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GROSS ANATOMY

BACK Deep muscles Muscle Origin Insertion Super icial vertically running muscles!"rector spinae Iliocosta Arises by a broad tendon Lumborum,thoracis and cervicis, fibers run l from posterior part of the superiorly to angles of lower ribs and i iliac crest, posterior cervical transverse processes s surface of sacrum, sacral -lateral and inferior lumbar column spinous progresses, and $ongissi supraspinous ligament horacis, cervicis, and capitis, fibers run m superiorly to ribs between tubercles and u angles, to transverse processes in thoracic s and cervical regions, and to mastoid -middle process of temporal bone! column Spinalis horacis, cervicis, and capitis; fibers run -medial superiorly to spinous process in the upper column throracic region and to skull Interme%iate o#li&ue running muscles! Transversospinalis Semispi Arises from throracic and horacis, cervicis, and capitis, fibers run n cervical transverse superomedially and attach to occipital bone a processes and spinous processes in thoracic and li cervical regions, spanning four to six s segments! Nerve supply Posterior rami of spinal nerves Main action Acting #ilaterally: they extend vertebral column and head; as back is flexed they control movement by gradually lengthening their fibers; acting unilaterally, they laterally bend vertebral column

Posterior rami of spinal nerves

"xtend head and thoracic and cervical regions of vertebral column and rotate them contralaterally

Multi i%u s

Arises from sacrum and ilium, transverse processes of #-L$, and articular processes of %&-%'

(ibers pass superomedially to spinous processes, spanning two to four segments

)tabili*es vertebrae during local movements of vertebral column

Rotatore s

Arises from transverse processes of vertebrae; best developed in throracic region

Pass superomedially and attach to +unction of lamina and transverse process of vertebra of origin or into spinous process above their origin, spanning one to two segments

)tabili*e vertebrae and assist with local extension and rotary movements of vertebral column

Deepest muscles'

Interspinales

)uperior surface of spinous processes of cervical and lumbar vertebrae

,nferior surfaces of spinous processes of vertebrae superior to vertebrae of origin

Posterior rami of spinal nerve

Aid in extension and rotation of vertebral column

Intertransver sarii

ransverse processes of cervical and lumbar vertebrae

ransverse process of ad+acent vertebrae

Posterior and anterior rami of spinal nerve

Aid in lateral bending of vertebral column; acting bilaterally, they stabili*e vertebral column

Triangles o t(e #ac) *triangle auscultation+ lum#ar triangle o ,etit1. Triangles of auscultation $ocation: medially-trape*ius; inferiorly-latissimus dorsi; anteriorly- medial border of the scapula -bone.! Clinical signi icance: by placing the bell of the stethoscope with in the triangle of auscultation, a physician can hear clear sounds of the respiratory organ! 2. Lumbar triangle or Petits triangles $ocation' posterior part of the abdominal wall! ,t is bounded anteriorly by the posterior margin of external obli/ue muscle, posteriorly by the anterior border of the latissimus dorsi and inferiorly by the iliac crest! he floor of the triangle is formed by the internal obli/ue and the transverses abdominis muscle! Clinical signi icance' weak area of the prone to the development of lumbar hernia Blood supply of the back A0 "0,") %ervical region: b ranches arise from the occipital artery, a branch of the external carotid from vertebral artery, a branch of the subclavian artery from the deep cervical artery, a branch of the costoicervical trunk, a branch of the subclavian artery (rom ascending cervical artery, a branch of the inferior thyroid artery horacic region: branches arise from the posterior intercostal arteries Lumbar region: branches arise from the subcostal and lumbar arteries )acral arteries: branches arise from the iliolumbar and lateral sacral arteries, branches of the internal iliac artery 1",2) form complicated plexuses extending from the vertebral column from the skull to the coccyx divided into internal and external venous plexuses o freely communicate with the veins in the neck, thorax, abdomen and pelvis internal vertebral plexus lies w3n the vertebral canal but outside the dura mater of the spinal cord embedded in areolar tissue and receives tributaries from the #asiverte#ral veins, meninges and the spinal cord drained by the intervertebral veins w3c pass outward w3 the spinal nerves thru the invertebral foramina, where they +oined by the tributaries from the external plexuses and in turn drain into the vertebral, intercostals, lumbar and lateral sacral veins

- its body articulate with the body of the other pubis of the other hip bone midline anteriorly at the symphysis pubis B0 3emur *t(ig( #one Articulates above with the acetabulum to form the hip +oint and below with the tibia to form the knee +oint! ,t has a head, neck, a long shaft, and medial and lateral condyles! Popliteal surface, a flat and triangular area on the posterior surface, is formed in the distal end of the shaft! C0 ,atella *)nee cap Largest sesamoid bone (ormed within the tendon of the /uadriceps femoris muscle in front of the knee +oint ,t is triangular and its apex lies inferiorly! he apex is connected to the tuberosity of the tibia by the legamentum patellae. he posterior surface articulates with the condyles of the femur D0 Ti#ia *s(in #one Large weight-bearing medial bone of the leg Articulates with the condyle of the femur and head of the fibula above, and with the talus and the distal end of the fibula below! he expanded upper end has the lateral and medial condyles -tibial plateus., the shaft which is triangular, and the lower end with a saddle-shaped articular surface and medial malleolus! "0 3i#ula *cal #one )lender lateral bone of the leg and takes no part in the transmission of the body weight ,t has an expanded upper end or head that posses articular surface for the articulation with the lateral condyle of the tibia, a long and slender shaft+ and a lower end which forms the triangular lateral malleolus! 30 Bones o t(e 3oot 40 Tarsals 5 bones of the ankle here are seven tarsal bones! a0 Calcaneum - largest bone of the foot and forms the prominence of the heel - posterior surface forms the prominence of the heel and gives attachment to the tendo calcaneus -Achillis tendon). #0 Talus - the only one that articulates with the tibia and fibula at the ankle +oint - articulate below with the calcaneum, and in front the navicular bone - it possesses a head, neck and a body c0 Navicular - located distal to the talus and proximal to the three cuneiform bones - gives attachment to the main part of the tibialis posterior tendon %0 Cu#oi% #one - the most lateral bone in the distal row of the tarsal bone - deep groove on the inferior aspect lodges the tendon of the peroneus lungus muscle e0 Cunei orm #ones - three small, wedge-shaped bones that articulate proximally with the navicular bone and distally with the first three metatarsal bone - it is composed of the middle, the medial, and lateral cuneiform bone 60 Metatarsals an% ,(alanges - each possesses a ead, !haft, and a "ase - first metatarsal is large and strong, supports body weight - fifth metatartsal has a prominent tubercle, attachment for peroneus brevis - each toe has 4 phalanges except the big which has only 5

$O."R "/TR"MITY A0 1ip #one *co2a or innominate #one Large irregular bone (not flat bone) formed by the fusion of the ilium, ischium, and the pubis! hey meet at the acetabulum! ,t articulates with the sacrum at the sacroiliac joints and forms the anterolateral walls of the pelvis! ,t also articulates with the other hip bone anteriorly at the symphysis pubis. ogether with the sacrum, and coccyx, the four bones composed the pelvis 4parts: a! ,lium - upper flattened part of the bone, posses the iliac crest - ends in front at the anterior iliac spine b! ,schium- L-shaped possessing an upper thicker part of, the body, and a lower thinner part, the ramus. c! Pubis - anterior inferior portion of the hip bone - divide into a body, superior ramus, and inferior ramus

A0 1ip 7oint Articulation between the hemispherical head of the femur and the cup-shaped acetabulum of the hip bone! Type synovial ball-and-socket +oint $igaments iliofemoral ligament, pubofemoral ligament, ischiofemoral ligament, transverse acetabular ligament, ligament of the head of the femur Nerve supply (emoral obturator, and sciatic nerves and the nerve to /uadratus femoris Movement (lexion, extension, abduction, adduction, lateral rotation, medial rotation,circumduction #t has a wide range of movement but less than the shoulder joint B0 Knee 7oint largest and most complicated, consist of two condylar +oints between the medial and lateral condyles of the femur and the corresponding condyles of the tibia, and a gliding +oint between the patella and the patellar surface of the femur! Articulation bet! the condyle of the femur and the condyles of the tibia and their cartilaginous menisci; in front is the articulation between the lower end of femur and patella Type hinge synovial joint for the femur-tibia +oint; plane gliding synovial joint for the patella-femur +oint $igaments E tracapsular Ligaments ligamentum patellae lateral collateral ligament medial collateral ligament obli/ue popliteal ligament !ntracapsular Ligamnets cruciate ligaments Bursae Relate% to t(e Knee 7oint "nterior Bursae suprapatellar bursa prepatelar bursa superficial infrapatellar bursa deep infrapatellar bursa Posterior Bursae popliteal bursa semimembranous bursa Nerve Supply (emoral, obturator, common peroneal, and tibial nerves Movement 0otatory movement, flexion, extension, medial rotation, lateral rotation C0 ,ro2imal Ti#io i#ular 7oint Articulation bet! lateral condyle of the tibia and the head of the fibula! Type plane, gliding synovial +oint $igaments anterior and posterior ligaments Nerve Supply common peroneal nerve Ot(ers small amount of gli%ing movement D0 Distal Ti#io i#ular 7oint (page $%&, !nell) Articulation between the fibular notch at the lower end of the tibia and the lower end of the fibula! Type fibrous +oint Nerve supply deep peroneal and tibial nerves supply the +oint $igaments interosseous ligament, anterior and posterior ligaments, inferior transverse ligament Movements small amount of movement !ynovial joints has capsules this one has no capsule and the articular surfaces are bony. 'his is a characteristic of a fibrous joint. "0 An)le 7oint %onsist of a deep soc(et formed by the lower ends of the tibia and fibula, into which is fitted the upper part of the body of the talus. Articulation bet! lower end of the tibia, the two malleoli, and the body of the talus Type synovial hinge +oint

$igaments medial or deltoid ligament, and the lateral ligament -composed of anterior talofibular, calcaneofibular and posterior talofibular ligaments. Nerve Supply deep peroneal and tibial nerves Movement dorsiflexion, plantar flexion 30 Tarsal 7oints 40 Su#talar 7oint 6 posterior +oint bet! the talus and calcaneum Articulation bet! the inferior surface of the body of the talus and the facet on the middle of the upper surface of the calcaneum Type synovial plane +oint $igaments medial and lateral -talocalcaneal. ligaments, interosseous -talocalcaneal. ligament Movements gliding and rotatory movement, inversion and eversion 60 Talocalcaneonaviocular 7oint 6 anterior +oint bet! the talus and the calcaneum and also involves the navicular bone! Articulation is bet! the rounded head of the talus, the upper surface of the sustentaculum tali, and the posterior concave surface of the navicular bone. Type )ynovial +oint $igament plantar calcaneonavicular ligament Movement gliding and rotatory movement, inversion and eversion 80 Calcaneocu#oi% 7oint Articulation bet! anterior end of the calcaneum and the posterior surface of the cuboid! Type synovial plane +oint $igaments bifurcated ligament, long plantar ligament, short plantar ligament Movement gliding and rotatory movement, inversion and eversion (note that the previous three joints has inversion and eversion movements) 90 Cuneonavicular 7oint Articulation bet! the navicular and the three cuneiform bones! Type synovial gliding +oint $igaments %apsule is strengthen by dorsal and plantar ligaments :0 Cu#oi%eonavicular 7oint Type fibrous +oint $igaments dorsal, plantar, and interosseous ligaments ;0 Intercunei orm an% Cuneocu#oi% 7oints Type synovial plane +oints $igaments dorsal, plantar, and interosseous ligaments G0 Tarsometatarsal An% Intermetatarsal 7oints Type synovial plane +oint! $igaments dorsal, plantar, and interosseous ligaments 7oint cavity tarsometatarsal +oint has a separate +oint cavity! 10 Metatarsop(alangeal An% Interp(alangeal 7oints Articulation bet! 7etatarsals and phalanges, and between phalanges of the five toes! $igaments deep transverse ligaments Movements abduction and adduction of the toes, performed by the interossei muscles, are minimal and take place from the midline of the second digit and not the third, as in the hand! T"NDON Are cords of dense regular connective tissue that attach the s(eletal muscles to the periosteum of the bones! he collagen fibers run along the longitudinal axis of the tendon and transfer the pull to the contracting muscle to the bone! )arge numbers of fibroblast are found between the collagen fibers. Are dense regular connective tissue that attached muscles to bone by virtue of their richness in collagen fibers! hey are white and inextensible!

