Lecture'01'

Intro&and&Terminology!
Basic'Tissues'
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Somatic'Systems!
Soma'='body'(greek)'
Body!walls!and!limbs!
Skin,!skeletal!muscle,!bones!and!joints!(walls!of!body!cavities!!including!parietal!layer!of!serous!
membrane)!
Somatic!nerve!supply!(somatic!nervous!system)!
Parietal!vascular!supply!!paries!(latin)!=!wall!
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Supply'Systems'
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Visceral'Systems'
Viscus'(latin)'='sticky'
Organs,!glands!and!tubes!with!smooth!muscle!(contents!of!body!cavities!including!visceral!layer!of!
serous!membrane)'
Visceral!nerve!supply!(autonomic!nervous!system)'
Visceral!vascular!supply'
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Terminology!
Planes'of'Reference' ! ! ! ! Terms'of'Movement!
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Terms'of'relationship' ! ! ! ! Terms'of'comparison' !

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 LECTURE'02'
Human&Form&and&Function&
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Subphylum:'Coelomate'
Coelomates)
o Have)Segmented)body)wall)!)Allows)independent)motion)
o Hollow)fluid)filled)(closed))body)cavity)
o Possesses)a)gut)tube)(a)feature)of)all)coelomates)
o Develops)from)3)germ)layers)
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Germ'Layers'
The)potentials)(and)limitations))of)cells,)tissues)and)organs)are)
determined)by)the)germ)layers)from)which)they)are)derived)
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Phylum:'Chordate'
Chordates)
o Have)hollow)nerve)cord)or)
neural)tube)(derived)from)the)
ectoderm))
o Notochord)(derived)from)
mesoderm))
o Pharyngeal)pouches))at)the)
cranial)end)of)the)gut)tube)(derived)from)the)ectoderm))
" Remnants)of)the)pharyngeal)pouches)are)retained)in)the)
mandibular)arch,)auditory)tube)and)inner)ear,)and)are)also)
derivative)of)our)chordate)ancestry.)
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Segmentation)
A)Chordate)characteristic)
Somites:)coelomate)and)chordate)segments)that)form)the)nerve)supple,)bony)elements)and)other)
structures)
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Polarity)
A)chordate)characteristic)
Structures)are)arranged)in)such)a)way)that)
there)is)a)cranial)to)chordal)arrangement)of)
somites)
The)positioning)of)segments)in)a)body)from)
a)cranial)to)chordal)way)
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Subphylum:'Vertebrate'
Vertebrate)(back)bone))features)
o Spine,)skull)and)skeleton)
o Spinal)cord)and)spinal)nerves)
o 4)limbs)with)5)digits)
Characterised)by)the)vertebral)column)
o Provides)structural)support)and)protection)
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Basic'Tetrapod'limb'Pattern)
Have)5)digits,)jointed)upper)and)lower)limbs,)
Limb)pattern)is)still)very)primitive)in)humans)
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Class:'Mammalia'
Mammalian)features)
Skin)and)appendages)(hair,)sweat)sebaceous)
glands,)mammary)glands))
Placenta))!)delivers)nutrients)
Warm)Blooded)
o Have)a)4)chambered)heart)which)allows)for)2)pulmonary)systems.))
Expanded)forebrain)
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Order:'Primates)
Primate)features:)
Binocular)(frontUfacing))vision)
Opposable)thumb))
o Gives)very)mobile)limbs)and)allows)for)living)in)trees)as)evident)by)ancestry)
Freedom)of)arms)
Nails)rather)than)claws)
Clavicle)
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Family:'Hominidae'
Hominid)features:)
Lack)of)a)tail)
Larger)body)size)and)bigger)brain,)
)More)upright)posture.))
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Species:'Homo'sapiens'
Human)features:)
Upright)posture)
o Vertebral)column)has)an)s)shape)to)ensure)
all)the)body)weight)does)not)fall)on)one)
structure)!)distributes)body)mass)to)enable)
upright)posture)for)longer)periods.))
Non)opposable)big)toe))
o Helps)to)stabilise)us)when)the)weight)falls)
forward.))
Line)of)gravity)between)feet)
o Follows)a)straight)line)downwards,)allowing)
us)to)keep)upright)
Bipedal)locomotion)
o Weight)is)being)held)by)one)foot)at)a)time)
Speech)
o Epiglottis)descends)during)development)allowing)speech)
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 Lecture'3'
Embryology)1)
Introduction)to)Embryology)and)Ectodermal)Derivates)
Embryology'and'Topographic'Anatomy'
Human&body&develops&from&a&single&cell&(the&zygote)&
Understand&development&&understand&why&the&adult&body&is&the&way&it&is&(and&pathologies)&
Understand&anomalies&
Not&a&molecular&approach&
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Periods'of'Human'Embryology'
Egg&(conceptus):&fertilization&to&end&of&3rd&week&
Embryo:&Beginning&of&4th&week&to&end&of&the&8th&week&
Fetus:&3rd&month&to&birth&
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Phases'of'human'embryology'
Gametogenesis&(formation&of&egg&and&sperm)&
Fertilization&(formation&of&zygote)&
Cleavage&(formation&of&morula&and&blastocyst)&
Gastrulation&(formation&of&three&germ&layers,&three&major&axes)&
Formation&of&tubeLwithinLaLtube&body&plan&&
Organogenesis&
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Early'Human'Development'
Egg&fertilised&in&fallopian&tube&
Moves&into&uterus,&dividing&on&the&way&
One&division&per&24h&initially&
16&cell&stage&(3&days)&is&called&the&morula&
At&4&days,&cell&mass&(Blastocyst)&undergoes&cavitation&to&form'a'new'cavity&
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Illustration'of'the'First'Four'Days'
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Blastocyst&
Blastocyst&has&two&types&of&cell&
o Outer&epithelial&layer&(trophoblast)&
! Forms&some&extraembryonic&structures&(part&of&placenta)&
o Inner&cell&mass&(cluster&of&cells)&
! Will&develop&into&a&human&
o Trophoblast&forms&some&extraembryonic&structures&(part&of&
placenta)&&
o Between&5&and&10&days,&blastocyst&implants&into&uterine&wall&
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Gastrulation'
To&form&germ&layers:&ectoderm,&mesoderm,&endoderm&
Give&rise&to&distinct&tissues&in&adult&
Formation&of&primitive&streak&
Two&germ&layer&stage:&
o Inner&cell&mass&splits&
o Forming&embryonic&disc&
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Embryonic'Stem'Cells'
Embryonic&stem&(ES)&cells&are&isolated&form&inner&cell&mass&
In&tissue&culture,&divide&indefinitely&
Can&give&rise&to&cells&characteristic&of&any&part&of&the&body&(pluripotent)&
Can&give&rise&to&teratomas&
Cells&from&16&cell&morula&and&earlier&are&totipotent&(give&rise&to&new&embryo)&
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Two'Germ'Layer'Stage'
Inner&cell&mass&splits&&epiblast&and&
hypoblast&(together,&bilaminar&disc)&
Embryo&=&part&of&epiblast&
Rest&of&epiblast&and&all&of&primitive&
hypoblast&give&rise&to&extra&
embryonic&tissue&
At&this&stage&the&future&human&is&a&
flat&disc&of&cells.&&
Humans&have&a&yolkLsac,&but&no&
yolk.&It&is&the&2&layer&structure&
which&is&most&important.&&

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Three'Germ'Layer'Stage&
Gastrulation&=&formation&of&3&layers&from&2&
Ectoderm,&mesoderm&and&endoderm&form&as&three&flat&discs&of&cells,&one&on&top&of&another&by&
gastrulation&of&two&germ&layer&stage.&&
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Gastrulation'
On&upper&surface&of&
bilaminar&disc&(on&epiblast)&a&
line&of&thickened&cells&appear&
(primitive&streak)&in&caudal&
part&of&embryo&
Primitive&streak&invaginates&
to&form&primitive&groove.&&
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Gastrulation'Cont.''
At&primitive&groove,&cells&fold&inwards&and&migrate&into&space&between&epiblast&and&hypoblast&
First&cells&to&arrive&move&into&hypoblast&to&form&embryonic'endoderm&
Later&cells&become&embryonic&mesoderm'
Cells&left&in&epiblast&become&embryonic&ectoderm&
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Fate'of'Cells'Moving'Through'the'Primitive'Groove'
&From&the&top&you&have&the&embryonic&disc,&the&primitive&disc,&streak&forms&at&one&end&and&the&cells&
start&to&migrate&in.&
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Embryonic'Body'Axes'
The&dorsal&side&is&basically&the&bag&of&the&embryo&
Primitive&node&is&the&little&loop&
Within&the&node&is&a&little&hollow&groove&which&is&liquid/fluid&
filled&
Node&is&important&for&setting&up&leftLright&asymmetry&
Cilia&within&the&node&rotate&
Leftward&fluid&flow&
Cilia&are&little&hairs&that&are&motile&
Cilia&rotating&straight&up&give&concentric&circle&and&you&dont&get&any&
movement&in&any&direction&of&the&fluid&
However,&at&an&angle:&will&cause&the&fluid&within&the&node&to&move&from&
one&end&to&the&other&end&
Shown&to&be&important&for&asymmetry&
Hypotheses'for'breaking'symmetry&
Movement&of&the&liquid&from&within&the&node&from&right&to&left&
Morphogen&Hypothesis&
o Molecules&which&are&transported&with&the&fluid&to&the&one&side&
and&find&receptors&at&the&surface&and&can&affect&gene&expression&
and&determine&that&they&are&cells&on&the&left&side&
Nodal&vesicular&parcel&hypothesis&
o Seem&to&be&vesicles&being&transported&from&right&to&left&
o Similar&to&first&except&within&vesicles&
 Two&cilia&hypothesis&
o Seems&most&likely&
o At&the&edges&of&the&node,&the&cells&have&cilia&also&but&
they&are&not&motile&
o They&can&detect&the&movement&of&the&fluid&from&right&
to&left&and&then&transfuse&the&signal&to&the&cells&are&
direct&right&from&left&
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Formation'of'Notochord'
Cranial&midline&extension&from&primitive&node&form&hollow&tube&
Tube&grows&in&length&(cells&added&from&primitive&node)&
Primitive&groove&lengthens&and&then&retracts&caudally&
Primitive&streak&regresses&
As&it&retracts,&it&lays&down&notochord&in&mesoderm&
Tube&fuses&with&endoderm&L>&notochrodal&plate&
Detaches&from&endoderm&to&form&solid&rod=&notochord&
Cells&of&notochord&interact&with&overlying&ectoderm&(induction)&to&cause&
formation&of&neural&tissue&
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Origin'of'Notochord'
Primitive&groove&is&in&ectoderm'
Notochord&is&in&mesoderm'
Notochord&formed&by&cells&migrating&down&from&ectoderm'
Cells&move&through&primitive&node.&'

Fate'of'Cells'Moving'through'primitive'groove'
Cells&moving&through&different&levels&of&primitive&groove&have&different&mesodermal&fates&
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At'21'days'
Primitive&streak&retracted&and&nearly&gone&
Full&notochord&laid&down&as&primitive&streak&retracts&
Neural&plate&and&fold&evident&
Regions&of&mesoderm&already&fated&e.g.&heart&
Oropharyngeal&membrane&present&
Ectoderm&and&endoderm&fused&here&
Location&of&mouth&
Cloacal&membrane&the&same,&location&of&
anus/urogenital&opening&
Teratomas'from'Primitive'Streak&
Primitive&streak&should&disappear&
Sometimes&cells&of&primitive&streak&retained&
Most&common&tumour&in&newborns&
1:35,000&births&
Benign,&corrected&by&surgery&
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Extraembryonic'Tissues'
All&from&embryonic&epiblast.&'
Embryo&now&in&uterine&wall'
In&fluid&filled&space&within&chorion'
Surrounded&by&chorionic&villi&and&maternal&blood&supply.&'
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Derivates'of'the'Three'Tissue'Types'
Ectoderm&&Nervous&system&and&epidermis'
Mesoderm'&Blood,&heart,&kidneys,&gonads&and&most&
bones,&muscles&and&connective&tissues'
Endoderm'&Epithelium&of&gut&and&associated&organs.&'
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Ectoderm'and'the'Nervous'System'
Notochord&induces&overlying&ectoderm&to&form&neural'
plate&
Neural&plate&forms&neural'groove&
Neural&plate&folds&around&groove&to&form&neural'tube&
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Formation'of'neural'plate'and'neural'tube'
Neural&Plate&
Cranial&to&primitive&node&
Ectodermal&cells&differentiate&into&thick&plate&of&pseudo&stratified,&columnar&neuro&epithelial&cells=&
neuroectoderm&
Neural&tube&
Formation=&neurulation&&
Invagination&of&neural&plate=&neural&groove&
closure&
Neurulation&
Neural&tube&initially&one&cell&think&
Neural&tube&is&hollow&
There&is&a&rostral&to&caudal&gradient&in&the&formation&of&
the&nervous&system&&
Rostral&is&older.&&
Neural&tube&zippers&shut,&starting&from&multiple&
points&
Last&to&close&are&anterior&and&posterior&neuropores&
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Segmentation'of'neural'tube'
Rostral&end&of&neural&tube&starts&to&swell&
Neural&tube&initially&one&cell&layer&thick&and&
hollow&
Carnial&end&starts&to&swell&forming&vesicles&
Vesicles&give&rise&to&brain&
Remainder&to&the&spinal&cord&
Forms&3&distinct&vesicles&
Prosencephalon&(forebrain)&
Mesencephalon&(midbrain)&
Rhombencephalon&(hindbrain)&
" Further&Segmentation&
Prosencephalon&splits&&telencephalon&and&diencephalon&
Rhombencephalon&&7&segments&
Rest&is&spinal&cord.&&
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Neural'crest'
Cells&at&top&of&neural&tube&form&neural&crest&
Migrate&away&from&neural&tube&to&form&a&wide&range&of&
structures.&&
Group&of&embryonic&cells&that&are&pinched&off&during&the&
formation&of&the&neural&tube&(the&precursor&of&the&
spinal&cord)&but&that&do&not&remain&as&a&part&of&the&
central&nervous&system.&The&cells&of&the&neural&crest&
migrate&to&numerous&locations&in&the&body&and&
contribute&to&the&formation&of&diverse&structures,&
mostly&associated&with&the&nervous&system&
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Neural'Crest'Derivatives&
Dorsal&Root&Ganglia&
Sympathetic&and&parasympathetic&ganglia&
Enteric&Ganglia&
Schwann&cells&
Melanocytes&&pigment&cells&
Muscle&cartilage&and&bone&of&skull,&jaws,&face&and&pharynx&
Dentine.&&
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Neural'Crest'
and'Facial'Development.''
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 Lecture'4'
Embryology)2)
Mesodermal'Derivates'
Dermis,(Muscles,(Skeleton,(Urogenital(
tract,(Heart(and(blood(vessels,(wall(of(gut(
and(respiratory(tract,(Haemopoietic(
tissue,(pleura,(peritoneum,(pericardium.((
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Mesoderm(
Middle(layer(of(embryo(
Divided(into:((
1) Paraxial'Mesoderm'(medial)((closest(
to(notochord'
2) Intermediate'mesoderm''
3) Lateral'mesoderm'
(
Fate'of'mesoderm'
Paraxial'Mesoderm'
o Dermis(of(the(skin(
o Axial(skeleton(
o Axial(and(limb(muscles(
Intermediate'mesoderm'
o Urogenital(system(

Lateral'Mesoderm'
o Ventrolateral(body(wall(
(maybe(some(dermis?)(
o Visceral(pleura,(peritoneum(
o Blood(vessels(and(blood(
forming(tissue(
o Heart(
o Wall(of(gut(and(respiratory(
tissues.((
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Paraxial'mesoderm'and'somites'(Somitogenesis)'
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Swellings((somitomeres)( At(the(20(somitomere(stage,( ' Additionally(somites(replace(
appear(progressively(down( the(eighth(pair(of( ' somitomeres(caudally.((
length(of(paraxial( somitomeres(becomes(an( ' (
mesoderm( independent(pair(of(somites.( '
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Epithelialization!
Fissure'formation'(separation!
Periodicity!
Specification!
Differentiation!

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Paraxial'Mesoderm='Somatic'Mesoderm'
In(the(head(region(
o Head(mesoderm((together(with(neural(crest)(forms(skeleton,(muscles(and(connective(tissue(
of(face(and(skull(
In(the(trunk(region(
o Forms(somites,(which(will(produce(muscle,(bone(and(connective(tissue(

Development'of'Somites'
Somite(splits(into(sclerotome(and(dermomyotome'
Dermomyotome(splits(into(dermatome(and(myotome('
o Scelerotome(=(skeleton(except'skull'
o Dermatome(=(dermis(of(skin'
o Myotome(=(trunk(muscles'
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Fate'of'Somitic'Cells'

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Formation'of'Vertebrae'
Sclerotome(splits(into(cranial(and(
caudal(section(
Segmental(spinal(nerve(grows(
through(to(innervate(myotomes(
Caudal(section(fuses(with(next(
cranial(section(to(form(vertebral(
rudiment(

Limbs'
Limb(development(in(fourth(to(
eight(week(
Muscle(from(lateral(myotome((somite),(bone(and(connective(tissue(form(lateral(plate(mesoderm.((
(
Limb'Skeleton(
In(Trunk,(axial(skeleton(from(sclerotome,(
appendicular((limb)(skeleton(from(lateral(plate.((
(
(
Formation'of'Limb'Bud'
Cells(migrate(from(lateral(myotome(
Proliferate(at(site(of(limb(
Form(swelling(
Go(on(to(form(muscle(
Skeleton(from(local(lateral(plate(mesoderm(
Forms(at(discrete(position(=(limb(field(
Mesenchymal(cells(from(lateral(plate(mesoderm((skeletal(cells)(and(somites((muscle)(migrate(in((
(
(
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The'Limb'Field'
A(patch(of(mesoderm(per(limb(has(capacity(to(form(limb((free(limb)((
Remove(free(limb(patch,(surrounding(cells(can(compensate(
Remove(whole(patch,(no(limbs(
Transplant(free(limb(patch(and(get(ectopic(limb(
Limb'Development(
Ectoderm(overlying(limb(bud(forms(apical(ectodermal(ridge(and(now(
controls(limb(growth(
Splitting(of(ectodermal(ridge(results(in(diplopodia(
Not(a(genetic(mutation((mechanical(damage.((
(
Limb'Specification'and'Hox'genes'
Limb(segments(are(defined(by(combinations(of(Hoxd(

genes(
Fingers(defined(by(Hoxd(9Y13,(upper(arm(by(Hoxd(9Y10(etc.((
(
Hoxd'expression'in'limb'bud'
Hoxd(genes(expressed(successively(in(growing(limb(bud(
Loss(of(one(Hoxd(gene(mainly(affects(single(limb(segment.((
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Intermediate'mesoderm''
The(urogenital(system!
o Kidneys!
o Gonads!
o Respective(duct(systems!
 '
Thalidomide'
Drug(given(in(1958Y1962(for(morning(sickness((
Produced(profound(limb(abnormalities(
Identified(as(teratogen(by(William(McBride((since(embroiled(
in(scientific(fraud(claims)(
Thalidomide(withdrawn,(but(now(used(for(leprosy(
complication(and(for(multiple(myeloma(
Disrupts(limb(development(during(first(trimester(
Window(for(effect(is(short((between(20Y36(days(postY
conception)((
Action(unclear.((
(
Digit'Development'
Feet(and(hands(start(off(as(symmetrical(discs(
Digits(sculpted(by(cell(death((apoptosis(or(programmed(cell(
death)((
Can(leave(webbing(behind,(or(failure(can(result(in(syndactly(
(fused(fingers)(
Other(mechanissm(identify(digits(1Y5((1(has(2(phalanges,(
others(3)(
(
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The'Heart'Fields'
The(cells(that(will(form(the(heart(are(identifiable(in(trilaminar(
embryo(
Form(horseshoe(shape(in(anterior(mesoderm(
Development'of'the'heart'
Splanchnic(mesoderm(forms(bilateral(tubes'
Two(endocardial(tubes(brought(together(in(midline'
Fusion(produces(heart'
Myocardium((muscle),(pericardium((sac)(and(endocardium((epithelial(lining)(from(mesoderm'
Parts(of(the(heart(midline(and(major(outflows(vessels(from(neural(crest'
The(cells(that(will(form(the(heart(are(identifiable(in(trilaminar(embryo'
Form(horseshoe(shaped(anterior(mesoderm(=(cardiac(crescent(or(first(heart(field'
Subpopulation(of(cells(form(endocardial(tubes'(via'vasculogenesis)'
Fusion(of(tubes(along(midline(=(primary(heart(tube'
Single(endocardial(tube(with(adjacent(mesoderm(differentiating(into(cardiomyocytes'
Heart(beat(is(initiated(around(
21st(day(
o Needed(for(normal(
heart(development(
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Origin(of(Cardiac(Tissues(
Myocardium((muscle),(pericardium((sac)(and(endocardium((epithelial(lining)(from(mesoderm(
Parts(of(heart(midline(and(major(outflow(vessels(from(neural(crest(
Heart'development(
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Fusion'of'Endocardial'Tubes'(2'! '1)'
Two(endocardial(tubes(fuse(to(make(single(heart(tube(
(

Heart'Folding'
Circulation((in(sinus(venosus(and(out(via(truncus(arteriosus(
Tubular(heart(must(fold(to(produce(four(chambers(of(heart.((

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Heart'Folding(
Folding(results(in(left(bias(to(ventricles(
(
(
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Four'Chambers'from'Two(
Single(atrium(and(ventricle(to(divide(
simultaneously'
Septum(primum(divides(atrium('
Interventricular(septum(divides(
ventricle.('
Endocardial(Cushions(divide(atrium(from(ventricle.('
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Atrial'Septum(
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Septum(primum(starts(to( (
divide(atrium( (
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Hole((foramen(primum)(
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persists(for(some(time.((
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As(foramen(primum(closes,(
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foramen(secundum(opens(
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Septum(secundum(forms( (
alongside(septum(primum( (
( (
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 Septum(secundum(
overlaps(septum(primum,(
forms(foramen(ovale( (
( (
Acts(as(a(one(way(flap( (
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Allows(blood(to(pass(form( (
right(to(left(atrium( (
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Ventricular'Septum'
Grows(from(apex(of(the(heart(
Forms(thick(incomplete(septum(
Final(part(of(septum(thin(and(membranous(
Can(fail(to(form,(leaving(a(hole((very(common(birth(defect)((
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Vasculogenesis'and'angiogenesis'
Until(the(end(of(the(second(week((circulation(is(required(after(this),(nutrition(of(embryo(is(by(
diffusion(
Third(week,(first(blood(vessels(appear(outside(the(embryos((umbilical(vesicle,(developing(placenta(
and(connecting(stalk).(
Vasculogenesis:(De(Novo(assembly(of(blood(vessels(from(mesodermally(derived(cells(
o Requires(both(recruitment(of(mesodermal(progenitors(to(the(endothelial(cell(lineage(and(
organisation(of(their(progeny(into(microvessels(
o Occurs(only(during(embryogenesis(
Agiogenesis:(Blood(vessels(formation(of(preYexisting(vasculature(
o Organization(into(a(precise(spatial(pattern(within(a(particular(tissue(
o Occurs(during(embryogenesis(and(in(the(adult(
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Blood'islands'and'Vasculogenesis'
Vasculogenesis'(formation(of(blood(vessels(where(none(exist(
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Vessels(form(by(diffusion(of(lumens(from(multiple(blood(islands((blood(cells(from(endothelium((
(
Development'of'the'aortic'arches(
Start(off(as(symmetric,(segmental(
A(Branchial((gill)(circulation(
Selectively(lose(segments(
Final(version(asymmetric,(most(vessels(lost,(some(new(vessels(added.((

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 Lecture'5'
Integumental)System)&)Skin)
Integumental*System*
Skin*is*the*largest*organ*
Includes*appendages*
Derives*from*ectoderms*
Roles*of*Skin*
Skin*is*outermost*layer*of*the*body*
Provides*protection*because*made*up*of*dead*cells*
o Provides*protection*against*physical*injury*
o Made*up*of*dead*keratinous*cells,*no*strong*nerve*supply*results*in*ability*to*take*injury*
with*minimal*pain*
Barrier*from*pathogens*because*it*is*dry*
o Skin*is*acidic*
o Pathogen*protection*
o Sweat*has*low*pH*value*(4D5)*
o Sebaceous*glands*provide*protection*
against*pathogens,*as*well*as*sweat*glands*
o Not*so*much*from*viruses,*they*are*far*
smaller*than*pores*
o Some*microbes*cant*survive*oily*surface*
Protection*from*UV*radiation*
o Melanocytes*on*top*of*skin*
o UV*is*ionising*radiation,*when*in*contact*with*DNA,*causes*mutations*(occasionally*a*
mutated*cell*is*immortal*and*becomes*a*cancer)*
Water/fluid*barrier*
o Prevents*water*loss/*absorption*to*a*high*extent*
o When*skin*is*burnt,*first*concern*is*fluid*loss*as*outer*barrier*is*lost*
Important*for*providing*sensation,*nerve*glands*below*epidermis*
o Fine*tuned*sensory*nerves*
Control*temp*
o HotD*blood*vessels*dilate*
o Vasodilation*dissipates*heat,*and*cool*down.**
o ColdD*vasoconstriction,*conserve*energy*and*heat.**
o Sympathetic*nervous*system*response*
o Temp*both*denatures*proteins*and*also*causes*other*issues*for*the*body*
Social*draw*
Synthesis*of*vitamin*D*
Pascinian*corpuscle,*sensitive*to*vibration*
*
Skin*Structure*
Three*layers*of*skin*
Epidermis**
o Derived*from*ectoderm**
o Doesnt*have*a*nerve*or*vascular*supply*(very*
little)*
Dermis*
o Sebaceous*glands*
o Hair*follicles*
o Derived*from*mesoderm*
 Hypodermis*
o Derived*from*mesoderm*
o Aka*Subcutaneous'tissue*
o Filled*with*subcutaneous*fat*
o Provides*insulation*to*the*body*
Epidermis*
4D5*layers*
Topmost*layer:*stratum'corneum**
o Provides*protection*from*physical*injury**
! ***Keratinocytes**
! Melanocytes*
Melanocytes*synthesise*pigments,*make*way*up*from*basal*layer,*and*
keratinocytes*take*melanocytes*and*placed*on*top*of*nucleus*of*
keratinocytes,*melanocytes*cells*clump*together,*density*gives*skin*colour.*
How*often*they*are*pushed*up*depends*on*skin*colour*
Albino*lack*enzyme*which*allows*to*synthesise*pigments,*autosomal*recessive*
Bottom*layer:*stratum'basalis**
o Basal*cells*
Dermis**
Contains**
Blood*vessels*
Sweat*glands**
o Apocrine*
! Clumped*in*armpits*and*genital*areas*
! Odorous*
o Merocrine*glands*
! Underneath*skin*
! Everywhere*
! NonDodorous*
! Sweat*when*hot*
Sebaceous*glands**
o Produce*oil,**
o Very*close*to*hair*follicle,**
o Not*on*palms*or*soles*
Nail*roots**
o Start*in*dermis*and*then*come*out*
o Nail*is*then*dead*keratin*
Sensory*nerve*endings**
o Lie*within*dermis*
o Attach*on*hair*follicle,*smooth*muscle*
o *Erector*pily*muscle*
o *Has*nerve*endings*innovated*by*SNS*
o *Activated*by*cold,*shiver*
Two*Zones*
o Papillary*layer*
o Reticular*layer**
! Collagen*fibres*are*more*loosely*arranged,*transition*between*dermis*and*
hypodermis*
! High*in*elastic*tissue*
o Where*epidermis*is*determines*the*thickness*
o Extensor*surface*is*exposed*to*the*elements,*and*is*thicker*than*the*flexor*surface*
 o Because*of*rotation*that*has*taken*place*in*limbs,*the*extensor*surface*in*lower*limbs*on*
the*anterior*surface*
Subcutaneous*tissue*(layer*of)*
Superficial*fascia*
o Has*most*of*the*fat*
o Is*the*layer*which*provides*temp*regulation*
Deep*fascia*
Thickness*of*Skin*
* Thick*skin*is*where*epidermis*is*thick*
o Hair*is*absent*from*thick*skin*
o Also*no*sebaceous*glands*there,*though*there*are*sweat*glands*
o The*way*they*connect*to*muscles*etc.*by*connective*tissue*fibres*and*the*segments*form*
skin*creases,*
Body*surface*area*
*Collagen*fibres*making*contact*with*a*deeper*layer*of*skin,*relaxed*skin*tension*lines**
Cuts*heal*better*when*working*along*the*tension*lines*as*opposed*to*cutting*perpendicular,*causing*
excessive*scarring*
Rule*of*9s,*2x9s*back*etc.,*useful*in*burns*
*Skin*appendages*etc.*
Pilosebaceious*unit*
o Arrector*pili*muscle*
o Sebaceous*gland*
o Hair*and*hair*follicle*
Sweat*glands*
o Merocrine*
o Apocrine*
o Sebaceous*
o Ceruminous*
o MammaryD*modified*sweat*glands*(all*these*glands*start*off*from*ectoderm*but*
have*layer*of*connective*tissue*down*to*mesoderm*
Skin*can*meet*with*mucosal*layer;*is*a*mucocutaneous*junction*
Nail*bed*lies*in*dermis,*very*sensitive*because*underneath*is*nerve*
and*blood*supply*
Nerve*and*blood*supply*
Epidermis*has*none*
Dermis*has*good*supple*
Nerve*fibres*associated*with*skin*allow*us*to*perceive*extremely*fine*
touch,*mechanoreceptors,*pressure*is*felt*and*picked*up*by*these*
receptors*
Pain*by*nociceptors,*part*of*afferent*nerve*supply*
Motor*nerve*fibres*
* *Part*of*somatic*system*
Visceral*sympathetic*nerves*innovate*the*following*
Hot*and*cold*perceived*by*vasomotor*nerve*fibres*
Increase*surface*area*and*allow*heat*to*escape*
Sudomotor*fibres*innovate*sweat*glands*
Pilomotor*allows*hair*to*stand*on*end*
Dermartomes*
Patch*of*skin*innovated*by*same*spinal*cord*segment*(nerve)*becomes*a*
dermatome*
Innovated*by*the*same*nerve*(attached*to)*
Segmental*supply*
Dermatome*innovation*is*very*segmented*
Limbs*spread*from*midline,*are*jointed,*consider*limb*formation*in*order*to*understand*dermatome*
pattern*
7*somites*pushes*out*C4*pushes*C5,*then*C6,*C7*goes*all*the*way*to*distal*tip,*central*one*goes*to*
distal*tip,*C7,*C8*etc.*returns*to*midline.*This*is*somite*pattern*
Axial*line*is*where*they*do*not*overlap*
Pre*axial*border*is*going*to*tip,*from*mid*line,*post*axial*is*other*way*
Territories*supplied*by*peripheral*nerves*
Mapping*dermatomes,*overlap*is*important*
Overlap*is*greater*for*pain*and*temp,*but*not*for**
Midline*of*body*is*central*axial*line,*zone*of*non*overlap*
*
Nerve*infections*
Herpes*goes*along*the*dermatome*pattern**
Referred*pain*
Pain*experienced*at*site*is*different*from*the*source*
Brain*refers*pain*back*to*the*skin*which*overlies*a*segment**
Diffused,*not*picked*up*in*organ,*referred*to*dermatome*lying*over*
If*a*viscous*organ*migrates,*it*takes*is*nerve*and*blood*supply*with.*E.g.*diaphragm.*Pain*in*the*
diaphragm*is*felt*in*the*neck*
Blood*supply*of*skin*
Blood*vessels*are*mesoderm*derived*
Blood*vessels*present*in*dermis*
No*blood*vessels*in*epidermis*
Two*blood*level*supple*
Continuous*AV*anastomoses*in*skin*
*
Lymph*drainage*of*skin*
Pattern*of*lymph*drainage;*gets*collected*along*the*vessels**
Superficial*is*where*lymph*is*collected*
First*level*of*protection*for*any*kind*of*infection*
Clump*into*lymph*nodes,*major*intersections*
Axillary*
Lymph*is*a*fluid,*includes*white*blood*cells*and*extra*stuff*
Lymph*is*an*ultra*filtrate*of*blood*
Lymph*networks*drain*into*each*other**
*
 Lecture'6'
Nervous(System(1(
Nervous'System!
Central!Nervous!System!(CNS)!
o Made!up!of!the!brain!and!spinal!cord!
Peripheral!Nervous!System!(PNS)!
o Nerves!outside!the!brain,!brainstem!and!
spinal!cord!
o Outside!the!bone,!within!the!body!
o Made!up!of!twelve!pairs!of!cranial!nerves!
emerging!from!the!brain,!and!thirty@one!
pairs!of!spinal!nerves!(emerging!from!the!spinal!cord)!
! Each!pair!of!spinal!nerves!corresponds!to!an!associated!spinal!cord!segment!
Orientations'of'the'Brain''
Central!nervous!system!is!elongated!(of!vertebrates)!
o The!rostro@caudal!neuraxis!of!quadrupeds!is!essentially!horizontal!(ventral!and!dorsal)!
! Caudal@!toward!the!tail,!bottom!of!the!pelvis!
! Rostral@!towards!the!beak,!towards!the!head!
! Ventral@!forward!(anterior)!
! Dorsal@!towards!the!back!(posterior)!
! Horizontal@!transverse!
! Superior@!on!top!of!
! Inferior@!bottom!of!
! Distal@!the!farthest!part!from!the!midline!
! Proximal!!closest!to!the!midline!!
o The!neuraxis!is!essentially!vertical!in!humans!but!is!rotated!at!the!rostral!end!(the!head,!up!
through!neck!then!rotates!90!degrees!through!head!
o Rostra!caudal!along!spinal!cord!and!then!rostro!caudal!through!the!brain!
'

