts of the Prostate Gland In the Ejaculatory Ducts the sperm become mixed with seminal fluid secreted by the Seminal Vesicles and Prostate Gland During ejaculation the semen is spurtedout the Urethral Canal of the Penis and deposited in the upper part of the Vagina of the female The sperm then pass up through the Uterus and reach the Fallopian Tubes about 45 minutes after copulation Fertilization of an ovum by a sperm usually occurs within the Fallopian Tube rectum of female uterus 4 The REFRACTORY PERIOD the period following an orgasmwhen a male is unable to ejaculate again E DISEASES AND DISORDERS OF THE MALE REPRODUCTIVE SYSTEM 1 Impotence inability to attain or maintain an erection 2 Infertility Sterility a low sperm count in ejaculate b Causes 1 cryptorchidism quothidden testesquot failure of Testes to fully descend down into the scrotum 2 vasectomy 3 Venereal Disease VD a symptom b Gonorrhea ohancre sores pronounced quotshang39 kerquot Page 10 caused by the diplococcus bacteria Neisseria gonorrheae c Syphilis caused by the spirochete bacteria Treponema pallidum d Genital Herpes caused by the r Orchitis inflamation of the Testes 5 Eunuchism deficiency of Testosterone r Uterine tube Prepuce 39 Uterine cervix Herpes simplex II Virus i hepaltitis ilhiUiBiquoti39E1Iii 39 IiI Irnsuasdu A bail M aaaaimonallovnrs in M shlivgelilwosns 39 aseptilc l39nenrIgIls mousing coulgh H th u llllrc Iwilgr l39Ii I391il ail sirE1nm i1gIing 11rprtruiu fever I Reported Cases or Noufinble Diseases i I 1 Tom Numbers Specmed i 1312236 3939D Source US Public Heauh service 1974 Duausonusutnuuun 39 c B Eiacuiatory duct r Seminal vesicle Ampulla of 39 6 bladder 39 Prostate i gland I Bulbourethral Mi 1 Sperrnatic cord T Epididymis at V Testis 39 U rethra Anus ductus deferens a corpus spongiosum 39 i Corpus cavernosum Corpus spongiosum Page 12 an MIdonounIt c F0M0 quotquot quotquotquot Embryological development of the external genitalia in the male and female o 9 Vaginal Birth Canal vagina Latin for quotsheathquot a 4inch long muscular tube lined by keratinizing stratified squamous epithelium I b Hymen vascularized membrane present in young girls c Bartholin39s Glands 1 secrete fluids into the vaginal canal during the begining of sexual arousal for lubrication 2 homologous with Cowper39s Glands in the male d Vaginal Yeast Infections caused by Candida albicans quotcandidiasisquot RI2 Page 13 e Functions of the Vaginal Canal l f 1 copulation N39quot5f3QOUPSE quot39quot C0 Us 2 childbirth f Episiotomy surgical cutting of the erineun the region betulen the vaginal can and the anus 39Eiitoris E W dawns f or Vest buhe V of va ina Lablurn I 5 9 maiu I I 06h Ugethrai L hvilum k ori ce my urn nice Hyman T T mmghviat 39r a The Vulu Pudendnm Femininum Episiotolny A vagina B median episiotomy clued by tm 1 5 9quot C Internal Genitalia FdopasTuB r V urinary y bladder e cervix rectum H1 gc a i vaginal canal in e 0 g P A P quotEn mi 39 1l1itnfris lahium minor labium major SideView of the Female Reproductive System RI3 Page 14 vagina OVHMHN iollicle 3 quot3 1 Ovaries quotQalifQ an l fl P a Size 135quot x32quotx 1quot Z e by b Functions Zfllm 1 O genesis Development of Primary Follicles a stimulated by FSH produced by the Pituitary Gland b normally 1 Primary Follicle matures each month c each Follicle consists of i the Ovum ii Follicle cells d Total Number of Primary Follicles that mature in a woman39s reproductive lifetime 2 Secretion of Hormones into the bloodstream a hormones are produced by the Follicle cells of the developing Follicles b Estrogens i include Estradiol Estriol and Estrone ii stimulate feminization 2 Page 15 c Progesterone quotbeforepregnancyquot i stimulates vascularization growth of blood vessels of the endometrial lining of the Uterus ii stimulates a 12 degree rise in the woman39s basal body temperature c Homologous Structures in the Male and Female J E i l E testes ovaries penis clitoris Bartholin39s Glands labia majora Cowper39s Glands scrotum oviducts a 4inch long muscular tubes lined by a ciliated mucous membrane ciliated simple columnar epithelium with goblet cells Fallopian uterine Tubes b fertilization of the ovum usually occurs within the Fallopian Tube c Tubal Ligation salpingectomy Uterus Womb a hollow muscular organ located between the Urinary Bladder and the Rectum see figure at bottom of page 13 b Size 1quot wide x 3quot tall c Gross Anatomy 1 fundus upper portion of Uterus where Fallopian tubes join 2 body middle portion 3 cervix lower portion of Uterus a external os location where mouth of Uterus opens into the Vaginal Canal 39 b vaginal fornix upper recesses of the Vaginal Canal c USE or THE DIAPHRAGM R I5 Page 16 d PAP Papanicolaou SMAR test for cervical cancer Cancer incidence in an by site