%onsist of parallel, closely packed bundles of collagen separated by small /uantity of intercellular ground substance! (ibrocytes have elongated nuclei parallel to the fibers! - (ascicles of type-, collagen. %ollagen bundles of the tendons -primary bundles. aggregate into larger bundles -secondary bundles. enveloped with loose connective tissue with blood vessels and nerves! Presence of fluid that function as lubricant permitting easy sliding movement of the tendon with its sheath! 'ensile strength of tendon is similar with the bone; a tendon which a cross-section diameter of #8 mm would support 988-#888 kg! hey are slightly elastic and may be stretched by up to 9: of their length without damage! )ince tendons are composed of collagen and their vascular supply is sparse he #loo% supply to ten%ons: small arterioles from ad+acent muscle tissue pass longitudinally between the fasicle, branching and anastomosing freely, accompanied by venea comitantes and lypmhatic vessels from ad+acent loose connective tissue or synovial sheaths! 7etabolic rate of tendons is very low but increases during infections and in+uries! 0epair involves initial proliferation of fibroblast followed by interstitial deposition of new fibers! ;rowth decreases along the tendon to the muscle to the osseous attachments! Nerve supply to t(e ten%ons: is sensory there is no evidence of any evidence of any capacity or vasomotor control!

fibroblasts fibrocyte fibroblasts fibrocyte Collagen i#er one direction <ne direction, less orientation regular Color white )lightly yellow Ligament has elastin+ which gives them a slightly yellow appearance! (for more info, as( ,ulius-. #ts nice if this is presented in table.) 1.#. $escribe the lumbar and sacral ple us and branches he nerves that innervate the lower limb originate from the lumbar ple us, situated in the abdomen, and the sacral ple us, situated in the pelvis! hese plexuses permit nerve fibers to be arranged and distributed efficiently in different nerve trunks to the various parts of the lower limb! $um#ar ple2us (page &/0 of !nell1s 2linical Anatomy) (ormed in the psoas muscle from the anterior rami of the upper four lumbar nerves he anterior rami receive gray rami communicantes from the sympathetic trunk, and the upper two give off white rami communicantes to the sympathetic trunk! Branc(es Distri#ution ,lihypogastric nerve "xternal obli/ue, internal obli/ue, transverses -L#. abdominis muscles of anterior abdominal wall; skin over lower anterior abdominal wall and buttock ,lioinguinal nerve "xternal obli/ue, internal obli/ue, transverses -L#. abdominis muscles of the anterior abdominal wall (same with above); skin of the upper medial aspect of thigh, root of penis and scrotum in male, mons pubis and labia minora in the female! Lateral cutaneous )kin of anterior and lateral surfaces of the nerve of the thigh thigh -L5, 4. ;enitofemoral nerve %remaster muscle in scrotum in male; skin -L#, 5. over anterior surface of thigh; nervous pathway for cremasteric reflex (emoral nerve -L5, ,liacus, pectineus, sartorius, /uadriceps 4, &. the largest3 femoris muscles, and intermediate cutaneous branches to the skin of the anterior surface of the thigh and by saphenous branch to the skin of the medial side of the leg and foot; articular, branches to hip and knee +oints! <bturator nerve -L5, ;racilis, adductor brevis, adducto longus, 4, &. obturator externus, pectineus, adductor magnus -adductor portion., and skin on the medial surface of thigh; articular branches to hip and knee +oints (articular branches, sames as the femoral nerve) )egmented Euadratus lumborum and psoas muscles branches Sacral ,le2us Lies on the posterior pelvic wall in front of piriformis muscle! (ormed from the anterior rami of the fourth and fifth lumbar nerves and ther anterior rami of the first, second, third, and fourth sacral nerves Branc(es Distri#ution )uperior gluteal ;luteus medius, gluteus minimus, and tensor nerve fasciae latae muscles ,nferior gluteal nerve ;luteus maximus 2erve to piriformis Piriformis muscles 2erve to obturator <bturator internus and superior gemellus internus muscles 2erve to /uadratus Euadratus femoris and inferior gemellus femoris muscles Perforating cutaneus )kin over medial aspect of buttock nerve Posterior cutaneous )kin over posterior surface of thigh and nerve of thigh popliteal fossa, also over lower part of buttock, scrotum, or labium ma+us )ciatic nerve -L&, $; >amstring muscles -semitendinosus, biceps )#, 5, 4. (largest) femoris FlongheadG, adductor magnus ibial portion Fhamstring partG., gastrocnemius, soleus, plantaris, popliteus, tibialis posterior, flexor

$IGAM"NT A ligament is a band or sheet fibrous tissue connecting two or more bones, cartilages, or other structures, or serving as support for fasciae or muscles! Ligaments are similar to tendons, except that the elements are somewhat less regularly arranged; it is also a little stretchable than tendon! hey therefore permit freedom of movement within a certain limited range while holding the attached bones firmly in place! <ther types of ligaments from fibrous sheets that support such internal organs as the kidneys and spleen! hey composed of two types: #! 3i#rous ligament 7ost is composed of dense bundles of collagen fibers and are unstretchable under normal conditions! 5! "lastic ligament he other type is composed largely of elastic tissue and can therefore regain its original length after stretching! Ligaments have essentially *+ blood vessels of their own to bring them nutrients which their nutrition must come from diffusion of nutrients, most likely from a +oint itself! - his should make it evident to that ligaments are easily in+ured!. 7A=<0 >,) <L<;,%AL ?,(("0"2%") @" A""2 "2?<2) A2? L,;A7"2 ) ,2%LB?" >" (<LL<A,2;: %ollagen fibrils of ligaments are often less compact! )ome fibrils of many ligaments are not parallel! )ome fibrils are more flattened than tendons and form sheets or bands of tissue! "2?<2) A2? L,;A7"2 ) ;0<A @C A< ?,(("0"2 P0<%"))"): APP<), ,<2AL ;0<A > -,s this for the tendonsD. 6 surface fibroblasts divide to produce additional fibroblast which secrete matrix to the outside of existing fibers! ,2 "0) , ,AL ;0<A > -Ligaments niD. 6 fibrocyte proliferate and secrete matrix inside the tissue! "2?<2) v!s L,;A7"2 ) Ten%on 3unction attach muscles to bones Component ?ense regular connective tissue Cells spindle-shaped $igament attached bones to bones fibrous connective tissue spindle-shaped

%ommon Peroneal portion

Pudendal nerve

digitorum longus, flexor hallucis longus, and via medial and lateral plantar branches to muscles of sole of foot; sural branch supplies skin on lateral side of leg and foot @iceps femoris muscle -short head. and via deep peroneal branch, tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius, and extensor digitorum brevis muscles; skin over cleft between first and second toes! he superficial peroneal branc+ supplies the peroneus longus and brevis muscles and skin over the lower third of anterior surface of leg and dorsum of foot! 7uscles of perineum including the external anal sphincter, mucous membrane of lower half f anal canal, perianal skin, skin of penis, scrotum, clitoris, and labia ma+ora and minora

(loor: gutter shaped formed from lateral to medial by iliopsoas, the pectineus, and the adductor longus! 0oof: formed by the skin and fasciae of the thigh Contents: terminal part of the femoral nerve and its branches femoral sheath femoral artery and its branches femoral vein and its tributaries deep inguinal lymph nodes

@ranches to lower limb foramen that leave the pelvis through the Greater Sciatic 3oramen' #! sciatic nerve 6 largest branch of the plexus and largest nerve in the body 5! superior gluteal nerve 4! inferior gluteal nerve &! nerve to /uadratus femoris muscle $! nerve to the obturator internus muscle 9! posterior cutaneous nerve of the thigh @ranches to the pelvis muscles+ pelvic viscera an% perineum #! Pudendal nerve 6 leaves the pelvis thru the greater sciatic foramen and enters the perineum through the greater sciatic foramen 5! nerves to piriformis muscle 4! pelvic splanchnic nerves Lymphatic drainage of lower e tremity I0 Inguinal $ymp( No%es A0 Super icial Inguinal $ymp( No%es Lie in the superficial fascia below the inguinal ligament %ori&ontal group - below and parallel to the inguinal ligament - medial members receive superficial lymph vessels from the anterior abdominal wall below the level of the umbilicus - lateral members receives superficial lymph vessels from the back below the level of the iliac crest 'ertical group - along the terminal part of the great saphenous vein - receives most superficial lymph vessels of the lower limb he efferent vessels pass through the saphenous opening in the deep fascia and +oin the deep inguinal nodes B0 Deep Ingiunal $ymp( No%es Located beneath the deep fascia and lie along the medial side of the femoral vein he efferent vessels enter the abdomen by passing through the femoral canal to lymph nodes along the external iliac artery II0 ,opliteal $ymp( No%es About six nodes are embedded in the fatty connective tissue of the popliteal fossa 0eceive superficial lymph vessels that accompanies the small saphenous vein from the lateral side of the foot and leg into the popliteal fossa Also receive deep lymph vessels accompanying the anterior and posterior tibial arteries

"dductor )*ubsartorial+ ,anal An intermuscular cleft situated on the medial aspect of the middle third of the thigh beneath the sartorious muscle Commencement above the apex of the femoral triangle Termination below at the opening in the adductor magnus Boun%aries' Anteromedial wall: formed by the sartorios muscle and facia Posterior wall: formed by the adductor longus and magnus Lateral wall: formed by the vastus medialis Contents' terminal part of the femoral artery (emoral vein ?eep lymph vessels )aphenous nerve 2erve to the vastus medialis erminal part of the obturator nerve Popliteal fossa impt! area of transition between the thigh H leg and is the ma+or route by w3c structures pass from one region to the other! ?iamond shaped space behind the knee +oint formed between muscles in the posterior compartments of the thigh and leg 7ost prominent when the knee +oint is flexed CONT"NTS' Ti#ial nerves an% Common i#ular originate proximal to the popliteal fossa as the 5 ma+or branch of the sciatic nerve 7ost superficial of the neurovascular structures H enter directly from above under the margin of the biceps femoris: o Ti#ial nerve descends vertically through popliteal fossaHexits deep to the margin of plantaris muscle to enter the posterior compartment of the leg o Common i#ular nerve exits by following the biceps femoris tendon over the lower lateral margin of the popliteal fossa, and continues to the lateral side of the leg where it swings around the neck of the fibulaHanters the lateral compartment of the leg! ,opliteal artery continuation of the femoral artery in the anterior compartment of thigh, and begins as the femoral artery passes posteriorly through the adductor hiatus in the adductor magnus muscle appears in the popliteal fossa on the upper medial side under the margin of the semimembranosus muscle! ?escends obli/uely through the fossa with the tibial nerveHenters the posterior compartment of leg where it ends +ust lateral to the midline of the leg by dividing into the anteriorHposterior tibial arteries! ?eepest of the neurovascular structures in the popliteal fossaHis therefore difficult to palpate; however, a pulse can usually be detected by deep palpation medial to the midline ;ives rise to branches w3c contribute to vascular anastomoses around the knee ,opliteal vein ,s superficial to and travels w3 the popliteal artery! "xits the popliteal fossa superiorly to become the femoral vein by passing through the adductor hiatus 4or the nerves and blood vessels5 'race the commencement, branches and termination. Roo o popliteal ossa

(emoral Triangle A depressed area situated in the upper part of the medial aspect of the thigh +ust below the inguinal ligament Boun%aries: )uperiorly: inguinal ligament Laterally: satorious 7edially: medial border of the adductor longus onusele

%overed by superficial fascia and skin )mall saphenous vein is the most impt! structure in the superficial fascia Posterior cutaneous nerve of thigh is the one other structure that passes through the roof

!nguinal canal A slit-like passage that extends in a downward and medial direction, +ust above and parallel to the lower half of the inguinal ligament Commencement @egins at the deep inguinal ring Termination superficial inguinal ring

he scalp is a multilayered structure with layers that can be defined by the word itself: - ) 6 )kin; - % 6 %onnective tissue -dense.; - A 6 Aponeurotic layer; - L 6 Loose connective tissue; - P 6 Pericranium Layers "xamining the layers of the scalp reveals that the first three layers are tightly held together, forming a single unit! his unit is sometimes referred to as the scalp proper and is the tissue torn away during serious IscalpingJ in+uries! ,t is separated from the pericranium -periosteum of the calvaria. by loose connective tissue! @ecause of this potential areolar cleavage plane, the scalp is fairly mobile!

Boun%ary A*'67#+7 8A))5 formed along its entire length by the aponeurosis of the external obli/ue muscle! <n the other hand, internal obli/ue muscle covers the inguinal ring w3 a cremastic fascia-cremastic muscle. P+!'67#+7 8A))5 formed along its entire length by the transversalis fascia CONT"NTS' Spermatic cor% %onsists of structures passing between the abdominopelvic cavities and the testis, and the 4 facsial coverings that enclose these structures: o ?uctus deferens o Artery to ductus deferens o esticular artery o Pampiniform plexus of veins o %remasteric arteryHvein o ;enital branch of genitofemoral nerve o )ympatheticHvisceral afferent nerve fibers o Lymphatics o 0emnants of the processus vaginalis heses structures enter the deep inguinal ring down to inguinal canal and exit to superficial inguinal ring Roun% ligament o t(e uterus A cord-like structure that passes from the uterus to the deep inguinal ring where it enters the inguinal canal (emoral *heath he femoral sheath for the femoral vessels in the lower limbs is formed from the fascia trans-ersalis and the fascia iliaca that covers the iliacus muscle! Contents from lateral to medial: femoral artery femoral vein femoral canal -usually containing a lymph node.! he femoral canal is also the site of a femoral hernia! he femoral nerve is not considered to be in the sheath! *aphenous .pening he saphenous opening is a gap in the deep fascia of the thigh +ust below the inguinal ligament! ,t transmits the great saphenous -ein, some small branches of the femoral artery/ and lymph -essels! he saphenous opening is situated about #!$ in -& cm. below and lateral to the pubic turbecle! he falciform margin is the lower lateral border of the opening, which lies anterior to the femoral vessels! he border of the opening then curves upward and medially, and then laterally behind the femoral vessels, to be attached to the pectineal line of the superior ramus of the pubis! he saphenous opening is filled with loose connective tissue called the cribriform fascia!