Imaging'
Sectional!images!of!the!CNS!may!be!obtained!while!the!subject!is!laying!down,!so!care!is!needed!in!
specifying!the!plane!of!section!
o Scan!plane!is!vertical!
Nerve'Fibres'
Nerve!fibres!have!the!following!characteristics!
o Excitability:!enables!an!area!of!cell!membrane!to!change!electrical!polarity!when!stimulated.!
o Conductivity:!enables!a!wave!of!excitation!to!be!propagated!along!a!cell!membrane.!
Components!of!a!nerve!fibre:!!
Centrally!located!axon!and!surrounded!by!supporting!cells!(with!or!
without!a!myelin!sheath!between!them).!!
o Axon:!a!major!propagation!of!the!cell!membrane!with!enclosed!
cytoplasm@!axoplasm@!from!a!nerve!cell.!
! Nerve!cells!are!termed!neurons!
 o The!supporting!cell!is!the!Schwann!cell,!and!is!in!the!form!of!a!sheath!called!the!neurilemma!
o Myelin!is!a!fatty!insulator!(derived!from!the!Schwann!cell)!around!the!axon!and!internal!to!
the!neurilemma,!enabling!rapid!conduction.!
Connective!tissue!of!a!peripheral!nerve:!!!
A!nerve!is!made!up!of!nerve!fibres!(derived!from!ectoderm)!and!connective!
tissue!(mesoderm!derived)!
A!tubular!sheath!of!connective!tissue,!endoneurium,!surrounds!each!nerve!
fibre.!
Bundles!of!nerve!fibres!surrounded!by!connective!tissue!are!called!
perineurium.!!
The!whole!nerves!is!wrapped!in!a!connective!tissue!sheath,!epineurium.!!
These!connective!tissues!are!primarily!made!of!collagen!fibres,!with!some!fat!occasionally!present!
between!the!epineurium!and!perineurium.!(usually!at!sites!where!the!nerves!are!subjected!to!
stretch!or!compression)!
Synapses'
The!peripheral!nervous!system!and!ganglia!are!derived!from!cranial!and!spinal!nerves.!
Although!a!neuron!possesses!only!one!axon,!it!may!receive!numerous!synapses!from!axons!of!other!
neurons.!
This!occurs!within!the!cell!body!(surrounds!the!nucleus)!and!within!the!prolongations!of!cell!
membrane,!called!dendrites,!near!the!cell!membrane.!
Cell!membranes!of!synapsing!neurons!are!separated!by!the!synaptic!cleft!(a!gap)!
Sensory'and'motor'nerve'fibres'
Sensory!fibres!
o Afferent!(carry!signals!to!CNS)!
o Conduct!impulses!from!organs!that!are!sensitive!to!stimuli!
Motor!fibres!
o Efferent!(carry!signals!from!CNS)!
o Conduct!impulses!to!organs!that!may!respond!actively!
Typical!sensory!neuron!has!no!dendrites!
o Has!a!short!single!axon!instead!
Separate!pathways,!spinal!roots!connecting!to!the!CNS!
Neurons'and'neuroglia'
Brain!and!spinal!cord!consist!of!nerve!cells!plus!supporting!
cells!
Neuroglia!support!neurons!in!the!brain!and!spinal!cord!
o Majority!of!these!cells!are!astrocytes!
! These!star!shaped!cells!have!processes!with!
foot!plates!that!surround!blood!vessels!
o Some!neuroglial!cells!are!more!like!schwann!cells!
that!support!peripheral!nerve!cells.!!
! These!myelin@forming!cells!are!the!
oligodendrocytes!
! Oligodendrocytes!(in!the!CNS)!and!Schwann!
cells!(in!the!PNS)!are!glial!cells!that!provide!
insulation!to!nerve!axons.!
! The!lipid!bilayers!of!oligodendrocyte!cell!membrane!that!forms!this!insulation!(the!
myelin!sheath)!gives!the!axonal!bundles!a!white!appearance,!and!hence!fibre!tracts!
in!the!brain!and!spinal!cord!are!called!whit!matter.!
'
'
'
Nervous'Systems'
The!central!nervous!system!(CNS)!comprises!the!brain!and!spinal!cord!
The!peripheral!nervous!system!(PNS)!is!defined!as!the!nerves!
connecting!the!central!nervous!system!to!the!body!(the!periphery),!and!
includes!a!number!of!neuronal'clusters'(ganglia)!at!specific!location!
along!those!peripheral!nerves.!!
Meninges'
Sac!that!holds!the!brain!
The!brain!and!spinal!cord!are!bathed!in!CSF!and!meninges,!providing!
both!support!and!protection.!
The!meninges!are!the!membranes!covering!the!brain!and!spinal!cord!
and!has!its!own'vascular'supply!
They!are!comprised!of!the:!
o Dura!Mater!=!outside!tough!cloak!layers!
o Arachnoid!mater!
o Pia!mater!
The!subarachnoid!space!is!filled!with!cerebro@spinal!
fluid!(CSF)!
It!has!a!high!metabolic!demand!and!thus!has!a!large!
vascular!supply.!!
The'Dura'Mater!
A!thick!(tough,!fibrous@!like!a!leather!
bag)!membrane!that!is!the!outermost!
three!layers!of!the!meninges!that!
surrounds!the!brain!and!spinal!cord.!!
Derived!from!the!mesoderm!!
Envelops!the!arachnoid!matter!
Made!of!connective!tissue!
Own!vascular!supply!
Sub!dura!space@!potential!space0!
could!be!more!space!if!something!gets!in!between!Dura!and!arachnoid!matter,!like!an!uninflated!
balloon!
Arachnoid'layer''
Closely!adheres!to!the!dura!
Clear!glad@wrap@ey!sac!
Derived!from!the!ectoderm!Connective!tissue!
Spidery!tendrils!that!come!down!from!the!arachnoid!layer!to!pia!mater!
Under!this!is!the!sub!arachnoid!space,!very!large,!has!all!the!blood!vessels!supplying!the!brain!in!this!
space.!
Pia'Mater'
A!delicate!covering!directly!investing!the!brain!and!spinal!cord!(as!well!as!the!bloody!vessels!
supplying!them).!!
Touching!the!brain,!no!sub!space!
Derived!from!the!ectoderm!
Follows!all!way!through!the!brain,!dura!and!arachnoid!are!in!the!outside!except!for!a!few!areas!
Between!arachnoid!and!pia!!subarachnoid!space@!is!fluid!(looks!like!water!and!saltier),!cerebro!
spinal!fluid!
!
!
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The'Ventricular'System'
Large,!3D!shape!and!an!epithelial!lining!(epedyma)!
Two!large!C@shaped!lateral!ventricles!communicate!with!the!midline!third!ventricle!(thin!blade!of!
space)!(via!intraventricular!foramen)!which!continues!to!the!fourth!ventricle!(via!cerebral!aqueduct)!
The!fourth!ventricle!communicates!with!the!subarachnoid!space!by!a!large!median!arpeture!and!
two!smaller!ones.!
Choroid!plexus!lines!this!
!
Cerebro'Spinal'Fluid'(CSF)'
Bathes!the!brain,!controls!pH,!cushions!from!force,!contains!essential!ions!
Formed!in!the!ventricles!by!the!choroid!plexuses,!vascular!folds!of!the!
ependymal!lining.!
CSF!circulates!in!the!subarachnoid!space,!in!equilibrium!with!extracellular!
fluid!surrounding!the!neurons!and!neuroglia.!!
Returned!to!the!venous!system!within!the!cranial!cavity.!
Colourless!bodily!fluid,!which!is!found!in!the!brain!and!spine.!(Mostly!
water!and!some!ions)!
It!is!produced!in!the!choroid'plexus'(specialised'vascular'tissue,'type'of'cell)!of!the!brain,!acting!as!a!
cushion!or!buffer!for!the!brain.!In!the!walls!of!the!tunnel!inside!the!
brain!
Provides!basic!immunological!protection!and!essential!in!cerebral!
auto!regulation!of!cerebral!blood!flow.!!
Constitutes!the!content!of!the!ventricles,!cisterns!and!sulci!of!the!
brain.!!
Hydrocephalus!can!occur!if!no!drain!of!CSF,!or!slower!drainage!rate!
Arachnoid!granulations,!like!pimples!in!the!brain,!CSF!goes!from!the!
choroid!plexus,!travels!around!the!brain!and!spinal!cord!to!inside!the!sub!arachnoid!space,!through!
the!arachnoid!granulations!into!the!venous!system!in!between!the!dura@!through!which!CSF!leaves!
The'Meninges'and'CSF'
More!fluid!in!brain!creates!high!pressure!"!the!liquid!cant!compress!
High!pressure:!pushes!brain!around!causing!damage!
The!condition!hydrocephalus-(abnormal!accumulation!of!
cerebrospinal!fluid!(CSF)!in!the!ventricles'of'the'brain)!is!
treated!in!infants!by!draining!from!the!ventricles!into!the!
peritoneal!cavity.!!
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The!meninges!
and!CSF!
Babys!head!can!expand!!(bones!of!skull!not!connected)!
Brain!gets!larger!in!baby!
o Treat!with!tube!into!ventricle!and!drain!the!fluid!out,!absorbed!back!into!venous!system!
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 Adult'
o Cant!increase!head!size!(same!with!any!excess!of!fluid,!anywhere!in!body)!
o The!pressure!inside!the!skull!goes!up,!possibly!dramatic!
o Too!much!pressure!will!oppose!the!blood!flow!coming!through,!important!to!brain!
o Uneven!pressure!will!try!to!push!the!brain!around!(into!hard!surfaces@!hole!at!bottom!of!
skull)!
o Rigid!structures,!falx!cerebri!for!example!dont!like!being!moved!and!will!damage!the!brain!
o Also!between!cerebrum!and!cerebellum,!tight!band!of!connective!tissue,!will!start!to!
herniate,!this!is!where!brain!stem!is!controlling!vital!functions,!compromising!vital!functions!
o Tumour!growth!
o Radio!opaque!in!CT!scan,!clotted!blood!has!excess!calcium,!absorbs!X!ray!
! adheres!most!where!skull!connects!
! epidural!bleed!
!
If!trying!the!increase!the!volume!in!an!adult'skull,!a!hematoma!results.!E.g.!increase!in!CSF!volume,!
bleeding,!tumour!growth.!"!Pushes!brain'
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Brain'Structure/Views!
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White'and'Grey'matter'Distribution'
o In!the!brain,!Grey!matter!is!external!and!white!matter!is!internal'
o In!the!spinal!cord!the!orientation!is!inverse.!'
o Grey'matter!!contains!neuronal!cell!bodies,!dendrites,!short!
axons!and!glia'
o White'matter'!contains!myelinated!axons!and!glia!(especially!
oligodendrocytes),!white!from!fat'
!
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Oligodendrocytes'
Oligodendrocytes!(in!the!CNS)!and!Schwann!cells!(in!
the!PNS)!are!glial!cells!that!provide!insulation!to!nerve!
axons'
The'lipid'bilayers'!of!oligodendrocyte!cell!membrane!
that!forms!this!insulation!(the!myelin!sheath)!gives!the!
axonal!bundles!a!white'appearance!
# Hence,!fibre!tracts!in!the!brain!and!spinal!cord!are!called!White'Matter!
!
For!large!diameter!axons,!myelin!increases!the!speed!of!the!nerve!impulse!
Neurilemma=outermost!nucleated!cytoplasmic!layer!of!Schwann!cells!that!surrounds!the!axon!of!the!
neuron.!!
Nerves!
Axons!in!the!periphery!cluster!together!to!form!nerves:!
o Collections!of!thousands!of!individual!axons!in!a!common!
external!connective!tissue!sheath!(epineurium).!!
Within!the!nerve!axons!are!sub!grouped!into!fascicles,!surrounded!by!
a!perineurial!sheath!
!
Nerve'Distribution'
Total!of!31!spinal!segments!
Acronym!of!Cut!The!Lettuce:!CTL!
o Cervical:!!8!vertebrae,!8!nerves!
o Thoracic:!12!vertebrae,!12!nerves!
o Lumbar:!5!Vertebrae,!5!nerves!
o Sacral:!5!Vertebrae,!5!nerves!
o Coccygeal:!1+!
Extra!info:!
Axons!have!gaps;!signals!can!jump!faster,!hence!
myelinated.!Myelin!conducts!electricity!from!point!
to!point!quickly.!Increases!the!conduction!
potential.!
Node!of!ranvier@!the!gap!in!between!each!bit!of!
myelin!sheath!
Skin!is!dermatome,!muscle@!myetome!!
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 LECTURE'7'
Connections)
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Spinal'nerves'and'fibre'types'
Posterior(and(anterior(nerve(roots(
Each(pair(of(spinal(nerves(is(attached(to(the(corresponding(spinal(cord(segment(via(nerve(roots(arising(as(a(
series(of(rootlets(from(the(posterior(and(anterior(aspects(of(the(spinal(cord.(
Posterior(nerve(roots(are(purely(sensory(and(anterior(purely(motor.(
They(contain(only(afferent(and(efferent(fibres(respectively.(
A(serrated(fold(of(pia(mater,(the(denticulate(ligament,(within(the(subarachnoid(space(separates(the(
posterior((dorsal)(and(anterior((ventral)(nerve(roots.((
A(swelling,(ganglion,(is(found(in(
each(posterior(root.((
o Composed(of(clusters(of(cell(
bodies(of(sensory(nerve(
fibres((have(both(proximal(
and(distal(axonal(
extensions,(unlike(motor(
fibres)(
Afferent(fibres(in(posterior(roots(
Somatic(afferent(nerves,(both(
cutaneous((superficial)(and(
proprioceptive((deep),(form(the(
vast(majority(of(fibres(in(the(posterior(root(of(spinal(
nerves(at(all(levels.(
In(addition.(Posterior(roots(from(T1(to(L2(convey(some(
visceral(afferent(fibres((which(accompany(the(visceral(
efferent(fibres(but(passed(through(a(sympathetic(ganglion(
Dorsal(
without(synapsing.(( Route((
o These(fibres(convey(visceral(pain(fro(thoracic(,( ganglia((
abdominal(and(upper(pelvis(viscera.((
Efferent(fibres(in(anterior(roots(
Somatic(efferent(fibres(comprise(the(vast(majority(of(
fibres(in(the(anterior(roots(of(all(spinal(nerves(
Dural(Sleeve(
The(union(of(an(anterior(nerve(root(with(a(posterior(nerve(
root(forms(a(spinal(nerve.(
Each(spinal(nerve(emerges(from(an(intervertebral(foramen(
Nerve(roots(are(invested(by(thin(pia(mater,(continuous(with(that(surrounding(the(spinal(cord(
When(anterior(and(posterior(nerve(roots(pass(into(an(intervertebral(formane(they(also(receive(a(
dural(sleeve,(an(arachnoidKlined(extension(of(dura(mater.((
The(dural(sleeve(emerges(with(the(epineurium(of(the(spinal(nerve.((
Segmental'nerve'distribution(
Each(spinal(nerve(supplies(an(associated(neurosome,(this(includes(its(dermatome,(via(cutaneous(
branches(of(the(posterior(ramus(and(the(anterior.((
A(spinal(nerve(also(supplies(the(myotome,(a(mass(of(associated(muscle,(via(muscular(branches.((
Thoracic(spinal(nerves(are(regarded(as(typical(spinal(nerves.(The(segmental(pattern(of(distribution(
from(a(thoracic(spinal(nerve(is(retained(in(both(its(posterior(and(anterior(rami.((
The(segmental(pattern(of(distribution(from(cervical,(lumbar(and(sacral(spinal(nerves(is(disguised(by(
their(anterior(rami(linking(to(form(plexuses.((
Branchial'arches'
The(mixed(cranial(nerves(supply(special(muscles(that(possess(certain(properties(of(somatic(and(
visceral(muscle.(
Muscles(of(the(jaw,(face,(pharynx(and(larynx(are(derived(from(the(branchial(arches.(
These(are(paired(masses(of(mesoderm(situated(between(gill(clefts((ectoderm(depressions(overlying(
endoderm(pouches.)(
Branchial(arches(may(also(be(termed(pharyngeal(arches.(
Each(branchial(arch(is(supplied(by(a(mixed(cranial(nerve(
The(cranial(nerves(with(both(motor(and(sensory(fibres(are(peculiar(in(that(their(supply(includes(
branchial(arch(muscles(involved(in(a(special(set(of(reflexes.((
Although(structurally(identical(to(skeletal(muscles(and(capable(of(voluntary(movement,(branchial(
muscles(develop(from(splanchnic(mesoderm.((
These(muscles,(which(tend(to(be(covered(in(mucous(membrane(or(located(near(a(mucocutaneous(
junction,(are(also(functionally(related(to(smooth(muscle.(
Somatic'efferents'
Are(distributed(to(the(extraocular(muscles((via(cranial(nerves)(
These(skeletal(muscles(are(responsible(for(movements(of(the(eyeball(
Nerve'Ganglia'
Posterior((dorsal)(root(ganglia(
A(nerve(ganglion(is(a(localised(enlargement(on(a(component(of(the(PNS.(
It(is(due(to(a(collection(of(neural(cell(bodies.(
They(occupy(much(more(space(than(axons(
They(may(be(sensory(or(motor(
They(are(created(by(the(collection(of(cell(bodies(of(sensory(neurons(
They(are(found(on(the(posterior(root(of(every(spinal(nerve((just(before(posterior(root(unites(with(the(
anterior(root(to(form(the(spinal(nerve)(
Each(posterior(root(ganglion(resides(in(an(intervertebral(foramen,(regardless(of(the(length(of(the(
associated(nerve(root(
Cranial(nerve(ganglia(
The(sensory(ganglia(of(cranial(nerves(are(located(in(or(near(the(associated(foramina(of(the(skull(
Autonomic(ganglion((
Motor(ganglia(are(associated(with(autonomic(nerves((not(somatic).(
Autonomic(ganglia(are(swellings(created(by(clusters(of(cell(bodies(of(visceral(motor(neurons(and(are(
distinguished(from(a(sensory(ganglion(by(the(presence(of(synapses.(((
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Peripheral'Nerves'
Peripheral(nerve(axons(can(be(either((
o Efferent((carrying(signals(from(the(CNS)(or(
o Afferent((carrying(signals(to(the(CNS)(
Although(mixed(in(the(peripheral(nerves,(they(have(separate(pathways,(spinal(roots,(connecting(to(
CNS(
Dorsal(=(sensory(neurons(&(Ventral(=(motor(neurons(
Efferent((blue)(and(afferent((red)(axons(segregate(at(the(
point(just(before(they(contact(the(CNS((spinal(cord(and(
brainstem):(sensory(axons(join(at(the(CNS(vie(a(dorsal(
(posterior)(root,(motor(axons(join(at(a(ventral((anterior)(
root.((
Axon(travels(out(through(ventral(route(and(joins(peripheral(
nerve.(
 Sensory(neuron(sits(in(little(clusters(on(peripheral(nerve.(Posterioral(route(ganglian((clusters).(Makes(
it(connections(in(the(central(nervous(system.((
( Connections:(the(structure(of(nerve(cells(reveals(their(penchant(for(connectivity(
Some(of(the(more(tractable(pathways(of(neural(information(flow(are(those(between(the(central(and(
peripheral(nervous(system(
Nerve'distribution'and'branches'
Peripheral(nerve(distribution(
Peripheral(nerves(supply(their(target(organs(by(branches.(
The(structures(supplied(by(branches(of(a(particular(nerve(are(regarded(as(its(distribution(
This(distribution(depends(on(the(functional(fibre(types(within(the(nerve.(
Somatic(afferent(fibres(are(distributed(to(skin,(bones,(joints(and(muscle.(
Those(arising(from(receptors(in(the(skin(are(called(superficial(somatic((cutaneous)(afferents;(thos(in(
bones(etc.(are(deep(somatic((proprioceptive)(afferents.(
Somatic(efferent(fibres(are(distributed(to(skeletal(muscles.((
Visceral(efferent(fibres(are(sym[athetic(and(primarily(vasomotor.((
o These(fibres(are(distributed(to(blood(vessels(in(muscle,(bones,(joints(and(skin.((
o Sudomotor(fibres((to(sweat(glands)(and(pilomotor(fibres((to(arrector(pili(muscles)(are(also(
distributed(to(the(skin(
Peripheral(nerve(branches(
A(typical(peripheral(nerve(distributes(its(fibres(via(muscle,(cutaneous,(articular(and(vasomotor(
branches.(
o Muscular:(contain(both(motor(and(sensory(fibres(
o Cutaneous:(primarily(made(of(sensory(fibres((some(sympathetic),(terminal(branch(is(usually(
cutaneous(
o Articular:(sensory,(can(arise(indirectly(from(muscular(
o Vasomotor:(purely(sympathetic(postKganglionic(fibres.((
Hiltons(Law(
A(nerve(that(supplies(a(muscle(producing(movement(at(a(joint(also(supplies(
sensation(to(the(joint(and(the(skin(overlying((the(insertion(of()(the(muscle.(
Branching(sequence(of(nerves(
Each(nerve(of(a(particular(compartment(supplies(muscular(branches((to(the(
associated(flexor(and(extensor(muscle(group),(then(articular(branches((for(
sensation(from(that(aspect(of(the(joint(underlying(the(muscles)(and(then(
terminates(as(a(cutaneous(nerve((supplying(skin(overlying(the(part(that(is(
moved).(
Cranial'Peripheral'Nerves'
In(addition(to(the(31(pairs(of(spinal(nerves,(the(peripheral(nervous(system(
includes(the(cranial(nerves(
A(ventral(view(of(the(brain(shows(numerous(nerves(connected(to(the(brain,(
especially(to(the(brainstem.(
These(are(cranial(nerves(
The(12'cranial'nerves(have(a(variety(of(special(sensory,(general(sensory,(motor(and(
autonomic(functions(
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Test'Question(
A(tract(is:(a(bundle(of(axons(
A(Nerve(is(a(bundle(of(nerve(tissue(
A(ganglion(is:(a(swelling(in(a(nerve(cell(body(
Spinal'Cord'Protection(
The(meninges((Dura(matar,(arachnoid(and(pia(mater),(
and(the(CSF(in(the(sub(arachnoid(space,(protect(the(
spinal(cord(as(well(as(the(brain.((
Spinal'Afferents'
Have(their(cell(bodies(in(the(PNS((the(posterior(
ganglion)('
Spinal'Efferents(
Have(their(cell(body(in(the(CNS(anterior(horn(
Nerve'Pathways'
Peripheral(nerve((somatic)'
Note(that(nerve(trucks(are(mixed(in(terms(afferents(
and(efferents'
Same(nerve(may(have(a(lot(of(fibres(
Each(routlet(is(hundreds(of(neurons,(not(one.((
Spinal(grey(matter(is(full(of(neruons(which(connect(
up(the(input(and(output(info'
Autonomic'Nervous'System'
An(Effector(system(in(the(CNS(and(PNS(mediating(
unconscious(homeostatic(control(of(organ(and(body(
physiology(
In(the(Parasympathetic(NS(Connections(from(the(CNS(are(
about(as(far(away(as(you(can(get.(They(dont(have(nearby(
ganglia.(The(ganglia(are(located(next(to(the(organs(in(target(
(
Enteric'Divisions'of'the'peripheral'nervous'system'
Enteric(nervous(system((autonomic(neurons(in(the(gut(wall)(
is(the(third(component(of(autonomic(system(
A(huge(number(of(neurons(in(the(GIT(wall(forming(circuits(responsible(for(mixing,(peristalsis(and(
secretion(
Midline(is(intermediate(horns,(above(the(blue.(Autonomic(neurons,(not(in(the(cervical(cord(or(from(
L2(downwards(
( White(myelin(ramus(
Spinal(cord(grey(matter(columns(
Grey(matter(within(each(side(of(the(spinal(cord(is(arranged(at(3D(columns(
The(anterior(column(contains(cell(bodies(of(somatic(motor(neurons.(Their(axons(exit(via(anterior(
nerve(roots(
The(posterior(column(contains(neurons(relaying(and(integrating(sensory(information(
The(lateral(column(contains(the(cell(bodies(of(autonomic(neurons.(
Sympathetic(neurons(lie(in(all(thoracic(segments(of(the(spinal(column(as(well(as(the(upper(two(
lumbar(segments(
Neural(tube(
The(brain(and(spinal(cord(are(both(derived(from(the(ectoderm.((
During(development(the(neural(plate,(a(longitudinal(midline(thickening(of(ectoderm,(forms(a(groove.((
 This(neural(groove(has(folds(that(meet(and(become(buried(as(the(neural(tube.((
Ganglia(and(Schwann(cells(derive(from(the(neural(crest(
The(brain(develops(from(the(expanded(cranial(end(of(the(neural(tube,(the(spinal(cord(from(its(
narrow(caudal(part.((
The(cranial(end(of(the(neural(tube(is(subdivided(into(various(parts,(each(which(includes(a(cavity((the(
lateral(ventricles,(third(ventricle,(cerebral(aqueduct(and(fourth(ventricle)((
The(spinal(cord(also(has(a(central(canal(
Notochord(
The(notochord(is(a(mesoderm(derived(flexible(rod(providing(support.((
The(nerve(cord(lying(dorsal(to(it(is(ectodermKderived(while(the(gut(tube(ventral(to(it(is(endoderm(
derived.((
The(notochord(and(the(tail(disappear(almost(completely(from(an(embryo((the(notochord(remnant(
forms(the(nucleus(pulposus(of(each(intervertebral(disc;(the(tail(remnant(the(coccyx)(
(
(
MotorK(anterior,(action(moving(things(ventral,(info(comes(in(from(spinal(cord(
Central(canal,(filled(with(CSF(
Axons(have(gaps,(signals(can(jump(faster,(hence(myelinated.(Myelin(conducts(electricity(from(point(to(point(
quickly.(Increases(the(conduction(potential.(
Node(of(ranvierK(the(gap(in(between(each(bit(of(myelin(sheath(
Connections:(the(structure(of(nerve(cells(reveals(their(penchant(for(connectivity(
Some(of(the(more(tractable(pathways(of(neural(information(flow(are(those(between(the(central(and(
peripheral(nervous(system(
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 LECTURE'08'
Skeletal'Systems'and'Bones'
Skeletal'Framework'of'Body'
Subdivided(into:(
o Axial(skeleton((skull,(vertebral(column,(ribs(and(sternum.(
o Appendicular(skeleton((limbs(and(limb(girdles)(
Skeletal(system(includes:(
o Bones,(cartilage((
! Cartilage(is(derived(from(mesoderm(
(
Function'of'skeletal'system'
Supports(the(body(and(muscles(
Protects(and(encloses(visceral(organs(
Helps(in(movement(
o Muscles(work(as(levers(to(move(the(body(
Blood(formation(in(bone(marrow((
o Red(blood(cells(formed(in(bone(marrow,(within(bones(
o Immune(cells(deposited(and(formed(
Stores(minerals(and(salts(like(calcium(and(phosphorus(
o Can(release(and(hydrolyse(these(minerals(whenever(necessary(
Removes(foreign(and(toxic(heavy(metals(
o if(foreign(body(gets(into(skeletal(system,(the(skeletal(system(
must(remove(it(
(
Types'of'bones(
Long((includes(some(of(the(bones(within(the(hand,(metacarpal)(
o Tubular(structures((hollow)(
o Arm(and(leg(bones("(Larger(movement(
Short((ankle(and(wrist)(
o CubeIlike(structures(
o Carpal,(tarsal(bones("(slight(movement(
Flat((
o Two(plates(which(come(together(
o Cranial(bones,(sternum,(pelvis,(scapula(
Irregular(
o Vertebrae,(bones(of(face(
Other(
o Pneumatic((holds(airI(air(circulates(within(the(bones(and(is(warmed(up(before(being(passed(
in,(eg(bones(around(nasal(cavity),(sesamoid((small(accessory(bones(embedded(in(tendons.(
Work(like(ball(bearings,(permit(smooth(gliding(action,(stop(tendons(making(deep(grooves(in(
bone(eg(knee(cap),(accessory(
206(bones(in(adult(body((More(however,(in(a(child("(bones(yet(to(fuse.((
(
(
(
(
(
Bone'Composition'
Cells((osteogenic)(
o Osteoblasts(
! Bone(producing(cells(
o Osteoclasts(
! Bone(dissolving'cells(
Extracellular(matrix(
o 2/3rd(inorganic(
! Mineralise(ground(substance((helps(resist(compression)(
! 85%(hydroxyapatite((crystallised(calcium(phosphate(gives(the(bone(strength),(10%(
calcium(carbonate,(other(minerals.(
o 1/3rd(organic(
! Collagen(fibres,(protein,(carbohydrates(molecules(
! Allows(us(to(take(weight(and(resist(tension(so(that(our(bones(do(not(break(easily(
! Collagen(also(allows(bending(as(needed(
o Combination(provides(for(strength'and'resilience(
! Minerals((inorganic)(resist(compression,(collagen((extracellular)(resists(tension(
Structure'of'a'Long'Bone'
Periosteum((collagen(based)(
o Outer(fibrous(covering((not(present(at(
contact(end(of(bones)(
o Articular(cartilage(at(joint(
o All(around(the(bone(except(at(the(
articular(ends,(instead(have(hyaline(
cartilage(
o Periostium(has(two(layers(to(it,(outer(is(
fibrous,(the(inner(is(osteogenic(cells,(if(
you(strip(away(the(periosteum(it(will(
bleed(due(to(rich(blood(supply(
o Straight(away,(however,(osteogenic(
cells(will(start(the(healing(process(
Compact(bone(
o (of(the(weight,(highly(dense(
o found(at(the(top(and(bottom(of(the(long(bones,(the(outer(margins(
Spongy(bone(
o (of(the(weight(
o Made(up(of(trabeculae((lattice(network(of(bony(matrix),(air(filled(bubbles(
o Inside,(where(the(end(meet(up(with(the(articular(surface(
Diaphysis,(middle(part(of(the(bone(which(grows(first(
Epiphysis,(are(separated(from(the(diaphysis,(and(they(grow(separately(
Epiphyseal(plate,(between(diaphysis(and(epiphysis,(hyaline(cartilage(plate,(important(due(to(the(
place(where(bone(growth(occurs(
Nutrient(foramen(
o Opening(of(blood(vessel(
o has(artery(running(through(it(
o lets(through(nutrient(vein/vessel(
Endosteum,(inner(tubular(cavity(
 **Bone)Marrow)is)also)formed)in)flat)
bones,)not)just)long)bones**)
Encircles(the(medullary(cavity(
o Tubular(internal(space(
o Formation(of(bone(marrow(
Medullary(cavity(
o Red(bone(marrow((required(when(growing)(
! Changes(to(yellow(bone(marrow(over(time(
o Yellow(bone(marrow((
! Greater(proportion(of(fatty(tissue(
! Can(revert(back(to(red(marrow(when(needed(((e.g.(fracture)(
! After(fusion(of(bones(takes(place,(red(bone(marrow(slowly(changes(to(yellow(
! Can(turn(back(if(needed(
(
Structure'of'a'Flat'Bone'
External(and(internal(layer(of(compact(bone(
Middle(layer(is(spongy(bone.(No(Marrow(cavity(
Spongy(bones(called(diploe(
Air(filled(bubbles(called(trabeculae((spongy(bone(latticeIwork)((
Flat(bones(lifeIlong(repository(of(red(bone(marrow(

