Download pdf - Anatomy Super Supplement

8/20/2019 Anatomy Super Supplement

http://slidepdf.com/reader/full/anatomy-super-supplement 1/37

Head and Neck

Loubomir E. Antonio, M.D.

Bones of Skull

Cranium

Eight (8) Bones

Fronta

!arieta (")

#cci$ita

%em$ora (")

&$henoid

Ethmoid

Facial Bones

Fourteen (') bones

• *gomatic(")

• Ma+iae (")

• Nasa bones(")

• Lacrima (")

• omer (')

• !aatine (")

• -nerior concha (")

• Mandibe (')

New Born Skull

Fontanelles

Anterior fontanelle “Bregma”

Diamond/sha$edBet0een

%0o ha1es o ronta bone

%0o $arieta bones

2osed b* 18 months

Posterior fontanelle “Lamba”

%rianguar

Bet0een

%0o $arieta bones

#cci$ita bone

2osed b* !rst "ear of life

CL#N#CAL S#$N#F#CANC%

De$ressed 3 Deh*dration

Buging 3 -ncreased -2!

&astoi ProcessNot $resent at birth

De1eo$s during 4rst " *ears o ie


Force$s dei1er* ma* resut to Facia ner1e in5ur*

Ault Skull

Sutures

/ 4brous t*$e ( s*narthroses )

/ 6ormian or -nca bones in bet0een sutures

Coronal Suture

• Fronta bone

• !arieta bone

Sagittal Suture

• !arieta bones

Lamboi Suture

• !arieta bone• #cci$ita bone

Ault Skull

Pterion

%hinnest $art o atera 0a

Bet0een

Anteroinerior corner o the $arieta bone

7reater 0ing o s$henoid

#N'(AC(AN#AL )%&*(()A$%S

%+iural 3 Ant. di1ision midde meningea arter*

Subural 3 2erebra 1eins

Subarachnoi 3 Aneur*smAngioma

#ntraParench"mal 3 Lenticuostriate arter*

#N'(AC(AN#AL )%&*(()A$% ,#NFAN'-

E+cessi1e moding

%ears anterior attachments o a+ cerebri to tentorium cerebei

Beeding comes rom9

$reat Cerebral .ein

Straight sinus

#nferior Sagittal sinus

S/0LL F(AC'0(%

Adut

/ ikened to an eggshell

/ s$intering o bone

:oung chid/ ikened to a table tennis ball

/ ;$ond racture<

F(AC'0(%S *F C(AN#AL F*SSA%

Anterior Cranial Fossa

/ E$ista+is

/ =hinorrhea

/=acoon>s e*e

/ E+o$hthamos

&ile Cranial Fossa ,%A/%S'-

/ #torrhea=hinorrhea

/ Damage to 2N ?,,@

/ Damage to 2N ,8

Posterio Cranial Fossa

/ Batte>s sign

/ Damage to 2N ,'C,''

Nasal fractures

/ most common

/ considered o$en ractures

/ damage to muco$eriosteum

/ se$ta hematoma

&a2illofacial fractures

/ acia s0eing

/ di$o$ia

/ maoccussion o$en bite deormities

/ anesthesia$aresthesia in the cheek or

u$$er gum (inraorbita ner1e)

Le Fort Classi!cation of &a2illofacial Fractures

A('%(#AL S0PPL3 Anterior 2ircuation/ -2A

!osterior 2ircuation/ A

4%N*0S 5(A#NA$%

&u$erior sagitta sinus

-nerior sagitta sinus

7reat 1ein o 7aen

&traight sinus

%rans1erse sinus

&igmoid sinus


6ueckenstet7s 'est

() FA#L0(% o the cerebra 1enous $ressure to rise as measured b*

a umbar ta$ in the sub arachnoid s$ace u$on com$ression o the -

signi4es obstruction at the 1ertebra cana or meninges (tumor)



Ca.ernous Sinus Contents

2Ns ---, -, ',"

and -

-2A


2a1ernous &inus %hrombosis

inections in the dangerous area o the ace

thrombosis o the facial vein

organisms ascend through inf. ophthalmic vein

CSF PA')A3

2horoid $e+us

Latera 1entrices

oramen o Monroe

?rd 1entrice

aueduct o &*1iusiter

th 1entrice

oramen o Luschka

and Magendie

&ubarachnoid s$ace

Arachnoid granuations

Cranial Ner.e # *lfactor" Ner.e

#actor* ner1e ces /G #actor* bub /G #actor* tract /G#actor* area

'"+e9 &ensor*

Function9 &mes

Lesion9 Anosmia

Foramen9 2ribiorm $ate

#nner.ate (egion9Nasa 2a1it*

Cranial ner.e ## *+tic Ner.e

=etina /G #$tic chiasm /G #$tic tract /G L7B /G #$tic

radiation /G isua corte+

'"+e9 &ensor*

Function9 ision

Lesion9 isua 4ed de4cits (Ano$sia)