SKIN he skin is the outer layer of the scalp! ,t is similar structurally to skin throughout the body with the exception that hair is present on a large amount of it! he skin of the scalp is thin especially in elderly people, except in the occipital region! he skin contains many sweat and sebaceous glands and hair follicles! he skin of the scalp has an abundant arterial supply and good venous and lymphatic drainage systems! CONN"CTI<" TISS=" -dense. ?eep to the skin is dense connective tissue! his layer anchors the skin to the third layer and contains the arteries, veins and nerves supplying the scalp! Ahen the scalp is cut, the dense connective tissue surrounding the vessels tends to hold cut vessels open! his results in profuse bleeding! A,ON"=ROTIC $AY"R he deepest layer of the first three layers is the aponeurotic layer! (irmly attached to the skin by the dense connective tissue of the second layer, it is a strong membranous sheet that covers the superior aspect of the calvaria! he term galea -L! helmet. aponeurotica is sometimes used to indicate the helmetlike nature of the epicranial aponeurosis! his aponeurosis is the membranous tendon of the fleshy bellies of the epicranius mescle $OOS" CONN"CTI<" TISS=" A layer of areolar or loose connective tissue separates the aponeurotic layer from the pericranium and facilitates movement of the scalp proper over the calvaria! ,t is somewhat like a sponge because it contains innumerable potential spaces that are capable of being distended with fluid! @ecause of its consistency, infections tend to locali*e and spread through the loose connective tissue! ,"RICRANI=M he pericranium is the deepest layer of the scalp and is the periosteum on the outer surface of the calvaria! ,t is a dense layer of speciali*ed connective tissue that has relatively poor osteogenic properties in adults! he periosteum or pericranium of the calvaria is firmly attached to the bones by connective tissue fibers known as )harpeyJs fibers! hey penetrate the bones and firmly anchor the pericranium to the calvaria; however, it can be striped fairly easily from the cranial bones of living persons, except where it is continuous with the fibrous tissue in the cranial sutures! >ere, the pericranium passes inwardly and is continuous with the endocranium on the internal surface of the calvaria! >Dangerous area? o t(e scalp ?angerous area of the scalp he loose areolar connective tissue layer is the dangerous area of the scalp because pus or blood in it can spread easily! ,nfection in this layer can also be transmitted to the cranial cavity through emissary veins that pass from this layer through apertures in the cranial bones, e!g! the parietal foramina! he emissary veins connect with the intracranial venous sinuses, e!g! the superior sagittal sinus. ,nfections in the loose connective tissue layer may produce inflammatory processes in the emissary veins, leading to thrombophlebitis of the intracranial venous sinuses and the cortical veins! An infection is unable to spread into the neck because the occipitalis muscle is attached posteriorly to the highest nuchal line of

1"AD
)calp he scalp is the part of the head that extends from the superciliary arches anteriorly to the external occipital protuberance and superior nuchal lines posteriorly! Laterally it continues inferiorly to the *ygomatic arch!

the occipital bone and posterolaterally to the mastoid parts of the temporal bones! An infection is unable to spread laterally beyond the *ygomatic arches because the epicranial aponeurosis is continuous with the temporal fascia, where it is attached to these arches! An infections or fluid -e!g! pus or blood. can enter the eyelids and the root of the nose because the frontalis muscle is inserted into the skin and dense and dense subcutaneous tissue and is not attached to the frontal bone! @ecause of the free movement permitted by the loose connective tissue layer, it is through it that the sclp proper separates during accidents -e!g! when the hair is caught in machinery.!

Sur ace lan%mar)s o t(e (ea% NASION - depression in the midline at the root of the nose! "/T"RNA$ OCCI,ITA$ ,ROT=B"RANC" bony prominence in the middle of the s/uamous part of the occipital bone! ,t lies in the midline at the +unction of the head and neck and gives attachment to the ligamentum nuchae! A line that +oining the nasion to the external occipital protuberance over the superior aspect of the head would indicate the position of the underlying (ALK %"0"@0,, )BP"0,<0 )A;;, AL ),2B), and the L<2;, B?,2AL %"0"@0AL (,))B0", which separates the right and left cerebral hemisphere! <"RT"/ highest point in the skull in the sagittal plane! ANT"RIOR 3ONTAN"$$" ,n the baby, the anterior fontanelle lies bet! the 5 halves of the frontal bone in front and 5 parietal bones in behind! ,t is usually not palpable after L months! ,OST"RIOR 3ONTAN"$$" in the baby, the posterior fontanelle bet! the s/uamous part of the occipital bone and the posterior borders of the two parietal bones! ,t is usually closed by the end of the #st year! S=,"RCI$IARY RIDG"S the prominent ridges on the frontal bones above the upper margin of the orbit! ?eep to this ridges on either side of the midline lie the frontal air sinuses! S=,"RIOR N=C1A$ $IN" a curved ridge that runs laterally from the external occipital protuberance to the mastoid process of the temporal bone! ,t gives attachment to the trape*ius and sternocleidomastoid muscle! MASTOID ,ROC"SS O3 T1" T"M,ORA$ BON" pro+ects downward and forward from behind the ear! ,t is undeveloped in the newborn child and grows only as the result of the pull of the sternocleidomastoid, as the child moves his head! ,t can be recogni*ed as a bony pro+ection at the end of the 5nd year! A=RIC$" AND "/T"RNA$ A=DITORY M"AT=S it lies in front of the mastoid process! he external auditory meatus is about # in! -5!$ cm. long and form an )-shaped curve! TYM,ANIC M"MBRAN" normally pearly gray and is concave toward the meatus! he most depressed part of the concavity is called the B7@< and is caused by the attachment of the handle of the malleus on its medial surface! @YGOMATIC ARC1 extends forward in front of the ear and ends in front in the *ygomatic bone! Above the *ygomatic arch is the "7P<0AL (<))A, which is filled with the temporalis muscle! Attached to the lower margin of the *ygomatic arch is the masseter muscle!

S=,"R3ICIA$ T"M,ORA$ ART"RY the pulsations of the superficial temporal artery can be felt as it crosses the *ygomatic arch, immediately in front of the auricle! ,T"RION the point where the greater wing of the sphenoid meets the anteroinferior angle of the parietal bone! Lying #!$ in! -& cm. above the midpoint of *ygomatic arch, it is not marked by an eminence or a depression, but it is impt! beneath it lies the anterior branch of the middle meningeal artery! Above and behind the external auditory meatus, deep to the auricle, can be felt a small depression, the )BP0A7"A AL 0,A2;L"! his is bound behind a line drawn vertically upward from the posterior margin of the external auditory meatus, above by the )BP0A7"A AL %0") of the temporal bone, and below by the external auditory meatus! he bony floor of the triangle forms the lateral wall of the mastoid antrum! T"M,OMANDIB=$AR 7OINT easily palpated in front of the auricle! ANT"RIOR BORD"R O3 T1" RAM=S O3 T1" MANDIB$" the posterior border of the ramus is overlapped above by the parotid gland, but below it is easily felt through the skin! he outer surface of the ramus of the mandible is covered by the masseter muscle and can be felt on deep palpation when this muscle is relaxed! BODY O3 T1" MANDIB$" it is possible to examine the mandible from the symphysis menti, in the midline anteriorly, as far backward as the angle of the mandible! 3ACIA$ ART"RY the pulsations of the facial artery can be felt as it crosses the lower margin of the body of the mandible, at the anterior border of the masseter muscle! ANT"RIOR BORD"R O3 T1" MASS"T"R it can be easily felt by clenching the teeth! ,AROTID D=CT it runs forward from the parotid gland one finger breadth below the *ygomatic arch! ORBITA$ MARGIN it is formed by the frontal, *ygomatic, and maxillary bones! S=,RAORBITA$ NOTC1 it transmits the supraorbital nerve, which can be rolled against the bone! ,t can be felt at the +unction of the medial and intermediates thirds of the upper margin of the orbit! IN3RAORBITA$ 3ORAM"N lies $mm below the lower margin of the orbit, on a line drawn downward from the supraorbital notch to the interval between the two lower premolar teeth! IN3RAORBITA$ N"R<" it emerges from the foramen and supplies the skin of the face! MA/I$$ARY AIR SIN=S situated within the maxillary bone and lies below the infraorbital foramen on each side! 3RONTA$ AIR SIN=S situated within the frontal bone and lies deep to the superciliary ridge on each side! ,arts o #ones o t(e s)ull %<7P<), ,<2 !utures 6 immobile +oints that unite several separate bones of the skull !uture ligament 6 connective tissue between the bones -mandible is an exception; mobile temporomandibular +oint unite it to the skull. M@ones of the skull can be divided into cranium and acial #ones; the vault is the upper part of the cranium and the #ase o t(e s)ull is its lower part!N

%0A2,B7 consists of the following bones: (rontal bone # Parietal bones 5 <ccipital bone # emporal bones 5 )phenoid bone # "thmoid bone # (A%,AL @<2") consists of the following bones: Oygomatic bones 5 7axillae 5 2asal bones 5 Lacrimal bones 5 1omer # Palatine bones 5 ,nferior conchae 5 7andibleP # he skull can be viewed in different aspectsQ A2 "0,<0 1,"A <( >" )RBLL (rontal bone !upercillary arches !upraorbital notch or foramen +rbital margins 2asal bones Anterior nasal aperture 1omer "thmoid !uperior conchae 9iddle conchae #nferior conchae 7axillae #ntermaxillary suture #nfraorbital foramen Alveolar process Alveolar arch 9axillary sinus Oygomatic bone :ygomatic bone :ygomatic arch 7andible LA "0AL 1,"A <( >" )RBLL (rontal bone %oronal suture Parietal bones )agittal suture Lambdoidal suture <ccipital bone emporal bone !;uamous 'ympanic 9astoid process :ygomatic process )phenoid bone <reater wing of the sphenoid Pterion )uperior temporal line ,nferior temporal line emporal fossa Pterygomaxillary fissure Pterygopalatine fossa ,nferior orbital fissure P<) "0,<0 1,"A L( >" )RBLL )agittal suture Lambdoidal suture <ccipital bone 6xternal occipital protuberance !uperior nuchal lines )BP"0,<0 1,"A <( >" )RBLL %oronal suture )agittal suture

,2("0,<0 1,"A <( >" )RBLL >ard palate 7axillae Palatal processes of the maxillae #ncisive fossa #ncisive foramen Palatine bone ori=ontal plates of the palatine bones <reater palatine foramen )esser palatine foramen %hoanae 1omer )phenoid bone 9edial pterygoid plates Pterygoid hamulus )ateral pterygoid plate 4oramen ovale 4oramen spinosum !pine of the sphenoid Auditory tube emporal bone 9andibular fossa Articular tubercle !;uamotympanic fissure !tyloid process 2arotid canal 4oramen lacerum 'ympanic plate 6xternal auditory meatus !uprameatal spine !ylomastoid foramen ,ugular foramen <ccipital bone Pharyngeal tubercle +ccipital condyles ypoglossal canal ,aranasal sinuses PA0A2A)AL ),2B)") Are cavities found in the interior of the maxilla, frontal, sphenoid, and ethmoid bones Lined with mucoperiosteum and filled with air %ommunicate with nasal cavity through relatively small apertures "nlarge appreciably after the Lth year and become fully formed in adolescence! ?,(("0"2 PA0A2A)AL ),2B)") 7axillary sinus Located within body of maxilla Large, pyramid-shaped cavity lined with mucous membrane %ommunicates with the nasal cavity and serves as a voice resonator ,ts base forms the lateral wall of the nose and the apex in the *ygomatic process of the maxilla 0oot is formed by the floor of the orbit, whereas the floor is formed by the alveolar process (rontal sinuses %ontained by frontal bone wo in number )eparated from each other by a bony septum "ach sinus is roughly triangular, extending upward above the medial end of the eyebrow and backward into the medial part of the roof of the orbit ,ts mucous membrane is supplied by the supraorbital nerve )phenoidal sinuses Lie within the body of sphenoid bone wo in number

,ts mucous membrane is supplied by the posterior ethmoidal nerves

1ugular foramen "thmoidal sinuses %ontained within ethmoid bone, between nose and the orbit )eparated from the orbit by a thin plate of bone ?ivided into three groups: Anterior group 7iddle group Posterior group

surface of the temporal bone, behind the rough surface of the apex @ehind the carotid canal

internal carotid artery and nerve plexus ;lossopharynge al nerve -,K.; vagus nerve -K.; accessory nerve -K,.; inferior petrosal sinus, sigmoid sinus; internal +ugular vein "missary vein

,ondylar canal

Important openings o t(e #ase o t(e s)ull an% t(e structures t(at pass t(roug( t(em Opening at t(e #ase o s)ull ,ncisive foramen' two lateral apertures namely' 3oramina o Stenson 3oramina o Scarpa 0reater palatine foramen Lesser palatine foramen ,terygoi% canal (oramen o-ale $ocation immediately behind the incisor teeth! Structures t(at passes on t(ese openings 2asopalatine nerve; sphenopalatine vessel

2astoid foramen

Posterior angle of the hard palate; larger opening Posterior to greater palatine foramen; smaller opening @ase of pterygoid process @ase of pterygoid process

;reater palatine nerve and vessel Lesser palatine nerve and vessel ransmission of a nerve and artery 7andibular division of the trigemal nerve -14.; lesse petrosal nerve (illed with cartilage in living

*tylomastoid foramen %ypoglossal canal

(ormen magnum

,n the lateral parts of occipital bone, behind either condyle is a depression, the condyloid fossa, which receives the posterior margin of the superior facet of the atlas when the head is bent backward he outer surface of the temporal bone is perforated by numerous foramina; one of these, of large si*e, situated near the posterior bor base of this styloid process ,t lies in the epiphyseal +unction between the basiocciput and the +ugular process of the occipital bone! @ehind the basilar portion of the occipital bone; bounded laterally by the occipital condyles

it transmits a vein to the transverse sinus and a small branch of the occipital artery to the dura mater! (acial nerve -1,,. >ypoglossal nerve -K,,.; meningeal branch of the ascending pharyngeal artery "nd of brain stem3 beginning of the spinal cord; vertebral arteries, spinal roots of the accessory nerve; meninges

(oramen lacerum

(oramen rotundum (oramen spinosum ,arotid canal

At the base of the medial pterygoid plate is a large and somewhat triangular aperture or opening; bounded in front by the great wing of the sphenoid, behind by the apex of the petrous portion of the temporal bone, and medially by the body of the sphenoid and basilar portion of the occipital bone @ase of pterygoid process )ituated on the outer side of the foramen ovale, in a posterior angle <n the interior

7axillary division of the trigemal nerve -15. 7iddle meningeal artery "missary vein;

>Dangerous area? o t(e ace he danger triangle of the face is situated at the nose portion! 1eins -facial vein. in this area communicate with the dural sinuses through

the superior and inferior ophthalmic veins -veins of the eyeball., which drain into the cavernous venous sinuses of the dura matter!