and sex g 4 Male p Farnde sun 23 13 Oral 3 2 Lung 13 3 Breast 23 Colon and rectum 11 P 5 13 Other digestive 10 8 Prostate 10 DN Uterus 15 Urinary tract y 7 7 3 d Histology of the Uterus Leukemia and Iynguomas 7 e 1 Endometrium quot mquot 11 14 glandular lining of Uterus ciliated columnar epithelium supplied with many blood vessels 2 Myometrium a muscular layer of the Uterus visceral muscle tissue b labor contractions during parturition childbirth initiated by the action of Qgytocin a hormone secreted by the Pituitary Gland C C 3 Perimetrium parietal peritoneum covering over the Uterus e Hysterectomy Surge a remove oi Hie U392rus D THE MENSTRUAL CYCLE 1 the periodic shedding of a portion of the endometrial lining of the Uterus 2 length of average Menstrual Cycle 28 Days 2234 days 3 Definitions a Day 1 of Cycle 1st day of menstruation loss of menses b menses tissue cells tissue fluid amp blood that is shed c Day 14 of Cycle approximate date of ovulation the release of the ovum d Follicle consists of the Ovum surrounded by follicle cells RI6 Page 17 Tl1 EErs39lampili3al39 Tissue W q mmmcmu Maluring Follicle Yolky Cyloplasm 43 quot Ruptured Follicle Outer Wall Retrogreaive Corpus Luleum Corpus Luleurn Germinal Epithelium Emerging from Follicle 4 Preovulatory Follicular Phase Days 113 a FSH secreted by the Pituitary Gland stimulates a Primary Follicle to develop into a Graafian mature Follicle b the Follicle cells secrete Estrogen into the bloodstream Days 513 c Estrogen stimulates the growth of the endometrial lining of the Uterus 5 Ovulation Day 14 a LH secreted by the Pituitary Gland stimulates ovulation 4 b the ovum ruptures the Graafian Follicle and enters the Fallopian Tube c Day of Ovulation 14 cycle time 28 d quotmittelschmerzquot middle pain pain associated with minor bleeding following ovulation e Ovarian Cyst a large Graafian Follicle that has failed to ovulate R7 Degenerating corpus Iuteum Pquot539 3quot ry tollncle tomme Ghnnuncwae E3f 9 nS E lfrogesterone and astrogens In l my P AA pmas Y fl m I Emu changes O quot V Q CV59 339 quot 39 N g Q ZN5v f q i a V I1 1 P U II 39 iv Iii Ii 5 ail ea sg P r r sai Aiu 21 5 23 2 Pteovulatory Phase Da Postovulatory Phase 6 Postovulatory Luteal Phase Days 1528 a LH continues to be secreted by the Pituitary Gland until Daz 28 b LH causes the Follicle Cells now called the QORPUS LUTEUM to secrete Progesterone and some estrogen into the bloodstream c Progesterone stimulates vascularization and maintenance of the endometrial lining of the Uterus d Progesterone also stimulates a 12 degree rise in the woman39s basal body temperature 15 P Hill 1lll IE IEl E1HIll ll THESE 0178 Page 19 28 DAY CYCLE 1 IEISTIIITIOI IEEIHS 2 3 4 l Variations in rectal temperature of women during the menstrual cycle and pregnancy Note that there is a fall in tempera ture just prior to ovulation after which temperature remains high if 51 5 1 pregnancy occurs If pregnancy does not occur the temperature drops a few days before the beginning of the next menstruation Early morning rectal temperature PF 13 14 I7EIlilla39lT1I 1 EijE 1 10 ll IITEICDUISE OI IIIESE DIT5 1 LEAVES LIVE SPEII 9 12 to mnuzr tcc ill 0 THESE Mli V 39 9315 pregnancy 15 N 111819 21121 39 sec cur mu 1 1 I IEPIESEI1 1 39 ovulation 22 Q 11 menstruation 23 24 25 26 21 28 El39il L39x39s12quot l7l 39V I l I l I I J l quotII I II I I l lE ll II I 1il I I i I I I 1 a1le n E E 1 1r1n1sm n1222nmm if March April uturrnumou A D far P N Items Mann 1 3 D a 1 day 14quot39day Q mday BLACK uulatnsquotsAF nnrsquot caLon n NUMBERS quotuusnrs ntrsquot e If the Ovum is NOT fertilized in the Fallopian Tube 1 the ovum passes out of the woman39s body through the vaginal canal Note if the ovum was fertilized within the Uterus it will have passedout of the woman39s body before the embryo was deveoped enough to implant 2 the Pituitary Gland stops secreting LH by Day 28 the Corpus Luteum stops secreting Progesterone and estrogen and degenerates the endometrial lining of the Uterus begins to be shed menstrual bleeding 3 Menstruation a RECALL the lst Day of Menstruation DAY 1 of a new cycle b menstruation lasts about 5 days 37 days c about 12 oz of tissue fluids and blood are lost RH Ovarian and Menstrual Cycles simpli ed Page 20 ovarian cycle llenatrual cycle Phases Events Phases Events Follicular Z FlSlllse cretion by Menstruation Endornetriun bru s r Days 1 13 pituitary Dayst5 down Proliferation Endometriuln rebuilds Days 6 13 Follicle maturation and secretion of estrogen Ovulation Day 14 39 Luteal Days 1528 f Endometriurn thickens and glands are secretory Secretory Days 1528 LH secretion by pituitary Corpus luteum formation and secretion of progesterone If the Ovum is fertilized in the Fallopian Tube eightcell fourcell twocell iii