(
Properties'of'bone'
Trabecular(bone((good(at(resisting(static((e.g.(weight(bearing)(forces(
o Forms(the(latticework((
o Dont(make(bones(too(heavy(
o In(the(neck(of(the(femur(the(trabeculae(bones(are(arranged(
vertically,(able(to(take(the(pressure(from(the(entire(body(because(
weight(is(transferred(
Cortical(bone((good(at(resisting(dynamic((e.g.(bending)(forces(
(
Types'of'Cartilage(
Cartilage(is(precursor(for(most(bones(
Is(avascular,(aneural,(no(lymphIdrainage((exception(is(fibro(cartilage)(
Gets(nutrition(from(the(diffusion(from(surrounding(synovial(membrane(and(fluid(
3(types(of(cartilage:(
1) Hyaline(
! On(articular(surfaces((where(bones(join)(
! Parallel(collagen(fibres((very(glossy),((
! Glossy(appearance(
! Model(for(foetal(skeleton(
! Have(synovial(fluid,(good(lubrication(allowing(the(bones(to(move(
against(bone((
! Hyaline(cartilage(at(the(articular(surfaces(means(that(it(can(take(
lots(of(rubbing(against(bone,(no(pain(
2) Fibro((more(irregular)(
! Forms(discs,(meniscus,(labrum((outer(rim(of(cartilage)((
! More(dense,(irregular(collagen(fibres(
! Found(in(the(midline(of(the(body(
 ! Outer(rim(of(outer(third(of(the(cartilage(does(get(some(form(of(nerve(and(blood(
supply,(from(surrounding(membrane(
3) Elastic(
! Elastic(collagen(fibres(
! External(ear,(auditory(tube,(parts(of(larynx((all(change(shape(
! Does(heal,(but(very(poorly(due(to(minimal(nerve(and(blood(supply(
(
Bone'formation:'Ossification'
A) Intramembranous(
o Flat(bones(of(skill,(clavicle,(mandible.(Start(off(as(fibrocartilage(
o Fibrous(cartilage(precursor(
B) Endochondral(
o Long(bones(and(most(other(bones(
o Start(from(precursor(of(hyaline(
Bone(first(appears(between(weeks(6I8(of(intrauterine(life(
(
A)'Intramembranous'Ossification'REVIEW'
Produces(flat(bones(of(skill(and(clavicle(
Bone(formed(from(mesoderm(
Steps(of(the(process:(
1) Mesenchyme(differentiate(and(condense(into(a(sheet(of(soft(tissue((gets(genetic(signal(to(
condense(and(form(sheet)(at(the(ossification(centre(
Transforms(into(a(network(of(soft(trabeculae(
Sheet(covers(outer(and(inner(layer(of(mesenchyme(
This(is(intramembranous(ossification(and(mesenchyme(begins(to(experience(metabolic(
activity(in(the(layer(between(those(two(outer(layers.(
Gives(soft(structure(which(condenses(to(form(trabeculae(
Begin(having(metabolic(processes(
2) Osteoblasts(gather(on(the(trabeculae(to(secrete(osteoid(tissue((uncalcified(bone)(
3) Osteoclasts(remodel(the(centre(to(contain(marrow(spaces(and(osteoblasts(remodel(the(surface(
to(form(compact(bone.((
4) Mesenchyme(at(the(surface(gives(rise(to(periosteum(
Typically(start(of(as(cartilage(hence(meaning(there(is(no(blood(supply,(but(the(signal(for(bone(
formation(comes(from(the(blood(supply(entering(into(the(cartilage(model,(and(once(this(happens(
you(have(vast(metabolic(activity,((blood(supply(comes(in(and(deposits(the(bone(forming(cells,(
osteoblast(gather(of(the(trabeculae(which(form(on(the(inner(layer(of(the(mesenchyme,(they(
form(the(latticework,(depositing(themselves(around(the(trabeculae(and(form(the(gaps,(lecumae.((
Osteoclasts(then((have(come(along(with(the(blood(supply(also),(once(the(latticework(has(been(
formed(the(osteoclasts(break(away(the(outer(margins,(as(they(break(them(away(they(plaster(
them(onto(the(outer(edges(of(bone.((
The(membrane(which(is(one(the(outer(and(inner(surface(of(ossification.((
Within(the(trabeculae(is(where(you(have(the(marrow(spaces.(
Mesenchyme(left(on(the(top(and(bottom(then(gives(rise(to(feriostium.((
(
(
(
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 Flat(bones(are(a(lifelong(repository(of(marrow,(but(there(is(no(medullary(cavity,(it(is(stored(
within(the(spaces(
B)'Endochondral'ossification''1o'centres'
Hyaline(cartilage(model(
1) Bone(first(appears(in(middle(of(shaft(
2) Cartilage(progressively(replaced(by(bone,(extending(towards(the(
ends((epiphyses)(
3) A(nutrient(artery(penetrates(into(the(bone(increasing(nutrient(
availability(to(the(cells.((
4) Bone(simultaneously(formed(in(periosteal(and(endosteal(layers,(
to(remodel(the(medullary(cavity,(which(fills(with(capillary(and(red(
bone(marrow(
Most(other(bones((e.g.(vertebrae)(also(have(primary(centre(of(
ossification(and(bone(is(laid(down(in(a(similar(manner.(

(
Role'of'the'Nutrient'Artery'
Major(artery(supplying(long(bone(
Enters(nutrient(foramen(
Invades(the(primary(centre(
Brings(osteogenic(cells(
Osteoblasts'=(bone(forming(cells(
Osteoclasts(=(bone(remodelling(cells(
(
Parts'of'developing'long'bone'
Diaphysis((between(growth)(forms(the(
shaft(
Epiphysis((upon(growth)(forms(the(ends(
Metaphysis((beyond(growth)(forms(part(
of(diaphysis(adjacent(to(epiphysis(at(each(
end(
o Site(of(remodelling(and(high(
metabolic(activity.((
Epiphyseal(growth(plate(between(metaphysis(and(epiphysis(
(
Ossification''Secondary'Centres'
Secondary(centres(of(ossification(generally(appear(at(epiphyses('
Epiphyseal(arteries(and(osteogenic(cells(invade(epiphysis'
Deposit(osteoblasts,(erode(cartilage'
Both(ends(of(long(bones,(but(one(end(of(digits,(ribs'

Pressure(epiphyses(associated(with(joints'
Traction(epiphyses(associated(with(attachments(of(tendons(or(ligaments'
Distal(femur(&(proximal(tibia(have(medicoIlegal(significance'
The(longer(the(bone,(the(longer(the(growth.('
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Epiphyseal'Growth'Plate'(disk)'
Continued(longitudinal(growth(occurs(at(epiphyseal(growth(plate(
Cartilage(cells(on(the(epiphyseal(surface(progressively(mature(and(die(to(be(replaces(by(bone(at(the(
metaphyseal(surface(
When(fully(developed(the(only(remaining(cartilage(is(articular'cartilage!at(the(ends(of(the(bone.((
Epiphyses(
Epiphyses(have(great(clinical(significance:(
o Indicate(a(bone(is(still(growing(
o If(damages,(may(interrupt(growth(at(site(
o May(be(confused(with(a(fracture(
o Provides(good(indication(of(skeletal(age(in(forensic(situation(
Epiphysial(line(remnant(in(adult(long(bone(
(
Achondroplastic'Dwarfism(
Long(bones(of(the(limbs(stop(growing(but(other(bones(unaffected(
Spontaneous(mutation(is(DNA(
o Mutant(allele(is(dominant(
Chondrocytes(in(metaphysis(fail(to(multiply(and(enlarge(
(
Neurovascular'Supply'of'Bone'
4(types(of(arteries(supply(a(long(bone:(
o Nutrient((providing(osteoblasts(to(initiate(ossification(at(the(
primary(centre)(
o Periosteal(
o Metaphyseal(
o Epiphyseal(
Concept(of(end(arteries(and(anastomoses(
End(arteries(are(of(clinical(significance.(Obstruction(may(lead(to(
death((necrosis)(of(the(tissue(they(supply(
Bone(receives(abundant(sensory(and(pain(nerve(fibres(
Lymph(vessels(accompany(blood(vessels.((
(
Fractures'
Bone(susceptible(to(fracture:(
o May(be(associated(with(tearing(and(stripping(of(periosteum,(
especially(with(displacement(of(broken(ends(
o Common(in(children((greenstick((fracture(which(doesnt(
completely(snap)(and(in(adults((due(to(osteoporosis)(
(
Age'and'Disguise'
Bony(outgrowths((osteophytes(
Compression(fractures(common(in(vertebrae(
(
Ectopic'sites'of'bone'formation'&'bone'pathology(
Bone(may(form(in(other(tissues,(e.g.(viscera,(muscle(
Bone(may(undergo(major(reconstruction(
(
 Lecture'9'
Articular)system)and)joints)
)
Articular'system'and'joints''
Articular!system:!Joints!of!the!body!and!associated!ligaments!
Types!of!joints!
o Fibrous!
o Cartilaginous!
o Synovial!!
Types'of'joints''
Fibrous!joints!
Held!together!by!fibrous!suture!
o Suture!(between!skull!bones)!
o Syndesmosis!(fibrous!tissue!linking!long!bones!e.g.!distal!tibia!and!fibula)!
o Gomphosis!(tooth!held!in!socket!by!periodontal!ligament)!
Cartilaginous!joints!
Held!together!by!cartilage!
o Primary!
! Hyaline!cartilage!b/w!bones!
! Disappear!during!development!
! Eg!epiphyseal!plate!
o Secondary!
! Wedge!of!fibro!cartilage!b/w!layers!of!hyaline!cartilage!(lines!the!bones)!
! Eg!intervertebral!disc!
! Located!in!the!midline!(Dont!allow!a!lot!of!movement,!they!rejig!within!the!
vertebral!column)!
Synovial'joints'
Bones!separated!by!joint!cavity!!
Enclosed!in!fibrous!joint!cavity,!meet!at!articular!surface,!cartilage,!the!pint!where!they!meet!up!is!
enclosed!in!capsule!
Lubricated!by!synovial!fluid!
Allow!extensive!movement!
Tend!to!be!associated!with!limbs!and!limb!girdles!
Types'of'synovial'joints'
! By!shape!of!articulated!joints!
Uniaxial!
Gliding!movement!
! Plane!
! Hinge!
o Convexity!in!one,!and!concavity!in!the!corresponding!bone,!movement!occurs!in!a!singular!
plane!
o Flexion!and!extension,!ulna!with!humorous!
Pivot!
o Bone!that!locates!against!another!bone!and!there!is!a!ligament!which!holds!the!bone!in!
place,!annular!ligament.!!
o E.g.!radius!pronation!and!supernation!relative!to!the!ulna,!ligament!goes!around!the!radius!
but!doesnt!attach!to!it,!pivoting!actions!
o Atlas!moves!against!the!axis,!C2!against!C1!and!the!base!of!the!skull!due!to!bony!projection!
and!there!is!a!ligament!in!place!allowing!this!loose,!rotational!movement!
!
!
!

! 1!
Biaxial!
Condylar!
o Felxion!and!extension;!adduction!and!abduction!
Saddle!joint!
o Forwards!back,!not!side!to!side,!thumb!is!a!saddle!joint,!extension!and!adduction!etc,!and!we!
can!combine,!and!opposition,!very!peculiar.!
Multiaxial!
Ball!and!socket!
o Allow!combine!to!do!circumduction,!includes!abduction,!extension!!
o More!than!two!planes,!also!rotation!
Types'of'synovial'joints'
By!number!of!articular!surfaces'
Simple:!one!pair!of!articulated!sources!(most!synovial!joints)!
Compound:!More!than!one!pair!of!articular!surfaces!(elbow!and!knee!joints)!
Complex:!Joint!cavity!subdivided!into!more!than!one!joint!by!compartment!by:!
o Fibro!cartilaginous!discU!TMJ,!clavicula!stern!
o Incomplete!menisci:!Knee!joint!
o Allow!separate!movements!to!occur,!but!maintains!stability!
Movement'of'bone'at'synovial'joints'
Flexion/extension!
o Sagittal!plane!
Abduction/adduction!
o Coronal!plane!
Rotation!(medial!and!lateral)!
o Transverse!plane!
o Pronation!and!supernation!
Features'of'synovial'joints'
Articular!cartilage!
o Avascular!and!aneural!
Fibrous!capsule!!
o Surrounds!synovial!joint!
o Normally!attaches!at!site!of!epiphyseal!plate!
Joint!cavity!or!synovial!cavity!
o !Is!the!space!between!the!bones!
Synovial!membrane!!
o Doesnt!go!onto!the!articular!surface,!because!it!secretes!the!synovial!fluid!and!blood!supply!
o Lines'the'non=articular'surfaces!
o Synovial!membrane!mesophelium!
Ligaments!
o Collagen!reinforcements!!
Special!structures!
o Labrum!
o Disc,!menisci!
o Intracapsular!tendon!
o Bursae!
o Fat!pad!
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! 2!
Fibrous'capsule'
Encloses!the!joint!
Reinforced!by!(intrinsic)!ligamentous!thickenings!
o Collagen!fibres!that!encircle!the!joint!fibres!are!thicker!on!the!median!and!lateral!side,!this!
thickening!is!described!as!the!ligament!which!supports!the!joint,!the!intrinsic!ligament!(starts!
off!on!a!particular!surface,!stays!on!it,!extrinsic,!starts!on!one,!walks!to!another)!(lateral!coU
lateral!ligament)!
May!have!muscles!attached!to!it!or!openings!in!it!to!permit!access!for!communicating!structures!(e.g!
tendons,!bursa)!!!!!
o Can!have!muscles!start!off!within!the!joint!capsule,!tendon!of!the!muscle!will!come!out,!has!
intraUcapsular!pathway,!will!rub!against!the!bone,!to!stop!it!creating!a!groove,!there!is!a!
bursa!stopping!extra!friction.!
Receives!a!rich!sensory!nerve!supply!of!proprioceptive!(stretch!and!joint!
position)!&pain!fibres!
The!fibrous!capsule!and!ligaments!receive!poor!blood!supply!
Synovial'membrane'
Capsule!lined!by!synovial!membrane!
o Secretes!synovial!fluid!into!the!joint!space!
Small!amount!of!fluid!for!the!size!of!the!joint!
Very!thin!layer!of!mesophelium!
Single!layer!of!loosely!packed!connective!etissue!
Highly!vascular,!good!blood!supply!
If!it!tears,!it!bleeds!
Fluid!works!as!lubricant,!glossy!appearance!of!ligaments!
Other!function!is!that!it!provides!the!nutrition!for!underlying!cartilage,!
because!it!does!not!have!the!blood!supply!
Injury!to!the!membrane!
Effusion!
o Excess!synovial!fluid!in!cavity!through!mild!irritation!of!synovial!membrane!
o Depending!on!the!work!you!put!on!the!joints,!it!will!secrete!extra!fluid!which!allows!the!
lubrication!to!tale!place!
o If!the!membrane!receives!any!damage,!reacts!by!secreting!synovial!fluid,!excess!fluid!and!
causes!synovial!affusion,!causes!inflammation,!warm!to!touch!
Haemarthrosis!
o Bleeding!into!the!joint!cavity!through!tear!of!synovial!membrane!
o If!tear!in!the!membrane!there!will!be!bleeding!within!the!joint!cavity,!there!will!be!blood!not!
fluid!
Septic!arthritis!
o Microorganisms!in!joint!cavity!through!penetrating!injury.!Danger!of!permanent!destruction!
o Penetrating!injury!in!already!harmed!capsule,!break!in!the!capsule!
o Microorganisms!can!penetrate!
o Cartilage!starts!to!break!down!and!float!within!the!capsule!and!joint!will!lock!
Ligaments'
Made!up!of!collagen!fibres,!designed!to!resist!tensile!forces!
Extremely!elastic!sometime,!designed!to!allow!stretch!
Intrinsic!ligamentsU!lie!on!the!capsule,!reinforce!the!capsule!
Extrinsic!ligamentsU!separate!from!the!capsule!
(extracapsular/intracapsular)!
Ligaments!that!work!from!the!clavicle,!arent!part!of!the!joint,!but!
provide!support!for!the!jointU!extracapsular!
Intracapsular,!ligament!that!lies!within!knee!joint!within!the!capsule,!
they!criss!cross!within!the!capsule!

! 3!
 Accessory!ligamentsU!located!at!a!distance!from!the!joint!
Ligament!injury!
Types!IU!minimal!disruption!of!fibres!
Type!IIU!up!to!50%!disruption!(clinical!laxity)!
Type!III!complete!rupture!(10U20%!strain)!,!can!happen!with!an!avulsion!
fracture,!ligament!pulls!the!bone!away!
U You!can!determine!the!injury!unless!it!is!located!very!deep!to!muscles,!it!
can!be!masked!by!supportive!muscles,!e.g.!shoulder!injury!
U Some!ligaments!are!particularly!prone!to!injury!(e.g.!lateral!ligament!
at!the!ankle!is!in!separate!three!bands)!
Labrum'
Fibrocartilangeous!rim!!deepens!socket!in!ball!&!socket!joints;!
shoulder!and!hip)!
Is!a!ring!that!encloses!a!ball!and!socket!joint.!!
Socket!has!a!ring!of!fibrocartoilage!
Ball!fits!within!shallow!cavity,!if!socket!is!tight,!limiting!balls!movement,!when!it!tries!to!move!would!
irritate!the!socket,!the!rim!deepens!the!socket,!!
Avascular!and!aneural,!doesnt!hurt;!receives!nutrition!from!synovial!fluid!
Blood!supply!on!the!outer!!
Discs'and'menisci'
Complete!or!not,!completely!separate!two!compartments,!disc!is!complete!
separation,!meniscus!is!the!semicircular,!start!bigger!and!then!get!pushed!to!the!
side!
Made!of!hydrocartilage,!!

Dont!get!lots!of!blood!supply!
In!knee!can!get!damaged,!bits!of!meniscus!can!
tear!or!breakaway,!can!cause!fibrocartilage!to!
break!away!and!loose!bodies!cause!pain!
Work!to!spread!synovial!fluid!
Menisci!and!discs!generally!only!receive!blood!
(and!nerve)!supply!at!their!periphery!(outer!
third)!!common!site!of!injury!
Intracapsular'tendon'
Pathway!!
Covered!by!synovial!membrane!throughout!
intracapsular!course.!
E.g.!Intracapsular!tendon!of!long!head!of!biceps!(helps!stabilise!head!of!the!humerus)!
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! 4!
Bursae'
Bursa!(L)!!Purse!
Pockets!that!are!made!of!synovial!membrane!
Fluid!filled!pockets!
Lies!in!regions!that!have!lots!of!movement!
Reduce!friction!
Susceptible!to!irritation!or!infection!
Bursae!sometimes!connect!with!the!synovial!cavity,!
communicating!versus!non!communicating!
If!infection!is!in!a!communicating!bursae!can!get!into!joint!
Fat'pads'
Act!as!space!fillers!
Intracapsular!but!exrasynovial!
Surrounding!space,!have!swabs!of!fat!
Help!to!spread!synovial!fluid!
Within!the!capsule!but!dont!have!the!membrane!and!so!are!
extra!capsular!
Have!nerve!and!blood!supply,!so!can!be!painful!if!the!pad!is!
supressed!
Possess!nerve!and!blood!suppy!!may!be!pinched!between!
articular!surfaces,!causing!pain!
Joint'injury'
Some!are!more!susceptible!to!injury!
Subluxation!vs!dislocation!radius!pivot!joint!rotation!action!
Special!structures!may!be!endangered!(eg!nerves!or!vessels)!
!
Neurovascular'supply'of'joints'
Strong!pain!fibres!
Joint!capsule!and!ligaments!have!rich!proprioception!and!pain!fibres!
Articular!surface!covered!by!hyaline!cartilage!is!aneural !
Hiltons!LawU!nerves!supplying!muscle!moving!joints!supply!joints!
Rich!blood!supply!to!synovial!membrane,!bone!and!joint!from!surrounding!
muscles!
Poor!blood!supply!to!fibrous!capsule!and!ligaments!
Articular!hyaline!cartilage!aneural!and!avascular!except!in!the!periphery!
Arthritis'and'artificial'joints'
Arthritis!is!broad!term!for!pain!and!inflammation!
Osteoarthritis!results!from!years!of!joint!wear!
o Articular!cartilage!softens!and!degenerates!
o Bone!spurs!develop!on!exposed!bone!tissue!causing!pain!

Rheumatoid!arthritis!is!
autoimmune!attack!on!the!joint!
o Antibodies!attack!the!synovial!
membrane,!enzymes!in!
synovial!fluid!degrade!the!
cartilage,!bones!ossify!
Arthroplasty!is!replacement!of!
diseased!joint!with!artificial!device!
called!prosthesis!

! 5!
 LECTURE'10'
Muscular(System(and(Muscles(
Function'of'Muscles'
Produce(movement,(movement(of(whole(region,(or(small(region(
Provide(stability,(
Communication(purposes((e.g.(face(to(convey(emotion)(((((
Control(body(openings(
Produce(heat(release(the(heat(through(mechanical(energy(via(movement(
(
Types'of'Muscle:'
3(Types(depending(on(Striated/nonAstriated,(voluntary/involuntary,(somatic/visceral(
1) Skeletal(Striated(Muscle(
Striated,(voluntary,(somatic(
Muscle(cells(are(long(fibres(
Have(transverse(striations(
Under(voluntary(nervous(control(
Hypotrophy(can(be(built(up.((
Once(muscle(has(been(matured,(if(it(endures(trauma,(the(muscle(will(heal(but(not(exactly(
the(same.(
2) Cardiac(Striated(Muscle(
Only(in(the(heart(
Short(segmental(fibres(which(meet(up(with(each(other(in(interAcollated(discs(
Striated,(involuntary,(visceral(
Short(fibres,(rhythmic(contractions(
Controlled(by(the(intrinsic(pacemaker(system.(
Also(hypotrophy,(if(blood(flow(is(increased(then(the(heart(will(pump(faster,(and(the(heart(
will(increase(in(size(
Cannot(regenerate(
3) Smooth(Muscle(
NonAstriated,(involuntary,(visceral(
Found(in(organs(and(blood(vessels(
Erector(pili(muscle(made(of(smooth(muscle(
Spindle(shaped(
Tapering(towards(either(end(and(smooth(in(the(centre(
Single(nucleus(
Smooth(muscle(can(divide,(eg(uterus,(increases(for(baby(and(then(shrinks(
Rhythmic,(eg(for(peristalsis((
(
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Connective'Tissues'of'a'Muscle'
Deep(Fascia:(Essentially(continuation(of(the(epimysium(!(
connective(tissue(
Endomysium:(Thin(layer(of(connective(tissue(
o Fairly(loosely(organised(
o Capillaries(and(nerves(for(the(muscle(travel(
under(this(layer(
Perimysium:(middle(layer(
Epimysium:(the(outermost(layer(and(thickest,(merges(with(the(
deep(facia.(
Fasicle:(grain(of(meat,(enclosed(in(connective(tissue(((a(bunch(of(muscle(fibres)(
Epidermis,(superficial(fascia,(deep(fascia,(epimysium(
Tendon(attaches(the(muscle(to(the(bone,(follow(the(connective(tissue,(continuous(with(the(
periostium(of(the(bone.(
Connective(tissue(ends(up(separating(muscle(into(muscle(compartments.(Muscles(which(do(flexion(
and(extension(are(separated(through(tissues,(intermuscular(septum.(
'
'
Deep'Fascia'
Works(as(a(really(tight(stocking(provides(support(against(the(
muscle(action,(the(muscle(exerts(pull(in(that(space.((
Separates(muscles(of(the(same(function(
Intermuscular(Septa(
o Deep(fascia(that(encircles(the(muscles(
o Separation(of(muscles(
Fascial(compartments(
o Groups(of(muscles,(which(share(a(function.((
Retinacula(
o Tight(band(at(wrist(and(ankle(
o Holds(the(tendons(in(place.((
o Forms(very(tight(stocjing(that(contains(the(tendons((
( which(are(travelling(through,(otherwise(would(bowstring.((
o The(tendons(then(go(through(fibroAoseous(tunnels,(go(to((
( the(distal(end(of(the(digits.(
o Sometimes(a(muscle(wont(go(to(retinaculum,(eg(Achilles((
(
More'connective'Tissue'
Tendon(
o Strong(anchor((
o Connects(muscle(to(bone(
o The(fixed(or(proximal(point(of(a(muscle(is(its(point(of(origin(
o Origin(is(the(proximal('fixed(part(muscle(
o Insertion(is(the(distal(part(of(the(muscle(
Aponeurosis(
o Flat(sheet(of(connective(tissue(
o Provides(a(large(structure(from(which(a(muscle(originates(
o Lies(in(regions(which(need(stability(
 o E.g.(In(the(scalp.((
o Not(as(flexible((
Raphe(
o Tendonous(insertion(point(for:(
" Slings(that(work(to(support(structures(
o Usually(found(at(the(midline(
o Find(themin(regions(where(they(need(to(provide(support(for(overlying(
structures(
o Support(from(either(side(come(to(middle(ad(meet(to(form(a(raphe(
Fascial(Sheath(
o Arterys(and(veins(as(well(as(nerves(need(a(protective(covering(
o Thin,(encloses(the(neurovascular(bundle(
o is(fairly(loose(to(allow(the(contraction(and(expansion(of(the(blood(vessels(
Synovial(tendon(sheaths((
o Tendons(are(able(to(do(quick(action(in(tiny(space(without(rubbing(the(bone(
o Fascial(sheath(with(synovial(fluid(
o Double(layer(which(covers(tendons(
o Can(make(connections(with(bursa(
(
Infections'in'synovial'sheath(
Sometime(synovial(tendon(sheaths(can(connect(with(Bursae,(and(if(it(doesnt(communicate(with(
bursa,(in(an(injury(it(will(be(isolated.((e.g.(pointer(finger(vs(pinky)(
Tendon(infection(
(
Tenosynovitis'
Inflammation(in(the(sheath,(which(encloses(the(tendon.((
Tendon(sheath(infection(
If(tendons(travel(through(constricted(space,(if(the(tendons(rub,(they(are(more(prone(
to(inflammation(or(pain(from(repetitive(action.(
(
Muscle'Classification''
Fusiform:(
o Spindle(shaped,(wide(belly,((
o Narrow(tendon(insertions(and(origins.((
o IN(regions(where(quick(actions(required(
Parallel(
o short(fibres,(start(at(origin(and(insertion(muscular(
o Tendonous(insertions(along(the(length((
o E.g.(Rectus(abdominus)(
Convergent(
o Lots(of(muscles(start(at(origin,((
o Converge(to(form(small(insertion(
o Start(wide,(converge(to(a(narrow(point(
o Muscle(that(provide(a(lot(of(weight,(large(
insertion(area(to(a(small(one(
o E.g.(Pectoralis(Major.((allows(for(movements(
like(adduction((closer(to(midline)(
(
Muscle'Classification'Cont.'
Unipennate(
o Tendonous(shaft(on(one(side(
o All(the(muscle(fascicles(meet(at(one(
side(
Bipennate(
o Tendonous(shaft(in(the(midline(
o Fibres(meet(in(midline(
Multipennate(
o Have(several(bipennate(muscles(all(
together(
o Increases(the(cross(sectional(area(
o Muscles(have(stronger(pull(
o Cross(section(will(be(really(wide(
Circular(
o Find(around(orifices.((
Lever'No.' 1' 2' 3'
(
Movement' Middle' Fulcrum( Resistance( Effort(
First(order(levers( Component'
(F)( (R)( (E)(
o Resistance(=(end(
o Fulcrum(=(middle((
o Effort(=(end.((
" E.g.(Skull(balanced(on(vertebral(column.((
Second(order(levers(
o Fulcrum(=(end(
o Resistance/load(=(middle(
o Effort(=(end(
" E.g.(about(balance,(temporomandibular(joint,(temporalis(muscle(keeping(jaw(shut.((
" E.g.(Achilles(tendon(
Third(order(levers(
o Fulcrum(=(end(
o Effort(=(middle((
o Resistance(=(end(
" Provides(quick(movements(e.g.(bicep(
movement.((
" Usually(long(muscles(
Fulcrum(=(pivotal(point(
TradeAoff(between(power(and(movement(

nucal(muscles(work(against(the(pivot(point(provided(at( atlantal(occipital(
joint(
trade(off(between(range,(long(distance(has(range(of(movement(but(not(as(powerful(
(
Form'of'Skeletal'Muscle'
Parallel((
o Length(proportional(to(range(of(movement(
 o Can(shrink(and(contract(to(50%((
Oblique(
o Power(proportional(to(mass((
o Greatest(in(Multipennate(muscles(
(
Names'of'Muscles(
Size:(
o Pectoralis(major((lies(on(the(pectoral),(gluteus(maximus((large(muscle(on(gluteus(region)(,(
Extensor(pollicis(brevis((short(extensor(of(the(thumb).((
Shape:(
o Trapezius((shaped(like(trapezium),(deltoid((shaped(like(a(deltoid),(rhomboid()shaped(like(a(
rhomboid)(
Location:(
o Rectus(abdominus((Abdominal(region),(splenius(
capitis,(extensor(
Number(of(heads(
o Rectus(brachi,(triceps(brachi((three(heads),(
quadriceps((four(heads)(
Action(
o Flexior(carpi(ulnaris((flexor(of(the(carpus(on(the(
ulnar(side),(levator(scapulae,(depressor(anguli(oris(
Quirky(
o Sartorius,(soleus,(gastrocnemius(((
(
Muscle'Contractions''Isometric'and'Isotonic'Contractions'
Sometimes(muscles(can(act(upon(reflexive(actions((
Reflexive'contraction(
o Diaphragm(movement(
o KneeAjerk(A(usually(used(to(test(neuronal(control(
Tonic'contraction(
o Normal(muscle(tone(
o At(any(particular(time,(as(long(as(you(are(awake(and(not(paralysed,(you(are(in(tonic(
contraction.((
Phasic'contraction'
o Isometric'contraction(
" Increase(in(muscle(tension,(no(
change(in(length,(no(movement.((
" Tonous(increased(
o Isotonic'Contraction(
" Concentric)Contraction(
High(muscle(tension,(
muscle(shortens,(
movement(occurs(
" Eccentric)Contraction(
The(muscle(then(goes(back(to(its(original(position(
Muscle(tension(present,(muscle(lengthens,(movement(occurs(
'
Actions'of'Muscles(
Prime(Mover(
o At(any(particular(time(on(muscle(will(be(doing(the(
main(action(
Synergist(
o Assists(prime(move(in(its(contraction(
Antagonist(
o It(lets(go((eccentric(contraction)(to(let(the(prime(
mover(do(its(action(
Fixator(
o locks(on(the(joint(to(let(the(joint(do(its(action(
o Stabilises(the(joint.((
(
Types'of'Muscle'injury'
Graded(in(severity(
o Types(I,(II(&(III(
o If(a(few(fibres(tear(there(is(no(loss(of(function(
o When(muscle(tears(completely,(very(painful(and(loss(of(function.((
Avulsion(fracture(=(when(bone(removed(by(tension.((
Some(muscles(especially(prone(to(injury((2(joint(muscles.((
(
Neurovascular'supply'of'muscles'
Neurovascular(hilum(
o Opening(where(muscle(supply(is(
Blood(supply'
o Adjacent(arteries(and(veins'
o Vascular(pedicles'
o Anastomoses'
'
Neurovascular'Supply'of'muscles'
Principles(of(nerve(supply(
o MotorAunit(
" Motor(neuron(and(muscle(fibres(it(innervates(
o CranialAcaudal(arrangement(
" Comes(from(segmental(pattern(and(coelomate(
ancestry(
o Nerve(plexi(for(limb(muscles(
" Group(of(nerve(which(innervate(entire(group(of(
muscles.((
o Functional(groups(
" Nerve(supply(is(provided(by(nerve(plexi(
o Between(functional(groups(
o Developmental(origin.((
o If(the(muscle(travels(developmentally(then(it(carries(all(its(
nerve(supply(with(it(
 LECTURE'11'
Vascular(System(and(Vessels(
Cardiovascular'System''
Cardiovascular,system,
o Pulmonary,arterial,system,
! Relates,to,blood,flow,just,from,heart,to,lungs,
! Returned,to,heart,after,gaseous,exchange,
o Systemic,arterial,system,
! Arteries,(arterioles),
Carry,oxygenated,blood,(high,pressure,,due,to,
thicker,ventricle,walls,of,the,left),
! Veins,(venules),,
Return,deoxygenated,blood,(low,pressure),
! Capillaries,,
Exchange/connection,
Lymphatic,system,,Cleans,out,the,tissues,,picks,up,lymph,fluid,(pathogens),
o Lymph,vessels,,
o Lymph,trunks, Lymphatic*system*direction*
o Lymph,nodes,
o Lymphoid,tissue,
Hydrostatic,pressure,=,pulling,down,pressure,by,gravity.,,
!
Circulatory''Mesoderm'Derived'
Only,present,in,mesodermMderived,structures,(therefore,not,present,
in,endorderm,derived,structures,eg,epidermis,,or,endoderm),
Articular,cartilage,is,mesoderm,derived,,however,due,to,high,pressure,
experienced,it,is,also,without,blood,supply,or,lymph,drainage.,
Avascular,and,nonMlymph,structures:,
o Ectoderm,derived:,
! Epidermis,
o Endoderm,derived:,
! No,blood,supply,
! Surface,epithelium,
o Articular,Cartilage,
! Although,mesoderm,derived,,is,avascular,
! Is,an,exception:,subject,to,compression,&,friction,
,
Structure'of'Vessels,
3,Layers,of,tunic,
1) Intima:,endothelium,,
! Within,intima,is,basement,membrane,
! A,lining,of,endothelium,,which,is,really,
single,layer,structure,of,epithelium,that,has,
supporting,basement,membrane.,
Endothelial,lining,doesnt,have,blood,
supply.,,
2) Media:'smooth,muscle,
 !Great,deal,of,elasticity,,thickness,of,the,middle,layer,helps,differentiate,between,
arteries,and,arterials,,and,arterials,and,lymphatics.,,,
3) Adventitia:'fibrous,muscle,
! Outermost,layer,
! Nerve,layers,which,deliver,nerves,to,media.,
! And,contains,blood,supply,
! Inner,layer,gets,blood,through,diffusion,
! Relatively,thicker,walls,,pressure,greater,in,arteries,than,veins.,
! Hydrostatic,pressure,(gravity),often,needs,to,be,counteracted,with,pressure,of,the,
heart,(hence,why,typically,when,measuring,heartbeat,is,places,at,level,of,trabecular,
level,of,heart,,level,where,hydrostatic,pressure,is,cancelled,out.,
! Opening,in,arteries,is,smaller,,and,elastic,walls,help,to,pump,the,blood,through,and,
smaller,lumen,helps,the,pressure,to,be,maintained.,
! Pressure,in,veins,lower,,volume,greater,
,
Vessel'Structure'Continued'
Differences:,
ARTERIES, VEINS, LYMPHATICS,