?angerous area of <f the face

@ounded by the facial vein! Anatomical explanation: ,nfection of the dangerous area may spread to the dual sinuses infecting brain and meninges due to the communication of veins! Bloo%supply *arterial supply an% venous %rainage-+ lymp(atic supply an% nerve supply o t(e muscles o t(e (ea% A0 "0,AL )BPPLC <( >" (A%" (ace receives a rich blood supply from 5 main vessels: acial and super icial temporalis arteries which are supplemented by sacral small arteries that accompany the sensory nerves of the face! 3ACIA$ ART"RY -coiled. ?escription: ma+or vessel supplying the face <rigin: external carotid artery %ommencement:angular mouth ermination: <phthalmic artery %ourse: "xternal carotid artery, arches upward to the submandibular salivary gland! ,t curves around the inferior margin of the body of the mandible towards the anterior border of the masseter muscle -pulse can be easily felt.! ,t runs upward in a tortuous course toward the angle of mouth! Ascends deep into the *ygomaticus muscles and the levator labii superioris! 7oves to the nose then to the medial angle of the eye where it anastomoses with the terminal branches of the ophthalmic artery! BRANC1"S ORIGIN AR"A*S- S=,,$I"D *ubmental artery (acial artery at the lower border of the mandible )upplies the skin of the chin and lower lip !nferior labial artery Arises near the angle of the mouth 0uns medially in the lower lip and anastomoses with its fellow of the opposite side *uperior labial artery Arises near the angle of the mouth 0uns medially in the upper lip and gives branches to the septum and ala of the nose Lateral nasal artery Arises from the facial artery alongside the nose )upplies the skin on the side and down the nose S=,"R3ICIA$ T"M,ORA$ ART"RY ?escription: smaller terminal branch of the external carotid artery <rigin:commences in the parotid gland %ourse3area supplied: ascends in front of the auricle to supply the scalp BRANC1 ORIGIN AR"A*S- S=,,$I"D Trans-erse facial artery Arises within parotid gland 0uns forward across the cheek +ust above the parotid duct! MA/I$$ARY ART"RY ?escription: larger of the two terminal branches of the external carotid artery <rigin: "xternal carotid artery %ourse3Area supplied: branch of several branches which contribute to the arterial supply to the face BRANC1"S ORIGIN AR"A*S- S=,,$I"D !nfra3orbital artery "nters the face through the infra-orbital foramen )upplies the lower eyelid, upper lip, and the area between these structures! Buccal artery "nters on the superficial surface of the )upplies structures near the buccinator muscle buccinator muscle 2ental artery "nters through the mental foramen )upplies the chin O,1T1A$MIC ART"RY ?escription: a branch of the internal carotid artery <rigin: internal carotid artery %ourse3Area supplied: enters the orbit BRANC1"S ORIGIN AR"A*S- S=,,$I"D *upraorbital artery @ranches of the ophthalmic artery that enters )upply the skin of the forehead -anterior scalp. the orbit *upratrochlear artery @ranches of the ophthalmic artery that enters )upply the skin of the forehead -anterior scalp. the orbit 4ygomaticofacial artery %omes from the lacrimal branch of the )upplies the area of the face over the *ygomatic ophthalmic artery bone "nters the face through the *ygomatocifacial formane $orsal nasal artery erminal branch of the ophthalmic artery )upplies the dorsum of the nose "xits in the medial corner

1"2<B) ?0A,2A;" <( >" (A%" 3ACIA$ <"IN -straight. ?escription: 7a+or vein draining the face <rigin: 2ear the medial corner of the orbit as the supratroc(lear and supra!or#ital veins come together to form the angular vein! his vein becomes the facial vein as it proceeds inferiorly and assumes a position +ust posterior to the facial artery! %ommencement: )upratrochlear and supra-orbital veins to form the angular vein ermination: +oins the +ugular vein %ourse3Area supplied: (acial vein descends across the face with the facial artery until it reaches the inferior border of the mandible! >ere the artery and vein part company and the facial vein passes superficial to the submandibular gland to enter the +ugular vein! (acial vein receives tributaries from veins draining the eyelids, external nose, lips, cheek, and chin that accompany the various branches of the facial artery! ributaries of the facial vein: his is +oined by the pterygoid venous plexus by the %eep acial vein and to the cavernous sinus by the superior ophthalmic vein! Transverse acial vein +oins the superficial temporal vein within the parotid gland! LC7P> ?0A,2A;" <( >" (A%" Lymphatic drainage from the face primarily moves towards three groups of lymph nodes! GRO=,S O3 $YM,1 NOD"S $OCATION *ubmental nodes ,nferior and posterior to the chin *ubmandibular nodes )uperficial to the submandibular gland and inferior to the body of the mandible

Pre3auricular and parotid

2odes anterior to the ear

ACTION*S?rains the medial part of the lower lip and chin bilaterally ?rain lymphatics from the medial corner of the orbit, most of the external nose, medial part of the cheek, the upper lip and the lateral part of the lower lip that follow the course of the facial artery ?rains most of the eyelids, a part of the external nose, and the lateral part of the cheek

2"01" )BPPLC he nerve supply of the muscles of the face is the nerve of the second pharyngeal archSthe seventh cranial nerve -(acial 2erve.! ,t is divided into five terminal groups of branchesStemporal, *ygomatic, buccal, marginal mandibular, and cervical branches! 7< <0 2"01") <( >" (A%" 3ACIA$ N"R<" -%ranial 2erve 1,,. ?efect: @ells palsy3paralysis <rigin and %ourse: "merges as two roots from the anterior surface of the hindbrain between the pons an% t(e me%ulla o#longata! he roots pass laterally in the posterior cranial fossa with the vestibulocochlear nerve and enter the internal acoustic meatus in the petrous part of the temporal bone! At the bottom of the meatus, the nerve enters the facial canal that runs laterally through the inner ear! ,t then becomes related to the middle ear and the aditus to the tympanic antrum and emerges from the canal through the stylomastoid foramen! he nerve now passes forward through the parotid gland to its distribution! Areas supplied: )upplies the muscles of the face, cheek and scalp; the stylohyoid; the posterior belly of the digastric muscles of the neck; the stapedius muscle of the middle ear! Action: %ontrols facial expression, salivation and lacrimation and is a pathway for taste sensation from the anterior part of the tongue and floor of the mouth and from the palate! BRANC1"S Temporal branch 4ygomatic branch Buccal branch 2arginal mandibular branch ORIGIN )uperior border of the parotid gland "merge from the anterosuperior border of the parotid gland Anterior border of the parotid gland "merge from the anteroinferior border of the parotid gland ,nferior border of the parotid gland AR"A*S- S=,,$I"D 7uscles in the area of the temple, forehead and supra-orbital area 7uscles in the infra-orbital area, the lateral nasal area, and the upper lip 7uscles in the cheek, the upper lip, and the corner of the mouth 7uscles of the lower lip and chin

,er-ical branch )upplies the platysma )"2)<0C 2"01") <( >" (A%" TRIG"MINA$ N"R<" *Cranial nerve <?escription: Largest of the cranial nerves %ourse: Leaves the anterior aspect of the pons as the small motor root and a large sensory root! he nerve passes forward from the posterior cranial fossa to reach the apex of the petrous part of the temporal bone in the middle cranial fossa! ,t has 4 divisions! Areas supplied: supplies the skin and face, proprioceptive fibers to the underlying muscles of facial expression! he sensory nerve supply to the mouth, teeth, nasal cavities and paranasal sinuses! DI<ISIONS BRANC1"S AR"A*S- S=,,$I"D .phthalmic 5er-e Lacrimal ner-e )kin, con+unctiva of lateral part of the upper eyelid

)upplies the skin of the forehead, upper eyelid, con+unctiva, side of the nose down to and including tip!

2a illary 5er-e )upplies the skin on the posterior part of the side of the nose, the lower eyelid, the sheek, the upper lip and the lateral side of the orbital opening!

2andibular 5er-e )upplies the skin of the lower lip, the lower part of the face, the temporal region, and part of the auricle! ,t then passes upward the side of the scalp!

*upraorbital ner-e (winds around the upper margin of the orbit at the supraorbital notch. *upratrochlear ner-e -winds around the upper margin of the orbit medial to the supraorbital nerve. !nfratrochlear ner-e -leaves the orbit below the pulley of the superior obli/ue muscle. E ternal nasal ner-e -leaves the nose by emerging between the nasal bone and the upper nasal cartilage. !nfraorbital ner-e -direct continuation fo the maxillary nerve! "nters the orbit and appears on the face through the infraorbital foramen! ,t immediately divides into numerous small branches, which radiate out from the foramen. 4ygomaticofacial ner-e -passes onto the face through a small foramen on the lateral side of the sygomatic bone. 4ygomaticotemporal ner-e -emeges in the temporal fossa through a small foramen on the posterior surface of the *ygomatic bone. 2ental ner-e -emerges from the mental foramen of the mandible. Buccal ner-e -emerges from beneath the anterior border of the masseter muscle. "uriculotemporal ner-e -ascends from the upper border of the parotid gland between the superficial temporal vessels and the auricle.

)kin and con+unctiva -central part of upper eyelid., skin of the forehead )kin and con+unctiva -medial part of upper eyelid., skin on the lower part of the forehead -close to the median plane. )kin and con+unctiva on the medial part of the upper eyelid and the ad+oining part of the side of the nose )kin on the side of the nose down as far as the tip )kin of the lower eyelid and cheek, side of the nose, and the upper lip

)kin over the prominence of the cheek )kin over the temple

)kin of the lower lip and chin )kin over a small area of the cheek )kin of the auricle, the external auditory meatus, the outer surface of the tympanic membrane, and the skin of the scalp above the auricle!

N"CK

ANT"RIOR AS,"CTS )ymphysis menti )ubmental triangle he lower margin can be felt where the two halves of the body of the mandible unite in the midline his lies between the symphysis menti and the body of the hyoid bone! ,t is bounded anteriorly by the midline of the neck, laterally by the anterior belly of the digastric muscle, and inferiorly by the body of the hyoid bone! he floor is formed by the mylohyoid muscle! he submental lymph nodes are located in this triangle Lies opposite the 4rd cervical vertebra (ills in the interval between the hyoid bone and the thyroid cartilage his notched structure lies opposite the &th cervical his structure fills in the intercal between the cricoid cartilage and the thyroid cartilage An important landmark in the neck that lies at the level of the 9th vertebra, at the +unction of the larynx with the trachea, at the level of the +unction of the pharynx with the esophagus, at the level of the middle cervical sympathetic ganglion, and at the level where the inferior thyroid artery enters the thyroid land! his structure fills in the interval between the cricoid cartilage and the # st ring of the trachea! (elt by gentle palpitation +ust above the isthmus of the thyroid gland Lies in front of the 5nd, 4rd, and &th rings of the trachea Lies in front of the 5nd, 4rd, and &th rings of the trachea Ahen present, this artery ascends in front of the trachea to the isthmus of the thyroid gland from the brachiocephalic artery %onnects the 5 anterior +ugular velas +ust above the suprasternal notch @etween anterior ends of the clavicle, superior border f manubrium sterni; opposite lower body of 5

@ody of the hyoid bone hyrohyoid membrane Bpper border of the thyroid cartilage %ricothyroid ligament %ricoid cartilage

%ricotracheal ligament #st ring of the trachea ,sthmus of the thyroid gland ,nterior thyroid veins hyroidea ima artery =ugular arch )uprasternal notch ,OST"RIOR AS,"CTS external occipital protuberance nuchal groove ligamentum nuchae -cervical spines #-9. $AT"RA$ AS,"CT )ternocleidomastoid muscle rape*ius muscle Platysma muscle 0oot of the neck Anterior triangle of the neck %arotid sheath Posterior triangle of the neck 0oots of the trunk of the brachial plexus 4rd part of the subclavian artery "xternal +ugular vein )alivary glands