Foramen9 #$tic cana

#nner.ate (egion9 #rbit

Cranial ner.e ### *culomotor Ner.e

Anterior midbrain /G Latera 0a 2a1ernous &inus /G

&#F /G E#M>s e+ce$t &# and L=

s$hincter $u$iae

2iiar* musces

'"+e9 Motor

Functions9

• E#Ms

adduction most im$ortant action (media rectus)

• 2onstricts $u$i (s$incter $u$iae)

• Accomodation (ciiar* musce)

• =aises u$$er e*eid (e1ator $a$iae)

Lesion9 Di$o$ia, aterae+terna strabismus

Foramen9 &u$erior oribita 4ssure


Cranial ner.e #4 : 'rochlear Ner.e

!osterior midbrain /G Latera 0a ca1ernous &inus /G &#F /G

&u$erior #biue

'"+e9 Motor

Function9

De$resses and abducts e*eba (&u$erior obiue)

-ntorts

Lesion9

6eakness ooking do0n 0ith adducted e*e

DiIcut* going do0n stairs

Head tits a0a* rom esioned side

Foramen9 &u$erior orbita 4ssure


Cranial ner.e 4# Abucent Ner.e

Bet0een $onsmedua /G 2a1ernous &inus 0-2A /G &#F /G

Latera =ectus

'"+e9 Motor

Function9 Abducts e*eba (atera rectus)

Lesion9 di$o$ia, mediainterna strabismus, oss o $arae gaJe

Foramen9 &u$erior orbita 4ssure


Cranial Ner.e 4 : 'rigeminal Ner.e

Anterior $ons

/ sma motor root

/arge sensor* root %rigemina 7angion

%rigemina 7angion ( anterior border )/ arises the ? di1isions

Cranial ner.e 41:*+hthalmic Ner.e

!asses in the atera 0a o 2a1ernous &inus /G &#F

Nasociiar*

Post. Ethmoida

#nratrochear

Long ciiar* ner1e

Anterior ethmoida /G External nasal nerve ( ti$ o

nose )

Sensor* br. %o ciiar* gangion

Fronta 3 di1ides into su$raorbitatrochear ner1es

Lacrima

zygomaticotemporal branch of V2 lacrimal

gland'"+e9 &ensor*

Function9 7enera sensation o oreheadsca$cornea

Lesion9

• Loss o sensation in skin o oreheadsca$

• Loss o bink reKe+ 0 2N --

#nner.ate (egion9 #rbit and sca$

Cranial ner.e 4; &a2illar" Ner.e

Foramen rotundum /G $ter*go$aatine ossa -#F

&eningea branch

<*gomaticotem$ora acrima gand ( 0 acrima ner1e

o ' )

<*gomaticoacia

$angionic branches 3 '* ner1es going to $ter*go$aatine

gangion

Posterior &u$erior A1eoar&idde &u$erior A1eoar

Anterior &u$erior A1eoar

'"+e9 &ensor*

Function9 7enera sensation o $aatae, nasa ca1it*, ma+iar* ace,

ma+iar* teeth

Lesion9 Loss o genera sensation in skin o1er ma+ia, ma+iar* teeth

Foramen9 Foramen rotundum

#nner.ate (egion9 !ter*go$aatine ossa (ea1e b* o$enings to ace

ora, and nasa ca1it*)

Cranial ner.e 4= &anibular Ner.e

Foramen o1ae /G -nratem$ora ossa

'"+e9 Mi+ed

&otor9 &N%&*N#C9 &" Ass &eets 'he 'oilet

&*oh*oid

Anterior digastric

&usces o mastication

'ensor 1ei $aatini

'ensor t*m$ani

Sensor"9 &N%&*N#C9 L#BA$

Lingua ner1e

#nerior A1eoar

Bucca ner1e

Auricuotem$ora ner1e

$angion ( otic gangion )

Lesion9

Loss o genera sensation in skin o1er mandibe, mandibuar teeth,

tongue

6eakness in che0ing

a0 de1iation to0ard 0eak side

%rigemina neuragia (intractabe $ain in ", ? territor*)