A rnoiul1 zyrltgola T gee stowage il 7oge 397 5 E IRE I P 39 J H L 939 g39rov ri39ng follicles i pt sllerquotie r Ml quot of the uterus endomeirium 6 T myornetrium tnotu r ovulation mhblrlEm tomcle m am oocyte Diagrarnrnatic summary of the ovarian cycle fertilization and deveiopment during the first week The numbers indicate days after fertilization The ovurn is released trotn the ovary at ovulation and passes into the uterine tube where it is met and fertilizedby a sperm The zygote divides repeatedly as it passes down the uterine tube and becomes a rnorula The rnorula enters the uterus develops a cavity and becomes a blastocyst The blastocyst begins to invade the endometrial lining of the uterus 1 the embryo will implant in the endometrial lining of the Uterus within 1 tnreek after fertilization approximately DAY 21 of the cycle 2 the chorionic villi of the Embryo forms vascular associations with blood vessels of the endometrium of the Uterus 13 3 CHORIONIC GONADOTROPIN CG a hormone formed by the chorionic vill into the maternal circulation R20 iuof the Embryo and secreted Spiral artery inner cell mass P Outer ssytoftrophohlast shell Chorionzio cavity idua capsularis r b CG stimulates the Corpus Luteum in the mother39s ovary to continue to secrete Progesterone and estrogen throughout the pregnancy Thus even though LH stops being secreted by DAY 28 CG causes the corpus luteum to continue to secrete Progesterone which maintains the endometrial lining of the Uterus throughout the entire pregnancy In actuality then the CG produced by the embryo is controlling the mother39s ovaries during pregnancy I There will be no more menstrual cycles occurring until after the end of pregnancy c CG can presently be detected in the blood of the pregnant woman about 34 weeks after conception about 12 weeks after her missed period of menstration d Other Signs of Pregnancy i absence of menstrual period ii tenderness and enlargement of the breasts iii quotmorning sicknessquot nausea amp aversion to food iv extreme fatigue v increased frequency of urination R2 Last 7 menstrual 0 period Ovum 1El15mm 2Dirulatinnquot P P Elaislluizitfsti V f TL3mm gal l I ta HeriigHaaii 1 mp an Ion r xE3939ll Ji39gi nr 2 39lZli5rnrni V T Peziars emhrnu 394 3395 LL 2 39 W 2 begins 939 Z gm he ff E 5 positive 3 E 39quot39 lt 1 g I 39 I E 5 All 5 D 1 H W I m 2 J 5 1 I 9 139 Bimanual exarninatiar Notice the Actual size of embryos and their position of the left hand and he fact that mc brfn quot1 39 139 513 C319 basal n hi the wrist is not exed laterally or medially and mo 395 men ml hm rY39 the hand is not supinated The examining ngers here are palpating the cervix of a normally ante exed uterus Softening of lower uterine segment as an early sign of pregnancy Hegar39s sign R22 Page 23 E Reproductive Function in the Female 1 Menarche lst menstrual cycle usually between 1114 yrs 2 Menopause a the menstrual cycle becomes irregular and ceases about 50 yrs of age b CAUSE the ovaries stop responding to the gonadotropic hormones FSH and LH secreted from the Pituitary Gland Estrogens and Progesterone stop being secreted from the Ovaries Uterus and other sexual organs atroph in size c other manifestations of Menopause 1 headache muscular pains amp emotional instability 2 quothot flashes warm sensations that spread from the trunk up to the face F DISEASES AND DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM 1 Ovarian Cysts fluidfilled tumors of the Ovary 2 Uterine Fibroids a benign tumors of the myometrium I b may lead to abnormal bleeding 3 quotCervical Cancer A a 3rd most comon cancer in females after skin amp breast cancer b diaggosed using PAP smear 4 Amenorrhea a absence of menstruation b associated with a deficiency of estrogens 1 if due to lack of FSH given Pergonal 2 if due to lack of Estrogens given Premarin 39 5 Endometriosis ectopic growth of endometrialtissue of Uterus 6 Vaginitis a characterized by a whitish discharge accompanied by itching b commonly caused by Trichomonas vaginalis or Candida albicans 7 Venereal Diseases a gonorrhea b syphilis c Herpes simplex II R23 Page 24 IV PARTURITION childbirth A Fetal Position 1 the fetus normally rotates during the 7th month of pregnancy 2 Normal Position Gephalic Presentationface posterior n V I729 x ES I P Breech presentation Right ucropostenor Right ucroanmior 3 Breech Presentation Fac i39eseaon B Gestational Period 935 months mg a Right mentoantenor 1 Date of Delivery onset of last period 7 days 3 months 1 10 days Example July 10 7 days 3 months April 17 i 10 days 2 Average Full Term Child 20quot long 7 lbs head accounts for k of body G Prelabor 1 effacement thinning of the cervix due to the baby39s head pressing down on the cervix 2 quotshowquot expulsion of a blood tinged