Lies in the midline at the +unction of the head and neck

?ivides the neck into anterior and posterior triangle "xtends from the superior nuchal line of the occipital bone, downward and forward to the posterior border of the lateral 4rd of the clavicle "xtends from the body of the mandible downward over the clavicle onto the anterior thoracic wall! Present are the suprasternal notch in the midline anteriorly and the clavicles! At the medial end of the clavicle, the sternoclavicular +oint can be identified he isthmus of the thyroid gland lies in front of the 5nd, 4rd, and &th rings of trachea! he lateral lobes can be palpated deep to the sternocleidomastoid muscle! %arotid sheath 7arked out by a line +oining the sternoclavicular +oint midway between the tip of the mastoid process and the angle of the mandible he spinal part of the accessory nerve is superficial as it emerges from the posterior border of the sternocleidomastoid and runs downward and backward to pass beneath the anterior border of the trape*ius! <ccupy the lower anterior angle of the posterior triangle <ccupy the lower anterior angle of the posterior triangle Lies in the superficial fascia deep to the platysma Parotid, submandibular and sublingual glands can be palpated <pens into the mouth on the side of the frenulum of the tongue

Main Arteries+ main veins+ main lymp( no%es an% main nerves o t(e nec) 7A,2 A0 "0,") #! Common Caroti% Artery *CCA 0uns upwad through the neck, from the sternoclavicular +oint o the upper border of the thyroid cartilage where it divides into ext and internal carotid arteries erminal part shows a locali*ed dilatation: carotid sinus -serves as a reflex pressoreceptor mechanism. "mbedded in the carotid sheath throughout its course;ives off no branches apart fr! the 5 terminal branches a! 0ight common carotid artery: arises from the brachiocephalic artery behind the right sternoclavicular +oint b! Left common carotid artery: arises from the arch of aorta in the superior mediastinum 0elations: anteriorlaterally )kin, fascia, sternocleidomastoid, sternohyoid, sternothyroid, omohyoid Posteriorly %ervical vertebra, prevertebrl muscles, vertebral musces, sympathetic trunk 7edially Larynx, pharynx, trachea, esophagus Laterally ,nternal =ugular vein and vagus vein 50 "2ternal Caroti% Artery *"CA <ne of the terminal branches of the %%A; supplies the neck, face, scalp, tongue and maxilla @egins at upper border of thyroid cartilage H terminates at subs of the parotid gland Lies w3in the carotid triangle 0elations: Anteriolaterally )kin, fascia, hypoglossal nerve, pos! belly of digastric muscle, stulohyoid muscles, internal +ugular vein, facial nerve Aall of the pharynx, internal carotid artery, stylopharyngeus muscle, glossopharyngeal nerve, pharyngeal branch of vagus #. 5. 4. &. $. 9. '. L. superior thyroid artery ascending pharyngeal artery lingual artery facial artery occipital artery post auricular artery superficial temporal artery maxillary artery

0elations Anteriolaterally Posteriorly 7edially Laterally

)kin, fascia, ant border of sternocleidomastod, hypoglossal nerve )ympathetic trunk, longus capitis muscle, transverse process of 4 upper cervical vertebrae Pharyngeal wall and superior laryngeal nerve ,nternal +ugular vein

7A,2 1",2) #! Internal 7ugular <ein *I7< receives blood from th brain, face, neck begins at the +ugular foramen in the skull as a continuation of the sigmoid sinus dilatatios: superior bulb 0elations Anteriolaterally )kin, fascia, steirnocleidomastoid, parotid-salivary gland, stylohyoid, spinal part of accessory nerve, post belly of digastric Posteriorly Levator scapula, scalenus medius and ant, cervical plexus, phrenic nerve, vertebral vein, thyrocervical trunk 7edially ,%A, cranial nerve -T, #8, ##, #5., %%A and vagus nerve ributaries a! inferior petrosal sinus b! facial vein c! pharyngeal vein d! lingual vein e! superior thyroid vein f! middle thyroid vein g! occipital vein 7A,2 LC7P>2<?") #! Deep Cervical $ymp( No%es from a chain along the anteriolateral surface of the ,=1 embedded in the carotid sheaths and receive afferent lymph vessels from neighboring structures efferent vessels +oin to from the +ugular lymph trunk -drains to the thoracic duct. 7A,2 2"01") <( >" 2"%R #! <agus nerve composed of both motor and sensory fibers; originates in the medulla oblongata and leaves the skull through the middle +ugular foramen posses 5 sensory ganglia: ganglion and inferior ganglion passes vertically down the neck w3ion the carotid sheath @ranches a. b. c. d. e. f. g. h. meningeal branch auricular branch pharyngeal branch superior laryngeal nerve internal laryngeal branch external laryngeal branch 5 or 4 cardiac branches recurrent laryngeal branch

7edially

@ranches:

4! Internal Caroti% Artery the other terminal branch of the %A; supplies the brain, eye, forehead and other part of the nose begins at the level of the upper border of the thyroid cart and ascends in the neck to the base of he skull

5! Accesory Nerve composed of motor fibers; formed by the union of cranial roots -arises fro the medullar oblongata. and spinal roots -arises fr $ upper cervical segements. 4! >ypoglossal 2erve -#5th cranial nerve. motor nerve to the tongue muscles; arises in medulla oblongata descends bet ,%A and ,=1 @ranches a. b. c. d. menilingeal branch descending branch nerve to the thyrohyoid muscular branches t(e nec) an% t(eir

,21") ,2; LAC"0 <( ?""P %"01,%AL (A)%,A completely surrounds the neck, splitting to enclose the sternocleidomastoid and trape*ius muscles is attached posteriorly to the ligamentum nuchae roofs over the anterior and posterior trianglaes of the neck superiorly: splits to enclose submandibular and parotid glands o thickened to form stylomandibular ligament inferiorly: attached to the acromion, clavicle, and manubrium sterni

@oun%aries o t(e triangles o respective contents

>,2 P0" A0A%>"AL LAC"0 completely surrounds the thyroid gland , and binds the gland to the larynx encloses parathyroid gland and inverts the infrathyroid muscles

he neck can be divided into two ma+or triangles, with multiple smaller triangles: A0 Anterior triangle

@ordered by the anterior border of the )%7, midline of the neck, and the mandible 7uscular triangle- formed by the midline, superior belly of the omohyoid, and )%7 %arotid triangle-formed by the superior belly of the omohyoid, )%7, and posterior belly of the digastric )ubmental triangle- formed by the anterior belly of the diagastric, hyoid and midline )ubmandibular triangle- formed by the mandible, posterior belly of the digastric, and anterior belly of the digastric

P0"1"0 @0AL LAC"0 covers the prevertebral muscles: longus capitis and longus cervicus passes around the neck 5b attached to the ligamentum nuchae the posterior triangle forms the fascial floor interval b3n pharynx and the prevertebral fascia is called the retropharyngeal space

B0

,osterior triangle! #or%ere% #y t(e posterior #or%er o t(e SCM+ trapeAius an% clavicle )upraclavicular triangle-formed by the inferior belly of the omohyoid, clavicle and )%7 <ccipital triangle-formed by inferior belly of the omohyoid, trapea*ius and )%7

>Dangerous area? o t(e nec) he layers of the deep cervical fascia are dangerous parts of the neck consists of areolar tissues that supports the muscles, vessels, and the viscera of the neck in certain areas, it condensed to form aa welldefined fibrous sheets called the investing layer+ the pretrac(el layer and the preverte#ral layer also condensed to form the carotid vessels to form carotid sheath

CARDIO<ASC=$AR #! 1"ART an organ whose function is to pump the blood it is a cone-shaped, hollow muscular organ about #5cm long from base T cm wide at its widest point and 9cm thick! it has four chambers separated by a septa -septum is a wall that separa chambers. and valves! consists of two pumps in series: -#. one pump propel blood through the lungs for exchange of oxygen and carbon dioxide -the pulmonary circulation. -5. pump propels blood to all other tissues of the body -the systemic circulation. the bulk of the heart lies beneath the sternum and between the lungs an mediastenium! (unctional Anatomy of the >eart >eart located in the thoracic cavity3 mediastinum which supplies energy to propel blood throughout the body primary function is to 7A,2 A,2 %,0%BLA ,<2 so that an ade/uate supply of blood of sufficient pressure is delivered to the tissues "very 5& hours, each half of the heart contracts more than #88,888 times, pumping over 98 barrels of blood ;ross )tructure of the >eart -<utline. #! (ibrous )keleton 6 interconnected rings of dense fibrous % ; provide firm attachment sites for valves, insertion of muscles

5!

Layers a! "ndocardium b! 7yocardium c! Pericardium - consists of (ibrous pericardium outer sac; network of collagenous fibrous tissues upper end is continous with the external coasts of the great vessels base is attached to central tendon in diaphragm )erous pericardium ,nner sac; 5 layers: -#. visceral pericardium -epicardium. - adherent to outer muscles - extends to the great vessels and reflected back to form the: 5! -5. parietal epicardium 6 lines fibrous epicardium

&!

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1alves ring-like shelves of reflected endocardium wJc are responsible for unidirectional flow of blood & valves: 5 Atrioventricular -7itral H ricuspid.; 5 )emilunar -Aortic and Pulmonary. <pening and closing: due to pressure gradient across valves Papillary 7uscles muscular columns U inner surface of the ventricles w3c pro+ect like papillae presence of delicate fibrous strands 6 %><0?A" "2?,2A" 6 that extends upward to be attached to A-1 leaflets contract when the 1entricular Aalls contract during w3c they pull the vanes-leaflets. of the valves inward toward the ventricles to prevent their bulging too far backward toward the atria

B$OOD <"SS"$S ma+or blood vessels carry blood to or from the heart, and are connected to smaller vessels to form a closed system! hese are composed of : a! the ART"RI"S/ a series of efferent vessels that becomes smaller as they branch, and whose function is to carry the blood, with nutrients and oxygen, to the tissues! b! the CA,I$$ARI"S+ the smallest blood vessels, constituting a complex network of thin tubules that anastomose profusely and through whose walls the interchange between blood and tissues takes place! c! the <"INS+ which result from the capillaries into a system of channels! his channels become larger as they approach the heart toward which they convey the blood to be pumped again! these vessels form three ma+or circulatory pathways:

(unctions of the Pericardium: #! >elps anchor the heart 5! 0educes friction between the pulsating heart and its environment 4! Limits the distention of the heart during diastole %ardiac %hambers a! Atria - located posteriorly, thin-walled - muscles disposed into 5 sheets: -#.)uperficial3 <bli/ue sheets -5. ?eep 7uscle Layer - fiber bundles arranged U right angle with the superficial layer. (unctions of the Atria: #! )erves as an elastic reservoir and conduit from the venous bed to the ventricle 5! Possess booster pump action, enhancing ventricular filling and maintaining low mean arterial pressure 4! >elp bring about closure of the A-1 valves before ventricular systole b! 1entricles form base and anterior surface of the heart ventricular muscles are arranged in & layers: 5 )uperficial Layers: Super icial Sino Spiral muscle - < H , U ricuspid valve ring Super icial Bul#o Spiral muscle 6 < H , U 7itral 1alve ring 5 ?eep Layers: - act as circular constrictor muscle fibers Deep Sino Spiral Muscle encircles both ventricles Deep Bul#o Spiral muscle 6 encircles only left ventricle 4!

,=$MONARY CIRC=$ATION+ serving the respiratory portion of the lungs! CORONARY CIRC=$ATION, serving the heart wall itself! SYST"MIC CIRC=$ATION+ serving all other parts of the body! R"S,IRATORY Rig(t Bronc(us ,s wider, shorter and more vertical than the left bronchus Length: 5!$ cm long >as three divisions: )uperior Lobar @ronchus 7iddle Lobar @ronchus 0ight ,nferior Lobar @ronchus ;ives rise to its first branch, the superior lobar bronchus, enters the right lung opposite the fifth thoracic vertebra

A*ygos veins arches over it and the right pulmonary artery lies at first inferior, then anterior to it! After giving off the superior lobar bronchus, which arises posterosuperior to the right pulmonary artery, it crosses the posterior aspect of this artery to enter the pulmonary hilum posteroinferior to the artery! ,t then divides to a middle and inferior lobar bronchus! a! 0ight )uperior Lobar @ronchus Arises from the lateral aspect of the parent bronchus and runs superolaterally to enter the hilum! About # cm away from its origin, it divides into three segmental bronchi: Apical )egmental @ronchus - continues superolaterally towards the apex of the lungs, which it supplies, dividing near its origin into apical and anterior branches: the Posterior )egmental @ronchus and the Anterior )egmental @ronchus Posterior )egmental @ronchus - serves as the posteroinferior part of the superior lobe, passing posterolaterally and slightly superiorly and soon dividing into a lateral and a posterior branch, the Anterior )egmental @ronchus 0uns antero-inferiorly to supply the rest of the superior lobe it then divides near its origin into lateral and an anterior branch of e/ual si*e 7iddle Lobar @ronchus )tarts about 5 cm below the superior, from the front of the parent trunk, descends anterolaterally and soon divides into Lateral )egmental @ronchus 7edial )egmental @ronchus Passing to the lateral and medial part of the middle lobe respectively 0ight ,nferior Lobar @ronchus his is the continuation of the principal bronchus and beyond the origin of the middle lobar bronchus At a little below its origin from the principal bronchus, it gives off posteriorly a large superior -apical. segmental bronchus )uperior -apical. segmental bronchus 0uns posteriorly to the upper part of the inferior lobe, subse/uently dividing into: a! 7edial @ranch b! )uperior @ranch c! Lateral @ranch he first two branches usually arise from a common stem After giving off to the superior segmental branch, the continuing right inferior lobar bronchus descends posterolaterally! 7edial @asal )egmental bronchus branches from its anteromedial aspect, running inferomedially to serve a small region below the hilum!