Foramen9 Foramen #1ae

#nner.ate (egion9 -nratem$ora ossa

#N>0(3 '* ')% L#N$0AL N%(4%

2#=&E inratem$ora ossa

inerior to su$erior constrictor

(cose* reated to ast moar tooth)

1

submandibuar triange

In cases of clumsy extraction of impacted 3rd molar tooth

Cranial Ner.e 4## : Facial Ner.e

Type: Mi+ed

Function:

&otor9 muscles of facial expression, posterior belly of

digastric, stylohyoid, stapedius

Sensory

'aste to anterior twothirds of tongue!palate

"utonomics

&ai1ates (submandibular, sublingual glands#

%ears (lacrimal gland )

Makes mucus (nasal and palatine glands#Lesion9

• 2orner o mouth droo$s, can>t cose e*e, can>t 0rinke

orehead, oss o bink reKe+, h*$eracusis

• Ateration or oss o taste (ageusia)

• E*e dr* and red

Foramen9 -nterna auditor* meatus

#nner.ate (egion9 Face, nasa and ora ca1it*, branches ea1e ski

in st*omastoid oramen, $etrot*m$nic 4ssure, or hiatus o acia cana

Cranial ner.e 4### 4estibulocochlear Ner.e

estibue AND semicircuar cana G estibuar gangion G -nt.

acoustic meatus G Brainstem2erebeum

2ochea /G &$ira gangion /G -nterna acoustic meatus /G

Auditor* 2enter

'"+e9 &ensor*

Function9

Hears

Linear acceeration (gra1it*)

Anguar acceeration (head turning)

Lesion9 Loss o baance, n*stagmus

Foramen9 -nterna auditor* meatus

#nner.ate (egion9 -nner ear

Cranial Ner.e #? $losso+har"ngeal Ner.e

'"+e9 Mi+ed

Function9

&enses $har*n+, carotid sinusbod*

&ai1ates ($arotid gand)

%astes ($osterior one third o tongue)

Motor to one musce / st*o$har*ngeus

Lesion9 Loss o gag reKe+ 0ith 2N

Foramen9 uguar oramen

#nner.ate (egion9 Neck$har*n+tongue

Cranial Ner.e ? 4agus Ner.e

'"+e9 Mi+ed

Function9

Musces o $aate and $ha*n+ or s0ao0ing e2ce+t tensor veli

palatini (2N ) and stylopharyngeus (2N -)

%o a musces o ar*n+ ($honates)

&ensation to ar*n+ and ar*ngo$har*n+

&ensation to ar*n+ and 7- tract

%o 7- tract smooth musce and gands in oregut and midgut

Lesion9

Nasa s$eech. Nasa regurgitation (due to $aate 0eakness)

D*s$hagia, $aate droo$

1ua $ointing C*N'(ALA'%(AL rom aOected side

Hoarseness4+ed 1oca cord

Loss o gag reKe+ 0ith -

Loss o cough reKe+

Foramen9 uguar oramen

#nner.ate (egion9 Neck !har*n+ Lar*n+ %hora+ Abdomen

Cranial Ner.e ?# S+inal Accessor" Ner.e

Brainstem : ;roots, &otor anSensor": Ner.usintermeius -

#nternal acousticmeatus

Facial canalChorda tympani$etrot*m$anic

4ssure-nratem$ora

ossa

#nner %ar@&ile earNerve to

stapedius

5oins ingua ner1e$eniculate an lion

Brainstem uguaroramen Neck 3P*S'%(#*( toS'L*P)A(3N$%0S

#&P*('AN'B(ANC)%S

%*m$anic branchesser $etrosa ner1e

#tic gangion 0

!arotid gand

Auricuotem$oraner1e

2arotid branch2arotid bod*sinus

!har*ngea branch

!har*ngea $e+us( 0 2N and &N& )

Lingua branch!osterior '? o

tongue

Ner1e to

Brainstem uguaroramen Neck/0ithin the carotidsheath

#&P*('AN'B(ANC)%S, neck -9

Cardiac branches2ardiac $e+us

(ecurrent ar*ngeaner1e ALL-ntrinsic musces oar*n+ %?C%P' CRICO!"ROI#

Auricuar branches %*m$anic

membrane!inna

&eningea branches



'"+e9 Motor

Function9

%urn head to o$$osite side (Sterocleidomastoid )

Ee1ates and rotates sca$ua (Trape$ius)