mucous plug D Labor 1 Hormones affecting occurrence a Oxytocin b Relaxin hormone secreted by the Ovaries stimulates dilation of the cervix and the softening of the pubic symphysis and pelvic ligaments Q24 Page 25 I f g J E a riuia is S Al39IlIiIl39I 2 Stages of Labor a Dilation Stage 1 duration 216 hours 2 contractions are 1520 minutes apart 3 events a dilation of the cervix b rupture of the amniotic sac 1 L of fluid b Delivery Stage 1 duration 260 minutes 2 contractions are 12 minutes apart 3 events r a crowning head of the fetus drops down to the vaginal canal b birth of the child c Afterbirth Stage discharge of the placenta quotafterbirthquot with umbilical cord attached R25 39 1 amnion and anterior vaginal Page 26 uterine wall chorion cervical canal pocenta abdominal wall can partiallyseparated hernalotna placenta Fquot umbilical Card w quot Drawings illustrating the processes oi birth A and B The cervix is dilating during the first stage of labor as the result of the amnion and chorion being forced into the cervical canal C to E The fetus passes ttarottgh the asrthat and uag ina iIll39lr39lg the SEEDHid stage of labor F As the uterus contracts during the third stage at I1ahurthei placenta latds up andquot pulls away tram the uterine wall Separation of the placenta results in hIeettirig flnlll llftlnlg a large hematoma Later the pliattenta and its associated membranes are expelled trom the utsrutis Ii1gtEi39lEl l i39tll1 h1r39tu rthetr uterinin contractions 7 4 ole 7 bab3r39shead has 8 The nti39stsquots It hand lifts ths head slightly upward Her right hand gently presses the i IEt lIl39lEl 39lEI39quotl hack anti 39t hc tsti1itc pad is laced ofsrcr the arms la j The thed395r tsrrlarges and is being iifted out by the nurse tuiwanr the mtthcrquots ahtiasttan in the t ltli ll39t1iilltg dlirsittihn tsf the birth tarsal l39tt The artery fortscps is busing appviisd tn the urrthifIisajl ctrd prior to IL39illli5ilI1Es quotThere is no pain for there are no nersrcs in lll1E lEEll39d mi The baby is thisid upside down to shew srrin7ititic flttid to drain from the air pasrsstges An irtjcciiion is 7heittg given in the 39mtT l tE139l5 lsft thigh to ensure 39l lquotIrill39 litlt1EIl2l l1 FIIiquot t39quotllEI rt ofthe uttrus This may he done the head is Irsing l39tIlquotIquotl and 39tTl1 F he gihi iit1lT tFlIlEIltl i rather that iI39l Irami15ELll3rll O Courtesy f A Paths and Dcpartrncrtt of FhsJl39 graphgr St Thtimasquot Hospttait Lmtttnn 1 R26 Page 27 E Assessment of the Newborn F 1 APGAR RATING 2 Apgar nevvborn scoring system ECO 1396 0 sign i Acrostic M D7 I A A Appearancre Heart rate Not detectable Below 100 Above 100 F PuEe Respiratory effort Absent Slow irregular Good crying G Grlmace it Muscle tone Flaccid limp Some exion Active motion A Attitude tttcnel of extremities R Flesiraftioans Re ex irritability No response Grimace Cough sneeze 39 or cry 39 5 Color Blue pale Body pink Completely pink ezttrerniities blue Sgturce Used by oi Dr Virginia Apgar 1974 lithe natural skin color of the child is not white alternative tests for color are applied such as color oi mucous rnembranes of mouth and conjunctiva quotcolor of lips palms hands and soles of feet I Blood Tests C 1 L be A I at ha a Test for Phenylketonuria quotPKUDiseasequot gt 1 min and blggdey on een pgar Sccii t Apgar score A pH b Test for Calactosemia lto3 531073 4 to 7 70 to 720 8 to 10 39 Over 725 Source Adapted from P A M Dawes quotResuscitation of the c Test for Hypothyroidism Newborn American foam CH of N mmgl m5839 I mum 1974 F The Puerperium 1 the period between the end of labor until the return of the woman to her prepregnant physiological state 2 Resumption of the Menstrual Cycle a about 2 months in nonnursing mothers b about 5 months in nursing mothers G DISEASES AND DISORDERS OF PREGNANCY 1 2C Spontaneous Abortion Miscarriage usually due to defective fetus Eclampsia a metabolic disorder of pregnancy Toxemia b associated with water amp salt retention edema hypertension and albuminuraa c can lead to convulsions amp coma Cesarian C Section a removal of the child through an abdominal incision b frequency about 14 of deliveries c Causes 1 cephalo pelvic disproportion CPD 2 failure to progess in labor R2 The Nervous System 31 The Nervous System I General Organization Q9 A Central Nervous System CNS T T T T 1 brain enclosed within the skull 2 spinal cord a enclosed within the vertebral column b extends from the foramen magnum to L2 B Peripheral Nervous System PNS 1 12 pairs of Cranial Nerves 2 31 pairs of Spinal Nerves a one pair emerges at each level of the spinal cord b 8 pairsof cervical spinal nerves 3 each nerve is like a cable consisting of thousands of nerve bers neurons nerve cells a sensory afferent nerve bers conduct information