4! &! $!

Anterior @asal )egmental @ronchus ?escends anteriorly Lateral @asal )egmental @ronchus ?escends laterally Posterior @asal )egmental @ronchus ?escends posteriorly ,n more than half all right lungs, a subsuperior -subapical. segmental bronchus arises posteriorly from the right inferior lobar bronchus # to 4 cm from the superior segmental bronchus! his is then distributed to the region of the lung between the superior and posterior basal lamina!

#!

5!

4!

$e t Bronc(us 2arrower and less vertical than the right Length: nearly $ cm long "nters the hilum of the left lung level with the sixth thoracic vertebra Passing left inferior to the aortic arch, it crosses anterior to the esophagus, thoracic duct and descending aorta he left pulmonary artery is at first, anterior and then superior to it >aving entered the hilum, it divides into: Left )uperior Lobar @ronchus Left ,nferior Lobar @ronchus a! Left )uperior Lobar @ronchus - Arising anterolaterally from its parent stem, this bronchus curves laterally and divides into: i! )uperior ?ivision 6 continues a further # cm, and gives off: Anterior )egmental @ronchus; further # cm, it gives off : Apicoposterior )egmental @ronchus before giving off Apical and Posterior @ranches ii! ,nferior ?ivision 6 descends anterolaterally to the anteroinferior part of the left superior lobe -the lingual. forming the : lingular bronchus which divides into )uperior lingular segmental bronchi ,nferior lingular segmental bronchi b! Left ,nferior Lobar @ronchus - descends posteriorly for # cm and then the : i! )uperior-apical. bronchus rises posteriorly and distributes essentially the same as in the right lung ii! Anteromedial stem 6 divides into medial basal and anterior basal segmental bronchi iii! Posterolateral stem 6 divides into lateral and posterior basal segmental bronchi! )upplies all

b!

#! 5!

c!

#!

5!

same territories as those of the right! R"NA$ Ki%ney -

,liohypogastric nerve ,liolingual nerve

0eddish brown in fresh state @ean-shaped, retroperitoneal in the posterior abdominal region Lie in the extraperitoneal connective tissue immediately lateral to the vertebral column Located on the posterior abdominal wall, behind the peritoneum, on each side of the vertebral column, surrounded by adipose tissues "ach kidney is ## cm in length, 9 cm in breadth and 4 cm in anteroposterior dimension Average weight: #$8 grams -men.; #4$ grams -women. Long axis of each kidney 6 inferolateral; transverse axis 6 posteromedial )uperiorly at the level with the upper border of the #5th thoracic vertebra, inferiorly with the 4rd lumbar vertebra Rig(t )i%ney )lightly inferior to the left )uperior pole is anterior to the #5th rib $e t Ki%ney longer and narrower than the right lies nearer the median plane #!$ cm longer than the right )uperior pole is anterior to ##th and #5th ribs

$e t )i%ney Anteriorly )uperior pole 6 left suprarenal gland -medial side.; intraperitoneal stomach and spleen ,nferiorly 6 retroperitoneal pancreas -mid-part of the kidney. Lateral side 6 left colic flexure and the beginning of the descending colon -lower half of the kidney .; intraperitoneal +e+enum -medial side. Posteriorly )uperiorly 6 diaphragm ,nferiorly -medial to lateral direction. 6 psoas ma+or, /uadratus lumborum, transversus abdominis muslces %ostodiaphragmatic recess )ubcostal vessels and nerves ,liohypogastric nerve ,liolingual nerve

Ki%ney Structure 1ilum Located at the medial margin of each kidney ?eep vertical slit through which renal vessels, lymphatics and nerves enter and leave the substance of the kidney %ontinuous with the renal sinus

Coverings' 3i#rous capsule 6 surrounds the kidneys outer surface ,erirenal at 6 covers the fibrous capsule Renal ascia 6 condensation of connective tissues which lie outside of the perirenal fat and encloses the kidneys and suprarenal gland ,ararenal at 6 lies external to the renal fascia

Renal corte2 ?ark brown, outer portion %ontinuous band of pale tissue that completely surrounds the renal medulla o Renal columns 6 extensions of the renal cortex into the medulla between ad+acent pyramids; pro+ections into the inner aspect of the kidney dividing the renal medulla into renal pyramids

Relations o t(e )i%neys' o Rig(t )i%ney Anteriorly )uperior pole 6 right suprarenal gland Anterior surface 6 liver; separated by a layer of peritoneum 7edial surface 6 descending part of the duodenum ,nferior pole 6 right colic flexure -laterally.; segment of the intraperitoneal small intestine -medially. Posteriorly )uperiorly 6 diaphragm ,nferiorly -medial to lateral direction. 6 psoas ma+or, /uadratus lumborum, transversus abdominis muslces %ostodiaphragmatic recess )ubcostal vessels and nerves Renal me%ulla Light brown, inner portion o Renal pyrami%s - base oriented toward the cortex Me%ullary ray: striations extending from the bases of the renal pyramids into the cortex Renal papilla 6 pro+ects medially which indents the minor calyces Renal sinus 6 space within the hilum that contains the renal pelvis Renal pelvis 6 upper expanded portion of the ureter which divides into ma+or calyces -5-4 minor calyces.

o o o

Left renal vein %rosses anterior to the renal arteries and aorta going towards the inferior vena cava ributaries: left testicular -ovarian. vein and left suprarenal vein 0ight renal vein )hort 2o tributaries

Bloo% Supply Arteries Aorta V Renal Artery V : Segmental Arteries - enters each hilum - > in front H ? behind renal pelvis V $o#ar Arteries - arise from each segmental artery one for each renal pyramid V 8 Interlo#ar Arteries - run toward the cortex on each side of renal pyramid V Arcuate Arteries - +unction of cortex H medulla - arch over bases of pyramid V Several Interlo#ar Arteries - Ascend in the cortex V A erent Glomerular Arterioles - each intracts with glomerular portion of nephron H breaks into capillary network B Glomerulus V " erent Glomerular Arterioles V ,eritu#ular Capillaries -surrounds tubules. - reunite to form venous channels through which blood ultimately leaves the kidney Renal artery Lateral branch of abdominal aorta )upplies each kidneys Arise inferior to the origin of the superior mesenteric artery between the vertebra L# and L5 o Left renal artery arises a little higher than the right lies posterior to left renal vein 0ight renal artery longer and passes posterior to the inferior vena cava posterior to the right renal vein and inferior vena cavea anterior to right renal pelvis

$ymp( %rainage Lateral aortic nodes Nerve supply 0enal sympathetic plexus Afferent fibers enter the spinal cord in the #8th, ##th and#5th thoracic nerves

=R"T"R 7uscular tubes that extend from the kidneys to the posterior surface of the urinary bladder 4 %<2) 0,% ,<2): (,0) 6 where the renal pelvis +oins the ureter )"%<2? 6 where it is kinked as it crosses the pelvic brim >,0? 6 where it pierces the bladder wall 0"LA ,<2): 0ight Breter -Anterior. ?uodenum erminal ileum 0ight colic H ileocolic vessels 0ight testicular3ovarian vessels 0oot of the mesentery of the small intestine 0ight Breter -Posterior. 0ight psoas %ommon iliac artery -bifurcation of the right common iliac artery. Left Breter -Anterior. )igmoid colon Left colic vessel )igmoid mesocolon Left testicular3ovarian vessels Left Breter -Posterior. Left psoas %ommon iliac artery -bifurcation of the left common iliac artery @L<<? )BPPLC <( >" B0" "0 Artery: Bpper end 6 renal artery 7iddle portion 6 testicular3ovarian artery Pelvis portion 6 superior vesical artery 1ein: 0espective corresponding arteries LC7P> ?0A,2A;": drains to the lateral aortic nodes H iliac nodes 2"01" )BPPLC:

Renal veins (ormed by multiple renal veins Anterior to the renal arteries

0enal, testicular3ovarian and hypogastric plexus in the pelvis! Afferent fibers travel with sympathetic nerves and enter the spinal cord in the #st and 5nd lumbar segments

o o o o

=R"T1RA ! 3"MA$" about # W in -4!L cm. and 9 mm in diameter 6 prone to B , due to shortness3nearness to vagina or anus extends from the neck of the bladder to the external meatus, where it opens into the vestibule about # in below the clitoris traverses the sphincter urethrae and lies immediately in front of the vagina openings of the ducts of the paraurethral glands 6 found at the sides of the external urethral meatus Brethral crest 6 during the passage of urine, the anterior and posterior walls of the urethra are in apposition and the epithelium is thrown into longitudinal folds, one of which, on the posterior wall of the canal can be dilated relatively easy exclusive for urine only Arteries vesical and vaginal -principal. arteries <eins he venous plexus around the urethra drains into the vesical venous plexus around the bladder neck, and into the internal pudendal veins! An erectile plexus of veins along the length of the urethra is continuous with the erectile tissue of the vestibular bulb! $ymp(atic %rainage ,nternal and external iliac nodes Innervation Parasympathetic preganglionic fibers from the 5nd to the &th segments of the sacral spinal cord run in the pelvic splanchnic nerves and synapse in the vesical plexus in or near the bladder wall! Postganglionic fibers are distributed to the smooth muscle of the urethral wall! )omatic fibers 6 derived from the same sacral segments but do not synapse with vesical plexus )ensory fibers 6 run in the pelvic splanchnic nerves to the second to fourth segments of the sacral spinal cord! MA$" =R"T1RA #L-58cm long extends from the internalorifice in the urinary bladder to the external opening at the end of the penis -meatus. 5 Parts: Anterior -A. and Posterior -P. Brethra A: #9cm long, lies within the perineum -proximally. and the penis -distally. surrounded by the corpus spongiosum ,ro2imal component 6 bulbar urethra; surrounded by bulbospongiosus and entirely within the perineum ,en%ulous or ,enile Component 6 continues on the top of the penis P: &cm long, lies in the pelvis proximal to the corpus spongiosum, acted upon by the urogenital sphincter mechanisms Preprostatic urethra Prostatic Brethra 7embranous Brethra

flaccid penis 6 urethra has double curve urethral canal 6 mere slit, except the passage of fluid; in transverse section: transversely arched in the prostatic part, stellate in thepreprostatic and membranousportions, transverse in the bulbar and penile portions and sagital 6 external orifice

P<) "0,<0 PA0 A! Preprostatic urethra - # cm in length - extends from the base of the bladder to the prostate - contribute to @P> and symptoms of outflow obstruction in older men @! Prostatic Brethra - 4-&cm in length; tunnels through the substance of the prostate - closer to the anterior surface of the gland - continues above with preprostatic part and emerges from the prostate slightly anterior to its apex Brethral crest 6 midline ridge; pro+ects into the lumen causing it to appear crescentic in transverse section Prostatic sinus 6 a shallow depression on each side of the crest; floor perforated by the orifices of #$-58 prostatic ducts 1erumontanum 6 elevation; seen at the middle of the length of the crest; used as surgical landmark for the urethral sphincter during transurethral resection for benign enlargement of the prostate; at this point the urethra turns anteriorly by 4$ degrees and contains the slit-like orifice of the prostatic urticle - 5 small openings of the "+aculatory ducts. Prostatic utricle 6 cul-de-sac, 9mm long which runs upwards and backwards in the substance of the prostate behind its median lobe - walls are composed of fibrous tissue, muscular fibers and mucous membrane -pitted by the openings of numerous small glands. - develops from the paramesonephric ducts or urogenital sinus and is thought to be homologous with the vagina -Mvagina masculineN - uterine homologue 6 MutricleN Lowest most part: fixed by puboprostatic ligaments; immobile %! 7embranous Brethra - shortest -5-5!$cm. - least dilatable - narrowest section -except external orifice. - descends with slightly ventral concavity from the prostate to the bulb of the penis, passing through the perineal membrane, 5!$ cm posteroinferior to the pubic symphysis - wall composed of muscle coat which is separated from epithelial lining by a narrow layer of fibroelastic % - muscle coat contains:

Xbundles of smooth muscle 6 thin layer; continuous proximally with those of the prostatic urethra Xstriated muscle fibers 6 prominent outer layer circularly oriented Y together form the e2ternal uret(ral sp(incter - B0,2A0C %<2 ,2"2%" mediated by: radial folds of urethral mucosa submucosal % intrinsic urethral smooth muscle striated muscle fibers pubourethral component of levator ani - muscle coat and puborectalis 6 surround the membranous urethra and are attached to the inner surface of the ischiopubic ramus; fibers also reach up to the lowest part of the neck of the bladder and lie on the surface of the prostate - striated external urethral sphincter 6 has a posterior fibrous defect and is inserted throughout its length into the perineal body - @ulbourethral glands 6 invested in sphincteric muscle and drain into the membranous urethra during sexual excitement A2 "0,<0 PA0 lies within the corpus spongiosum penis -flaccid penis. #$cm long and extends from the end of the membranous urethra to the external urethral orifice on the glans penis starts below the perineal membrane at a point anterior to the lowest level of the symphysis pubis as #ul#ar uret(ra 5 widest part of the urethra, surrounded by bulbospongiosus #ul#ouret(ral glan%s 6 open into bulbar urethra approx 5!$cm below the perineal membrane; curves downwards as the penile urethra! narrow, transverse slit when empty, diameter of approx 9 mm when passing urine, dilated at its termination within the glans penis where it is known as the navicular ossa e2ternal uret(ral ori ice 5 is the narrowest part of the urethra, sagittal slit, about 9 mm long, bounded on each side by a small labium <ASC=$AR S=,,$Y AND $YM,1ATIC DRAINAG" =R"T1RA$ ART"RY Internal pu%en%al arteryC common penile artery uret(ral artery -+ust below the perineal membrane and travels through the corpus spongiosum to reach the glans penis. 6 it supplies the urethra and erectile tissue around it %orsal penile artery via circum le2 #ranc(es on each side and retrogradely from the glans, by the terminal branches <"INS Anterior =ret(ra 6 dorsal veins of the penis and internal pudendal prostatic plexus

,osterior uret(ra 6 prostatic and vesical venous plexus internal iliac veins

$YM,1ATIC DRAINAG" Anterior uret(ra -accompany those of the glans penis deep inguinal nodes --some. super icial no%es; e2ternal iliac no%es ,osterior uret(ra -internal iliac nodes; external iliac nodes

INN"R<ATION ,rostatic ple2us supplies the smooth muscle of the prostate and prostatic urethraZ derived from the pelvic plexus and lies on the posterolateral aspect of the seminal vesicle and prostate $esser cavernous nerves pierce the bulb of the corpus spongiosum proximally to supply the penile urethra Greater cavernous nerves carry the sympathetic supply which causes contraction of the preprostatic sphincter during e+aculation and prevents reflux of e+aculate into the bladder Neurons o Onu Ds nucleus an% #y perineal #ranc(es o t(e pu%en%al nerve lying ?,;") ,1" Structures o t(e Anterior a#%ominal Eall' S)in Anterior abdominal wall extends from the costal margins and xiphoid process superiorly to the iliac crests pubis and pubic symphysis inferiorly overlaps and is connected to: posterior abdominal wall paravertebral tissues forms a continuous but flexible sheet of tissue across the anterior and lateral aspects of the abdomen composed of : the integument, muscles and connective tissue lining the peritoneal cavity important role in maintaining the form of the abdomen and is involved in many physiological activities! Anterior abdominal wall tissues form the inguinal canal ,nguinal %anal connects the abdominal cavity to the scrotum in men or labia ma+ora in women form the umbilicus both of these sites are of considerable clinical importance he abdominal wall covers a large area ,t is bounded : superiorly by the xiphoid process and costal margins posteriorly by the vertebral column inferiorly by the upper parts of the pelvic bones

,ts layers consist of skin, superficial fascia -subcutaneous tissue., muscles and their associated deep fascias, extraperitoneal fascia, and parietal peritoneum

)R,2 he integument of the anterior abdominal wall comprises o skin o o soft tissues lymphatic and vascular structures segmental nerves

outer layer is formed from the skin and subcutaneous fat

,n the male, this layer continues over the penis and outer surface of the spermatic cord into the scrotum o ,n outer surface of the spermatic cord it is generally thin very little adipose tissue present pale red in colour o ,n the scrotum it also contains smooth muscle fibres, which form the ?artos muscle o (rom the scrotum it may be traced backwards into continuity with the superficial fascia of the perineum ,n the female, it continues from the suprapubic skin of the abdomen into the labia ma+ora and perineum

)kin non-speciali*ed and variably hirsute, depending on the sex and race All post-pubertal individuals have some extension of the pubic hair onto the anterior abdominal wall skin -commonly most pronounced in male, in whom the hair may extend almost up to the umbilicus in a triangular pattern. )ubcutaneous fat of the abdominal walls highly variable in thickness one of the areas where excess fat is stored during periods of obesity, particularly in males

Super icial an% %eep ascia+ an% ormation o rectus s(eat( at 8 levels )uperficial fascia consists mostly of a single layer layer contains a variable amount of fat lies between the skin and muscles of the anterior abdominal wall ,n the lower part, the fascia differentiates into superficial and deep layers between which lie superficial vessels and nerves and, in the region of the groin, superficial inguinal lymph nodes! A! )uperficial layer -%amperJs (ascia. hick areolar in texture contains a variable amount of fat greatly thickened in obese individuals ,nferiorly, it lies superficial to the inguinal ligament and is continuous with the superficial fascia of the thigh

?eep -membranous. layer -)carpaJs (ascia. as a distinct entity, the deep layer of the fascia is more membranous than the superficial contains elastic fibres! ,t is loosely connected by areolar tissue to the aponeurosis of external obli/ue, but in the midline it is intimately adherent to the linea alba and symphysis pubis ,n the male, the deep layer extends onto the dorsum of the penis and forms part of the superficial ligament of the penis 0elations: )uperiorly, it is continuous with the superficial fascia over the remainder of the trunk ,nferiorly, it lies superficial to the inguinal ligament and fuses with the overlying superficial layer and the underlying fascia lata in the inguinal flexure line or skin crease of the thigh ,n the male, the deep layer of the fascia continues inferiorly and medially over the penis and spermatic cord to the scrotum, where it becomes continuous with the membranous layer of the superficial fascia of the perineum ,n the female, it continues into the labia ma+ora and is continuous with the fascia of the perineum )uperficial inguinal pouch space ,n the child, the testis can fre/uently be retracted out of the scrotum into the loose areolar tissue between external obli/ue and the deep layer of superficial fascia over the inguinal canal! ransversalis fascia thin layer of connective tissue between the inner surface of transversus abdominis and the extraperitoneal fat part of the general layer of fascia between the peritoneum and the abdominal wall Posteriorly, it is continuous with the anterior layer of the thoracolumbar fascia, forms a continuous sheet anteriorly ,nferiorly, it is continuous with the iliac and pelvic fasciae superiorly it blends with the fascial covering of the inferior surface of the diaphragm

@! -

,t is attached to the entire length of the iliac crest between the origins of transversus abdominis and iliacus and to the posterior margin of the inguinal ligament between the anterior superior iliac spine and the femoral vessels ,n the inguinal region it is thick and dense augmented by aponeurosis of transversus abdominis! 7edial to the femoral vessels it is thin and fused to the pubis behind the con+oint tendon Anterior to the femoral vessels, fascia extends down from the fascia transversalis to form the anterior part of the femoral sheath! o ransversely Arched (ibres -constitute the deep crural arch. )tregthen the fascia )ome fibres spread laterally towards the anterior superior iliac spine some fibres run medially behind rectus abdominis some descend to the pubis behind the con+oint tendon he curved fibres of the deep crural arch thicken the inferomedial part of the rim of the deep inguinal ring he spermatic cord in the male, or the round ligament of the uterus in the female, pass through the transversalis fascia at the deep inguinal ring opening is not visible during dissection through the skin because the transversalis fascia is prolonged on these structures as the internal spermatic fascia, but it can be seen from within the abdomen once the peritoneum has been stripped off he internal spermatic fascia surrounds the testis and blends with the areolar tissue on the parietal layer of the tunica vaginalis it may contain smooth muscle fibres!

variable in thickness on the anterolateral wall, where it is thin in children and normal adults but often thickened in the obese, particularly in males; scanty in the suprapubic region, above the iliac crest and in the pelvis

"xtraperitoneal tissue is continuous with the epimysium of the muscles of the abdominal wall

"xtraperitoneal connective tissue layer of areolar tissue between the peritoneum and the fasciae lining the abdominal and pelvic cavities amount of extraperitoneal tissue varies: abundant on the posterior wall of the abdomen, particularly around the kidneys, where it contains much adipose tissue;

0ectus sheath (ibrous sheath that encloses 0ectus abdominis Anterior portion of this sheath extends the entire length of the muscle and fuses with the periosteum of the muscle attachments! Posteriorly, the sheath is complete in the upper two-thirds of the muscle! ,n the lower one-third, the posterior layer of the sheath stops approximately midway between the umbilicus and the pubis arcuate line lower border of the posterior sheath @elow arcuate line, rectus abdominis is enclosed posteriorly by the transversalis fascia and extraperitoneal connective tissue rectus sheath is formed from decussating fibres from all three lateral abdominal muscles! "xternal obli/ue internal obli/ue transversus abdominis each muscle forms a bilaminar aponeurosis at their medial borders he fibres from all three anterior leaves run obli/uely upwards, whereas the posterior leaves run obli/uely downwards at right angles to the anterior leaves Anterior rectus sheath composed of both leaves of the aponeurosis of external obli/ue and the anterior leaf of the aponeurosis of internal obli/ue fused together Posterior rectus sheath composed of the posterior leaf of the aponeurosis of internal obli/ue and both leaves of the aponeurosis transversus abdominis @ecause of this arrangement, both the anterior and posterior layers of the rectus sheath consist of three layers of fibres with the middle layer running obli/uely at right angles to the other two At the midline, the anterior and posterior layers are closely approximated (ibres of each layer decussate: to opposite side of the sheath, forming a continuous aponeurosis with the contralateral muscles also decussate anteroposteriorly, crossing from anterior sheath to posterior sheath linea alba the dense fibrous line caused by this decussation maybe used to identify the midline during surgical incisions, since they can

be seen as obli/ue fibres crossing at right angles he external obli/ue, internal obli/ue and transversus abdominis muscles paired, digastric muscles with a central tendon in the form of the linea alba! hese decussating fibres @elow the level of the arcuate line, the fibres forming the posterior rectus sheath rapidly cease running behind the rectus and all leaves pass into the anterior rectus sheath

STOMAC1 AND ITS S"GM"NTS ?ilated portion of the alimentary canal 4 main functions: o stores food o mixes the food with gastric secretions to form c(yme o controls the rate of delivery of the chyme to the small intestine -for efficient digestion and absorption. situated in the upper part of the abdomen and extending from beneath the left costal margin into the epigastric and umbilical regions fixed at both ends but mobile in between 0oughly =-shaped and has 5 openings: o car%iac ori ices it is where the esophagus enters the stomach Physiologic mechanism: prevents regurgitation of stomach contents into the esophagus! o pyloric ori ices formed by the pyloric canal thicker circular muscle coat of the stomach forms the anatomic and physiologic pyloric sp(incter pyloric sp(incter 6 controls the rate of discharge of the stomach contents into the duodenum Lies on the transpyloric plane exhibiting a slight constriction on the surface of the stomach 5 curvatures: o greater curvature much longer than the lesser curvature "xtends from the left of the cardiac orifice over the dome of the fundus along the left border of the stomach to the pylorus Gastrosplenic omentum -ligament. extends from the upper part of the greater curvature to the spleen Greater omentum extends from the lower part of the greater curvature to the transverse colon o lesser curvature forms the right border if the stomach extends from the cardiac orifice to the pylorus it is suspended from the liver by the lesser omentum! 5 surfaces: o anterior surface o posterior surface ?ivided into following parts: o 3un%us ?ome-shaped and pro+ects upward and to the left of the cardiac orifice!

Bsually full of gas Bo%y "xtends from the level of the cardiac orifice to the level of the incisura angularis -a constant notch on the lower part of the lesser curvature. o ,ylorus ubular part of the stomach ,t has a thick muscular wall called pyloric sp(incter ,yloric canal 6 cavity of the pylorus 7ucous membrane of the stomach is thick and vascular is thrown into numerous folds, rugae -folds flatten when the stomach is distended. 7uscular wall of stomach: o %ontains: longitudinal fibers 6 most superficial and most concentrated along curvatures circular fibers 6 encircle the body of the stomach and greatly thickened at the pylorus! obli/ue fibers 6 form the innermost muscle coat Peritoneum -visceral peritoneum. completely surrounds the stomach o Leaves the lesser curvature as the lesser omentum o ;reater curvature as the gastrosplenic omentum and the greater omentum o

SMA$$ INT"STIN" Longest part of the alimentary canal "xtends from the pylorus of the stomach to the ileocecal junction Ahere greater part of digestion and food absorption takes place "ndocrine secretion also takes place ?ivided into: $uodenum %-shaped tube #8 in! -5$ cm. long situated in the epigastric and um#ilical regions +oins the stomach to the +e+enum important in receiving the openings of the bile and pancreatic ducts curves around the head of the pancreas ?st in. (&.@ cm) resembles the stomach[ covered with peritoneum on its anterior and posterior surfaces has the lesser omentum attached to its upper border greater momentum attached to its lower border lesser sac lies behind this short segment remainder of the duodenum is retroperitoneal ,arts o t(e Duo%enum -#. 3irst ,art 5 in! -$ cm. long begins at the pylorus runs upward and backward on the right side of the first lumbar vertebra

lies on the transpyloric plane 6elations7 Anteriorly Euadrate lobe of the liver gallbladder Posteriorly Lesser sac -#st inch only. ;astroduoden al artery @ile duct Portal vein ,nferior vena cava !uperiorly "ntrance into the lesser sac -epiploic foramen+ #nferiorly >ead of the pancreas

>ead of the pancreas @ile duct 7ain pancreatic duct

-4.