Thicker,walled,(thick, Thinner,walled,, Difficult,to,see,

media),, Larger,lumen, Thinner,Walled,than,
Smaller,lumen, Valves,,flaps,of,endothelial, veins,
Greater,qty.,of,elastic, lining,which,stop,backflow, Valves,allows,flow,
fibres,in,media, , ,
,

,
,
,
,
,
Types'of'Arteries'
Elastic:,,
o Can,expand/contract,to,control,large,volumes,of,pressure,from,
contraction,of,heart,
o Closest,to,heart,(e.g.,Aorta),
o Large,quantities,of,elastic,tissue,
o Act,as,conduction,vessels,
o Prevent,sudden,drop,of,blood,pressure,
Muscular,
o Most,names,arteries,
o Large,amount,of,smooth,muscle,in,media,",regulates,tonus,(from,plaque,,stress,etc),
o Act,as,distribution,vessels,
o Progressively,reducing,in,calibre,
 o Redistribution,,rechanneling,possible,
! Take,blood,from,the,heart,and,redistribute,to,rest,of,system.,,
o Arterial,branches,to,somatic,structures.,,
,
Arterial'Branches,
Arterioles,
o Small,branches,
o Small,lumen,,thick,walls,
o Controlled,by,vasomotor,nerve,fibres,,
! Smooth,muscle,is,regulated,by,autonomic,nervous,system,,
! Regulated,by,sympathetic,nervous,system,(there,are,exceptions),,
o Mostly,innervated,by,SNS,
o Tonus,determines,blood,pressure,
o Approach,capillary,bed,
Capillary,
o Thinnest,wall,branches,
o Exchange,vessels,,arranged,in,a,network,of,capillary,beds,
o Exchange,permitted,by,difference,in,hydrostatic,pressure.,,
,
Anastomoses'and'Collateral'Circulations'
Anastomoses,is,linkage!between!blood!vessels,,
o (a,lumen,to,lumen,connection,without,intervening,capillary,bed),
provide,extra,level,of,blood,supply,
Offers,collateral,blood,supply,
Occur,in,highly,vascular,organs,(e.g.,muscle,and,around,joints),
True,and,potential,anastomoses,
o True,=,lumens,of,arteries,are,meeting,up,
! Large,calibre,arteries,that,make,contact,with,one,another,
eg,facial,arteries,around,mouth,
o Potential,=,when,arterioles,meet,each,other,",have,potential,for,
collateral,supply,
! Only,if,needed,
ArterialMvenous,(AV),anastomoses,
o b/w,arteries,and,veins,w/o,capillary,bed,,
! Outer,tips,exposed,to,elements,",likely,to,get,cold.,,
o Help,with,temperature,regulation,,sexual,intercourse,(erectile,and,clitoral,function),,
End'Arteries'
Do,not,link,with,other,arteries.,,
o Anatomical:, ,
! Single,artery,that,provides,blood,to,whole,or,part,of,
an,organ,,and,does,not,anastomose,with,another,
! Occlusion,means,death,(necrosis),of,tissue.,
! If,they,become,occluded,can,cause,major,problems.,
o Functional,,
! Depending,on,whether,occlusion,is,taking,place,
suddenly,or,gradually,,the,arterioles,can,double,up,
contact,,providing,collateral,blood,supply.,
 ! The,likelyMhood,of,small,calibre,arterioles,meeting,up,and,forming,anastomoses,e.g.,
coronal,arteries.,
! Potential,smallMcalibre,arteriole,anastomosis,
! Something,existing,collaterals,may,dilate,
! Can,have,anastomoses,happening,(key,difference),",develop,over,time.,,
,
,
Thrombus'and'Embolus'
Potential,problem,for,end,arteries,
Tension,in,vessels,can,increase,due,to,inner,lining,of,
calcium,developing,,this,is,plaque,,which,is,cholesterol,
of,fat,,which,collects,and,becomes,hardened.,
If,a,bit,of,the,plaque,becomes,dislodged,from,the,inner,
lining,,it,is,described,as,a,clot,or,thrombus,,if,clot,
dislodges,and,then,stops,the,flow,of,blood,,it,is,an,
embolus,
Thrombus,=,blood,clot,
Embolus,=,occlusion,of,pathway,(plug,of,blood,supply,to,a,region),,,is,a,plug.,Typically,found,where,
the,calibre,of,a,blood,vessel,is,decreasing,,from,larger,to,smaller,lumen.,
Can,happen,in,arteriole,supply,,more,common,in,the,vein,,esp.,the,deep,vein,of,the,calf,due,to,
gravity.,Often,ends,up,as,a,pulmonary,thromboMembolus,because,pathways,goes,from,the,vein,,into,
the,heart,and,then,into,the,lung,tissue.,,
,
Veins'
Carry,deoxygenated,blood,away,from,capillary,beds,
Flow,toward,heart,
Tributaries,of,veins,
o Venules,",pickup,blood,from,capillary,beds,
! Drain,Capillary,beds,,
! Thinner,walls,than,arterioles,
! Less,smooth,muscle,
! More,variable,
! Direction,of,flow,from,smaller,to,larger,vessels,,
,
Venous'Valves'
**Not,all,veins,have,valves**,
Many,veins,(particularly,superficial),possess,valves,to,direct,flow:,,
o Against,gravity,in,limbs,towards,heart,
o Connection,from,superficial,to,deep,veins,is,called,perforation,veins,
There,are,no,valves,in,deep'veins'of'the'trunk,
o Vertebral,and,azygous,(blood,can,flow,in,either,direction),
,
Venae'Comitantes'
Pairs,of,veins,,wrapped,around,an,artery,
Primarily,located,in,the,limbs,
Conserve,heat,,transferring,it,from,warm,arteria,l,blood,(passing,to,
periphery),to,cool,venous,blood,(returning,from,the,periphery).,,
,
,
Thoracic'Pump'and'Musculovenous'pump'
# Thoracic'
Inspiration'
o Diaphragm,gets,pushed,down,
o Lungs,expand,
o Blood,in,inferior,vena,cava,(IVC),gets,shorter,,
o Superior,vena,cava,(SVC),gets,longer,
o Blood,pushed,into,heart,
Expiration'
o Diaphragm,pushed,up,
o Pushes,air,out,of,lungs,
o SVC,shortens,",Blood,drained,to,heart,
o IVC,gets,longer,",Blood,collects,into,the,IVC,
# Musculovenous'pump'
o Pressure,in,fascial,compartment,increases,
o Venous,blood,is,pumped,back,to,heart,
o Makes,use,of,tight,fascial,compartment,and,intermuscular,septum,,
,
Perforating'Veins'and'Incompetence'
Perforating,veins,
o Allow,blood,supply,to,go,from,superficial,part,of,body,to,the,deep,part,
of,the,body,
o Have,valves,to,stop,backflow,of,blood,,
Varicosed,veins,
o Reduction,of,elasticity,
o Usually,occurs,in,older,individuals,who,have,had,a,long,time,of,standing,upright,(in,ankles),
o Varicosed,haemorrhoidal,veins,,
! Typically,found,around,the,region,of,the,anus.,,
,
,
Lymph'Vessels'and'Lymph'Nodes'
Lymph:,
o Tissue,fluid,(contains,plasma,proteins),
o Carries,nutrients,to,the,blood,vessel,
o Foreign,particles,get,carried,up,and,presented,in,lymph,fluid.,,
Lymph,Vessels:,
o Blind,origin,vessels,which,start,at,interstitial,fluid,in,the,capillary,bed.,,
o Carry,lymph,and,foreign,materials,to,lymph,nodes,where,it,is,filtered,and,exposed,to,
defence,cells,,
o Lymph,returned,to,the,circulation,(via,the,veins,
of,the,neck),
o Lymph,capillaries,drain,into,lymphatics,and,
lymph,trunk,,
o OneMway,valves,help,direct,flow,to,venous,
system,
Lymph'Flow'
The,result,of,3,mechanisms,(similar,to,veins),
o Milking'effect,close,contact,with,veins,
o squeezing'effect,action,of,surrounding,muscles,to,push,lymph,
o Sucking'effect,intrathoracic,pressure,and,respiration,(inhale/exhale),
Flow,in,larger,lymphatics,is,also,aided,by,the,presence,of,oneMway,valves,
Drain,into,larger,lymph,trunks,and,lymph'ducts,
Thoracic'duct'drains,all,except,upper,right,quadrant,
Right,lymphatic,duct,drains,upper,right,quadrant,,
Ultimately,returned,to,venous,system,
,
Lymph'nodes'
A,lymph,node,contains,lymphoid,tissue,
Lymph,nodes,filter,lymph,and,expose,antigens,to,the,immune,system,
All,lymph,drains,through,at,least,one,set,of,lymph,nodes,before,reaching,
the,venous,system,
o Sentinel,lymph,nodes,=,first,point,of,contact.,,
Typically,one,lymph,efferent,and,multiple,afferent,
,
Major'site'of'lymph'nodes'
Lymph,nodes,are,collections,of,lymph,tissues,which,
lie,through,the,body,
Collections,found,at,junction,of,the,head,with,the,rest,
of,the,body,
Limb,with,the,thorax,
Axillary,,inguinal,and,cervical,
,
,
,
Other'sites'of'lymphoid'tissue'
Thymus,,from,upper,thorax,into,the,neck.,
o Reaches,its,greatest,size,at,puberty,and,involutes,with,age,
Spleen,,sits,right,under,ribcage,
Tonsils,,collections,of,lymphoid,tissue,encircling,the,pharynx,&,draining,mucosa,of,alimentary,and,
respiratory,systems,
Peyers!patches,collections,of,lymphoid,tissue,in,the,mucosa,of,the,GI,Tract.,
,
Neurovascular'supply'of'vessels,
Nerve,Supply,,
o Mostly,SNS,
o Vessels,maintain,continuous,partial,tone,
! Exception:,erectile,tissue,also,receives,PNS,
Blood,supply:,
o Media,and,adventitia,receive,vasa,vasorum,,own,blood,supply,
o Endothelium,and,intima,receive,nutrition,through,diffusion,
,
 Lecture'13'
Vertebral(Column(and(Back(
Overview:"
Bones"
o Vertebral"column"
o Typical"vertebra"
o Vertebral"canal"
o Spinal"nerves"
Joint"
o Intervertebral"disc"
o Zygapophyseal"(facet)"joint"
Muscles"
o 2"compartments"
! superficial/intrinsic"
! deep/intrinsic"
o Lumbar"fascia"
Applied"anatomy"
"
Bony'framework'of'the'vertebral'column'
The"vertebral"column"
o Axial"skeleton""
o Regionally"distinct"vertebrae"
o Intervertebral"joints"(and"discs)"
o Vertebral"canal"and"intervertebral"foramen"
o 33"vertebrae"
o 7"cervical,"12"thoracic,"5"lumbar,"5"sacral"vertebrae"
(fuse),"variable"coxygeal"vertebrae"
o Between"vertebrae"are"joints"to"allow"function"
Function"
o Support/"supporting"axis"
o Movement"
o Protection"of"the"nervous"system"
! Protects"spinal"cord"
"
Structure'of'the'vertebral'column'
Primary/foetal"C"shaped"curvature;"anterioraly"concave"curvature"
Secondary"lordotic"curves"develop"in"the"cervical"and"lumbar"regions"
Abnormal"curvatures"may"occur:"
o Kyphosis,"hunchback,"increased"
primary"thoracic"curvature"
o Scoliosis,"sideways"curvature"
o Abnormal"lordosis,"sway"back."
Overweight"men"and"pregnant"
women"
o Impact"motion,"pain"and"capacity"for"moving"ribs"and"breathing"
After"a"few"months,"after"muscles"in"neck"mature,"baby"begins"to"lift"head"
and"take"interest"and"we"get"a"reverse"secondary"curvature,"lodotic,"it"is"in"
the"neck."
A"few"months"later,"with"pelvic"musculature"occurs,"start"walking,"we"get"lumbr"lordossi,"also"a"
secondary"curve."Helps"our"legs"be"below,"not"like"quadroped"
"
Structure'of'a'typical'lumbar'vertebra'
Vertebral"body"
o Anteriorally"
o Ring"on"outside"
Vertebral"arch"
o Posteriorally"are"pedigals"
o Bone"arches"around,"lamina"
o Processes"come"of"the"arch,"paired"structure"
! Transverse"process,"right"and"left"
! Spinous"process,"posteriorally"
! Articular"process,"superior"amd"inferior,"
two"of"each"
Vertebrae"are"irregular"bones"
The"body"is"quite"large,"pedicles"gives"rise"to"notch"
Vertebral"foramen,"which"then"becomes"canal"
Structure'of'typical'lumbar'vertebra'
Vertebral"body"is"important"for"weight"
Vertebral"arch,"pedicle"and"lamina"form"foramen"
which"protects"cord"
Processes"are"levers"for"muscles"to"move"joints"
Articular"processes"are"for"joints"
Vertebrae'are'regionally'distinct'
Sacrum"is"5"fused"vertebra"
Differences"in"size"reflect"the"amount"of"weight"each"
vertebra"take,"lumbar"are"larger"than"cervical,"distal"
sacral"are"quite"small,"because"legs"bear"weight."
Vertebral'canal'and'spinal'cord'
"""""The"spinal"cord"
Does"not"pass"the"full"length"of"the"spine"
When"born"it"does"pass"the"full"length"but"as"we"grow"taller"it"does"not"
Terminates"at"L1/2."Still"have"nerves"extending"
Cauda"equina."Rootlets"extend"further"down."Long"filaments"of"dorsal"and"ventral"rootlets"extending"
down"
Surrounded"by"the"meninges"
o Dura"mater"
o Arachnoid"mater"
o Pia"mater"
Intervertebral'Foramen'
Bilateral"intervertebral"foramen"
Boundaries"
_"by"inferiorally"by"a"superior"notch"and"superiorally"by"
inferior"notch"
anteriorally"intervertebral"disc,"makes"joint"bw"two"adjeacent"vertebrae"
Articular"region"posteriorally,"articular"facet"
Constrained"region"with"important"structure"
Contents"
o DRG,"dorsal"root"ganglia."Sensory"cell"bodies"of"the"nervous"system"reside"
o Mixed"Spinal"nerve"(yellow),"bw"every"adjacent"vertebrae,"comes"out"of"vertebral"column"
aking"pns"
o Vessels,"go"in"and"out"to"nourish"the"cord"
'
Spinal'Nerves'
"Spinal"nerves"that"emerge"from"intervertebral"foramen"
are"named"according"to"where"they"come"out"of"the"
spinal"cord.""
Second"cervical"nerve"
there"is"a"transition"to"name"the"nerve"roots"
_"in"the"cervical"vertebrae"the"nerves"are"named"for"the"
vertebra"they"emerge"on"top"of,"C1"on"top"of"C1."7"
cervical"vertebra,"8"cervical"nerves""
this"changes"at"thoracic"vertebra,"named"for"vertebrae"
they"come"out"below."
Yellow"is"cord,"green"meninges"
Vertebral"column"is"divided"into"anterior,"ventral"(motor"neurons)"and"dorsal"(sensory)"
horns"
Point"f"IF,"rootlets"combine"and"this"is"where"the"ganglion"is""
Mixed"spinal"nerve"is"formed"and"mixed"due"to"motor"and"
sensory"mixing"
Then"divides"into"anterior"and"posterior"rami"
Principle"of"organisation"is"important,"also"both"mixed"
Rootlets"emerge"bilaterally"from"the"spinal"cord"
Contain"ventral"(motor)"and"dorsal"(sensory)"roots"(horn)"
"""""""Note"location"of"cell"bodies"
Motor"neurons"in"the"spinal"cord"ventral"horn"
Sensory"neurons"in"the"dorsal"root"ganglion"
""""""
Mixed"spinal"nerves"give"off"anterior"and"posterior"rami"in"the"intervertebral"foramen"
"
Joints'of'the'vertebral'bodies'
"""""""Intervertebral"joints"28.93"
Secondary"cartilaginous"joints"
Anulus"
o Attaches"to"the"epiphyseal"ring"above"and"below"
consists"of"concentric"lamellae"
o Functions"to"keep"vertebrae"together"
Nucleus"
o Encapsulated"within"the"anulus"fibrosis"
o Consists"almost"entirely"of"water"
o Functions"to"keep"vertebra"apart"
Joints'of'the'vertebral'bodies'
Intervertebral"joints"
Functions"of"the"intervertebral"disc"
Anulus"
o Concentric"fibrous"rings"orientated"at"right"angles"
o Enables"movement"in"all"directions"without"tearing""
o Resists"excessive"movement"
Nucleus"
o Deformable"but"not"compressible"
o Shock"absorber""
'
'
'
'
Joints'of'the'vertebral'arches'
Zygapophyseal"(facet)"joints"
Plane"synovial"joints"
Articular"prcesses"
o Plane"synovial"joints""permit"gliding"along"only"one"axis"
o Movements"available"are"determined"by"the"shape"and"depth"of"the"articular"surfaces"
o Orientation"of"the"articular"processes"differ"regionally"
! E.g"thoracic"articular"processes""orientated"in"the"coronal"plane"and"permit"rotation"
! Lumbar"articular"processes""prientated"the"sagittal"plane"and"permit"flexion/"
extension"
Joints'of'vertebral'bodies'
"""""""Ligaments"of"the"vertebral"column""
Anterior"and"Posterior"Longitudinal"Ligaments"
Interspinous"and"Supraspinous"ligaments"
"""""""Ligaments"of"the"vertebral"column"
Ligament"Flava"
"
"
"
"
"
"
"
"
"
"
"
"
"
"
Muscles"of"the"back"
Superficial/"Extrinsic"muscles"of"the"back"
o Muscles"all"attach"to"and"act"on"the"upper"limb"
Deep/"Intrinsic"muscles"of"the"back"
o Muscles"all"attach"to"and"act"on"the"back"
" " Erector"Spinae"
! Prime"movers"
! Concentrically"return"the"flexed"trunk"to"the"upright"
posture"(i.e."extension)"
! Also"work"eccentrically"to"control"flexion"
Transverseospinalis"
! Short"muscles"
! Act"as"stabilizers"
! Prevent"excess"movement"
! Atrophy"rapidly"after"injury"
"
"
"
"
"
"
"
Lumbar"Fascia"
o Provides"attachments"for"extrinsic"muscles"of"the"back"
(e.g"trapezius,"latissimus"dorsi)"
o Provides"attachment"for"erector"spinae"
o Forms"a"tight"compartment"for"the"intrinsic"muscles"
(enhancing"their"actions)"
o Continuous"with"the"abdominal"wall"
Applied'anatomy'of'the'back'
Disc"prolapse"
o Bulge"
o Herniation"
o Extrusion"
Joint"degeneration"
o Thinning"of"articular"cartilage"/"narrowing"of"joint"space"
o Formation"of"bony"outgrowths"(osteophytes)"
o Articular"surfaces"make"contact"at"margins."Joint"mobility"decreases"
o Osteophytes"may"encroach"on"adjacent"structures"(e.g"spinal"canal"or"intervertebral"
foramen)"
o Severe"pain"especially"with"movement"or"weight"bearing"
"
"
"
"
"
"
 LECTURE'14'
Upper%Limb%1%%Bones%&%Joints%
Bony'Framework''Upper'Limb'
Attached((in(front)(to(axial(
skeleton(
1(proximal(bone(
2(distal(bones((one(rotates(
relative(to(the(other(
Pentadactyl(hand(
Thumb(rotated(90oC(to(digits((
permits(opposition(
o Part(of(mans(
evolutionary(success((
opposable(to(fingers((
o Allowed(manipulation(
of(environment(
(
Bones'of'the'shoulder'girdle'
Clavicle' Scapula'

Attaches(to(scapula' Flat(bone(
Pushes(the(arm(out(to(the(side' Spine(
Is(a(long(bone' Fossae((depressions)((for(muscle(
Supports(upper(limb' attachments(
Acromial(and(sternal(ends(for(joints' Processes:(acromion(and(coracoid(
Muscle(&(ligament(attachments' Glenoid(fossa(for(head(of(humerus(
''''''''''' (

' (

'

'

'

'

'

'

(
Bones'of'the'Arm''Humerus'
A(long(bone(with(a(shaft(and(2(ends(
Head((
Neck((anatomical(and(surgical)(
Tuberosities:(
o Greater(and(lesser((for(muscle(attachment(
Bicipital(groove((for(biceps(tendon)(
Epicondyles:((
 o Medial(and(lateral(for(muscle(attachment(
Condyles/articular(surfaces:(
o Trochlea(and(Capitulum(
Articular(surface(is(smooth(
(
(
Applied'anatomy'of'the'upper'limb:'
Fractured'Humerus(
Fracture(sites:(
o Surgical(neck(
o Midshaft(
o Supracondylar(
Structure(endangered:(
o There(are(nerves(and(blood(vessels(in(this(region(

(
Bones'of'the'Forearm:(
Radius'and'Ulna'
Ulna((medial)(&(Radius((lateral)((
o Both(long(bones(
o Articular(with:(
! Each(other(
! The(humerus(
o Linked(by(interosseous(
membrane(
(
(
(
(
(
(
(
Radius' Ulna'

Long(Bone( Long(bone(
Articular(with(ulna(and(humerus( Articular(with(radius(and(humerus(
Linked(to(ulna(via(interosseous(membrane( Linked(to(radius(via(interosseous(
membrane(
Articular(surfaces:( Articular(surfaces:(
o Head(&(Fovea( o Trochlea(notch(
o Ulnar(notch( o Radial(notch(
o Carpal(articulation( Tuberosities:(
Tuberosities:' o Olecranon(process(
o Radial(tuberosity' o Coronoid(process(
o Styloid(process' o Styloid(process'
'
'
'
'
 Bones'of'the'Wrist'and'Hand'
Short(bones(
Long(bones(
Sesamoid(bones(
Presence(of(the(
carpal(arch(
(
(
(
(
(
(
(
(
General'Principle'of'Joint'Stability'&'Mobility'
Mobile'Joints' Stable'Joints'

Ball(&(socket(joints(most(mobile( Congruent((&(often(deep)(articular(surfaces(
Stability(often(dependent(on((fixator)( Tight(capsule(with(strong(ligaments(
muscles( Limited(ROM(
Susceptible(to(subluxation(or(dislocation( Are(generally(immobile(
((
(
'
'
'
Joints'of'the'Shoulder'Complex(
1)'Joints'of'the'Clavicle'
(
Acromioclavicular'Joint' Sternoclavicular'Joint'

Plane(synovial(joint( Saddle(type(
Weak(capsule( synovial(joint( (
Stabilised(by(coracoclavicular(ligament' IntraXarticular( (
disc( '
Very(strong( '
capsule( '
Costoclavicular( '
ligament( '
'
'
'
'
'
'
'
'
'
Applied'Anatomy'of'the'Upper'Limb'
Fractured'Clavicle'
Commonly(fractures(when(weight(bearing(
Between(lateral(1/3rd(and(medial(2/3rd((
AKA(a(collarbone(fracture(
(
Joints'of'the'Shoulder'Complex'
2)'The'Shoulder''Glenohumeral'Joint'
Synovial(ball(and(socket(joint(
Large(humeral(head(to((shallow)(glenoid(fossa((very(unstable(joint(
Socket(deepened(by(glenoid(labrum(
Supported(by:(
o Coracoacromial(ligament((on(top);(runs(from(cromoid(
process(to(acromion(process.(Ligaments(usually(
connected(bw(two(different(bones(to(stop(relative(
movement.(However(the(two(processes(are(both(on(the(
clavicle,(so(no(relative(movement.(Instead(the(ligament(
stops(the(dislocation(of(the(humorous.(
o Long(head(of(biceps((in(front),(tendon(is(the(red.((
o rotator(cuff(muscles:((above,(behind,(in(front,(blend(with(
joint(capsule,(pull(humeral(head(towards(glenoid(&(
compress(it)(4(of(them,(originate(on(the(scapula(and(
attach(to(humours.(They(pull(humorous(towards(the(
glenoid(and(scapula,(stable(but(dynamically(stable(joint,(
controlled(muscle(
! Supraspinatus;(infraspinatus;(Teres(minor;(
Subscapularis(
Is(a(very(mobile(joint(and(hence(loses(stability(due(to(poor(congurency(with(the(flat(glenoid(fosa(and(
large(femoral(head((
Hence(need(other(structures(to(regulate(
stability(
o Glenoid(is(deeped(by(fibro(
cartilaginous(labrum(increases(the(
surface(area(of(articulation(
(
Applied'Anatomy'of'the'Upper'Limb(
Shoulder'(Glenohumeral)'joint'dislocation'
Anterior((most(common)'
o Force(applied(to(abducted(and(externally(rotated(arm'
Posterior((less(common)'
o Falling(forward(onto(outstretched(arm'
Humerus(drops(inferiorly'
Risk(of(nerve'injury'
Contact(sport;(arm(is(a(lever,(can(force(proximal(part(of(humerus(forward,(
usually(anterior(and(then(inferior(dislocation.(Can(occasionally(get(a(posterior(dislocation.(
'
Joints'of'the'Shoulder'Complex'
3)'The'ScapuloSthoracic'joint'(
(Not%a%true%joint,%a%physiological%joint%%no%bone%on%bone%articulation)%
Movement(of(the(scapula(across(the(thoracic(cage/wall(
Scapula(is(very(mobile,(gives(as(full(range(of(motion(
(movement(from(scapula(and(glenoid(joint;(2/3(ratio)(
ScapuloXhumeral(rhythm:(
o Preserves(the(lengthXtension(relationships(in(muscles,(
esp(rotator(cuff(muscles(
o Increases(the(range(of(movement(
o Prevents(muscular(impingement(around(joint(
Scapula(site(on(thoracic(cage:(
o Moves(up(and(down(
o Elevates(and(compresses(
o Protracts(and(retracts(
(
(
Elbow'Joint'
Compound(joint(
Unusual(situation(of(two(distinct(joints(
residing(within(same(joint(capsule.(
True(elbow(joint,(bw(humerus(and(ulna((
Joint(distal(to(that(is(joint(between(radius(
and(ulna.((
Top(of(the(radius(does(articulate(with(
capitulum.(
Technically(radius(and(ulna(come(into( contact(
twice,(hence(proximal(joint,(because(there(is(a(second(one,(distal(
Proximal,(the(head(of(the(radius,(against(the(ulna(
A(ligament,(anular,(starts(on(ulna(and(finishesat(ulna(
Loops(around(the(head(of(the(radius(and(pulls(it(towards(the(ulna,(allowing(the(head(of(the(ulna(to(
rotate(while(staying(in(contact.(
Lateral,(collateral(ligament(attaches(to(the(anular(ligament,(highly(unusual.(
Pronation,(supernation(movement(is(allowed(through(the(proximal(radioulnar(joint.(
'
 The'Elbow'Joint' The'Proximal'Radioulnar'Joint'

Hinge(type(synovial(joint(
Strong(collateral(ligaments(reinforce(
capsule(
Radius(plays(no(major(role((
o Glides(along(with(range(of(motion(
Movement(only(in(one(plane(
In(full(extension(radius(isnt(in(contact(with(
humerus(
'
Pivot(type(synovial(joint(
Between(head(of(radius(and(radial(notch(of(
the(ulna(
Head(of(radius(encircled(by(anular(ligament(
o Radius(can(rotate(within(the(
ligament(
Movements:(
o Pronation(and(Supination(

17.04'lecture'15''
'
'
Joints'of'the'Wrist'Complex'&'Hand'
1)'The'Distal'Radioulnar'Joint'
Pivot(type(synovial(joint(
Between(the(head(of(the(ulna(and(the(ulnar(notch(on(
the(distal(radius(
Proximal(radioulnar(and(distal(radioulnar(joints(linked(
by(interosseous(membrane(
They(function(as(one(joint(
Proximal(+(distal(radioulnar(joints(permit(pronation(and(
super(nation(
Ulna,(in(pronation(and(supernation,(doesnt(move,(the(
radius(rotates(around(it.((
Both(joints(are(functionally(paired(for(por(and(supernation(
(
(
(
2)'The'Wrist'Joint(
The(Radiocarpal(joint(
A(Condyloid(type(synovial(joint(
Between(the(distal(radius(and(carpal(bones(
An(articular(disc(is(present(on(the(ulnar(side(
 Primary(articulation(is(between(radius(and(the(two(carpel(bones.(
RadioXcarpal(joint(
Scaphoid(and(lunate((
Compound(joint(
Ulna(is(not(articular(at(the(wrist(joint(
Articular(disc(at(the(distal(part(of(the(ulna,(blocking(articulation.(
Condaloid(joint,(flexion(and(extension(
Abduction(and(adduction;(radially(deviation,(ulnar(deviation(
8(carpel(bones,(quite(arched(
3)'Joints'of'the'Hand'&'Fingers'
Hand' Fingers'

8(Carpal(bones(+(5(metacarpal(bones(
The(intercarpal(joints(between(the(bones(of(
each(row(
The(midcarpal(joint(between(the(proximal(
and(distal(rows(of(carpal(bones,(contributes(
to(flexion(and(extension(movement.(
The(carpoXmetacarpal(joints((between(
carpals(and(metacarpals):(
o I:((Saddle(type;(thumb(only;(allows( (
mobility(
o IIXV:(Plane(synovial(joint(
'
' '
Metacarpophalangeal(joints((between(
metacarpals(and(phalanges):(
o I:(Hinge(joints((flexion/extension)(
o IIXV:(condyloid((flexion/extension(&(
abduction/adduction)(
Interphalangeal(joints((between(
phalanges):(
o Hinge(Joints((flexion/extension(