from the organs of the body to the CNS b motor efferent nerve bers conduct commands from the CNS to the other organs of the body II The Meninges A membranes that ensheath the CNS B there are 3 meningeal coverings 1 pia mater a delicate membrane that is highly vascularized amp adheres to the surface of the brain amp spinal cord b the subarachnoid space lled with CSF 2 arachnoid membrane 3 dura mater a dense regular fibrous connective tissue that provides a tough barrier against foreign agents b the epidural space C meningitis inflammation of the meninges The Nervous System S2 g Ill Supporting Cells or The Nervousisystem A neuroglial cells 1 present in the CNS make up 12 the volume of the brain 2 4 Types a oligodendroglia oligodendrocytes fonn myelin sheaths around certain nerve fibers in the CNS b astrocytes 1 surround capillaries within the CNS 2 create a barrier between the bloodstream and the brain cells called the quotBloodBrain Barrier 3 microglia 4 ependymal cells B Schwann Cell neurolemnocytes 1 present in the PNS 2 form myelin sheaths around certain nerve fibers IV Cerebrospinal Fluid CSF A formation of the CSF W produced by the choroid plexus within the ventricles chambers of the brain B circulation of the CSF ventricles of the brain 0 central canal of the spinal cord D subarachnoid space via foramen of Magendie medianaperture C reabsorption of the CSF excess fluid subarachnoid space DDDDI cranial venous sinuses D functions cushions the brain and spinal cord against trauma IHJU l lj E Clinical Considerations 1 hydrocephaly 2 lumbar puncture spinal tap a puncture made into the subarachnoid space between L3 and L4 recall the spinal cord ends at L2 buses 1 sampling of CSF 2 regional anesthesia block a spinal quotsaddlequot block b epidural block The Nervous System S3 V Neurons nerve fibers A General Characteristics 1 quotexcitable cellsquot o nerve amp muscle cells have the capacity to generate electrical impulses action potentials 2 nerve amp muscle cells are highlyspecialized cells that do not divide in the adult B Basic Structure 1 cell body 2 neuronal processes a dendrites detect stimuli changes b axons 1 conduct action potentials away from the cell body 2 tenninate in synaptic axonal knobs c synaptic axonal knobs 1 release one type of neurotransmitter chemical onto another neuron or another cell 2 the junction formed between a neuron and another cell is called a quotsynapsequot d myelinated neuronal processes 1 oligodendroglia in CNS or Schwann cells in PNS 2 Nodes of Flanvier C 3 Functional Types of Neurons 1 Sensory afferent Nerve Fibers a transmit information from the organs of the body to the CNS b unipolar shape c include 1 Somatic Sensory Neurons a transmit information from the skin or skeletal muscles to CNS b information reaches consciousness 2 Visceral Sensory Neurons a transmit information from visceral internal organs to CNS b information doesn39t reach consciousness The Nervous System S4 2 lnterneurcns Association Neurons G 2 g p F F P p G a located entirely within the CNS b transmit APs from one neuron to another PE yE l P all fDeSlorl MAKING c multipolar shape 3 Motor efferent Nerve Fibers a transmit commands from the CNS to the effector organs b multipolar shape c include 1 Somatic Motorneurons a innervate skeletal muscles b under voluntary control 2 Autonomic visceral Motorneurons a innervate visceral smooth muscle cardiac muscle and glands b not under voluntary control VI Development of the Brain A Prosencephalon Forebrain 1 Telencephalon a Cerebral Hemispheres b Basal Ganglia Nuclei 2 Diencephalon a Thalamus b Hypothalamus B Mesencephalon Midbrain 1 Colliculi 2 Cerebral Peduncles C Rhombencephalon 1 Metencephalon aPons b cerebellum 2 Myelencephalon a Medulla oblongata S4 The Nervous System 39 S5 VII General Terms A Gray Matter collections of neuron cell bodies within the CNS B White Matter consists of bundles of myelinated nerve fibers that conduct impulses within the CNS 0 Commissures bundles of nerve fibers that crossover the midline quotdecussatequot from one side of the CNS to the other side 4 D Ganglia sing Ganglion collections of neuron cell bodies outside the CNS VIII Structural Areas Of The Brain A Telencephalon 1 Cerebrum a longitudinal fissure separates the right and left hemispheres b Corpus Callosum commissure myelinated nerve fibers that connect the 2 hemispheres together called a commissure Plg c Lateral Ventricles d Frontal Lobes e Parietal Lobes f Temporal Lobes Primary Auditory Area g Occipital Lobes Primary Visual Area hgyriggyrug3 of the cerebrum isulci sulcus of the cerebruml 1 central sulcus quotfissure of Rolandoquot a divides the FrontaI lobe from the Parietal lobes b precentral gyrus of the Frontal Lobe Primary Motor Area c postcentral