-5.

Secon% ,art 4 in! -L cm. long runs vertically downward in front of the hilum of the right kidney on the right side of L5 and L4! ?uodenal wall is pierced by the bile duct and main pancreatic duct about halfway down its medial border Bile %uct and main pancreatic %uct unite to form the ampulla that opens on the summit of the maFor %uo%enal papilla Accessory pancreatic duct -if present. opens into the duodenum a little higher up on the minor %uo%enal papilla 6elations7 Anteriorly (undus of the gallbladder 0ight lobe of the liver ransverse colon %oils of the small intestine Posteriorly >ilum of the right kidney 0ight ureter )aterally Ascending colon 0ight colic flexure 0ight lobe of the liver 9edially

T(ir% ,art 4 in! -Lcm. long rns hori*ontally to the left on the subcostal plane passes in front of the vertebral column and following the lower margin of the pancreas 6elations7 Anteriorly 0oot of the mesentery of the small intestine 1essels within the coils of the +e+enum Posteriorly 0ight ureter 0ight psoas muscle ,nferior vena cava aorta !uperiorly >ead of the pancreas #nferiorly %oils of +e+enum 3ourt( ,art 5 in! -$cm. long runs upward and to the left to the duodeno8e8unal fle ure held in position by the ligament o TreitA -peritoneal fold. attached to the right crus of the diaphragm 6elations Anteriorly5 @eginning of the root of the mesentery %oils of the +e+enum Posteriorly Left margin of the aorta 7edial border of the left psoas muscle Mucous Mem#rane an% Duo%enal ,apilla 2ucous membrane hick )mooth -first part of the duodenum.

-&.

hrown into numerous circular folds -plicae circularesMaFor %uo%enal papilla 0ounded elevation at the site where bile duct and the main pancreatic duct pierce the medial wall of the second part Accessory pancreatic %uct -if present. opens into the duodenum on a smaller papilla -8!'$ in3 #!T cm. above the ma+or duodenal papilla

1e8enum About Lft long @egins at the duodenojejunal flexure (reely mobile coils attached to the posterior abdominal wall by the mesentery of the small intestine (an-shaped fold of peritoneum Long free edge encloses the mobile intestine )hort root is continuous with the parietal peritoneum on the posterior abdominal wall along a line that extends downward and to the right from the left side of L5 to the region of the sacroiliac joint 0oot of the mesentery permits the entrance and exit of the superior branches of the superior mesenteric artery and vein, lymph vessels, and nerves into the space between the 5 layers of peritoneum forming the mesentery Lies coiled in the upper part of the peritoneal cavity below the left side of the transverse mesocolon Aider bored, thicker walled - due to larger, more numerous, and closely set plicae circulares)) , redder than the ileum =e+unal mesentery is attached to the posterior abdominal wall and to the left of the aorta =e+unal mesenteric vessels form only one or teo arcades, with long and infre/uent branches passing to the intestinal wall =e+unal end of the mesentery has fats deposited near the root and is scanty near the intestinal wall

Lies in the lower part of the peritoneal cavity and in the pelvis Bpper part of the ileum has smaller and more widely separated plicae circulares -absent in lower part) ,leal mesentery is attached below and to the right of the aorta 0eceives numerous short terminal vessels that arise from a series of three or four or even more arcades (at is deposited throughout the ileal end of the mesentery extending from the root to the intestinal wall ,eyerDs patc(es -aggregations of lymphoid tissue. are present in the mucous membrane of the lower ileum aong the antimesenteric border!

!leum About #5 ft long (reely mobile coils attached to the posterior abdominal wall by the mesentery of the small intestine

$ARG" INT"STIN" "xtends from the ileum to the anus! Primary function: absorption of water and electrolytes storage of undigested material until it can be expelled from the body as feces ?ivided into: ,ecum Lies below the level of the +unction of the ileum with the large intestine! @lind-ended pouch situated in the rig(t iliac ossa About 5!$ in -9 cm. long %ompletely covered with peritoneum Possesses a considerable amount of mobility -no mesentery. Appendix is attached to the posteromedial surface Presence of peritoneal folds in creates the superior ileocecal/ inferior ileocecal/ 9 retrocecal recess Taenia coli hree flat bands that restrict the longitudinal muscle -as in the colon. %onverge on the base of the appendix Provide the appendix with a complete longitudinal muscle coat <ften distended with gas and can be palpated through the anyerior abdominal wall At the +unctiom of the cecum with the ascending colon, the terminal part of the ileum enters the large intestine <pening id provided with 5 folds3lips with form the ileocecal valve Ileocecal valve 0udimentary structure %onsists of hori*ontal folds of mucous membrane that pro+ect around

the orifice of the ileum Plays little or no part in the prevention of reflux of cecal contents into the ileum !leocecal sphincter : circular muscle at the lower end of the ileum [ serves as sphincter and controls the flow og contents from the ileum into the colon [ smooth muscle tone is reflexly increased when the cecum is distended -gastrin! produced by stomach; relaxes muscle tone. 6elations7 Anteriroly5 %oils of small intestine )ometimes part of the greater omentum Anterior abdominal wall in the right iliac region Posteriorly Psoas ,liacus muscle (emoral nerve Lateral cutaneous nerve of the thigh Appendix -behind the cecum. 9edially Appendix arises from the cecum on its medial side "ppendi 2arrow, muscular tube containing a large amount of lymphoid tissue 1aries from 4 to $ in -L-#4 cm. @ase is attached to the posteromedial surface of the cecum about # in below the ileocecal +unction! he remainder of the appendix is free >as a complete peritoneal covering attached to the lower layer of the mesentery of the small intestine by the mesoappen%i2 7esentery of the appendix %ontains appendicular vessels and nerves Lies in the rig(t iliac ossa "ase is situated #34 of the way up the line +oining the right anterior superior iliac spine to the umbilicus -Mc BurneyDs point 2ommon Positions of the 'ip of the Appendix

>anging down into the pelvis against the right pelvic wall -most common) %oiled up behind the cecum -most common) Pro+ecting upward along the lateral side of the cecum (ront of or behind the terminal part of the ileum

"scending ,olon About $ in -#4 cm. long Lies in the rig(t loEer &ua%rant "xtends upward from the cecum to the inferior surface of the right lobe of the liver where it turns to the left to form the right colic fle ure and becomes continuous with the transverse colon Peritoneum covers the front and the sides of the ascending colon, binding it to the posterior abdominal wall 6elations7 Anteriorly %oils of small intestine ;reater omentum Anterior abdominal wall Posteriorly ,liacus ,liac crest Euadratus lumborum <rigin of the transverses abdominis muscle Lower pole of the right kidney ,liohypogastric and ilioingiunal cross behind it! Trans-erse ,olon About #$ in -4L cm8 long "xtends across the abdomen, occupying the unbilical region @egins at the right colic flexure below the right lobe of the liver >angs downward suspended by the transverse mesocolon from the pancreas Transverse mesocolon 7esentery of the transverse colon )uspends the transverse colon from the anterior border of the pancreas Attached to the superior border of the

transverse colon Posterior layers of the greater omentum attached to the vinferior border Position of % is extremely varioable because of the length of the transverse colon

Ascends to the le t colic le2ure below the spleen )uspended from the diaphragm by the p(renicocolic ligamentG 6elations7

Anteriorly ;reater omentum Anterior abdominal wall -umbilical and hypogastric regions. Posteriorly )econd part of the duodenum >ead of the pancreas %oils of the +e+enum and ileum

*igmoid ,olon #8-#$ in! -5$-4L cm. long begins as a continuation of the descending colon in front of the pelvic brim becomes continuous with the rectum in front of the )4 mobile and hangs down into the pelvic cavity in the form of a loop attached to the posterior pelvic wall by the sigmoi% mesocolon usually curves to the right of the midline +oining the rectum 6elations7 Anteriorly \ urinary baldder ] posterior surface of the uterus, upper part of the vagina Posteriorly 0ectum )acrum Lower coils of the terminal part of the ileum

,liac crest ,liacus Left psoas ,liohypogastric and ilioinguinal nerves Lateral cutaneous nerve of the thigh (emoral nerve

$escending ,olon About #8 in! -5$ cm. long Lies in the upper and lower /uadrants "xtends downwards from the left colic fle ure, to the pel-ic brim, where it becomes continuous with the sigmoid colon Peritoneum covers the front and the sides and binds it to the posterior abdominal wall 6elations7 Anteriorly %oils of the small intestine ;reater omentum Anterior abdominal wall Posteriorly Lateral border of the left kidney <rigin of the transverses abdominis muscle Euadratus lumborum

"NDOCRIN" ADR"NA$ G$AND Are yellowish retroperitoneal organs that lie on the upper poles of the kidneys! )urrounded by renal fascia but separated from the kidneys by perirenal fat! "ach gland has a yellow cortex and a dark brown medulla! he right suprarenal gland is pyramid shaped and caps the upper pole of the right kidney! ,t lies behind the right lobe of the liver and extends medially behind the inferior vena cava! ,t rests posteriorly on the on the diaphragm! he left suprarenal gland is crescentic in shape and extends along the medial border of the left kidney from the upper pole to the hilus! ,t lies behind the pancreas, the lesser sac, and the stomach and rests posteriorly on the diaphragm! @lood supply o he arteries supplying each gland are three in number: inferior phrenic artery, aorta, and renal artery! o A single vein emerges from the hilum of each gland and drains into the inferior vena cava on the right and into the renal vein on the left! Lymph drainage o Lateral aortic nodes 2erve supply o preganglionic sympathetic fibers from the splanchnic nerves; most of the nerves end in the medulla of the gland!

T1YROID G$AND %onsists of right and left lobes connected by a narrow isthmus! ,t is a vascular organ surrounded by a sheath derived from the pretracheal layer of deep fascia! he sheath attaches the gland to the larynx and trachea! "ach lobe is pear-shaped, with its apex being directed upward as far as the obli/ue line on the lamina of the thyroid cartilage! ,ts base lies below at the level of the & th or $th tracheal ring! he isthmus extends across the midline infront of the 5nd, 4rd, and &th tracheal rings! A pyramidal lobe is often present and it pro+ects upward from the isthmus, usually to the left of the midline! A fibrous or muscular band fre/uently connects the pyramidal lobe to the hyoid bone; if it is muscular it is referred to as the levator glandulae thyroideae! 0elations of the lobe o Anterolaterally: the sternohyoid, the superior belly of the omohyoid, the sternohyoid, and the anterior border of the sternocleidomastoid! o Posterolaterally: the carotid sheath with the common carotid artery, the internal +ugular vein, and the vagus nerve! o 9edially: the larynx, the trachea, pharynx, and the esophagus! Associated with these structures are the cricot(yroi% muscle, and its nerve supply, the e2ternal laryngeal nerve! ,n the groove between the esophagus and the trachea is the recurrent laryngeal nerve! XXX he rounded posterior border of each lobe is related to the superior and inferior parathyroid glands! 0elations of the isthmus o Anteriorly: sternothryoids, sternohyoids, anterior +ugular veins, fascia, and skin! o Posteriorly: 5nd, 4rd, and &th rings of the trachea! @lood supply o

?rains mainly laterally into the deep cervical lymph nodes! A few lymph vessels descend to the paratracheal nodes!

,ARAT1RYOID G$ANDS Are ovoid bodies and usually four in number and are intimately related to the posterior border of the thyroid gland, lying within its fascial capsule! he two superior parathyroid glands are the more constant in position and lie at the level of the midline of the posterior border of the thyroid gland! he two inferior parathyroid glands usually lie close to the inferior poles of the thyroid gland! hey may lie within the fascial sheath, embedded in the thyroid substance, or outside the fascial sheath! @lood )upply o he arterial supply to the parathyroid glands is from the superior and inferior arteries!

,IT=ITARY G$AND *1Y,O,1YSIS C"R"BRIit is small, oval structure attached to the undersurface of the brain by the infundibulum! is well protected by virtue of its location in the sella turcica of the sphenoid bone! he hormones produced influence the activities of many other endocrine glands, the hypophysis cerebri is often referred to as the master endocrine gland, thus, it is vital to life! ,t is divided into an anterior lobe or a%eno(ypop(ysis, and a posterior lobe or neuro(ypop(ysis! he anterior lobe o is subdivided into the pars anterior -pars distalis., and the pars interme%ia, which may be separated by a cleft that is a remnant of an embryonic pouch! A pro+ection from the pars anterior, the pars tu#eralis, extends up along the anterior and lateral surfaces of the pituitary stalk!

0elations o

Arteries: superior thyroid artery, inferior thyroid artery, and sometimes the thyroidea ima! o Aeins: superior t(yroi% drains into the +ugular vein; mi%%le t(yroi% vein drains into the internal +ugular vein; in erior t(yroi% which receives its tributaries from the isthmus and; the lower poles of the gland which drains into the left brachiocephalic vein in the thorax! Lymph drainage

o o o

!uperiorly: %iap(ragma sellae -separates the anterior lobe from the optic chiasma., which has an aperture that allows passage of the infundibulum! #nferiorly: the #o%y o sp(enoi%, with its sphenoid air sinuses )aterally: cavernous sinus an% its contents Posteriorly: %orsum sellae+ #asilar artery+ pons

@lood supply o he arteries are derived from the superior an% in erior (ypop(yseal arteries, branches of the internal carotid artery! he veins drain into the intracavernous sinuses!