'
Applied'Anatomy'of'the'Upper'Limb'
Wrist'and'Scaphoid'Fracture(
Fall(onto(outstretched(hand(and(break(wrist,(
Colles(fracture.(In(a(distal(part(of(the(radius,(
pushing(radius(posteriorly.((
'
(
 Lecture'15'
Upper'Limb'2''Muscles'and'Movements'
Shoulder)Movements)
Shoulder)movements:)
o Shoulder)girdle,)scapula)on)thoracic)wall)
o Retraction)=)pulling)scapula)towards)middle)
o Protraction)=)opposite)of)retraction)
o Elevate)and)depress)scapula)
o Re<orientate)the)glenoid)so)our)shoulder)is)in)a)better)position)to)lean)forward,)backward)
and)upward)

)
Forearm)Movements)
Remember:)radius)and)ulna)linked)by)interosseous)membrane)
Hinge)joint,)therefore)only)movement)in)one)plane)
Circumduction))
)
)
)
)
)
)
)
)
)
)
Movement)of)the)fingers)and)thumb)
Abduction)adduction)usually)relative)to)the)midline,)but)with)fingers,)the)hand)midline)is)used)
Thumb)flexion)and)extension)occurs)at)90)degrees)to)the)fingers,)in)the)coronal)plane,)so)abduction)
and)adduction)is)in)the)sagittal)plane)
Opposition,)thumb)pad)is)able)to)oppose)coming)to)opposition)with)all)of)the)other)fingers)
)
)
Upper)Limb))Fascia)
Muscles)are:))
o In)compartments)surrounded)by)deep)fascia)
o Fascia)encases)muscles,)single)and)groups)
o It)compartmentalises)muscles)with)similar)function)
o Interrosious)membrane)is)made)of)fascia;)retinaculum;)
aponeurosis;)digital)sheaths))
Fascia)of)the)arm:)brachial)fascia)(brachial)=)relating)to)the)arm))
Fascia)of)the)forearm:)antebrachial)fascia)(ante=before)))
)
)
)
)
)
)
)
)
)
)
)
)
Upper)Limb))Fascia)cont.)
Deep)fascia)can)be)specialised)
Interosseous)Membrane)
o Binds)Radius)and)ulna)together)
o Provides)attachment)for)muscles)
o Directs)forces)between)radius)and)
ulna)
Retinaculae)
o Binds)down)tendons)(prevents)bow)
stringing))
o Protects)nerves)and)vessels)
Flexor)Retinaculum)
o Forms)roof)of)the)carpal)tunnel)
o Contents)=)tendons)(&)synovial)
sheaths),)median)nerve)
Aponeurosis)
o Flat)sheath)of)connective)tissue)
Digital)Sheaths)
)
Upper)Limb))Muscles)
Can)tell)you)about:)shape,)action,)size,)attachment))
Muscles)work)as:)prime)movers,)synergists,)fixators/stabilisers)antagonists)
)
)
)
)
)
Upper)Limb))Back)muscles)
Superficial)(extrinsic))muscles)of)the)back)
o Not)true)back)muscles)
o All)attach)to)and)act)on)the)upper)
limb))
o One)attachment)to)the)back,)along)
the)VC)or)the)Fascia)of)the)VC,)and)
going)to)the)scapula,)clavicle)or)the)
humerus.)
o Trapezius:)superficial)muscle)of)the)
back,)broad)muscle.)The)superior)part)tends)to)elevate)the)scapula;)middle)pulls)the)scapula)
into)the)midline,)retracting)it;)lower)part)pulls)the)scapula)down,)repressing)the)scapula.)
o Rhomboid:)attaching)to)the)scapula.)
o Levator)scapulae:)attaching)to)the)scapula.)
o Latissimus)dorsi:)attaching)to)the)back)and)to)the)humerus.)
o The)nervous)system)codes)for)movement,)not)particular)muscles.)Nervous)system)will)only)
activate)the)part)of)trapezius)which)will)perform)the)function)it)wants)
Upper)Limb))Muscles)of)the)Shoulder)Girdle)
Muscles)of)shoulder/scapula)
o Attach)to)and)act)on)the)upper)limb))
o Pectorial)muscles,)serratus)anterior,)deltoid)
o primary)pectoralis)major)and)secondary,)attaches)to)the)humerus.)Flexing)the)arm)
o Pectoralis)minor)attaching)to)the)scapula)
o Soratis)anterior.)Serrated)appearance.)Attaches)to)the)ribs)and)the)underside)of)the)scapula.)
Keeps)the)scapula)gliding)smoothly.)And)keeps)it)flat)as)it)moves)around.)
o Long)headed)bicep,)two)heads:)Long)head)attaches)to)the)glenoid,)short)head)attaches)to)
corocoid)process.)
)
)
)
)
)
 Upper)Limb))Muscles)of)the)Shoulder)Girdle)CONT.))
Muscles)of)shoulder/scapula)CONT.))
ScapuloHhumeral)muscles:))
o Deltoid,)biceps,)rotator)cuff)
muscles)
Fixator)muscles:)
o Blend)with)capsule)of)joint)
o Pull)humeral)head)towards)glenoid)&)
compress)it))
Prime)movers:)
o Rotation)and)abduction)
Highly)compartmentalised)
)
Upper)Limb))Arm)Muscles)
Muscles)are)compartmentalizes)
Muscles)in)the)same)compartment)have)
the)same,)or)similar)muscles.)
Anterior)compartment)muscles)(forearm)
and)arm):)
o Biceps)brachii)&)brachialis)
(elbow)flexors)))
o Flexors))
Posterior)compartment)muscles)(arm)and)forearm):)

o Triceps)brachi)(elbow)extensors))
o Extensors)

Anterior)Compartment)Muscles) Posterior)Compartment)Muscles)

Biceps)brachii)
Coracobrachialis,)highly)variable)(evolved)))
Brachialis)
These)cross)the)elbow)joint,)biceps)attach)to)the)
radius,)brachialis)attaches)to)the)ulnar.)
Corocobrachialis<)Corocoid)process,)to)the)arm)
) )
Triceps)brachii)(3)heads),)one)tendon)
Long)head)attaches)to)scapula)
Medial)head)and)lateral)attaching)to)the)humerus.))
Groove)between)medial)and)lateral)head)for)nerve)
)
Upper)Limb))Forearm)Muscles)
Muscles)of)the)Forearm)are)
compartmentalised))
Anterior)compartment)muscles:)
o Wrist)and)finger)flexors)
Posterior)compartment)muscles:)
o Wrist)and)finger)extensors)
)
Muscles)of)the)Forearm)
! )Anterior)(flexor))compartment)
Muscles)in)3)layers:)
Superficial) Intermediate) Deep)Layer)

Muscles)in)this)layer)are)long) Arises)from)CFO,) !Flexor)pollicis)longus)(FPL))

Arise)from)the)medial)epicondyle)
of)the)humerus)
!Pronator)teres)(PT)))
!Flexor)carpi)radialis)(FCR)*)
!Palmaris)longus)(PL),)evolving)
out,)inserts)into)hand,)pulls)skin)
downward.))
!Flexor)carpi)ulnaris)(FCU)*)
All)arise)from)common)origin.)
Medial)epicondyle)common)
flexor)origin)
radius)and)ulna)
flexor)of)thumb)
Very)powerful)
!Flexor)digitorum)profundus)(FDP))
muscle)
tendons)pass)through)carpel)tunnel)
!Flexor)digitorum)
region)of)wrist)and)extend)to)the)
superficialis)(FDS))
digits)
arise)from)CFO,)radius)and)ulna)
!)Pronator)quadratus)(PQ))
very)powerful)muscle)
Arise)from)radius,)ulna)and)
unique)splitting)of)tendons)in) interosseous)membrane.)
digits)
)
pass)through)wrist)and)tendon)
extend)to)digits,)contributes)to)
wrist)flexion,)doesnt)go)to)thumb)

) )

) )

)
 !)Anterior)(Flexor))Compartment)cont.))
Many)muscles)have)tendons)that)gain)access)to)the)hand)
They)pass)through)the)carpal)tunnel)
Under)the)flexor)retinaculum)
Carpel)tunnel;)arch)arrangement)joined)by)flexor)retinaculum)
Number)of)tendons)(9))pass)through)this)point)
Pregnancy)can)cause)swelling)which)compresses)the)area)
Nerve)passes)through)here)too)
)
)
)
)
)
)
Upper)Limb))Forearm)Muscles)cont.))
! )Posterior)(extensor))compartment)

Superficial) Deep)

! )Brachioradialis) !)Supinator)

< Does)not)cross)wrist) !)Abductor)pollicus)longus)(APL)*)

< Main)action)at)elbow)
3)Muscles)extend)wrist:) !)Extensor)pollicis)brevis)(EPB)*)

!)Extensor)carpi)radialis)longus)(ECRL)) !)Extensor)pollicis)longus)(EPL)*)

!)Extensor)carpi)radialis)brevis)(ECRB)) !)Extensor)indicis)(EI))

!)Extensor)carpi)ulnaris)(ECU)) Arise)from)ulna)radius)and)interosseous)membrane)

2)Muscles)extend)digits:) ))

!)Extensor)digitorum)communis)(EDC)) *snuffbox)tendons)

!)Extensor)digit)minimi)(EDM)) )

Long)muscles)arise)from)common)extensor)origin) )
(CEO))

Tendons)pass)under)the)extensor)retinaculum)
) )

)
Muscles)of)the)forearm)
Synergistic)action)of)long)flexor)and)extensor)tendons)
o Maintains)optimal)length))tension)relationships)
Long)finger)flexors)are)not)sufficiently)long)to)act)across)all)joints)
simultaneously)
Extensors)must)contract)as)synergists)to)maintain)extension)at)the)wrist)
permitting)flexion)of)the)fingers)
Many)cross)two)joints)
Synergy)between)muscles)of)the)forearm,)despite)being)antagonist)
Extension)and)flexor)digitorum)have)large)bodies)and)are)very)powerful.)
)
Upper)Limb))Hand)muscles)
Intrinsic)muscles)of)the)hand:)
o Thenar)muscles)(x4))
o Hypothenat)muscles)(x3)))
o Lumbricals)(x4))
o Interossei)(x7))
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
Upper)Limb))Special)Structure)in)the)Hand)

)
)
)
)
 LECTURE'16'
Upper%Limb%3%%Nerves%&%Vessels%
Upper'Limb'Arteries'
Principles:+
o Branches+supply+skin,+muscles+joints+
o Branches+can+also+form+anastomoses+
o arteries+can+be+crimped+and+shut+down,+collateral+branches+which+
allow+flow+
'
'
'
'
'
'

'
Upper'Limb'Arteries'
Subclavian+artery,+below+
clavical+
Axillary+artery+
Brachial+artery:+
o Major+blood+vessel+of+
the+arm+
o Continuation+of+the+
axillary+artery+
o VentroBmedial+aspect+
of+the+arm+
o Divides+into+radial+
and+ulnar+arteries+
o In+flexor+compartment+
o Well+protected+behind+muscle+
All+same+artery,+changes+name+
Then+branches+
'
Ulnar'Artery'
Larger+branch+of+the+brachial+artery++
Principal+blood+supply+to+the+forearm+&+hand+
Terminates+as+the+superficial+palmar+arch+
Palpable+at+the+wrist+(anteroBmedially)+
+
Radial'Artery'
Supplies+the+lateral+aspect+of+the+forearm+
Post+branch+passes+through+snuff+box'
Terminates+in+the+palmar+arch'
Important+for+coronary+artery+grafts'
'
'
Palmar'Arterial'Branch'
Ulnar+artery+arches+and+anastomoses+with+radial+artery+
Superficial+and+deep+arch,+in+the+palm.+These+anastomose+
Digital+arteries+then+come+off+of+here+
'
Digital'Arteries'
Regarded+as+end+arteries,+no+alternate+blood+supply,+careful+
of+vasoconstriction+
Vulnerability+to+vasoconstrictor+drugs+
Can+cause+vasospasm+and+necrosis+
'
Applied'Anatomy'of'the'Upper'Limb'
Volkmanns'ischemic'contracture' Fractured'Scaphoid'

Ischaemia+leading+to+ Ischaemia+leading+to+
contracture+of+ avascular+necrosis++
forearm+flexor+ artery+that+supplies+this+++++++++++++++++ area++
muscles.++ is+very+near+and+so+a+
Induced+by+a+ fracture+can+cause+loos+ of+
supracondylar+fracture.++ blood+supply+to+
Break+to+bone+may+constrict+the+arteries+ scaphoid,+possible+causing+avascular+necrosis.++
causing+the+muscles+to+contract,+causing+
flexed+position+of+the+wrist.+
' '

'
'
'
'
'
'
'
'
'
'
'
Upper'Limb''Veins'
We+dont+have+veins+in+the+palm+of+our+
hand+generally+because+the+veins+would+be+
closed+down+too+often+due+to+our+use+of+
our+hands,+easily+compressed+walls.+Most+
veins+are+in+the+back+of+the+hand.+Goes+
through+venous+arches.+They+then+run+to+
two+main+drainage+points,+cephalic+vein+
and+vasilic+vein.+
Superficial+Veins:+
o In+superficial+fascia,+highly+variable+
o Begin+on+back+of+hand+as+dorsal+venous+
arch+
o Quite+variable+in+location+compared+to+
arteries.+
Main+Tributaries:+
o Cephalic+vein+
o Basilic+Vein+
o Median+cubital+vein+
! A+point+of+communication+between+cephalic+and+basilic+vein++
Deep+Veins+
o Via+perforating+veins+
o Accompany+major+arteries++venae+comitantes+
o Muscular+venous+pump+
o Valves+ensure+unidirectional+flow+
+
Upper'Limb''Lymphatics'
Lymphatic+channels/plexuses+in+the+hand+
Drain+white+blood+cells+from+regions+
Follow+superficial+veins+of+upper+limb+
Flow+into+axillary+nodes+
Drain+via+lymph+trunks+to+venous+system+in+neck+
Axillary+nodes+also+drain+chest,+breast+&+neck++
Does+cross+midline!+
o Right+UL+=+Right+lymphatic+duct+
o Left+UL+=+Thoracic+duct.++
+
Upper'Limb''Nerves'
The+upper+limb+receives+its+
nerve+supply+from+the+
brachial(plexus+
Collection+of+nerves+that+
emerge+from+the+nerve+roots+
from+C5BT1+
They+intermingle+to+make+the+
plexus+
5+major+terminal+branches+
 Arises+from+cervical+&+thoracic+cord+segments+(C5JT1)+
Via+anterior+rami+
5+Nerve+roots.++
Divisions:+
o Anterior+divisions+innervate+
flexor+compartments+
o Posterior+divisions+
innervate'extensor+
compartments++
All+muscles+in+the+anterior+
compartment+are+supplies+by+
anterior+divisions+and+similarly+for+
posterior+compartments.+
'
+
+
Upper'Limb'nerves'(flexor'compartment)'
Musculocutaneous+nerve'
o Arises+from+C5,6,7,+brachial+plexus'
o Supplies+anterior+compartment+of+the+arm'
o Muscles'
! Flexors+of+the+elbow'
o Skin'
! Overlying+lateral+aspect+of+the+forearm'
Median'Nerve'
Arises+from+C5,6,7,8,+T1+
Supplies+anterior+compartment+of+the+forearm+
Muscles+
o Most+anterior+compartment+forearm+muscles+
o Passes+under+carpal+tunnel+
o Also+supplies+most+muscles+of+the+thumb+
Skin+
o Palmar+3++digits+and+nail+beds+
o Susceptible+to+compression+in+carpal+tunnel+
o Note:+carpal+tunnel+syndrome+
Ulnar'Nerve'
Arises+from+C8,+T1+
Supplies+the+hand+
Muscles+
o Most+intrinsic+muscle+of+the+hand+
o Passes+over+the+carpal+tunnel+
o Doesnt+supply+thumb+
Skin+
o Passes+superficial+to+flexor+retinaculum+
o Medial+1++digits+(both+palmar+and+dorsal)+
o Susceptible+to+injury:+at+medial+epicondyle+
+
Upper'limb'nerves'(extensor'compartment)'
Axillary'nerve'
Arises+from+C5,+6+
Supplies+the+shoulder+
Muscles+
o The+main+abductor+muscle,+deltoid+
Skin+
o Over+the+shoulder+(military+badge+area)+
Susceptible+to+injury+in+shoulder+dislocation+and+fracture+in+
surgical+neck+
Radial'Nerve'
Arises+from+C5,6,7,8,T1+
Supplies+posterior+compartments+of+the+arm+and+forearm+
Muscles+
o Extensor+muscles+of+arm+and+forearm+
o Triceps,+posterior+forearm+muscles+
Skin+
o Posterior+skin+of+the+arm+and+forearm+
o Part+of+back+of+the+hand+
Runs+across+the+shaft+of+the+humerus,+between+med+and+lat+head+of+the+triceps+
Susceptible+to+damage+in++
o Humeral+shaft+fracture+
o Compression+(Saturday+night+palsy)+
o Wrist+drop++
Upper'Limb'Dermatomes'
Area+of+skin+supplies+by+a+single+spinal+cord+segment++
Intermingling+of+nerve+roots+from+C5+to+T1,+giving+rise+to+the+5+terminal+branches.+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+

+
'

+
+
+
+
+
Myotome''Segmental'supply'to'muscle'groups'

'
Upper'Limb''Nerve'injuries'
Upper%Trunk%(C5,%6)%
o Forceful+lateral+flexion+of+head+from+shoulder+
! E.g.+in+car+accident/during+birth+
o Paraesthesia+on+C5,+C6+dermatomes+
o Paralysis+of+C5,+C6+dermatomes:++
! elbow+flexors/forearm+
supination+
! waiters+tip+position+
Lower%Trunk%(C8,%T1)%
o Sudden+traction+of+the+upper+limb+
! E.g.+body+weight+is+caught+and+
hangs+
o Paraesthesia+in+C8,+T1+dermatomes+
o Paralysis+of+intrinsic+hand+muscles+
! claw+hand+(MCP+C,+IP+F)+
! Poor+fine+motor+control+(Klumpkes+palsy)++
+
+
+
+
+
+
+
+
 LECTURE'17'
Lower&Limb&1&&Bones&&&Joints&
Comparison'between'Upper'&'Lower'Limbs'
Shoulder)girdle)vs)Pelvic)girdle)
Lower)limbs)are)longer)
Upper)and)lower)limbs)rotate)developmentally)
o Rotation)of)the)UL)brings)flexor)surfaces)anteriorly)
! Rotate)so)our)thumbs)sit)laterally)90deg)
o Rotation)of)the)LL)brings)flexor)surfaces)posteriorly))
! Rotate)medially,)the)big)toe)ends)up)medial)90)deg)
o As)a)consequence)our)lower)limbs)are)rotated)180)degrees)to)
upper)
Femur)angulated,)to)get)weight)directly)under)the)bones)
Opposable)thumb/nonGopposable)big)toe)
Shoulder)girdle)is)freely)mobile)whereas)our)pelvic)girdle)is)stable.)
Paired)bones)in)the)leg,)are)stable)(unlike)the)forearms)are)unable)to)pronate)and)supinate),)has)
evolved)away.)
)
The'Pelvic'Girdle'
Sacrum)+)coccyx)attached)to)axial)skeleton)is)the)hip)
bone)
Hip)bone)(os)coxae))x2)
Attach)to)the)sacrum)posteriorally)and)then)come)around)
and)attach)to)each)other)anteriorally,)2)joints)
Stable)ring)of)bone)providing)great)stability)
Pelvis)=)hip)bones)+)sacrum)+)coccyx))
Variation)in)surfaces)between)males)and)females))
o Male)is)narrower)and)higher)
o Female)is)hsorter)and)wider)for)childbirth.)
Hip)bone)develops)as)three)distinct)bones)
o Ilium,)winged)structure)coming)around)laterally,)waist)
o Ischium,)coming)down)posterially,)muscles)attach)just)under)the)buttocks))
o And)then)anteriorally)there)is)the)pubic)bone,)in)the)midline.)
There)is)a)foramen)covered)in)a)membrane,)isnt)open.)Has)a)few)structures)passing)through)it,)called)
the)obturator)foramen.))
The)three)bones)unite)at)the)structure)acetabulum,)semilunar)structure,)is)the)hip)joint.)The)femur)
articulates)with)the)girdle)structure.)Is)round)and)deep,)very)different)to)shoulder)girdle.)Providing)
greater)stability.)
The'Femur'
Long)bone:)
o Shaft)and)2)ends)
Head)
Neck)
Trochanters)(for)muscle)attachments))(tubules)in)humerus))
o Greater)
o Lesser)
Shaft)(ends)in)two)articular)condiles))
Condyles:)
o Medial)
o Lateral)
Patella)
o Sesamoid)bone)
o Leverage)for)knee)extensions)
Bony)Trabecula)
o 2)main)systems)
o Intersect)to)resist:)
! Weight)bearing)forces,)especially)on)the)neck)
(vertical))
! Powerful)muscle)pulls)(arcuate))
o There)is)a)site)of)weakness)between)the)vertical'and)arcuate'
bundle))
o As)a)consequence)there)is)an)area)of)weakness,)Noff)fracture)
The'Tibia'and'Fibula)
Tibia:'
o Weight)bearing'
o Tibial)plateau))for)knee)joint'
o Shaft)(anterior)surface)subcutaneous))'
o Medial)malleolus'
o Trochlear)notch)for)ankle)joint'
o Tibial)tuberosity)'
Fibula:'
o NonGweight)bearing'
o Shaft)(for)muscle)attachments)'
o Lateral)malleolus'
)Do)not)move)relative)to)each)other'
Interoseous)membrane)between)them,)increasing)the)surface)area)for)muscular)attachment.'
The'Ankle'and'Foot'
Bony)anatomy)of)the)foot)
o Same)general)arrangement)as)hand)
o Larger)&)heavier)for)weight)transfer) Ligaments)form)the)
Phalanges) arch)
Metatarsal)
Tarsal)bones:)
o Talus)(no)muscle)attach),)calcaneus)(+5)more),)+)sesamoid)bones.))
)
The'Line'of'Gravity'
Line)of)gravity:)
o Passes)behind'hip)joint)(posteriorly))
! Resisted)by)anterior)capsule)
o Slightly)in'front)(anterior))to)the)knee)
! Resisted)by)posterior)capsule)
o Long)way)in'front)(anterior))of)ankle)
! Resisted)by)calf)muscles,)especially)soleus))
o You)do)not)want)gravity)to)be)running)exactly)through)your)joints,)will)eventually)cause)
degeneration)
)
Joints'of'the'Pelvic'Girdle'
Sacroiliac'joint'
o Synovial)plane)joint)
o Strong)interosseous)ligament,)little)move)
Sacrococcygeal'Joint'
o Cartilaginous)joint)
Pubic'symphysis'
o Cartilaginous)joint,)midline,)little)move)
Interface)between)spine)&)lower)limb)
Strong)complete)ring)of)bone)
o For)weight)transfer))
o Protects)contents)
Stability)v)mobility)compare)to)shoulder)girdle)))
Strong)ligamentous)support)
The'Hip'Joint'
Ball'&'Socket'Joint' Hip'Joint'Capsule'

Very)stable' Reinforces)by)strong)ligaments)
Deepened)by)labrum' In)front:)iliofemoral)ligament)
Movement)in)3)planes' Spirals)&)tightens)with)hip)
o Extension)=)maximum)stability)
Applied'Anatomy'of'the'Hip'Joint'
Fractured'Neck'of'Femur) Traumatic'Dislocation'of'Hip'

Vessels)anastomose)across)femoral)neck) Joint)capsule)unwinds)in)flexion)
Fracture)can)lead)to)avascular)necrosis)of) Position)of)greatest)laxity)
femoral)head.)) Sciatic)nerve)susceptible)to)injury)in)
Noff)Fracture) posterior)dislocation)
Degree)of)fracture)and)dislocation)must)be)
assessed,)due)to)vascular)supply)to)the)
head)(of)femur),)can)be)ruptured,)avascular)
necrosis.)
)

)
)
The'Knee'joint'
A)compound)and)complex)joint'
2)synovial)joints)within)one)capsule)
o Femur)with)tibia)(tibofemoral))
o Femur)with)patella)(patellofemoral)*)
o Patella)lies)within)the)tendon)
o Medial)and)lateral)condyle)arent)even,)lateral)is)higher,)
inhibiting)dislocation)laterally.))
The)knee)joint:)
o Hinge)joint)(but)some)rotation)occurs)))
! Only)flexion)and)extension,)1)plane)
o Incongruous)articular)surfaces)
o Good)ligamentous)support)
o Relatively)large)ROM)
o Stable)in)extension)
Support)primarily)comes)from)3)pairs)of)
structures)
The'Knee'joint'menisci'
2)menisci)G)Medial)and)Lateral)meniscus:)
o Fibrocartilage)disc)
o Semilunar)shape)
o WedgeGshaped)
Somewhat)mobile)but)are)attached)to)the)
horns,)which)are)attached)to)rigid)bone.))
Lateral)is)more)rounded,)medial)is)more)oval)
 Horns)of)menisci)attach)in)middle)region)(intercondylar)region)))
Increase)area)of)contact)by)~1/3)due)to)wedge,)becomes)very)congruent)
Shock)absorb))
Spread)synovial)fluid)
The'knee'joint'cruciate'ligaments'
Femoral)condyles)can)slide)forwards)and)backwards)on)the)tibia)
Provides)stability)in)the)sagittal'plane)
Stop)displacement)of)the)femur)relative)to)the)tibia)
Relative)to)the)femur:)
Injury)occurs)due)to)too)much)rotation)
o Contact)sport,)foot)grounded)and)then)leg)twisted.)The)ligaments)cross,)the)anterior)isnt)as)
strong)as)the)posterior)and)usually)ACL)is)ruptured)
Anterior'Cruciate'Ligament'(ACL)' Posterior'Cruciate'Ligament'(PCL)'

The)ACL)keeps)the)tibia)from)slipping'
forward'
Anterior)resists)the)femur)sliding)
posteriorly)off)the)tibial)plateau'
Arises)from)the)anterior)portion)of)the)
plateau.'
Starts)anteriorly)and)projects)posteriorly)'
'
The)PCL)keeps)the)tibia)from)slipping)
backward)
Posterior)resists)the)femur)sliding)anteriorly)
off)the)tibial)plateau)
Starts)posteriorly)and)projects)anteriorly)
Hence)they)cross)

)
'
'
'
'
'
'
'
The'Knee'Joint'Collateral'ligaments'
Medial)and)lateral)collateral)ligaments)")extracapsular)ligaments)
Contribute)to)medialGlateral)stability)
Resist)vagus)and)varus)movement;)abduction)and)adduction)
Taught)in)extension.))
Medial'Collateral'Ligament'(MCL)' Lateral'Collateral'Ligament'(LCL)'

Flat)broad)band,)adherent)to)joint)capsule)
Adherent)to)medial)meniscus)
Resist)vagus)stress'
Most)internal)fibres)blend)into)the)joint)
capsule)and)some)of)the)most)inside)fibres)
attach)to)the)meniscus'
Meniscus)is)somewhat)mobile)but)the)MCL)
helps)stabilise)it'
)
Rounded,)more)narrow)
Attaches)to)the)head)of)fibular)
Separate)and)distinct)from)joint)capsule)
Resist)varus)stress)
Much)thinner,)more)rounded)and)taught)
Attaches)to)the)head)of)the)fibul)

'

)
The'Knee'Joint'Bursae'
Typically)after)injury)there)will)be)swelling)above)the)knee)due)to)bursa)
Synovial)fluid)filled)sacs,)usually)occur)where)bone)rubs)
against)something)
Knee)has)a)bursa)continuous)with)the)knee)joint)
Knee)will)swell)with)injury,)because)the)swelling)will)go)into)
the)knee)and)into)the)bursa.)Swelling)come)up)above)the)
knee.)Blood)fills)the)joint)capsule)and)extends)upwards.)
)
)
)
)
)
)
)
)
The'Knee'joint''Applied'anatomy'
Patella'dislocation'
Patella)=)prone)to)dislocation)
In)the)image)(A),)the)patella)has)
dislocated)laterally)
)

The'Unhappy'triad)
Injury)to)ACL,)MCL)&)medial)meniscus)
1)structure,)2)structures)or)3)structures)injured)
Usually)repair)with)part)of)hamstring)tendon.)
Joint)area)most)stable)in)extension)
)
)
)
)
)
)
)
)
)
)
)
)
'
Tibiofibular'joints'
Superior:)
o Plane)synovial)joint)
o Allows)some)gliding)movement)
o Has)ligament)support)
Inferior:)
o Fibrous)joint)(Syndesmosis))
o Prevents)tibia)and)fibula)from)separating)
o Has)ligament)support)
o Well)protected)
o Ligaments)both)anteriorly)and)posteriorly)
Good$stability$+$low$leading)")Dislocation)rare)
Two)bones)joined)by)an)interosseous)membrane)
Syndesmosis)between)tibia)and)fibula)
Inferior)is)extremely)stable)
More)likely)to)break)leg)than)dislocate)this)joint)
Fracture)fibula)and)tibia)
Good)stability)+)low)loading)")rare)dislocation)
)
)
)
The'Ankle'Joint'
Talocrural'joint:)
o Hinge)type)synovial)joint)
o The)malleolar$mortise)
o Plantar)flexion)(flexion))
o Dorsi)flexion)(extension))
Medial'deltoid'ligament' Lateral'Ligament'

Very)strong)
5)ligaments)which)make)up)the)medial)
collateral)ligament)(just)appreciate)5))
Rarely)have)medial)injury)
Not)as)strong)
Commonly)injured)in)an)inversion)sprain)
3)component)ligaments)(less)=)weaker))
overall)protection)is)substantially)less)than)
the)medial)ligament)

) )
)
Joints'of'the'foot'
Subtalar)joint)
o The)joints)under)the)talus)
Midtarsal)joint)
Intertarsal)joint)
Tarsometatarsal)joints)
Metatarsophalangeal)
Dont'need'to'know'any'of'them,'just'appreciate'
there'are'many'joints'and'the'presence'of'an'arch.')
)
)
)
)
)
)
 LECTURE'18'
Lower&Limb&2&&Muscles&and&Movements&
Movements'of'the'Lower'Limb'
Hip$
$
$
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$
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Knee$and$foot$
$
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$ !inversion/eversion!also!a!plane!of!
$ movement,!only!at!subtala!joint,!not!
$ at!ankle!
$
$
$
$
$
The'Lower'Limb''Fascia'
Fascia$
o Layer$of$fibrous$tissue$
o Surrounds$individual$muscles$
o Surrounds$groups$of$muscles$
o Divides$muscles$into$compartments$
o Reduces$friction/allows$muscle$to$glide$
Intermuscular$septa$
o Folds$of$fascia$which$divides$the$thigh$and$leg$into$
compartments$
$
Deep'Fascia'of'the'Thigh'
fascia$lata$$
o Specialised$fascia$
o Thickens$laterally$to$form$the$iliotbial$band$(ITB)$
o Attaches$to$lateral$knee$
$
$
$
$
$
$
Muscles'of'the'Pelvic'girdle'
Anteriorly' Posteriorly'$

Iliopsoas'muscle:' Gluteal'muscles:'

Iliacus$ Gluteus$maximus$
Psoas$major$ o Only$recruited$in$power$extension.$
Psoas$minor$ Gluteus$medius$and$minimus$
$ o Abduct$the$hip$
o But$primarily$maintain$position$of$
$ pelvis$in$locomotion$
$ Extensor$and$Abductor&muscles$of$the$hip$