gyrus ofthe Parietal Lobe Primary Sensory Area 2 lgtera sulcus quotfissure of Sylvjusquot divides the frontal lobe from the temporal lobes S5 The Nervous System S6 2 Basal Nuclei quotBasal Gangliaquot Subcortical Nuclei a located deep within the white matter of each cerebral hemisphere b involved in sustained contractions related to posture B Diencephalon 1 Ihalam us a a rounded mass located medially very deep within the cerebrum b acts as a relay station for most sensory information 2 The Hypothalamus a located just below the Thalamus b the Hypothalamus is linked to the Pituitary Gland hypophysis by both 1 nerve fiber tracts 2 profuse network of capillaries called the hypothalamicpituitary portal system X if if c functions W gm 1 regulates body temperature 2 regulates appetite 3 regulates salt amp water balance 4 emotions amp sexual response 5 controls endocrine functions cl adjusts the activity of the various visceral organs to match the physical activity and energy requirements of theperson 3 Pituitary Gland Hypophysis 0B a infundibulum A r x b neurohypophysis c adenohypophysis P 4 The Pineal quotpineconeshapedquot Gland C Mesencephalon Midbrain superior upper portion of the brainstem 1 corpora Quadrigemina 4 rounded mounds a superior colliculiquot Oculomotor Reflex Center Center for Visual Reflexes b inferior colliculi 39 Auditory Reflex Center Center for Auditory Reflexes 2 Cerebral Peduncles a located just behind posterior to the optic chiasm amp Pituitary Gland b contains nerve fibers to 8 from the cerebrum S6 The Nervous System D Metencephalon middle portion of the brainstem 1Pons a rounded bulge on the inferior bottom surface of the brainstem b contains neural centers quotnucleiquot for several cranial nerves including 1 Trigeminal Nerve V sensations from the face 2 Facial Nerve VII control of muscles of facial expression 2 Cerebellum little brainquot a large structure located on posterior dorsal surface of brainstem b functions 1 tnakes movement of voluntary muscles smooth 8 coordinated 2 maintains body posture balance 8 muscle tone c transverse fissure located between the Cerebrum amp the Cerebellum d vermis located between the right amp left hemispheres of the Cerebellum e cerebellar peduncles 3 paired bundles of nerve fibers E Myelencephalon 1 Medulla Oblongata 3939the medullaquot a the lowermost portion of the brainstem b serves as a relay station and conduction pathway between the spinal cord and higher levels of the brain for ascending and descending fiber tracts c contains neural centers quotnucleiquot for several cranial nerves including 1 Vestibulocochlear Nerve VIII sense of hearing 2 Vagus Nerve X sensations from the face R d Visceral Reflex Centers 1 Cardiovascular Reflex Center regulates Blood Pressure 2 Respiratory Reflex Center 3 Coughing Reflex Center 4 Vomiting Reflex Center 5 Vestibular Balance amp Equilibrium Reflex Center The Nervous System S8 e pyramids 1 2 triangular elevations located on the inferior surface 2 location where many incoming ascending and outgoing descending nerve fibers crossover quotdecussatequot to opposite sides of the brain f olive oval enlargements on each side IX The General Organization Of The Spinal Cord A Structure of Spinal Cord 1 cervical enlargement 2 lumbar enlargement B Spinal Nerves 1 contain both sensory nerve fibers and motor nerve fibers thus called quotmixed nervesquot 2 the posterior dorsal root sensory branch of the spinal nerve 3 posterior dorsal root spinal ganglion location of somatic and visceral sensory nerve fiber cell bodies recall that they have a unipolar shape 4 the anterior ventral root motor branch of the spinal nerve C The Gray Matter of the Spinal Cord 1 the posterior dorsal gray horns location where sensory nerve fibers synapse onto inte rneuro nps 2 the anterior ventral gray horns location of somatic motomeuron cell bodies 3 the lateral gray horns a present only at the thoracic and lumbar levels of the spinal cord b location of sympathetic preganglionic autonomic motomeuron cell bodies 4 the central canal 5 the posterior gray commissure D The White Matter of the Spinal Cord 1 organized into bundles of sensory ascending and motor descending nerve fiber tracts fasciculi 2 anterior median fissure 3 posterior medial sulcus S8 The Nervous System S9 2 anterior median ssure 3 posterior medial sulcus 4 Examples of Motor Fiber Tracts a Corticospinal Pyramidal Tract Lateral Corticospinal Tract 1 nerve fibers that permit voluntary control of skeletal muscles 2 originate in Precental Gyrus of the cerebral cortex 3 most bers decussate in the pyramids of the Medulla oblongata 4 activate somatic motorneurons in anterior ventral gray horns b Extracorticospinal Extrapyramidal Tracts Reticulospinal Tract 1 nerve bers