Strong$hip$flexor$muscles$

' $

$
Muscle'compartments'of'the'Thigh'
Anterior$
o Quadricep$muscles$$most$extensive$
o Knee$extensors$
Posterior$
o Hamstring$muscles$
o Hip$extensors$&$knee$flexors$
Medial$
o Adductor$muscles$
o Hip$adductors$
(Lateral)$
o Gluteal$muscles$
o Does$not$extend$into$thigh$$
$
$
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'
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Anterior'Muscle'compartment'of'the'thigh'
Sartorius$
Quadriceps$muscle$
o Made$up$of$4$large$and$powerful$muscles$
o Rectus$femoris$(flexes$at$hip)$
! Most$anterior;$arises$on$the$pelvis$
and$joins$to$the$sesamoid$and$tibia,$
involved$in$extension.$$
! Most$often$injures$due$to$attachment$
to$hip$and$knee$joints$
o 3$vastus$muscles;$lie$under$rectus$femoris$
! Medialis$
! Lateralis$
! Intermedius$$
Normal$alignment$of$patella$maintained$by$vastus&
medialis$$
o Tend$to$suffer$lateral$dislocation$of$the$patella$
! Due$to$angle$of$inclination$of$the$femur;$causes$slight$tendency$to$pull$the$patella$
laterally.$$
! Most$distal$portion$of$vastus$medialis$has$rather$oblique$oriented$fibres,$which$grab$
onto$the$Quad$tendon$and$pull$it$medially.$$
o Vastus$medialis$has$oblique$fibres$to$keep$patella$tracking$more$medially$$
o After$injury$of$patella,$strengthening$on$vastus$medialis$increases$stability$of$patella$
Vastus$medialis$weakness$may$lead$to$
o Abnormal$tracking$of$patella$"$Cartilage$degeneration$
o Patella$dislocation$(laterally)$
'
Posterior'muscle'compartment'of'the'thigh'
Hamstring$muscles:$
o Three$2\joint$muscles:$
! Semimembranosus$(medial$side)$
! Semitendinosus$(medial$side)$
! Biceps$femoris$(long$head)$(lateral$side)$
! Prone$to$strain$when$active$across$both$joints$
simultaneously$
Flexors$of$the$knee$and$extensors$of$the$hip.$$
Muscles$that$cross$two$joints$are$more$liable$to$injury$since$they$can$be$
stretched\$strain$or$tear.$
$
$
$

$
$
Medial'muscle'compartment'of'the'thigh$
Adductor$muscles$
Adductors$of$the$hip:$
o 5\6$adductors.$Appreciate$them$as$a$group$
(no$names)$
o Occupy$the$medial$compartment$and$draw$
lower$limb$into$the$midline$
Inflammation$of$the$pubic$bone,$due$to$excessive$
force$and$tearing$
Common$source$of$groin$pain$and$pathology$
o Common$at$bony$attachment$(osteitis$pubis)$
o (Especially*adductor*longus)$
o Due$to$strength$of$muscles$
Hole$in$the$adductor$muscle,$adductor$magnus.$The$

hole$is$called$the$adductor$hiatus,$is$for$the$nerves$and$vessels$of$
the$lower$limb$$
Muscle'Compartments'of'the'leg'
Anterior$
o Contains$ankle$dorsi\flexors$
Posterior$
o Contains$ankle$plantar\flexors$
o Most$extensive$
Lateral$$
o Contains$ankle$everters$
Anterior'Muscle'compartment'of'the'leg$
Anterior$compartment$
o Tibialis$anterior$
o Extensor$hallucis$longus$(EHL)$
o Extensor$digitorum$longus$(EDL)$
o There$are$brevis$of$these$muscles$too$
Dorsiflexors$of$the$ankle$
Extensors$of$the$toes$
Overuse$may$lead$to$shin$splints$
(tenoperiostosis)$$
Deep'fascia:$
o Separates$muscle$compartments$
and$muscles$
o Muscles$surrounded$by$tight$
fascia$
Compartment$syndrome:$
o injury$causes$bleeding$and$
swelling$into$a$compartment.$
o If$sweeling$occurs,$neurvascular$
structures$susceptible$to$
compression,$veins$begin$to$
close$down,$therefore$blood$cant$
get$out,$increasing$pressure$further.$
 Lateral'muscle'compartment'of'the'leg$
Peroneal$(fibularis)$muscles$
o Longus$
o Brevis$
Everters$of$the$foot:$
o Drawing$the$sole$of$the$foot$to$the$outside$
o Strain$causes$pain$
o Not$particularly$strong$muscle,$mainly$useful$to$give$brain$a$sense$of$
where$the$foot$and$ankle$are$
o Proprioceptive$role$in$ankle$sprains$
$
$
Posterior'Muscle'compartment'of'the'leg'
Superficial' Deep'

Gastrocnemius$(paired$muscle$and$large)$ Tibialis$
o Power$muscle,$low$endurance$ Flexor$hallucis$longus$
Plantaris$ Flexor$digitorum$longus$
Soleus$ Plantaflexors$of$the$ankle$and$toes$
o Not$strong$or$powerful,$but$has$
high$endurance$ $
o Sustained$action$against$the$force$ $
of$gravity.$Keeps$us$upright$
Plantar$flexors$of$the$ankle$ $

Note:$ $

Power$vs.$postural$roles$ $
Venous$sinuses$in$soleus,$greater$volume$
capacity$than$veins$ $
Clinical$Significance:$
$
Calf$strain$
Venous$return$ $ $
Achilles$
tendinitis''
Intrinsic'Muscles'of'the'foot'
Plantar$muscles$(layers)$
o Hallucis$muscles$(hallucis$=$of$big$toe)$
o Digiti$minimi$muscles$(digiti$minimi$=$muscle$of$the$little$
toe/appendage)$$
o central$muscles$
Long$tendons$
Plantar$aponeurosis$&$ligaments$that$support$arches$
$
$
$
'
'
'
'
Applied'Anatomy'of'Muscles'of'the'Lower'Limb'
2'Joint'muscles'
Susceptible$to$strain$when$acting$across$both$joints$simultaneously$
active$insufficiency$
Prone$to$train$in$dynamic$activities:$
o Gastrocnemius/soleus$
o Hamstrings$
o Quadriceps$
Worse$when$they$cross$two$joints,$stretches$muscle$too$much$
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 LECTURE'19'
Lower&Limb&3&&Nerves&&&Vessels&
Arteries'of'the'Lower'Limb'
Major&arteries&begin&at&the&junction&of&the&
lower&limb&and&pelvis:&
o Descending&aorta,&branches&at&
pelvis&and&then&branches&again&
inside&the&pelvis&
o External&iliac&artery,&exits&the&pelvis,&
then&changes&to..&
o Femoral&artery&(+&profunda&
femoris),&supplies&the&lower&limbs,&
reasonable&superficial&on&anterior&
aspect&of&the&thigh,&despite&arteries&
preferring&flexor&surfaces&for&
protection.&&
o Moves&medially&through&the&
muscles,&ends&up&posteriorly&on&the&
flexor&surface&on&the&back&of&the&
thigh.&At&back&of&the&knee.&
o Popliteal&artery&
o Tibial&(anterior&and&posterior)&arteries&&
'
Arteries'of'the'Femoral'Neck'
hiatus&allows&passage&of&the&femoral&artery,&from&anterior&
through&medial&compartment&to&end&up&in&the&posterior&
compartment.&
Anastomoses&between&profunda&femoris&artery&branches&&
Pass&across&the&neck,&bound&down&by&capsular&fibres&&
Susceptible&to&damage&in&fractures&NOF&
&
Veins'of'the'Lower'Limb&
Superficial&Veins&
o Dorsal&venous&arch&
o Great&saphenous*&medial&maliolus&
o Small&saphenous*&make&arch&
(all&in&superficial&fascia)&
none&on&soles&of&feet&
Deep&Veins:&
o Venae&Comitantes&
o Venous&sinuses&in&soleus&
o Muscular&venous&pump&&
NB:&Valves&ensure&unidirectional&flow&
Clinical&significance:&
o Varicose&veins&
o Venous&thrombus/thromboembolus&&
o Saphenous&vein&grafts&&
Lymphatics'of'the'Lower'Limb'
Drainage&follows&superficial&veins&of&the&lower&limb&
o Inguinal&nodes&
o Drain&to&thoracic&duct&&left&side&&
o Lymph&flow&crosses&the&midline&
o Left&hand&nodes&drain&&of&the&body&
&
Nerves'of'the'Lower'Limb'
Anterior&rami&give&rise&to&plexuses&
Major&nerves&arise&from&Lumbosacral&plexus&
Compression*of*spinal*nerve*roots*may*cause*pain*
peripherally&&
&
&
Femoral&Nerve& Obturator&Nerve&&

Arises&from:&L2,&L3,&L4& Arises&from:&L2,&L3,&L4&

Supplies&extensor&(anterior)&compartment& Supplies&adductor&(medial)&compartment&of&
of&thigh& the&thigh&
Passes&under&inguinal&ligament& Enters&obturator&canal&in&pelvis&&
Supplies:& Supplies:&
o Quadriceps& o Adductor&muscles&
o Skin:&anterior&thigh&and&medial&leg&and& o Skin&medial&aspect&thigh&
foot& Clinical&significance:&
Rarely&injured:&most&common&in&direct& o Referred&pain&from&ovary&to&thigh&
trauma&& o Hip&pain&referred&to&knee&
Emerges&behind&soase& o Nerve&as&it&emerges&through&pelvis,&
Innervates&all&the&muscles&of&the&anterior& runs&close&to&the&hip&joint,&with&joint&
compartment&of&the&thigh.& degeneration,&can&get&bony,&spikes&
' referring&pain&to&medial&part&of&the&
thigh.&
&

&
'
'
Gluteal&Nerves& Sciatic&Nerve&

Arises&from&L4,&L5,&S1& Arises&from&L4,&L5,&S1,&S2,&S3&

Supplies&gluteal&muscles&(lateral& Supplies&posterior&(flexor)&compartment&of&
compartment&of&the&thigh)& the&thigh&
Exits&the&pelvis&through&the&greater&sciatic& Divides&at&apex&of&popliteal&fossa&into&2&
foramen& branches:&
o (above&below&pririformis)& o Tibial&nerve&
Supplies&gluteal&muscles' o Common&peroneal&nerve&
Clinical&significance&
o sciatica&
o Gluteal&injections&
o Chronic&hamstring&strains&
o Nerve&exits&same&foramen&as&the&
gluteal&nerve&
o Emerges&posteriorly&and&enters&the&
thigh.&
o Peraformis&muscle,&emerges&under,&
related&to&sciatica&
' '

'
Applied'Anatomy' '
Herniation'of'a'disc'
Sciatic&Nerve&
o Intervertebral&disc&prolapse&at&L5/S1&
o Irritation&of&the&S1&nerve&root&
Nucleus&can&push&its&way&posteriorly&(and&laterally),&and&result&in&
impingement.&&Commonly&occurs&in&lower&lumbar&region,&because&it&
takes&so&much&weight.&&
&
&
 Note&effects:&
o Pain,&paraesthesia,&motor&dysfunction,&atrophy,&loss&of&reflexes&&
o can&get&lower&leg&and&foot&pain&as&a&result&of&referred&pain&from&the&back.&
&
&
&
&
&
&
&
&
&
&
&
&
Tibial'Nerve' Common'Peroneal/Fibular'Nerve'

Arises&L5,&S1,&S2,&S3& Arises&from:&L4,&L5,&S1,&S2&

Supplies&all&posterior&compartment&leg& Superficial&fibular&nerve&&lateral&
muscles& compartment&
Arises&at&the&back&of&the&knee&(polissteal& Deep&fibular&nerve&&anterior&compartment&
fossa)& o Passes&around&the&head&of&fibula&
Enters&tarsal&tunnel&and&divides&into&plantar& Clinical&significance&&Compression&of:&
nerves& o Common&peroneal&nerve&at&lateral&knee&
Clinical&significance& &foot&drop&
&Compression&of:& o Anterior&compartment&syndrome&(deep&
o Tibial&nerve& fibular&nerve)&&
in&the&tarsal&(tarsal&tunnel&
syndrome)&
o Planter&
nerves&below&medial&arch&
(jogger&foot)''
'
Myotome'of'Lower'Limb'
myotomes:&the&more&proximal&parts&of&the&brachial&plexus&are&&responsible&for&more&proximal&parts&of&
movements&of&the&upper&limb&
'

'
'
Dermatomes'and'Neurosomes'of'the'Lower'Limb'
'
'

'

'

'

&
 LECTURE'20'
Principles*of*Viscera*and*Visceral*Systems*
Viscera'
Organs'that'regulate'internal'environment'
Occupy'cavities'in'the'body:'thorax,'
abdomen,'pelvis'
Also'found'in'head'and'neck,'glands'for'reg'
Involved'with'secretion,'excretion,'digestion'
absorption'
Hollow'Viscera'
Typically'tubular,'with'a'cylindrical'wall'and'a'
lumen'
Lumen''light'(at'the'end'of'the'tunnel)'
Mucosa'(internal'layer)'
contains'smooth'muscle'
that'may'produce'waves'of'
contraction''peristalsis'
mucosa'has'folds'to'
increase'SA'
Serosa'(external'layer)'minimises'friction.''
To'allow'passage'
Serosa'
Covers'external'surface'of'hollow'viscera'
Minimises'friction'
Usually'derived'from'lining'of'body'cavities'
Can'be'continuous'with'a'mesentery'attaching'viscera'to'body'
wall'e.g.'small'intestines'
Secrete'fluid'into'space'around'it,'minimising'friction,'washes'
against'serosa'and'lubricates'it.'
Can'be'continuous'with'mesantry''
Transverse'section'through'the'abdomen'
Extension'of'the'lining'of'the'body'wall'around'all'of'the'viscera'in'the'body'cavity'i.e'one'continuous'
entity'
Muscle'Coats''
Wall:'Circular'&'longitudinal'smooth'muscle'
Provides'for'motility'
o e.g.'peristalsis'
Expansion''
o e.g.'smooth'muscles'may'be'stretched'without'
changing'force'of'contraction'to'allow'for'storage'of'
larger'volumes'of'liquids'(bladder)'or'solids'(rectum),'
STOMACH'
At'critical'point'of'storage'(stretch)'reflexes'are'initiated'to'cause'micturition'or'defecation'
'
'
'
Lumen'of'tubular'(hollow)'viscus'
May'have'dilations'and'constrictions'
Constrictions:'
o Usually'at'beginning'&'end''
o Also'at'specific'sites'along'its'course''e.g.'where'male'urethra'pierces'pelvic'
floor'
o Help'limit'whats'moving'through'
A'duct'tends'to'narrow'where'it'approaches'the'wall'of'a'hollow'viscus''its'orifice'
(opening)'
Calculus'(stone)'likely'to'lodge'at'orifice'
o Often'caused'by'mineralisation'of'substance'(Ureteric'bigger'than'gall'stones)'
Sphincter'(from'Greek:'strangle)'
Tubular'Viscera'have'a'sphincter'
Bottom'of'a'reservoir'or'distal'end'of'a'tube'
1) Anatomical'Sphincter'
Localised'muscle'thickening'around'wall'of'tubular'viscus' '
controls'passage'&'prevents'reflux'of'contents'
Also'at'distal'ends'of'ducts,'near'an'external'orifice'
'
2) Functional'Sphincter'
No'localised'muscular'thickening'
Extra'closure'of'the'lumen'by'a'functional'mechanism''
Path'of'ureter'into'bladder,'passes'through'smooth'muscle'of'the'bladder'
wall.'As'bladder'is'filled,'it'expands'and'squashes'the'tube'
Has'an'oblique'path'as'it'moves'through'
o When'expands,'allows'entry'
o When'contractions,'disallows'entry'
Anatomical'Sphincters''Involuntary'of'voluntary'
Anatomical'sphincters'can'be'involuntary'or'voluntary'sphincters'
Involuntary'sphincters:'
o Made'of'smooth'muscle'
o Supplied'by'autonomic'NS'
o First'line'of'defence'
Voluntary'sphincters:'
o Made'up'of'skeletal'muscle,'under'voluntary'control'
o Supplied'by'somatic'nervous'system'
o Second'line'of'defence'
Solid'Viscus'
Glands:'
o Clusters'of'secretory'(or'excretory)'cells'e.g.'
pancreas,'liver,'thyroid'gland'
External'capsule'(protection)'and'serosa'(reduces'
friction)'
May'have'subdivisions:''
o Outer'cortex'
o Inner'medulla'
May'be'organised'into'lobes'(or'lobules)'e.g.'liver'
Shapes,'Grooves'&'Impressions'
Structures'adjacent'to'solid'viscera'produce'grooves'&'impression'on'it'
E.g.'the'groove'by'aorta'on'lung'and'impression'by'heart'on'lung'
Exocrine'vs'Endocrine'Glands'
Exocrine'Glands' Endocrine'Glands'

Glands'that'secrete'into'a'duct'of'system'of' Glands'that'secrete'directly'into'
ducts' blood'stream'
Ducts'emerge'from'hilum'of'viscera' Usually'secrete'hormones'that'
Open'into'hollow'viscera' act'in'other'parts'of'the'body'
E.g.'Liver'and'Bile'Duct' Rich'blood'supply'
E.g.'Adrenal'Glands'

' '
'
!'Some'Glands'are'both'Exocrine'and'Endocrine'
E.g.'Pancreas:'
o Exocrine'has'the'acinin'which'secrete'pancreatic'
enzymes'into'a'system'of'ducts'and'then'excrete'to'
deuodenum.'
o Islets'affect'glucose'regulation,'secrete'directly'to'
blood'vessels,'endocrine'
o Has'a'duct'system'secreting'into'hollow'viscera'
o Directly'secretes'into'blood'stream'
o Thus'it'has'exocrine'and'endocrine'properties'
Serous'Membrane'
Single'and'continuous'membrane'that'lines'a'body'cavity'and'contains'a'space'within'it'
Produces'fluid'which'lubricates'the'cavity'
Lines'body'wall'
Covers'part'or'all'of'a'viscus'(serosa)'
Subdivided'into'parietal'and'visceral'layers'
o E.g.'pleura'in'thoracic'cavity;'peritoneum'in'abdominal'
cavity;''
Visceral'layer'covers'viscera'&'receives'same'nerve'and'blood'
supply'as'viscera'from'body'wall.'Dont'tend'to'have'pain'from'viscera'membrane'
'
'
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'
'
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Development'of'Serous'Membranes'
Early'in'development,'organs/viscera'develop'in'body'wall'behind'a'cavity'
Space'enlarges'and'viscera'moves'into'cavity'
Viscera'grows'to'size'of'cavity.'Membrane'now'surround'whole'organ'
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Peritoneal'Cavity'
A'closed'cavity'in'the'abdomen'lines'by'a'serous'membrane'called'the'peritoneum'
Some'viscera'are'suspended'in'body'cavity'by'a'mesentery''connects'viscera'to'
body'wall'&'conveys'vessels'&'nerves'
A'serous'membrane'
Abdominal'wall'and'viscera'
Viscera'is'suspended'in'the'cavity'and'there'are'a'number'of'mesenteries'
connecting'it'to'the'body'walls'
'
Role'of'Mesentery'
A'mesentery'provides'viscus'with:'
o Mobility'
o A'pathway'for'nerves'and'
vessels'
During'development,'alternating'
parts'of'gut'retain'or'lose'a'
mesentery'along'with'their'
course''has'implications'for'mobility'and'fixation'
Viscera'suspended'on'the'end'of'a'mesentery'are'in'danger'of'twisting'
(torsion)'
Gut'tube'has'alternating'parts'
They'are'very'mobile'and'can'sometimes'twist,'constricting'blood'supply.'
'
Paired'Viscera'(textbook'ch8)'
Each'develop'&'are'located'on'one'side'of'body'
o Ejaculatory'ducts'
o Vas'deferens,'seminal'vesicles'
o Ureters'
o Kidneys'
Receive'nerve'&'blood'supply'from'each'side''
o This'has'implications'for'presentation'of'pain'
o Referred&pain'
'
'
'
'
Referred'Pain'
Referred'pain'is'the'perception'of'pain'in'areas'other'than'the'site'of'stimulation,'usually'due'to'
common'spinal'segmental'origin'of'the'nerves'to'the'
site'of'stimulation'and'the'site'to'which'pain'is'
referred'
Probably'due'to'convergence'of'the'two'inputs'to'the'
same'population'of'neurons'at'a'given'spinal'
segmental'level'
Visceral'pain'is'usually'referred'to'somatic'regions&
Referred'pain'from'paired'Viscus'
Pain'from'paired'viscus'referred'to'skin'on'same'side'
'
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'
'
'
'
'
'
Unpaired'Viscera'
GI'Tract'+'associated'glands'&'ducts''develop'in'midline'but'migrate'away'from'it'(associated'
orifices''mouth,'anal'canal'remain'in'midline)'
Nerve'supply'from'both'sides'of'spinal'cord'
Visceral'pain'referred'to'midline'skin'(over'origin'of'viscus)''because'dual'
sensory'nerve'supply'reaches'both'side'of'spinal'cord'simultaneously'
Pain'only'referred'to'(local)'overlying'skin'when'somatic'nerves'involved'
'
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 LECTURE'21'
Upper%Respiratory%Tract%
Upper'Respiratory''Functions'
Nasal%Cavity%
o Smell%
o Airway/breathing% Nasal%
Nasal%
o Resonance%for%sound% Cavity%
Cavity%
Oral%Cavity%
o Eating%%
o Talking%
Pharynx%
o (Airway/breathing)% Oral%Cavity%
Oral%Cavity%
Larynx%
o Sits%on%top%of%the%trachea%
o Vocal%ligaments%embedded%in%larynx%%
Larynx%
% for%phonation%
o Airway/breathing%
o Phonation% Oesophagus%
o AKA%voice%box%
Pharynx%
o Area%behind%the%nose,%mouth%and%
larynx%
o Opens%into%the%oesophagus%
o Swallowing%
o Immune%tissue%
%
Nasal'Cavity'
Mucous%membrane%and%features%of%
medial%wall%
o Medial%half%(one%side)%of%the%
nasal%cavity%
o Nasal%septum%visible%in%midline%
o Foreign%particles%stick%
o Helps%to%humidify%the%air%
o Want%to%be%warm%and%humid%so%
that%when%it%reaches%the%lungs%
its%not%too%dry%
Respiratory%area%
o Characterised%by%very%definite%epithelium%(ciliated)%
! Actively%beat%towards%throat%end%of%respiratory%system%
o Cilia%beat%towards%the%front%of%the%nasal/oral%cavity,%help%bring%mucous%produced%in%the%tract%
towards%the%front%so%we%can%expel.%
o Damages%in%smokers%
Smell:%uppermost%part%of%nasal%cavity,%including%upper%surface%of%the%superior%choncha%
Mid%sagittal%cross%sections%
Olfactory%area%
o Presence%of%filaments%projecting%into%epithelium%and%peirce%little%holes%in%the%roof%of%the%
nasal%cavity%collecting%info%about%smell,%which%is%carried%by%the%first%cranial%nerve%back%to%the%
brain.%
Features'of'Lateral'Wall'
Turbinates:%
o Shelves%the%bone%shells%
which%hang%off%the%
lateral%wall%
Creates%turbulence%into%the%air%
we%breathe%in%%
o Prolonged%rime%in%nasal%
area%
o Increased%temperature%
before%descending%into%lower%resp.%%
Conchii%%
o Not%a%lot%of%space,%they%occupy%a%large%part,%if%they%become%inflamed%you%get%the%airway%
blocked%
Features'of'Lateral'Wall'cont.%'
Openings%of%paranasal%sinuses%
3%Meatus:%
o A%space%under%the%concha%
Number%of%openings%in%the%wall:%
o Mostly%paranasal%sinuses%
%
'
'
'
'
'
Paranasal'Sinuses'
Spaces%in%the%bone%surrounding%the%nasal%cavity%
Para%=%adjacent,%nasal%=%nose,%sinus%=%space%
4%paranasal%sinuses:%
o Frontal%
o Ethmoid%
o Sphenoid%
o Maxillary%
They%communications%which%allow%the%bacteria%to%migrate%up%into%the%
sinuses,%compressing%the%mucosa.%Strong%pain%fibres%
Easy%for%inflammation%to%drain%downwards.%In%maxillary%sinus,%the%
drainage%hole%is%above,%hard%to%drain%
Sinuses%develop%as%out%poaching%of%nasal%cavity%%
Have%a%direct%connections%to%nasal%cavity%
o Creates%a%bacterial%passage%for%infection%(sinusitis)%
In%frontal%and%ethmoid%sinuses,%bacterial%must%travel%up%
o Infection%less%likely%and%remnants%drain%out%easily%
In%maxillary%sinus,%location%of%hold%and%cavity%creates%a%problem%for%draining.%%
%
%
%
%
Oral'Cavity'
Largely%build%around%eating%but%for%airway%as%well%
Open%inferiorally%
Mylohyoid%muscle%runs%anteriorly%to%the%hyoid%bone,%%
% projecting%to%borders%of%the%mandible%
'

'

Tongue'

Anterior%2/3,%posterior%1/3%
Functions:%
o Shape%bolus%of%food%
o Speech%
o Taste'
Filiform:'
o Covers%mucosa%on%the%whole%of%the%rest%of%the%tongue'
o Dont%have%taste%buds%around%the%base'
o Purpose%is%to%grip%bolus'
Tastebuds%'
o Are%embedded%around%the%base%of%the%papillae'
o Buried%in%the%lateral%and%inferior%wall'
o Lingual%tonsils,%group%of%immune%tissues'
o Papillae%swellings,%Valate%are%larger,%fungiform,%
smaller,%foliate'
o These%are%not%the%taste%buds,%they%contain%groups%of%
cells%that%are%the%taste%buds'
o Filiform%do%not%contain%taste%buds,%give%rough%
surface,%useful%in%cats%and%dogs'
'
Muscles'of'Tongue'
Tongue%are%movements%important%for%shaping%bolus%of%food%
and%in%speech%
Extrinsic'muscles'of'Tongue' Intrinsic'muscles'of'tongue'

Alter%position%of%tongue% Alter%shape%of%tongue%
Attach%outside%the%tongue%and%pull%the% Connect%to%other%intrinsic%muscles,%muscles%
tongue%certain%ways% in%the%tongue.%%

%
'
Teeth'
Chewing%
Shape%adapted%to%function%
Incisors:%
o Shearing%
Canine%
o Anchoring%food%"%pronounced%in%
carnivores%
Premolars%(2)%and%Molars%(3):%
o Grinding%and%macerating%food%(flat%
surface)%
o 3rd%molar%=%wisdom%tooth%last%to%erupt%
Larynx%
AKA%Voice%box%
Group%of%Cartilages%
Midsagittal%section%
Epiglottis:%
o Projects%up%and%posterior%to%the%tongue%
o When%food%passes,%pushes%down%epiglottis%
Thyroid%Cartilage%
o Adams%apple%(very%midline)%
o More%developed%in%male%
o Alters%voice%quality%
o Open%posteriorly%
Cricoid%cartilage%
o Forms%a%complete%ring%around%the%bottom%
of%the%larynx%
o Closed%posteriorly%
Laryngeal%inlet,%allows%air%in%and%out8%
%
Vocal'Ligament'
Vibration%causes%sounds%
production%
Vocal%ligaments%need%to%be%
abducted%for%phonation%and%
abducted%for%breathing%
Intrinsic%muscles%of%larynx%alter%
position%of%vocal%ligaments%
Arytenoid%cartilage%swivels%round%
Vestibular%fold%
o Superior%
o Flap%of%mucosa%above%this%
o Doesnt%actually%vibrate%to%produce%sound%
o Has%a%protective%function%
Vocal%ligament%x2%%
o Capable%of%swivelling%towards%or%away%from%each%other%
o To%produce%sound,%must%be%adducted%(toward%midline)%
o To%breathe%must%be%abducted%by%the%ligaments%%
Pharynx'
Structure%of%the%pharynx%is%supported%by%an%external%
layer%of%muscle%called%the%constrictors%
o Forms%a%sling%around%the%back%
Constricters%x%3,%contract%sequentially%for%swallowing%
%
%
%
%
%
%
%
Muscles'of'the'Pharynx'
" 'Constrictors''
Close%the%posterior%aspect%of%the%nose,%mouth%and%
larynx%
Contract%sequentially%during%swallowing%
o Forms%a%sling%
%
%
%
%
%
%
%
%
%
%
Nasopharynx'
Opening%of%auditory%tube%
o Allows%equalisation%of%pressure%between%eardrum%
Salpinopharyneus%muscle%
o Can%pull%on%the%auditory%tube%to%open%it%up%
o Contracts%to%open%(blocked%ears%remedy)%%
o Adenoids%become%inflammed%and%can%close%
off%the%nasal%cavity%affecting%breathing%and%
tone%of%the%voice%
o Openign%of%auditory%tube%connects%with%the%
middle%ear,%allows%equalisation%of%pressure,%
between%head%and%outside%pressure,%
sometime%mucous%can%block%it%
o Salpingopharyngeas%contracts%on%opening%
and%allow%pressure%to%escape,%pop%
%
%
%
%
%
'
Oropharynx'
Consists%mainly%of%the%soft%palate'
Palatine%tonsils,%sometimes%removed'
%
%
%
%
Laryngopharynx'
Epiglottis%
o Fluid%cannot%push%down%epiglottis%and%
hence%hoes%around%the%sides%of%the%
laryngeal%inlet%into%the%oesophagus%
o Epiglottis%is%pushed%by%food%and%covers%air%tube%and%whole%larynx%comes%up%
o Escape%route%is%the%piriform%recess%allows%fluid%to%flow%around%%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
 LECTURE'22'
Thoracic(Walls(and(Diaphragm(
Overview'of'Thoracic'Walls'
Protections*
o Of*internal*organs*
Mechanical*basis*of*breathing*
Includes*thoracic*cage*and*covering*
o Skin,*superficial*fascia,*subcutaneous*structures*
Breast*is*part*of*the*thoracic*wall*
Bony'Framework'of'Thorax'
Sternum*
o Manubrium*
o Body*of*sternum*
o Xiphoid*process**
1A7*true*ribs*because*they*connect*to*the*sternum*independently*with*the*costal*cartilage**
Anterior'View' Posterior'View'

* *

Middle'Rib''Posterior'View'
Atypical*ribs*=*1A2,*10A12*
Typical*ribs*=*3A9*
Two*ends*
o Sternal*end*(anterior)*
o Vertebral*end*(posterior)*
Four*parts:*
o Head*
o Neck**
o Tubercle*
! Smooth*articular*facet*"*joint*related*
! Non*articular*part*in*the*bony*bump*
(attachment*of*muscle*ligament)*
o Body*
! The*internal*surface*has*a*costal*groove*
Groove*for*neurovascular*bundle*passage*
Thoracic'Vertebra''T6''Lateral'View'
A*typical*thoracic*vertebra*has*3*facets*on*each*side*(2*on*the*vertebral*body*and*1*on*the*transverse*
process)*
o Provide*attachment*for*the*ribs,*superior*and*inferior*make*the*joint*
o Transverse*costal*facet*
A*typical*rib*articulates*with*its*own*vertebra*and*vertebra*above*
Has*the*longest(spinous*process*of*the*vertebra*types*
'

*
'
Articulations'for'Ribs:'
1)'Costovertebral'Joints' 2)'Costotransverse'Joints'

At*this*joint,*the*head*of*a*typical*rib*
articulates*with:'
o The*inferior*facet*of*the*vertebra*
above'
o The*associated*IV*disc'
o The*superior*facet*of*its*own*
vertebra'
o Joint*is*very*stable'
* Vert*stable*
* *
Costotransverse*joint:'
o Between*rib*tubercle*and*vertebral*
transverse*process*
Strong*ligaments*provide*strength*to*and*
limit*the*joints*movement*
Pay*most*attention*to*number*2*
Smooth*for*costotrans*joint,*rough*provides*
attachment*to*the*ligament*

*
*
*
Thoracic'Apertures'
Boundary*of*the*Superior*Aperture:*
o Posterior:*vertebra*T1*
o Lateral*1st*pair*of*ribs*and*costal*cartilages*
o Anterior:*the*superior*border*of*
manubrium*
o Smoothe*opening*towards*the*neck*
o Formed*by*the*superior*border*of*the*
manubrium;*internal*border*of*the*first*
ribs;*a*posteriorly*the*first*thoracic*
vertebra*
o Partially*closed*off*by*membrane,*
suprapleural*membrane,*sits*on*top*of*the*
pleura,*central*part*is*open*
Boundary*of*the*Inferior*Aperture:*larger*
o Anterior:*the*xiphoid*process*and*costal*margin*
o Lateral*11A12th*pairs*of*ribs*
o Posterior:*vertebra*T12*
o Closed*by*the*diaphragm*
! Completely*encloses*the*inferior*aperture*
o Inferior*thoracic*cage*
o Completely*closed*off*by*the*diaphram*
Superior'Aperture'
Lateral:*
o Closed*by*the*Suprapleural*membrane*
Central:*
o Open*
Suprapleural*membrane*
o Sits*above*the*membrane*and*is*open*centrally*to*allow*passage*of*vessels*
*
Diaphragm''Muscular'attachments*
Muscular*Part:*
o Has*circumferential*origins*(from*boundaries*of*inferior*aperture)*
o Inserts*into*the*central*tendon*
Central*tendon*
o No'bony*attachments*
o Inferior*aspect*of*the*diaphragm*in*the*diagram*to*the*right*
*
Diaphragm''Peripheral'attachments*
Xiphoid*process*anteriorly*
Costal*margin*laterally*
Ends*of*the*11A12th*ribs*further*laterally*
Arcuate*ligaments*posteriorly*
Superior*lumbar*vertebrae*via*crura*posteriorly*
Crura*ligaments*right*crus*longer*than*the*left*(below)*
Double*domes*(right*higher'than'left)*due*to*liver*pushing*right*up*
Chief*muscle*of*inspiration*
Diaphragm'Q'Passages'
IVC*(T8)*collects*all*venous*return*below*diaphragm*
o IVC*pass*from*abdomen*back*to*the*thorax,*inferior*vena*cava,*through*central*tendon*
Oesophagus*(T10)*is*the*duct*bringing*food*down*the*GI*tract*
o Pass*thorugh*muscular*part*at*T10,*thorax*to*abdomen*
Aorta*(T12)*provides*all*the*vascular*supply*(except*the*heart*itself)*
o Passes*behind!*the*diaphragm,*right*between*the*left*and*right*crus*
o Passes*behind*since*both*the*diaphragm*and*the*aorta*have*significant*movements.**
o Aorta*flow*is*not*impeded*by*constant*contraction*of*the*diaphram*
*
*
*
*
*
*
*
*
*
Nerve'Innervation'of'the'Diaphragm'
Motor*Innervation:**
o Phrenic*nerves*
! Left*phrenic*=*left*side*of*diaphragm*
! Right*phrenic*=*right*side*of*diaphragm*
Sensory*innervation*
Injury*to*the*left*phrenic*nerve*during*surgery*would*leave*to:*
o Paralysed*left*hemi*diaphragm*
o Patient*has*breathing*problems*and*diaphragm*=*chief*muscle*of*inspiration*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Intercostal'Space'
Intercostal*muscles,*Intercostal*nerves,*Intercostal*arteries,*Intercostal*veins*
*
*
*

*
*
*
Intercostal'Muscles'

External*intercostal*muscles*
o Inferomedial*
o Anteriorly*replaced*by*
external*intercostal*
membrane*
o Most*active*in*inspiration*
Internal*intercostal*muscles*
o Posteriorly*replaced*by*
internal*intercostal*
membrane*
o Doesnt*really*play*
important*part*in*expiration*
Innermost*intercostal*muscles*
o Discontinuous*
Nerves*and*fibres*are*between*the*
internal*intercostal*muscle*and* *
innermost*muscle*
Intercostal'Nerves'

Origin*from*anterior*rami*of*spinal*
nerves*(T1AT11)*
Between*internal*and*innermost*
intercostal*muscles*
Posterior*rami*"*supplies*muscle*of*
the*back*
Anterior*rami*"*intercostal*muscle*
Arises*from*thoracic*spinal*nerve*
Leaves*foramen*and*forms*rami*
Supply*the*three*layers*of*
intercostal*muscle*

*
Intercostal'Arteries*

Posterior*intercostal*arteries*
o Originate*from*aorta*
Anterior*intercostal*arteries*
o Originate*from*internal*
thoracic*arteries*
Posterior*arises*directly*from*the*
thoracic*aorta*
Anterior*arise*from*the*internal*
thoracic*aorta*
Accompanied*by*their*veins*which*
will*anastomoses*at*the*intercostal*
space*
*

*
*
Contents'of'intercostal'space'
*
*
*
*
*
*
*
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Movements'of'the'Thoracic'Walls'&'Diaphragm'
The*thorax*can*be*changed*at:*
o Vertical*dimension*by*movement*of*the*diaphragm*
o Anteroposterior*(AP)*dimension*by*movement*of*upper*ribs*
o Lateral!(Transverse)*dimension*by*movement*of*middle*ribs*
*
*
The'pump'handle'Movement' The'bucket'handle'movement'

Movement*of*upper*ribs*change*the*AP*dimension* Movement*of*the*middle*ribs*change*the*lateral*
of*the*thorax* dimension*of*the*thorax*

* *

*
*
Other'Muscles'of'the'Thoracic'Walls'
*
*
*
* *
*
 LECTURE'23'
Lower&Respiratory&Tract&
Thoracic'Cavity'
The$thoracic$cavity$is$divided$into$3$major$compartments:$
Right$pulmonary$cavity$(right$lung$site)$$
Mediastinum$(compartment$between$two$lungs$separates$thr$
two$lungs,$completely$independent$of$each$other)$
Left$pulmonary$cavity$(left$lung$site)$
Space$protected$by$thoracic$walls$
Pleura'
A$continuous$serous$membrane$that$covers$each$lung$
and$the$wall$of$the$pleural$cavity$
Divided$into:$
o Parietal$pleura$covering$the$wall$of$the$pleural$
cavity$
o Visceral$pleura$covering$the$surface$of$each$lung$
Can$be$sectioned$into:$
o Cervical$pleura$
! Lining$the$cervical$extension$of$the$
pleural$cavity$
o Costal$pleura$
! Related$to$the$ribs$and$intercostal$space$
o Mediastinal$pleura$
! Covering$the$mediastinum$
o Diaphragmatic$pleura$
! Covering$the$diaphragm$
Lung$root$connects$lung$to$mediastinum$
Pleura$is$continuous$$
Visceral$pleuracovers$lung,$parietal$covers$the$walls$
$
$
$
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Pleural'Cavity$
Only$a$potential&space$
Contains$a$few$mls$of$serous$plural$fluid$allowing$friction$free$
movement$of$the$lungs$
Between$visceral$and$the$pleural$cavity$
$
$
Pulmonary'Ligament'
DoubleJfolded$pleura$
Inferior$to$the$lung$root$
Represents$continuity$between$the$parietal$and$visceral$pleurae$
Pleural$sleeve:$
o Very$loose$sleeve$(too$loose$for$the$structure$it$surrounds)$
o Hangs$down$inferiorly$and$forms$a$double$folded$membrane.$
$Pulmonary$ligament$is$different$to$other$ligaments$in$that$it$doesnt$touch$bone,$and$has$a$double$
layered$membrane,inferior$to$the$lung$root,$which$is$where$the$pleura$becomes$the$parietal$pleura$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Nerve'Innervation'of'Pleurae'
lining$tissue$usually$shares$the$same$nerve$and$blood$supply$$
pain$with$somatic$system$is$sharp,$severe$and$well$localised.$
Lining$tissues$share$the$same$nerve$supply$as$the$structure$they$cover:$
o Visceral$pleurae$receive$autonomic$nerve$innervation$
o Parietal$pleurae$receive$somatic$nerve$innervation$
If$lung$is$penetrated$it$is$introduced$into$the$pleural$cavity$
o To$remove$needle,$insert$needle$into$intercostal$space$through$
3$layers$of$intercostal$muscle.$$
o Extremely$painful$as$nerve$supply$for$parietal$pleura$comes$
from$somatic$nervous$system$
$
$
$
$
$
Trachea'and'Major'Bronchi$
Trachea$
Supported$by$horseshoe$or$CJshaped$cartilage$rings$
Closed$posteriorly$by$trachealis$muscles$
Right$lung$wider,$shorter$and$more$vertical$
&
&
&

Bronchial'Tree&
The$right$main$bronchus$is$wider,$shorter$and$more$vertical$
than$the$left$main$bronchus$
Thus$is$objects$come$down,$they$are$more$likely$to$fall$into$
the$right$main$bronchus$
Main$bronchus$$subdivides$$
o "$lobar$bronchi$$subdivides$$
! "$Segmental$bronchi$
! independent$bronchop$
! $
! ulmonary$segment$
'
Bronchopulmonary'Segments'
PyramidalJshaped:$
o Base$at$lung$surface$$
o Apex$facing$hilum$
Separated$from$adjacent$segments$
Functionally$independent$segments$of$the$
lung:$$
o Supplied$independently$by$a$segmental$bronchus$
o Independent$blood$supply$and$nerve$supply$
o Surgically$resectable$
$
Lungs'
Apex$and$base$
Surfaces:$
o Costal$$
o Mediastinal$
o Diaphragmatic$(base)$
Borders$
o Inferior$
o Anterior$
o Posterior$
Fissures$and$lobes$
Paravertebral'gutter,$adjacent$to$column,$gutter$
shaped$space.$When$the$lung$inflates$the$posterior$side$will$push$against$the$space.$$

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$
Fissures'and'Lobes'$
Left' Right''

Fissures:$ Fissures:$
o Only$oblique$ o Horizontal$(divides$superior$above$
Has$the$cardiac$notch$(where$the$heart$sits)$ from$middle$lobe$below$
' o Oblique$(divides$superior$lobe$and$
middle$lobes$at$the$front$and$inferior$
lobe$at$the$back)$
Right$lung$is$bigger$and$heavier$than$left$
(however$it$is$shorter)$

'
$

$
Pulmonary'Arteries'and'Veins'
The$pulmonary$arteries$and$the$veins$are$responsible$for$oxygenation$in$the$lungs$
The$bronchial$arteries$and$veins$are$responsible$for$vascular&supply&of&the&lungs&
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Structures'at'the'Hilum'
Left'Lung/Side'(medial'view)' Right'Lung/Side'(medial'view)'

One$pulmonary$artery$(superiormost)$ One$pulmonary$artery$
Two$pulmonary$valves$ Two$pulmonary$veins$
o Anteriormost$and$inferiormost$ o Anteriormost$and$inferiormost$
Left$main$bronchus$ Right$main$bronchus$giving$rise$to$lobar$
Bronchial$vessels$ bronchi$
Nerves$ Bronchial$vessels$
Lymphatics' Nerves$
Lymphatics$
$

$
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Lymphatic'Drainage'of'Lungs'
Superficial$lymphatic$vessels$+$deep$lymphatic$vessels$
(spiderweb$surfaceJlining)$
$
Bronchopulmonary$(hilar$nodes)$
$
Tracheobronchial$nodes$
$
Bronchomediastinal$lymph$trunks$(right$or$left)$$
'
Nerves'of'Lungs'and'Visceral'Pleurae'
The$lungs$and$visceral$pleurae$receive$nerve$
innervations$from$pulmonary$plexus$
Both$sympathetic$and$parasympathetic$
contribute$to$pulmonary$plexus$
'
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$
 LECTURE'24'
Cardiovascular,System,1,
Pericardium'
A"fibrouserous"membrane"
o Covers"the"heart"and"the"great"vessel"
roots"
Composed"of"two"layers:"
o Fibrous"pericardium"continues"with"the"
central"tendon"of"the"diaphragm"
o Serous"pericardium"
o Blends"into"diaphragm"
o Heart"grows"into"the"sac"
o "
"
"
"
"
"
"
"
"
"
"
"
Serous'pericardium:'
o A"single"layer"of"serous"membrane"
Pericardial"cavity"
o A,potential,space"between"the"parietal"and"visceral"layers"of"serous"membrane"
! Similar"to"pleural"cavity"
o Contains"a"small"amount"of"fluid,"providing"a"frictionless"environment"
"
Cardiac'Chambers'(during'development'heart'undergoes'45'degree'rotation,'not'complete'Left'still'
forward'slightly)'
4"chambers:"
o Atria"(R"and"L)"
o Ventricles"(R"and"L)""
Apex:"
o Formed"by"the"L"ventricle"
o Left"5th"intercostal"space"
Base:"
o The"posterior"aspect"of"the"
heart.""
"
"
"
"
"
Surface'anatomy'of'the'heart'(sulcus'separates'the'chambers'on'the'surface)'
Each"atrium"forms"an"ear"shaped"structure"called"an"auricle,"which"projects"to"the"front"of"the"heart.""
o Aka"Atrium"appendage"
Atrioventricular"sulcus:""""""""""""""
o Aka"coronary"sulcus"
o Coronary"artery"lies"here"
o Continuous"to"form"posterior"interventricular"sulcus"
Anterior"interventricular"sulcus:"
o Site"right"between"the"ventricles"
o Continues"towards"the"back"of"the"heart"
"
Anterior'View' Posterior'View'(Base)'

" "

"
Right'Atrium'
Receives"all"venous"return"from"all"of"the"body"through"the"Vena"cava"
Superior"VC:"
o Above"drainage:"thorax"head"etc.""
Inferior"VC:"
o Abdomen,"pelvis,"lower"limbs"
Coronary"sinus:"
o Venous"blood"of"
the"heart"itself"
returns"to"the"
right"atrium"
Fossa"ovalis:"
o In"developing"
fetus"is"the"
foramen'ovale!"
"
"
"
"
"
Right'Ventricle:'
Thicker"walled'
Internal"surface"is"covered"by"muscular"ridges'
3"exceptions:'
o Papillary"muscles:'
! Still"muscular"ridges,"but"they"
are"specialised'
! Have"their"base"attaches"to"
the"walls,"but"the"apex"
projects"towards"the"lumen.'
! Attaches"to"the"stringOlike"
structures"chordae"tendinae'
Chordae"tendinae'
o Attaches"to"the"3"edges"of"the"
tricuspid"valves."'
Tricuspid"valves:'
o Between"right"atrium"and"right"ventricle'
"
Left'Ventricle" Left'Atrium'

Thickest"walled"of"all"chambers" Thin"walled"
Covered"by"massive"muscular"ridges"" Receives"oxygenated"blood"from"
Has"2"papillary"muscles" pulmonary"vein"(Lungs)""
Bicuspid/mitral"valve" Oval"shaped"impression"
" "

" "

Cardiac'Skeleton'
Composed:'
o Two"rings'
o Two"coronets'
! CrownOshaped"'
! Guard"opening"of"the"great"vessels'
Beginning"and"opening"of"aorta"and"pulmonary"valves'
Provides"attachment"for"cusps"of"the"valves'
Provides"attachment"for"myocardium'
Forms"and"electrical"insulator,"by"separating"the"atria"musculature"from"the"ventricular"
musculature'
Atrioventricular'Valve'
When"the"pressure"gradient"in"the"atrium"exceeds"the"pressure"valve"(atrial"contraction)"in"the"
ventricle"the"blood"will"flow.""
When"the"right"ventricle"contracts,"pressure"gradient"exceed"surrounding:"
o Blood"enters"the"pulmonary"trunk"
o However"the"AVOvalve"inhibits"backflow"from"pressure"gradient"into"atrium"
o Assisted"by"papillary"muscles"and"chordae"tendinae.""
Right"atrium"to"the"ventricle,"when"the"atrium"stops"contracting"blood"is"in"the"ventricle,"which"then"
contracts"forcing"blood"into"the"pulmonary"tract,"but"there"is"potential"for"backflow"to"the"atrium.""
Papillary"muscle"and"chordae"tendinae"help."Fibrous"rings"provide"attachment"to"the"atrium"and"
ventricle"
When"the"right"ventricle"muscles"contract,"it"pulls"toward"the"atrioventricular"valves."The"papillary"
muscles"also"contract"towards"the"tricuspid"valves."
"
"
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Pulmonary'and'Aortic'Valve'
All"semilunar"valves"(halfOmoon"shaped)""
Passive"opening"and"closing""
Both"have"three"cusps,"three"lunar"shaped"cusps."
No"papillary"muscle"or"chordae"tendinae"
Passive"opening"and"closing,"following"the"pressure"
gradients"
Features'of'the'Aortic'Valve'
Small"openings"for"the"coronary"arteries""
At"base"of"aortic"valce"you"can"see"two"openings,""
Right"and"left,"openings"for"pulmonary"arteries,"orifices"
Conduction'System'of'Heart"
Sinoatrial"(SA)"node"(pacemaker)"
o At"the"junction"of"superior"vena"cava"and"ROatrium"
o Generate"electrical"signals"across"atria"simulating"AV"node"
Atrioventricular"(AV)"node:"
o In"ROatrium"
o Near"the"opening"of"coronary"sinus"and"close"to"the"cusps"
of"the"tricuspid"valves"
o Distribute"electrical"signals"to"ventricles"via"AV"bundles"
"
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Nerve'Innervation'of'Heart'
The"heart"by"autonomic"fibres"from"the"cardiac"plexus"
o Located"at"the"base"of"heart"
o Formed"by"both"sympathetic"and"
parasympathetic"fibres""
Heartbeat"can"be"adjusted"by"nerve"input"
The"nerve"fibres"come"from"the"nerve"plexus"at"the"base"
of"the"heart"
"
"
"
"
 LECTURE'25'
Cardiovascular,System,2,
Aorta'
Ascending)Aorta:)
o Arises)from)left)ventricle)
Aortic)Arch:)
o At)the)level)the)manibrial5sternal)junction)
o Arches)superiorly,)posteriorly)and)to)the)left)
Descending)(thoracic))aorta)
Abdominal)aorta)
)
Aorta''Cont.')
Aortic)arch)
o Arch)anterior)and)over)the)bifurcation)of)
the)trachea)
o Arch)over)the)left)lung)root)
o Forms)the)medial)groove)on)the)left)lung)
Descending)aorta)
o Gradually)aligns)medial)
o At)roughly)T12/abdominal)aorta)the)descending)aorta)is)medially)location)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
Ascending'Aorta'
Origins)of)coronary)arteries)
o Proximal)part)of)the)ascending)aorta)
o Immediately)superior)to)the)aortic)valves)
Right)coronary)artery:)
o Supplies)right)atrium)and)right)ventricle)
Left)coronary)artery:)
o Supplies)left)atrium)and)left)ventricle)
)
)
)
)
Coronary'Arteries'
Two)main)arteries:)
o Right)coronary)artery)
o Left)coronary)artery)
Functional'end'arteries)
Pass)around)the)pulmonary)
trunk)
Supply:)
o Atria))including)SA)and)
AV)nodes!)(Located)in)
the)right)atrium,)
obstruction)to)the)right)
coronary)artery)will)
affect)conduction)of)
the)nodes!))
o Ventricles)
Right'coronary'arteries'
o Lies)in)the)atrioventricular)groove)of)the)right)side)
o When)it)reaches)the)inferior)border,)turns)and)still)travels)on)the)atrioventricular)groove)
o Anastomoses)with)the)left)coronary)arteries)(diamonds))
Left'coronary'arteries'
o Arises)from)left)side)of)ascending)aorta)
o Divides)into:)
! Circumflex)branch))runs)along)the)atrioventricular)groove)both)posteriorly)and)
anteriorly)and)anastomoses)with)the)right)coronary)artery)
! Anterior)interventricular)branch))runs)along)the)interventricular)groove,)and)when)
it)turns)to)the)posterior)side,)continues)to)run)along)the)interventricular)groove)and)
anastomoses)(diamonds))with)the)interventricular)groove.))
If)you)were)to)block)the)anterior)interventricular)branch,)the)anastomoses)from)the)posterior)end)is)
not)able)to)compensate.))
However,)if)you)slowly)reduce)flow)to)the)area,)the)cholesterol)plaque)gradually)builds)up,)then)the)
channel)can)compensate)vie)sending)blood)through.))
)
)
Variations'in'Distribution'of'Coronary'Arteries'
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Branches'of'the'Aortic'Arch'
Brachiocephalic'trunk)(brachio)=))arms,)
cephalic)=)head))
o First)branch)to)form)
o Right'common'carotid'artery'
o Right'subclavian'artery'
Left'Common'carotid'artery''
o Arises)as)independent)vessel'
Left'subclavian'artery'
o Arises)as)independent)vessel'
Ligamentum,arteriosum,
o Remnant)of)the)Ductus)
arteriosus'
o Similar)to)the)foramen)ovale,)in)
that)it)is)a)remnant'structure)of)

fetal)circulation'
)
Branches'of'Descending'Aorta'
Dont)remember)numbers,)just)principle)
Parietal)branches)
o Intercostal)5)walls!
o Pericardial)5)pericardium)
o Phrenic)5)diaphragm)
Visceral)branches)
o Bronchial))airways,)bronchial)trees)
o Oesophageal))
)
)
)
)
Great'Veins'
SVC)receives)all)venous)return)from)all)upper)
structures)except)the)heart)itself)
Internal)jugular)veins)
o Return)venous)flow)from)head)and)neck.))
o Run)alongside)common)carotid)artery)
Subclavian)veins)
o Accompany)the)subclavian)arteries)
On)each)side)the)internal)jugular)vein)and)subclavian)
vein)first)drain)into)the)brachiocephalic)veins,)which)
join)together)and)drain)into)the)SVC)
Brachiocephalic)vein)is)slightly)to)the)right,)and)hence)
the)right)side)drains)slightly)quicker)as)it)has)less)
distance)to)travel))
)
)
)
)
Coronary'arteries)
Coronary)arteries))
o Accompany)corresponding)arteries)
o Drain)into)the)right)atrium)at)coronary)sinus)
)
)
Azygous'Vein'
Variable)patterns)
Receive)blood)return)from)
o Thoracic)walls)and)pericardium)
o Lungs,)trachea,)bronchi)and)oesophagus)
Arch)over)the)root)of)the)right)lung)
SVC)drains)via)azygous)system)
At)the)posterior)thoracic)wall)against)the)thoracic)vertebrae)there)is)azygous)veins)which)return)
venous)flow)to)SVC)
Azygous)vein)drains)all)venous)blood)for)all)of)thorax)except)heart)
Situated)at)the)back)of)thoracic)wall)and)so)the)azygous)vein)arches)over)root)of)right)lung)to)join)the)
SVC)
o This)is)what)causes)the)arched)groove)on)the)right)lung)")azygous)groove)
)

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 LECTURE'26'
Gastrointestinal+Tract+1+
'
Bony'framework'of'the'abdominal'wall'
Abdomen(is(the(body(trunk(
between(the(thorax(and(the(
pelvis,(the(abdominal(wall(
structure(bridges(the(thorax(and(
the(pelvis,(the(muscles(supporting(
the(abdominal(wall(will(attach(to(
the(inferior(border(of(the(bony(
thorax(and(superior(border(of(
bony(pelvis(below(
Inferior(border(of(bony(thorax(
includes(the(xiphoid(process(at(
midline,(and(the(costal(margin(on(
each(side(anteriorly.(The(twelfth(
rib(posteriorly(on(each(side.(The(
middle(includes(the(5(lumbar(
column(and(the(intervertebral(
discs.((
Critical(bony(landmarks(of(the(
pelvis:(iliac(crest(is(the(top(part(of(
the(iliac(bone(extends(from(
posterior(then(laterally.(At(the(
front(we(see(the(bony(bump,(the(
anterior(superior(iliac(spine((ASIS)(
the(other(bony(bump(sits(inferiorly(this(is(the(anterior(inferior(iliac(spine,(provides(muscle(
attachment(towards(muscle(associated(with(the(lower(limbs,(no(association(with(abdominal(wall(
muscles.(
Pubic(crest,(laterally(on(each(side(there(is(pubic(tubercle.(Position(of(the(pubic(bone(is(actually(
inferior(to(the(ASIS((higher(than(crest(and(tubercle).((
(
Anterior'Abdominal'Wall+
Skin(
Superficial(fascia((Fascia=fat)(is(the(fatty(tissue(lining(the(skin(
Muscles:(
o 3(flat(layers(supporting(anterior(abdominal(walls(
o For(the(thorax,(the(intercostal(space(we(have(3(flatlayers(
o Supporting(the(abdomeninal(walls(we(also(haver(3(paired(
flat(layers(of(muscle,(they(are(facia(laterally(and(replace(
by(aponeurosis(upon(reaching(the(midline.((
o Paired(
Transversalis(fascia(
o Overlying(muscles(
Extraperitoneal(fascia((flat)(
Peritoneum(
Muscles'of'Anterior'Abdominal'Wall(
!(External'Oblique'Muscles'
Superficial(layer(
Fibre(direction:(Inferomedial(
Attachments:(
o Superiorly:((attach(to(Ribs(and(xiphoid(process(overlapping(
the(costal(margin(
o Medially:(Linear(alba(
o Inferiorly:(
" Iliac(crest((top(of(hip(bone)(&(ASIS,(laterally(
" Pubic(Tubercule(and(pubic(crest,(medially((
" Central(part(is(free(with(no(attachment(
" Free(interior(border(is(the(inguinal(ligament.(It(is(the(free(inferior(edge(of(the(
external(oblique(muscles,(spanning(from(the(ASIS(towards(the(pubic(tubercle.(
o Posteriorly(associate(with(the(posterior(abdominal(wall(muscles(
When(the(aponeurosis(reach(the(midline(the(fibres(will(interdigitate(and(form(the(linear(alba(
(
(
External'oblique'and'inguinal'ligament'
Insertions(of(inferior(part(of(EO(
o Lateral(part(attaches(to(iliac(crest(and(ASIS(
o Central(part(is(free,(with(no(attachments(
o Medial(part(attaches(to(pubic(tubercle(and(pubic(crest(
Inguinal(ligament(
o Free(inferior(border(of(EO(
o Thickened(as(under(curving(fibrous(band((inward(curving)(
o Extending(from(ASIS(to(pubic(tubercule(
o The(inguinal(ligament(attaches(to(the(pubic(tubercle(and(the(
impressed(medially(and(some(attach(to(pubic(crest.(There(is(a(
split,(a(hole.((
Muscle(fibre(direction(is(very(similar(to(the(external(intercostal(msucles,(medially(and(inferiorly(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
!(Internal'oblique'(IO)'muscles( ! 'Transversus'abdominus'(TA)(

Intermediate(layer(
Fibre(direction:(superomedial((almost(
perpendicular(to(the(external)(
The(lowermost(fibres:(
o Inguinal(ligament(of(the(EO,(it(is(a(
free(inferior(border(of(the(EOM(
spanning(from(ASIS(to(pubic(
tubercle.(The(lowermost(fibres(of(
the(IOM(arise(from(the(inguinal(
ligament((
o Arise(from(lateral(part((~2/3)(
inguinal(ligament(
o Arch(up(then(down(
o Inert(into(pubic(crest(via(conjoined(
tendon(
Superiorly(attach(to(costal(margin(and(
posteriorly(with(posterior(abdominal(
muscles(
Innermost(layer(
Fibre(direction:(transverse,(horizontally(
The(lowermost(fibres:(
o Arise(from(lateral((~1/3)(inguinal(
ligament(
o Arch(Up(then(down(
o Inert(into(pubic(crest(via(conjoined(
tendon(
Medially(replaced(by(aponeurosis(
Contributes(to(the(midline(linear(alba.(
Superiorly(attach(to(costal(margin(
Posteriorly(the(posterior(abdominal(wall(
muscles.(
(

( (

(
Vertically'Oriented'Muscles'
Rectus(Abdominus(
o Principle(vertical(muscles(to(support(anterior(
abdominal(wall(
o Paired(muscle((
o Origins:(pubic(symphysis(and(pubic(crest,(then(
ascend(and(then(insert(into(the(rib(cage(and(
coastal(margins(as(well(as(xiphoid(process(
o As(it(ascends(it(starts(to(diverge(and(become(
wider((
o Overlap(costal(margins(
o Insertions:(
 " Xyphoid(process(&(costal(cartilages(
o Intersected(by(tendons(three(times(to(make(it(stronger(due(to(the(length,(one(at(the(
umbilical(level(and(one(at(the(costal(margin(level(and(one(at(the(middle.(
o Enclosed(by(rectus(sheath(
o Tendinous(intersection:(
" Interrupts(length(of(muscle(3(times(
" Makes(muscle(much(stronger(
Pyrimidalis(muscles(
o Very(small(doesnt(play(a(great(role(in(supporting(the(anterior(abdominal(wall(
The(rectus(abdominus(are(closed(off,(enclosed(within(fibrous(envelope,(is(formed(by(aponeurosis(of(
three(flat(layered(muscles,(before(they(reach(the(midline(they(have(to(go(either(in(front(or(behind(
the(rectus(abdominus.(
Rectus'Sheath'
Formed(by(aponeurosis(of(EO,(IO,(and(
TA(
Incomplete(fibrous(compartment(for(
rectus(abdominus((
o In(upper(:(
" Surround(the(rectus(
abdominus(
o In(lower((
" Aponeurosis(is(in(front(
of(rectus(abdominus(
(
Layers'of'Anterior'Abdominal'Wall('
Skin(
Superficial(fascia(
External(oblique(
Internal(oblique(
Transversus(abdominus(
Transversalis(Fascia(
Extraperitoneal(fascia(
Peritoneum(
Inguinal(region:(between(ASIS(and(the(
pubic(tubercule(
(
(
Development'of'Inguinal'Canal'
Testes(originally(developed(high(up(in(
the(posterior(abdominal(wall(
Then(had(to(descend(and(leave(the(
abdominal(cavity((
o Its(too(warm(in(the(cavity!(
Must(leave(
At(about(7(months(reaches(anterior(
abdominal(wall,(1/2(way(down(
inguinal(ligament(
 To(leave(it(must(get(through(the(anterior(abdominal(wall(cavities(
Does(so(by(punching(a(wall(in(the(transversalis(fascia((
(
Inguinal'Canal'
An(oblique(pathway((infermodially)(for(testis(to(descent(through(abdominal(wall(into(scrotum(
Superior(to(the(inguinal(ligament(
Two(openings:(
o Deep(inguinal(rings(
o Superficial(inguinal(rings((
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
Inguinal'Canal'
Deep((internal)(inguinal(ring:(
o A(circular(hole(in(the(Transversalis(Fascia(
o Half(way(above(the(inguinal(ligament(
Superficial((external)(inguinal(ring:(
o A(triangular(split(between(those(fibres(of(the(EO(aponeurosis(
Descent(of(testes(drags(blood(vessels,(nerves,(duct(system(and(layers(of(abdominal(wall(into(
scrotum(
(

Boundaries'of'Inguinal'Canal'
Floor:(
o Inguinal(ligament(
Roof:(
o Arching(fibres(of(internal(oblique(and(Transversus(
abdominus(
Anterior(wall:(
o External(oblique(aponeurosis(and(internal(oblique(muscle(
(laterally)(
Posterior(Wall:(
o Transversalis(Facia(an(Conjoint(Tendon((medially)((
Inguinal'Hernias'
an#abdominal#hernia#is#a#protrusion#of#abdominal#contents#
through#a#defect#in#the#abdominal#wall(
Inguinal(hernia(
o =(a(protrusion(or(passage(of(abdominal(contents(into(the(
inguinal(canal(
 Two(types:(
o Indirect(inguinal(hernia((
o Direct(inguinal(hernia(
(
Indirect'Inguinal'Hernia' Direct'Inguinal'Hernia'

Is(a(protrusion(or(passage(through(the( Is(a(protrusion(or(passage(through(the(
deep(ring(obliquely(into(the(inguinal(canal( posterior(wall(of(the(inguinal(canal(

(
(
(
Bilateral'Indirect'Inguinal'Hernias'
A(protrusion(through(the(deep(ring(obliquely(into(the(inguinal(canal((
(
'
'
'
'
'
'
'
'
'
'
'
'
Muscles'of'Posterior'Abdominal'Wall'
Psoas(major(
o Arise(from(lumbar(vertebrae(
o Pass(Infermodially((deep(to(inguinal(
ligament)(
 o Insert(to(lesser(trochanter(of(femur(
Quadratus(Lumborum(
o Arise(form(12th(ribs(and(tips(of(lumbar(transverse(process(
o Lateral(to(psoas(major(
o Insert(to(iliac(crest(
Iliacus(
o Fills(in(space(of(Iliacus(fossa(
o Inserts(into(lesser(trochanter(of(femur(
(
Abdominal'Wall'
Lumbar(region(of(back((cross(section)(
3(layers(of(anterior(abdominal(wall(muscles(
( (
(
 LECTURE'27'
Gastrointestinal+Tract+2+
Hollow'Viscera'
Esophagus)
Stomach)
Small)intestine)
Large)intestine)
Gallbladder)
)
Solid'Viscera'
Liver)
Pancreas)
Spleen)
'
'
Abdominal'Viscera'and'Quadrants'
Divided)by)mid;sagittal)plane)and)transumbilical)
plane)
)
Peritoneum'and'Mesentery'
Peritoneum)
o Parietal)peritoneum)
o Visceral)peritoneum)
Peritoneal)cavity)
o Only)a)potential)space)
o Contains)small)volumes)of)serous)fluid)
o Lubricates)surface)between)peritoneal)membranes)to)create)a)frictionless)environment)
Intraperitoneal)viscus)
o Suspended)in)the)peritoneal)cavity)
o I.e.)Jejunum)
Retroperitoneal)viscus)
o Outside)the)peritoneal)cavity)
o i.e.)kidney)
Mesentery)
o 2)key)functions:)
! Provide)a)pathway)for)vessels)and)nerves)
! Provide)mobility)for)intraperitoneal)viscera)
)
)
)
)
)
)
)
)
)
)
Esophagus'
Starts)at)level)C6)same level as trachea
Descends)down)midline)and)passes)the)diaphragm)at)T10)
Primary)function)is)to)conduct)food)from)pharynx)to)stomach)
Is)a)muscular)tube:)
o C6))Cervical)constriction:)Has)narrowing)near)top)(anatomical)sphincter))
o T4/5))Thoracic)constriction:)Has)a)narrowing)where)the)bronchus)divide)and)create)an)
external)impression)on)esophagus)(functional)sphincter))
o T10))Diaphragmatic)constriction:)Has)a)narrowing)where)it)passes)through)the)diaphragm)
(functional)sphincter))
! Impacted)by)contract/expansion)of)diaphragm)

)
)
)
Stomach'
Esophagus)enters)stomach)
from)its)right)side)
Left)upper)quadrant))
Intraperitoneal)
doesnt enter from top
")Features:)
; Two)orifices)
; Two)curvatures)
! Lesser)curvature) left
! Greater)curvature))
! Both%proportional%to%length%of%
Text
curve%
; Two)surfaces)
; Four)parts)
! Cardia)
! Fundus)
Top)part)above)the)
cardia)
! Body)
Majority)of)the)stomach)
! Pyloric)part)
 Narrowing)part)of)the)stomach)
Divided)into:)Pyloric)antrum)and)pyloric)canal)(smaller)narrowing)part))
End)is)a)true)anatomical)sphincter)(pylorus))
Stomach''Internal'View'
Rugae)=)gastric)folds)of)stomach)
o Provide)the)stomach)with)increased)surface)area)
for)nutrient)absorption)
)
)
Small'Intestine'
1)'Duodenum'
2)'Jejunum'
3)'Ileum'
'
Duodenum'
Surrounds)the)head)of)the)pancreas)
Retroperitoneal)
Divided)into)four)parts:)
1) Upwards)and)backwards))
Against)psoas)major)
2) Descending)part)(on)medial)aspect)of)right)kidney))
has)a)hilum)of)right)kidney))
Against)head)of)pancreas)
Halfway)down)we)have)duodenal)papilla)minor)
(superior))and)major)(inferior))
o Location)for)pancreatic)secretion)of)bile))major)duodenum)papilla)
o Pancreatic)enzymes)are)secreted)
3) (level)L2/L3))turns)horizontally)to)the)left,)crossing'midline)
4) Goes)upwards)
Will)leave)posterior)abdominal)wall)and)continue)with)rest)of)small)intestine)
)
)
)
)
)
)
)
Jejunum'and'Ileum'
No)clear)differentiation)from)jejunum)and)ileum)
beside)that:))
o Left)upper)quadrant)=)jejunum)
o Right)lower)quadrant)=)ileum)
)
)
)
)
)
)
)
)
)
)
)
Jejunum' Ileum'

Usually)larger)in)diameter)
Larger)surface)area)")more)mucosal)folds)
Hence,)has)thicker)walls)
Rich)and)more)vascular)
Mesentery)=)less)fat)deposit)
Main)function)is)absorption)(more)at)
proximal)part))
'
Smaller)in)diameter)
Smaller)surface)area)")less)mucosal)folds)
Hence,)has)smaller)walls)
Less)vascular)
Mesentery)=)obscured)by)high)fat)deposits)
)

' )
'
Wall'of'Small'Intestine'
)
)
)
)
)
)
)
)
)
)
Large'Intestine'
Starts'at'ileoNcaecum'junction'
Forms)a)frame)for)small)intestine'
Inferior)to)the)caecum)is)the)appendix'
Following)caecum:'
o Ascends)and)passes)liver)and)then)
turns)90O)(The)hepatic)flexure)'
o Goes)horizontally)and)is)called)
transverse)column)towards)bottom)
of)the)spleen.)Then)turns)90O)(the)
splenic)flexure)'
o Goes)downwards)and)forms)the)
descending)column)'
o Turns)into)the)sigmoid)colon'
o Turns)back)into)the)midline)to)form)
rectum)'
'
Features'of'Large'Intestine'
Compared)to)small)intestine,)large)
intestine:)
o Is)much)broader)
o Have)tenia)coli))longitudinal)
layers)of)muscle)band)(not)
complete)muscle)layer))
! Walls)of)large)
intestine)are)larger)
than)the)tenia)coli)")
forms)baggy)
appearance))
o Haustra)=)baggy)appearance)
of)large)intestine)
o Omental)appendices)=)fatty)
appendages)(in)yellow))
! Hang)off)the)tinea)
Coli)
)

Caecum:)
Right)lower)quadrant)
A)blind)pouch)inferior)to)the)
ileocaecum)junction))
Intraperitoneal))in)mesentery)
)
Appendix)
Base)attaches)to)the)inferior)aspect)of)the)caecum)where)the)three)tenia)
coli)meet.)
Intraperitoneal))in)mesentery)
Size)and)position)of)the)appendix)differs)in)people.))
Colon)
Ascending)
o Fixed)at)posterior)abdominal)
wall)
o Retroperitoneal)
Transverse)
o Most)mobile)part)of)colon)
o Intraperitoneal)
Descending)
o Fixed)at)posterior)abdominal)
wall)
o Retroperitoneal)
Sigmoid:)
o Mobile)
o Intraperitoneal))
)
Rectum'
No)tenia)coli)")muscles)bands)have)merged)and)formed)complete)longitudinal)muscle)coat)
No)Haustra)
No)omental)appendics)

)
)
 LECTURE'28'
Gastrointestinal+Tract+3+
Liver'
The$largest$solid$viscus$
Mainly$in$the$right$upper$quadrant$
>1500$known$functions:$
o Bile$productions$
o Metabolisms$
o Filtering$of$blood$
Sits$right$below$the$right$diaphragm$surface$
(both$smooth$surfaces)$$
$
$
$
$
$
$
$
$
$
$
$
Surfaces'and'Bed'of'the'Liver'
! 'Diaphragmatic'surface'
Large$right$lobe$and$small$left$lobe$
o Divided$by$the$falciform$ligament$$
$
$
$
$
$
!$Visceral'Surface'
Concave$surface$(nonHsmooth)$
IVC$sits$within$the$groove$of$the$visceral$surface$
of$the$liver$
Gall$bladder:$
o Sits$at$visceral$inferior$surface$
Hilum:$
o Allowing$vessels,$nerves$and$ducts$to$
enter/exit$the$structure$$
o Also$called:$Portal'Hepatis$
o 3$main$structures:$
" Hepatic$artery$$liver$blood$
supply$
" Common$bile$duct$
" Portal$vein$$second$vascular$input.$Brings$venous$blood$of$GIT$to$liver$for$
metabolism$
Anatomical'Lobes'of'the'Liver'
Two$anatomical$lobes:$
o Left$and$right$lobes$
o Demarcated$by$ligaments$$
Two$accessory$lobes:$
o Caudate$(superiorly)$and$
quadrate$(inferiorly)$
o Separated$by$sagittal$fissures$
and$transvers$portal$hepatis$$
o Parts$of$the$anatomical$right$lobe$
$
Gallbladder$
Located$within$the$visceral$surface$of$the$liver$
Has$very$close$anatomical$relationship$with$liver$
Gall$bladder$not$covered$by$peritoneum$and$
doesnt$have$a$mesentery$
o However,$is$not$an$intraperitoneal$(or$
retroperitoneal$either)$structure$$
$
$
Gallbladder'and'Extrahepatic'Bile'ducts'
Two$hepatic$ducts$come$together$to$form$the$common$
hepatic$duct$
Common$hepatic$duct$forms$the$cystic$duct$to$form$
the$(common)bile$duct$$
Main$pancreatic$ducts$and$bile$duct$feed$into$
duodenum$(both$surrounded$by$sphincters)$$
Duodenum$surrounded$by$an$anatomical$sphincter$
o Usually$closed$and$hence$the$gall$bladder$
stores$the$bile$
o Relaxation$occurs$in$response$to$nerve$
regulations$regarding$fat$content$
o Also$relaxes$via$nerve$regulations$via$muscular$
input$
$
Gallstones'
Can$cause$severe$abdominal$pains$$
$
Pancreas'
Occupies$the$left$upper$quadrant$
Retroperitoneal$
Sits$right$against$the$posterior$abdominal$wall$
Tail$of$pancreas$right$against$hilum$of$spleen,$head$
adjacent$to$c$shaped$duodnum$
$
$
$
Pancreatic'Ducts'
Produces:$
o A$Endocrine$secretion$into$the$blood$
o An$Exocrine$secretion$into$the$duodenum$via:$$
" Main$pancreatic$duct$
" The$accessory$pancreatic$duct.$$
Collect$small$proportion$of$
pancreatic$enzyme$made$by$head$
of$pancreas,$goes$upwards,$cross$
the$common$bile$ducts$and$enters$the$second$part$of$the$duodenum$via$
the$minor$duodenum$papilla$
'
Spleen'
Largest$lymphatic$organ$
Left$upper$quadrant$$
Two$surfaces:$
o Diaphragmatic$
o Visceral$$
" Has$hilum$where$the$
splenic$artery$and$
splenic$vein$will$enter$
the$spleen$
Mechanism:$
o Highly$vascular$
o Situated$behind$ribs$9,10,11$on$the$left$
Effect:$
o Laceration$by$sharp$edges$of$ribs$!$LEFT$10th$RIB!$
o Profuse$bleeding$into$peritoneal'cavity.'$
" Highly$critical$$
$
Abdominal'Aorta'
Provides$blood$to$all$the$abdominal$contents$$
At$L5$divides$into$common$Iliac$arteries$$
3$main$unpaired$branches:$
o Celiac$trunk$
o Superior$mesentery$artery$
o Inferior$mesenteric$artery$
Unpaired$branches$supply$unpaired$
viscera$and$paired$branches$supply$
paired$viscera$and$abdominal$walls.$$
$
$
$
$
$
$
$
Origins'of'Abdominal'Viscera'and'Blood'Supply''
Trunk$right$against$vertebral$column$
Foregut$
o Supplied$by$the$celiac$trunk$
Midgut$
o Supplied$by$the$superior'mesenteric$artery$$
Hindgut$
o Supplied$by$the$inferior'mesenteric'artery$
$
$
Branches'of'Abdominal'Aorta$
Foregut:$$
o The$abdominal$esophagus$$inferior$to$the$
major$duodenal$papilla$
o Ends$at$the$second$part$of$duodenum$
Midgut:$
o Inferior$to$the$major$duodenal$papilla$$
distal$1/3$of$the$transverse$column$
o Starts$beyond$the$second$part$of$the$
duodenum$
o Includes:$appendix,$ascending$colon$
Hindgut:$
o Just$before$the$left$colic$flexure$$midway$
through$the$anal$canal$$
o Gives$rise$to$the$rest$of$transverse$colon,$
descending$colon,$sigmoid$colon,$rectum,$
and$anal$canal.$$
$
Coeliac'Trunk'
Celiac$trunk$supplies$all$the$derivates$of$the$foregut.$$
For$intraperitoneal$viscus,$arteries$first$run$within$the$mesentery,$then$arrive$at$their$target$organs.$$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Superior'Mesenteric'Artery' Inferior'Mesenteric'Artery'

The$superior$mesenteric$artery$supplies$the$ The$inferior$mesenteric$artery$supplies$the$
derivates$of$the$midgut$ derivates$of$the$hindgut$$

'
$
$
Venous'Drainage'
Paired$viscera$and$abdominal$walls$directly$drain$into$the$IVC$
Unpaired$viscera$(except$the$liver)$drain$into$the$IVC$via$the$portal$vein$
Drains$all$below$the$diaphragm$
$
$
$
$
$
Hepatic'Portal'Vein'
*pay$attn.$
to$diagram$
pathway*$
$
$
$
$
$
$
$
$
$
$
$
$
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$
$
$
 LECTURE'29'
Kidney'and'Urinary'System'
Components/Overview'
Adrenal(Gland:(
o Medial(aspect(
o Function(of(the(endocrine(system((not(kidney/urethra)((
Kidney(
Ureter(
Bladder(
Urethra(
(
Kidney'
Right(kidney(sits(slightly(lower(due(to(push(of(the(liver(on(
top((
Shape:(
o Described(as(a(bean(shape,(~10cm(long(
Position:(
o Retroperitoneal(
o Situated(roughly(from(T12ML3(
o No(fixed(!(closely(associated(with(the(diaphragm(
o Posterior(surface(sits(right(against(psoas(major(
muscle(and(quadratus(lumborum(
(
(
Perinephric'Fat'and'Renal'Fascia'
Solid(viscus:(
o Has(a(hilum(entering(
and(exiting(the(structure(
" Anteriorly(and(
medially(faced(
Covered(with(lots(of(fat(
o Fat(surrounding(kidney(=(
perinephric'fat(
o Continues(into(the(hilum(
Renal'fascia(
o Covers(the(layer(of(fat.((
Sits(against(the(Quadratus(
Lumborum(and(psoas(major(
muscle((
Kidney'Structure'
Renal(capsule(
o Capsule(which(covers(the(kidney(
Hilum(
o Space(within(hilum(is(called(the(renal(sinuses(
o Within(these(sinuses(is(lots(of(perinephric(fat((continuous(from(surface)(
Medulla(
o Pyramidal(shaped(
(renal(pyramid)((
Cortex(
o Outer(paler(layer(
o Separates(medulla(
(
(
(
(
(
(
(
(
Renal'Collecting'System'
Apex'of'medulla'
o Site(for(urine(secretion'
Minor'calyx''
o Collection(of(secreted(urine(from(
apex(of(medulla('
Major'calyx''
o Minor(structures(converge(to(for(
major(calyx'
Renal'pelvis''
o Upper,(dilated(portion(of(ureter'
'
Renal'Arteries'and'Veins(
Renal(hilum(M(front(to(back:(
o Renal(vein(
o Renal(artery(
o Renal(pelvis((
Also(contains(nerves(and(lymphatics((harder(to(
identify)(
Receives(blood(from(descending(aorta(
o Right(renal(artery(slightly(lower(
Returns(blood(to(SVC(
o Right(renal(veins(slightly(lower(
(
Renal'Arteries'and'Segmental'Branches'
Each(renal(artery(gives(rise(to(5(segmental(
arteries(
Renal(segments(
o Each(have(independent(blood(supply(
o Are(surgically(resectable((similar(to(the(lung!)(
" E.g.(if(pathology(associated(with(one(segment,(surgeon(can(remove(one(segment(
without(affecting(the(others(greatly((
(
(
(
(
(
(
(
(
(
(
(
(
'
Accessory'Renal'Artery'
Accessory(renal(artery(
During(development(
o Kidneys(developed(low(down(in(the(pelvis(
o IN(growth(migrate(upwards((opposite(to(testes)(
o Change(their(position(due(to(relative(growth(
rates(and(abdominal(posterior(wall(
o Hence,(when(the(kidneys(were(lower,(they(
received(blood(supply(from(lower(aortic(branches(
o When(the(rise(they(receive(new(blood(vessel(
from(the(aorta.(
o Lower(vessels(generally(obliterated,(but(
sometimes(they(remain!'! 'Accessory'renal'
artery.'(
Ureter(
Starts(at(abdomen,(finishes(in(pelvis(
Upper(part(=(renal(pelvis(
Begins:(
o At(hilum(of(the(kidney(
Descends:(
o Down(the(posterior(abdominal(wall.((
o Against(psoas(major(
o Tips(over(corresponding(tips(of(the(transverse(process(
of(lumbar(vertebrae.((
o Continues(against(the(posterior(surface(of(the(pelvis((
Terminal(portion:(
o Transverses(the(bladder(wall.(
Is(a(muscular(tube(!(has(constrictions.((
!'3'Narrowings:(
1)(Uretopelvic(junction:(
2)(Crosses(pelvic(brim:(
3)(Traversing(bladder(wall((obliquely)(
" When(the(bladder(contracts/compress,(it(compresses(the(terminal(portion(of(the(
ureter.((
" Forms(a(functional(sphincter(!(stops(urine(going(backwards.((
Kidney(stones(
o Often(lodge(at(the(three(narrowing(
(
(
Renal'and'Ureteric'Calculi'
Uretopelvic(obstruction((
o At(the(Uretopelvic(junction(
Midureteral(Obstruction(
o At(the(crossing(of(iliac(artery.((
Distal(ureteral(obstruction(
o At(the(UreteroMvesical(junction((

(
(
((
(
Urinary'Bladder'
Both(female(and(male(bladder((coloured(in(red)(
o Female(=(right(against(the(uterus(
o Male(=(right(against(the(rectum((
A(hollow(viscus(with(strong(muscular(walls(
Position:(
o Most(anterior(of(pelvic(viscera((
PyramidalMshaped(
o Apex(anterior(
o Base(posterior(
Component(parts(
(
(
(
Bladder'Neck(
The(bladder(neck(is(the(most(inferior(part(and(held(firmly(by(
ligaments((in(both(males(and(females)(
o Ligament(attaches(to(pubic(bones,(surrounds(head(of(the(
bladder(and(holds(it(tightly((dont(have(to(know(name(of(
ligaments)(
The(bladder(is(relatively(free(except'for'its'neck(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
Urinary'Bladder'
3(openings(form:(
o Inverted(Triangular(region((trigone)(
(
(
(
(
(
(
(
'
Urethra'in'Female'
Short(in(female((only(4cm(long)(
o Very(easy(to(traverse(with(catheter(
o Much(more(common(to(have(urinary(tract(infection((UTI)(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
(
Urethra'in'Male(
Longer((~20cm(long)(
Divides(into(four'parts:(
1) Preprostatic(part(of(urethra(
2) Prostatic(part(of(urethra(
Usually(surrounded(by(the(medial(lobe(of(the(prostate(
Benign(hypertrophy((occurs(at(medial(lobe,(surrounds(prostatic(part(of(urethra(
Hence,(is(a(site(of(pain(in(prostate(cancer.((Difficulty(urinating).((
3) Membranous(part(of(urethra(
Traverses(pelvic(floor(
4) Spongy((or(penile)(part(of(the(urethra(
Bends(twice,(once(when(it(traverses(the(pelvic(floor(
Secondly(when(penis(is(flaccid(
Due(to(length(of(urethra,(harder(to(insert(catheter,(however(much(less(likely(to(get(UTI(

(
(

(
 LECTURE'30'
Male%Reproductive%System%
Pelvic'Diaphragm'
Separates(pelvis(and(
perineum(
Supports(pelvic(viscera(
Suspends'the'viscera'above'
Forms(attachment(for(
external(genitalia((
Urogenital(and(anal(triangle(
Closes(off(the(pelvis(inferiorly(
Perineum(=(area(below(the(pelvic(diaphragm(
Front(half(=(Urogenital(triangle(
Back(half(=(Anal(triangle(
(
Pelvic'Diaphragm' '
Formed(largely(by(levator'ani'muscle'(3)(
o Puborectalis(
! From(pubis(around(back(of(anal(aperture(
o Pubococcygeus(
! Attaches(from(pubis(to(the(coccyx(
o Iliococcygeus(
! From(ilium(to(coccyx(
Urogenital(hiatus(
o Male(=(urethra(
o Female(=(urethra(+(vagina(
Anal(aperture(
o Anus(
o Supported(by(puborectalis("(forms(a(kink'in(the(end(of(the(rectum(supporting(faecal(
continence.(Relaxing(will(allow(passage(of(contents(from(anus.((
o (
Contains(openings(for(pelvic'viscera(
(
(
(
(
(
(
(
(
(
(
(
'

'
'

Deep'Perineal'Pouch'
Perineal'Membrane' Deep'Perineal'Pouch'

Superficial(to(pelvic(diaphragm(over(urogenital(
triangle(
Has(openings(for(urethra((male(and(female)(
and(vagina((female)((
Attached(to(the(pubic(arches(
Closes(a(large(part(of(the(urogenital(triangle(
Space(above(perineal(membrane(and(
enclosed(largely(by(urogenital(hiatus(
above(
Contains(skeletal(muscle(that(forms(
sphincters(around(urethra(and(vagina(
Contains(some(glands(in(male(

(
'
Testes'
Testes(contain(seminiferous'tubules((approx.(400L600)(
surrounded(by(thick(connective(tissue((tunica(albuginea)(
Spermatozoa(are(produced(in(seminiferous'tubules,'
collected(in(the(rete(testes(and(stored(in(the(epididymis(
until(ejaculation(
o Need(a(lower(temperature(to(develop("(
externalised(=(cooler.((
Spermatozoa(mature((acquire(ability(to(move(and(fertilize(
an(ovum)(while(stored(in(the(epididymis.((
Epididymis(
o Single(tube(supercoiled.((
(
(
(
(
(
(
(
(
(
(
Descent'of'Testes'and'Spermatic'Cord'
Gonadal(development(occurs(along((high(posterior(abdominal(wall((near(kidneys)(
Testes(descend(towards(inguinal(canal(by(7(months(gestation(and(through(inguinal'canal(into(
scrotum(just(before(birth((usually(9th(month)(
Descent(of(the(testes(drags(blood'vessels,'
nerves,'duct'system((vas(deferens)(and(layers(of(
abdominal(wall(into(scrotum(
Spermatic'cord'contains'features(of(all(these(
(blood(nerves,(ducts)(
Gubernaculum(anchors(testes("(doesnt(change(
in(length,(the(body(length(increases(and(the(
gubernaculum(keeps(it(low.((
(
(
(
(
(

Vas'deferens'(Ductus'Deferens)'
Muscular'duct'(smooth(muscle(wall)(which(transports(
spermatozoa(to(ejaculatory'duct(
Part(of(the(spermatic%cord(
Penetrates(abdominal(wall(through(the(Inguinal'canal(
Descends(along(the(lateral(wall(of(pelvic(cavity(to(meet(
duct'of'seminal'vesicle(to(form(ejaculatory'duct(
Ejaculation(mediated(by(sympathetic(nervous(system(
Vasectomy(involves(ligating'duct(to(
prevent(sperm(from(reaching(penis.((
o Easy(to(do(as(vas(deferens(is(
highly(accessible(have(a(feel(
and(appreciate(it(
In(males(there(is(both(a(common(path(
for(urine(and(sperm.((
Accessory'Glands'(3)'
Contribute(to(the(volume(of(the(semen(
Each(have(different(secretions(with(different(functions(
Prostate'gland:(Inferior(to(bladder,(superior(to(pelvic(diaphragm(
Seminal'vesicle:(Posterior(to(bladder(between(bladder(and(
rectums(
Bulbourethral'gland'
 Seminal'Vesicle( Prostate' Bulbourethral'Glands'

Posterior(surface(of( Inferior(to(bladder( In(the(deep'perineal'

the(bladder(
Ducts(of(seminal( Superior(to(perineal(membrane(
vesicles(joins(vas(
deferens(to(form(
ejaculatory(duct,(
which(empties(into(
prostate(
Contribute(to(volume(
of(semen(and(provide(
fructose((an(energy(
source(for(sperm)(and(
a(coagulating'gland(
'
Anterior(to(rectum( pouch'
Duct(opens(into(
Surrounds(urethra( spongy'urethra'
Many((30L40)(separate(glands( Mucous(type(
with(ducts(that(open(directly( secretion(into(
into(the(prostatic'urethra( lubricate(urethra'
Provides(approximately(20%(of( Forms(preLejaculate'
the(volume(of(semen(
Plays(a(role(in(activating'sperm(
The'2'Ejaculatory'ducts(pierce(
prostate(to(empty(into(prostatic(
urethra(

(
(
(
Benign'Prostatic'Hypertrophy(
Occurs(in(most(elderly(men(
Hypertrophy(of(central(prostate(
o Swelling(or(growth(
Compresses(urethra(and(can(eventually(block(it(entirely(
DRE(reveals(bulky(prostate(
(
(
(
(
(
(
(
(
Prostate'cancer'
Common(malignancy(in(men(
Affects(entire(thickness(of(prostate(
Diagnosed(by(DRE((feels(rock(hard)(and(blood(
tests(
Can(be(treated(by(radiotherapy,(chemotherapy(or(
removal((
(
Penis(
Perineal'membrane(and(pubic'arch(form(
attachment(for(roots(of(external(genitalia(
Roots(
o Attached(to(perineal(membrane(
and(pubic(arch(
Body(
o Is(pendulous(and(entirely(
surrounded(by(skin(
Erectile(tissues(consist(of:(
o 2'Corpora'cavernosa((
o 1'Corpus'Spongiosum(
! Expands(distally(to(form(
glans'penis'
'
'
'
'
'
Urethra(pierces(perineal(membrane(and(
enters(corpus(Spongiosum,(this(it(opens(
at(glans(penis(
Erection(is(mediated(by(parasymp.'NS,(
which(relaxes(arteries(in(penis,(allowing(
blood(to(fill(erectile(tissues.((
Ischiocavernosus'and(Bulbospongiosus'
muscles(move(blood(form(root(into(body(
of(penis(and(constrict(venous(drainage(
(
Erectile(tissues(covered(by(skin(
Body'of'penis:(
o is(Pendulous((hangs(down(loosely)(and(
entirely(surrounded(by(skin(
(
(
(
(
(
(
 Scrotum:(
o Is(homologue(of(labia(majora(in(females.((
o The(skin(fuses(in(the(midline(in(
development(of(male(genitalia(
(raphe)(and(testes(descend(
into(this(pouch(
Skin(over(glans(penis((prepuce)(is(open(
anteriorly(and(attached(to(glans(at(the(
frenulum(
(
(
(
(
(
(

(
 Lecture'31'
Female&Reproductive&System&
Pelvic'Diaphragm'
Separates(pelvis(and(
perineum(
Supports(pelvic(viscera(
Suspends(the(viscera(
above(
Forms(attachment(for(
external(genitalia((
Urogenital(and(anal(
triangle(
(
Pelvic'Diaphragm'
Formed(largely(by(levator'ani'muscle'(3)(
o Puborectalis(
o Pubococcygeus(
o Iliococcygeus(
Contains(openings(for(pelvic'viscera(
(
(
(
(
(
(
(
(
(
(
(
(
(
((
Perineal'Membrane' Deep'Perineal'Pouch'
Superficial(to(pelvic(diaphragm(over( Space(above(perineal(membrane(and(
urogenital(triangle( enclosed(largely(by(urogenital(hiatus(above(
Has(openings(for(urethra((male(and(female)( Contains(skeletal(muscle(that(forms(
and(vagina((female)(( sphincters(around(urethra(and(vagina(
 (
(
Damage'to'Pelvic'Floor(
Perineum,(levator(ani(and(perineal(fascia(
can(be(injured(during(childbirth(
Pubococcygeus(and(puborectalis(often(
torn(
Muscles(in(deep(perineal(pouch(can(also(
be(involved(
In(females(these(muscles(support(uterus(
and(vagina,(and(the(rectum(
Urinary(stress(incontinence(and(prolapse'
of(uterus(may(result,(and(even(faecal(
incontinence.((
(
(
(
(
(
(
(
Uterus'and'Vagina(
Uterus:(
o Thick(walled(muscular(
organ(that(facilitates(
development(of(embryo(
and(fetus(
o Has(inner(lining(called(
endometrium(and(outer(
lining(as(well(
Endometrium'(
o Inner(lining(that(supports(
pregnancy(and(is(shed(if(
conception(does(not(occur(
during(menstrual(cycle.((
Cervix:(
o Opens(inferiorly(into(the(
vagina(
 o Uterus(is(best(supported(at(cervix.((
Fallopian'(uterine)'tubes(
o Projects(laterally(and(open(into(peritoneum((posteriorly)(adjacent(to(ovaries(
Fimbriated'infundibulum(
o Facilitates(collection(of(oocytes((
Vagina(
o Thick(walled(muscular(tube(
o Flattened(anteroIposteriorly((
o Serves(as(a(passage(for(menses,(birth(canal(and(receives(penis(and(ejaculate(during(
intercourse.((
Fornix(
o Lateral(and(posterior((no(anterior)(
(
Position'of'Uterus(
Uterus(is(normally(anteverted'(AV)(relative(to(the(
vagina(and(anteflexed'(AF)(over(bladder(
o Uterus(is(almost(bent(90o(over(the(vagina((AV)(
o Secondary(angle(created(by(relation(to(bladder(
(AF)(
o The(structures(below(support(the(uterus(quite(
well.((
Cervix(opens(into(anterior(wall(of(vagina(
(

(
Prolapses'
Retroverted(uterus(is(more(likely(to'prolapse.(
(
(
(
(
(
(
(
(
Ovaries(
Located(adjacent(to(the(lateral(wall(of(the(pelvis(in(the(peritoneal(
cavity,(posterior(to(broad(ligament(
Attached(to(uterus(by(ligament(of(ovary(
Releases(an(oocyte(during(every(menstrual(cycle(between(puberty(
and(menopause(
Ovarian'vessels(
 o Come(in(from(lateral(wall(of(pelvis(
o Run(down(along(ovary(and(fallopian(tubes(
Uterine(vessels(
o Come(about(around(the(level(of(the(cervix(
Vaginal'vessels(
!(All(branches(of(internal'iliac'artery'except(for(the(
ovarian(vessels(which(originate(form(abdominal'aorta(
!(All(vessels(anastomose(with(each(other.((
(
(
(
(
(
(
Fertilization'and'Implantation'
Fertilization(usually(occurs(in(ampulla(
Implantation(is(usually(in(the(body(of(the(uterus((
Ectopic(pregnancy(can(occur(at(different(locations(
Placenta(develops(and(draws(blood(supply(where(
implantation(occurs(
Abdominal(pregnancies(can(allow(some(fetal(
development(provided(it(occurs(at(an(area(of(large(
vascular(supply.((
Fertilisation+sites:(
(
(
(
(
(
(
(
(
(
(
'
'
'

Peritoneal'folds(
Peritoneum(folds(over(the(top(of(pelvic(
viscera(
Forms(peritoneal(pouches(between(
pelvic(viscera(
Folds(of(peritoneum(come(together(over(
uterine(tubes(to(form(broad'ligament(
Ovaries(are(surrounded(by(peritoneum(
and(are(therefore(described(as(
intraperitoneal(
 Suspensory'ligament'of'ovary(formed(by(folds(over(ovarian(vessels(
RectoKuterine'pouch(
o Can(accumulate(fluid(when(lying(down(after(surgery(
o Aka(Pouch(of(Douglass(
Broad(ligament(
o Forms(a(mesenteryIlike(structure((sagittal(cross(section)((
(
(
(
(
(
(
(
(
Peritoneal'Folds'cont.''
'
(
(
(
(
(
(
(
(
(
(
(
(

'
'
'
'
'
'
'
'
'
'
Female'external'genitalia(
Perineal(membrane(and(pubic(arch(
form(attachment(for(roots(of(external(
genitalia(in(female(
Erectile(tissue(formed(by(two(corpora(
cavernosa,(two(bulbs(of(vestibule,(and(
the(glans(clitoris(attached(in(
between(
Analogs(of(male(erectile(tissues(
(and(vice(versa)(
Body(and(glans(clitoris(situated(
 anterior(to(urethra(and(glans(clitoris(is(exposed((not(covered(by(skin)(
Greater'vestibular'glands(are(located(posterior(to(the(bulbs(and(open(into(the(vestibule,(secreting(
mucous(secretions(that(lubricate(during(arousal(
Ischiocavernosus(and(Bulbospongiosus(muscles(
o Push(blood(forward(into(the(glans(clitoris(
(
(
(
(
(
Female'External'Genitalia'continued.''
Vulvar/pudendum'includes(the(erectile(tissues(and(the(overlying(skin(
Two(thin(folds(of(skin(either(side(of(the(midline(constitute(the(labia'minora(
Vestibule(is(the(area(between(labia(minora(and(contains(opening(of(urethra(and(vagina(
Labia'minora(come(together(anteriorly(at(the(glans(clitoris(
Larger'folds'of'skin,(over(the(bulbs(of(the(vestibule(and(lateral(to(labia(minora(are(the(labia'majora(
(
(
(