that provide involuntary control of skeletal muscles viz unconscious maintenance of posture and balance also involuntary shivering 2 originate in midbrain amp extend down to somatic motorneurons in anterior ventral gray horns 5 Examples of Sensory Fiber Tracts a Spinothalamic Tract Lateral Spinothalamic Tract 1 nerve fibers that convey sensory information about pain and temperature up to Cerebral cortex 2 2nd order nerve fibers decussate in Spinal cord amp then extend up to Thalamus 3 3rd order neurons relay sensory information up to Postcentral Gyrus b The Posterior Dorsal ColumnMedial Lemniscus Tract Fasciculus Gracilis and Fascioulus Cuneatus 1 nerve bers that convey sensory information about touch pressure and proprioception up to Cerebral cortex 2 sensory 1st order nerve fibers extend all the way up to Medulla oblongata 3 2nd order neurons decussate in Medulla oblongata 8 then extend up to Thalamus 4 3rd order neurons relay sensory information up to Postcentral Gyrus c Spinocerebellar Tract 1 nerve fibers that convey sensory information about proprioception to Cerebellum 2 2nd order nerve fibers extend up to Cerebellum S9 The Nervous System X The12 Pairs of Cranial Nerves 3939Oh Oh Oh To Touch And Feel Very Good Velvet AHquot S10 S10 T Number Name Nerve Fiber Type Function T TT T T T N I olfactory somatic sensory sense of smell olfaction o T from nose II I Optic somatic sensory 59quot f sight MSW y T from eyes III A Oculomotor somatic motor motor tlt3 eye muscles I Superior Rectus Medial Rectus Inferior Rectus 8 Inferior Oblique T also Levator Palpebrae Superioris I m athet39c g 3sgoic n39 tor motor to ms of eye pupil size IV Trochleaar I 7 somaticT motor motor Lg Supeiriioir Ubliqgiie W i I V Trigeminal somatic sensory sensations from the face incl forehead nose all teeth amp T T T the tongue T somatic motor motor to jaw muscles T T incl Masseter Temporalis VI Abducens somatic motor T TTTT motor E Lateral Fiecturs i me i i VII Facial soTmatiosensoijy sense of taste from tongue 1 somatic motor T motor Q facial muscles A Pa3935Y39quotPathe motor to salivary glands autonomic motor T T T quotTquot T T 1Vlll TVestibulocochTlear T somatic sensory sense oLhTearingTfromTcochlea I somatic sensory sense of balance equilibrium Tj fromTTyestibular apparatus T 9 IX Glossopharyngeal somatic sTensory sense of taste ll tongue viso p5 sensory T baroreceptor amp chemoreceptors somatic motor T motor to muscles for swallowing parasympath t39 4 motor to salivary glands autonomic motor P T T T T X Vagus i sensory from internal organs visceral e S quot 39 39V of thorax 3 abdomen somatic motor motorT9 Vocal cords in larynx T T parasympathetic motor to internal organs of as s o a t V sth9rax 8 abdomen XI T Accessory Tsomatjo seTnsorTy sensations from larynx amp neck somatic motor motor to muscles of neck amp shoulder T Stemocleidomastoid amp Trapezius XII T Ti Hypoglossal Tsclnatic sensory proprioception from tongig3 somatic motor motor Q tongue T onamzzmou OF THE NERVOUS SYSTEM Vi ANATOMICAL DIVISIONS shown in fnte or View mm nznvfvs mm arm 1rhuraaic spinal names I pairs D1 5 Lumhravr 5 SacraI 1 aa Licoccygeal E1r111aatinquotati A cluain iarnglia EGENTHAL NERVOUS 1 SYSTEM CNS Unmyelinulod bers 1 Glands E ector organ Skaleral smooth und cardiac muscles Wcomrnlnorvousoystemi PKj AT p j I Sginalcord p n N 0h gmEpHEuaaH S T PrI WlN G I M I a 6 Vlamtai Ii V lt1 sympaiinatac Z PampIra 1 139 TJ 1 5gapu5 V bl HE I E quotWquot Isympathet ganglion S R Ientn1vm at is vertebra 39dL InaIHu fd 39 aim Araralunpidmf Grgnuugrlm 39 E 1 H ulquld39u1 Sjnlviiri 39 E Iquot eHlt tiirma Einibailaa h ulhrii E139 Elmtr annmdumrmr Q E39J39a139quot 5 LFIl39uI j ifg 39IF gm39 T Flilatuzn Inf End Ifaiquot rigi1I EfivF Pquotai39II1urud fFl Imu mt l a 1anur39iaa 1 E39i39laiI1I3939IEl 0 39E E39 urn Mum quot FJa Faarnmnn n F aELquotIf p 51 593 I v 0 Po U X I P P 0 j l rh fu Central canal of 2 spinal cord E r 3939 V5 I139 Filurn terminale Pia mater Subarachnoid space Arachnoid Dura mater M avenous quot sinus Fol eerebri Inferior I Eiylii TEIquot iiln mi Great e veeltrehrvI vein 353Fhl P lrl iil siinssusi e l Soupri nr O s petrosal sinus v A t rIwiyht A quot iirIl1 Supraorbital vein e o e lnnelllux A to Vi m V39quot 0 39ll539i39quot39 39 j V TvItn39tnr ium cerebelli M quotT39 nshm rm sinus P Eanfltneu of sinuses lini39rIanrhitl39 0 vein 39 regional anesthesia block The central nervous system is protected not only by bone but also by three Lquot39 39 f quotquot quotquotquot3 7 3939 39quot i 39 j layers of meninges or membranes The spaces 39 N A 1quot between the meninges are filled with cerebrospinal uid It is possible to remove some of this uid as P shown here for examination purposes 2 V 1 395 395 W 39tr quot5 J 1 Vquot 7quot 1 J h 37 VJ l I r q u J l quot quotquotI mu E 39 39Igt39quotl P 1 39 A V 2 0 I 39quotquot39IrL1 V9quot 1l quot39 sirquot quota y of for wgirlal dl39am F 39 Ll Level of qnesthesia for Evagihal de1ivery and cesarean section SPINAL SADDLE BLOCK ANESTHESIA CONTINUOUS quot LUMBAR EPIDURAL ANESTHESIA HarteStirs P NEUROIVQL PROCESSES MRNEuR 0 Y F s c ltno os Uj lH T DENDMTESquot Ae ect c3 V 3 S hmu I fquot 5quot p A f WD AXoNs e3L quot 3w eREuaau area primary vesicles Flve eecendafy veelcles Adult derivatives of Well WW eve Tquot Wells Cavities p PB 39 TV ei quot j r e Cerebral Lateral k r T Go j hemisphere ventricles fOfBbI ampiI39I 4r R 1 V quot e TITEIBMUS Third A 3q Hypothelamus ventricle Mesenoephelon midbrain idb39 39quot Pans Flhombeneephalon indbrain T cerebellum Pnm Myeleneephalon efey Meduua o e r oblongata 4 wk I Spinal cord 5439quot wk 552 So canu tau u 9 B mtaa Ucm 3 35000 of 236 9 10301 zocomr L0ltwD2 222 M53 lt On2m ouogt 3 o maxoi EnEu HINDBHAIN 39 mmEaongt F ooE2 5 N V m T Z 0 P A pi 0 4 05 A E2a5EE mEmao ozno ououm4 aEomo 4 mEaa oaa Ea2mo 39 aEEus mooo mmE 2muoEoE O0 C mooo mEaa oonwT w o T 7 pq n 1 8 8 O I 0e A ooEmgt Eu 0 corpora quadngemlna wmo ltn0OO S24 0 flOl General amccioml areas of h kamp ubn1unumhndJ F 3 dprder neunqn 2nd order neuron 1st order nears 39 F39 quot a39 u 0 T i Fibers ofolfactory nerve I F e r V 0 T J Olfactory u quot 4 J4 jaaug L Fiainn3939 iIrquot3 quot quot iliIr 3quot quot iiquotiii lt Olfactory tractJ AV AA 4 I F V 39 Optlc nerve II Temporal lobe 5 E E v x 1 v Optic tract T De u Eemeteer nerve Jl 95 T IV A a 0 1 R 4 1 Tfochlear nerve IV Facial nerve vu 6 F r P K an I V T 0 s J 39lJ39ngeminal nerve V neg gvcf sjc ear 4 6b b T4 Abducens nerve VI Glossopharyngeal nerve IX 9 m r ivE I5 quotewe 4 Z p A Accessory P r exam Hypoglossal nerve XII Trxe ventral surface of the brain showing the cranial nerves S32 7 O Anmrint39 Ventral urw hum Ventral median ssure skin dorsal toot I iEEEEi5t 7391 J gEanfgIiurl f 7 7 V7 39 white matte T Spinal Nerve 5 f to brain V 5Piquot quot 339aquot i I To nucleus gracili or nucleus cuneatus Intmauegrrventai P 1 vi iirilemeumn 5 cornmissural inIras1egrnEnta39I interneuron 39 n Intlitseagmenaa intemeuron Ale ha mamr neuron 23 I3 Somatic To other parts of sensory the limbic system T Spinal cord Fibers 0 1 internal capsue c T Qaudate nuc en Tail of caudate nucleus Anterior Posterior cad of caudate nucleus Tnalamu I quot t Amygdaloid nucleus Lentiform nucleus a 0 39 Projection tibers to and trom spinal cord Cer bfat n 9 Thalamush I T T Iserettallum uctaus i t T x Brain stem T L reticulat V p 70 T113130 E Vestibular nucleus Pyramidal cortlcosplnal tracts H atiivnutuspiItai tract iub rua lnalt tract VazstthiuItnaptntal tract W an gt Pv If Lcswar meta rt 1utr439na ni S3o I5 39 A K F C 5 4 V red nucleus 0 39 P quotkl iE s c ll I El39IEIIil1 of iipyramids of medulla 0 4 h gt I I If39iquotb39r P fuI had in 02 F lN sf i cErehellur trag T pyramidal tracts cervical spinal cord n1naL1 J A ur1ica p39inal1ra it 7 thoracic spinal cord skeletal muscle J body muscles spot nerve Optic chiasm ilimtic tract ynEwe V chiasma V V 1 Dptin 0 gt radiation J J Occipilal lobe S33 plnnlm 1 semicircular canals Hslihaull f I39TI39IplaiI1 i1I39 l mbf M10 quotg d al P middle auditory E I l1I 39 oustachlan Iubo Tectorial membrane Supporting cell K Nerve fibers 1 Basilar membrane 554 B I Iquot r 1 IT 7quot I I 39I i P 7 I II V T L II P I I 39 P a 39 I 5 I i39H I I F quot 1 Y J I I j T I CE 1iIquotIIMllI L r E I 0 4 5i I I L V W In mi in 3l L I39IiIlIIL 1 MI E F 39 5II I IHEVAM IIquot I jim El g1 0 h h h h i III 394 III I I1i JIII u I 4 F I 35 I II IL 5 1 I 5 I I 3 IE F3 V p V 1 QI I 0W I N quot E I m1ELJ FLJIIIM I p jEi1 ILwIJIl5 I Ah39 II II T I TIEIIFII LEI GI 39 I quotIf I T I I I H 9 39quot quotVJ II II quotJ P I I 6 pg I l O I I quot V r 1 II LI II 0 E J4 I Ia 0 0 p 0 K 5 4 IIEm39sI II I 1 I ll g II I V 9 b I I J W E I II Z W P 5III gJl I 9IIIi Py III mi IIIquot L FIT imf W I fag quot p L HUM Hi 1 MI 9 Imp I V J I It 3 H i Wimp lma IHI1 IaF II I b I quotU I I7 I5 I EEl Iuj MI quot39 1quot E1 Q g39IgILII lEquot39ri KJV39U g E v 7 jT I 0 I 1I39 I T V III F TV ri I u T WFII Fl I 0 a P WILI I IquotII JII 39l K llfjl M quot39I quot I I I h I I 0g III 5quot II II V I IIII I c I f 9 Iquot39 1 ti I IID39 39 I H 3939Lquotquot IquotwflaI quoti quot 1 IEIHIEII 5 I I I laiT E I L 39 uX I j E II I 17151 i I 39 EIIf n I I I EL I I I7 Wquot a quotLEM H I fIII quot 0 r 1 II 31 7 75 p p I III I I II II iJr aIH 39 V 39V gtgrrV 1 l V Po 39IIfquotIIII I IIIIII1 391 JJI 39 4 II E Jquot5quotVli T gr 5 39 ii J J I lIII 51 quotp quot 53 E m ITHQ 3quot 39 I 2J 39I 2 P 7 an IIIIIII I J 1 tl L 1 Y I I I I I III l I quotHalf quot TmI 7 P I39 I II 355 391T I I 1 M II Bd 4 12 39 quotP I I II I E I