Lesion9

6eakness turning head to o$$osite side

&houder droo$

Foramen: uguar oramen

#nner.ate (egion9 Neck

Cranial Ner.e ?## )"+oglossal Ner.e

Brainstem G H*$ogossa cana G Neck do0n to lower border o&O$+,(%%" #IG'$RIC G crosses ext-int+ Carotid arteries .

ee+ to mylohyoid G below lingual nerve and submandibuar duct

#&P*('AN' B(ANC)%S9

&eningeal branch

5escening branch , C1 -

/ 5oins descending cervical nerve ( 2"2? ) to orm ANSA

C%(4#CAL#S

to su$$* &%E=N#H:#-D, #M#H:#-D, &%E=N#%H:=#-D

Ner.e to ')3(*)3*#5

Ner.e to $%N#*)3*#5

ALL musces o the tongue %?C%P' &'%'OG%O$$)$

'"+e9 Motor

Function9 Mo1es tongue (styloglossus, hyoglossus, genioglossus,

and intrinsics. +alatoglossus b* +har"ngeal +le2us-Lesion9 %ongue $ointing #PS#LA'%(AL side o $rotrusion

Foramen9 H*$ogossa cana

%nnervated &egion: %ongue

&%&*(#<%

A musces o the tongue are su$$ied b* 2N'"

E2E!% '"("T)*()SS+S

( $har*ngea $e+us 2N,'C)

A musces o the $aate are su$$ied b* the $har*ngea $e+us

E2E!% TES)& -E((% '"(("T%%

(2N 3 ?di1ision)

&%&*(#<%

A musces o the $har*n+ are su$$ied b* the $har*ngea $e+us

E2E!% ST()'/"&*E+S

( 2N - )A intrinsic musces o the ar*n+ are su$$ied b* the recurrent

ar*ngea ner1e

E2E!% 0&%0)T/&)%1

(E+terna branch 3 &u$erior ar*ngea ner1e )

Summar" of 'ongue #nner.ation

Sensation

Anterior "?rds

&ensation CN 4= ('rigeminal manibular)

%aste CN 4## (Facial)

!osterior '?rd

&ensation and %aste

Main* CN #? ($losso+har"ngeal),

E+treme $osterior CN ? (4agus)

&otor

2N ?## ()"+oglossal)

Scal+

la"ers

“S0"('”

Skin

Connecti1e tissue o su$er4cia ascia

A$oneurosis

Loose 2onnecti1e %issue ( angerous la"er )

Periosteum o sku and bones

*(B#'

!*ramida in sha$e*rbital &argin

&u$erior/ronta bone

Latera/ ronta and J*gomatic

-nerior/ J*gomatic and ma+ia

Media/ma+ia and ronta

%3% '(A0&A

/ Least $rotected rom the ("TE&"( side

Blowout Fractures

/ e+$odes %FE&%)&( into the Ma+iar*

sinus resuting to di$o$ia, in5ur* to

inraorbita ner1e and entra$ment o

inerior rectus musce

LA2=-MAL A!!A=A%&

Lacrima gand Lacrima $unctum

Lacrima canaicui

Lacrima sac

Nasoacrima duct

-nerior nasa concha

M-DDLE EA=

Su+erior wall

tegmen t*m$ani ($etrous bone)

Anterior wall

thin bone $ate -2A

" o$enings %ensor t*m$ani

Eustachian tube

Posterior wall

aditus to mastoid antrum

$*ramid 3 sta$edius tendon

&eial wall atera 0a$romontor* o inner ear

" 0indo0s o1a

round

Lateral wall

t*m$anic membrane(dKat)

e$it*m$anic recess

#nferior wall

%hin bone $ate -

#NF%C'#*NS AN5 *'#'#S &%5#A

- !athogenic organisms ascending through the

pharyngotympanic tube rom the naso$har*n+

C*&PL#CA'#*NS

Acute Mastoiditis&igmoid sinus %hrombosis

/ thru the mastoid antrum

Meningitiscerebra abscess

/ su$erior*Facia ner1e $as*Lab*rinthitisertigo

/ media*

#sseus membranous ab*rinth &ensor* organ

estibue

&emicircuar 2ana

2ochea

trice and &accue Macua

&emicircuar Ducts 2rista am$uaris

2ochear Duct organ o 2orti

C*C)L%A

&caa 4estibui

&caa Mediacochear duct

nerve

!ter*go$aatine

gangion&ubmandibuar

&ubingua gand

St"lomastoiforamenLacrimaNasa!aata gands Ant."? tongue

!osterior auricuar

&t*oh*oid

!osterior be* odigastric

!har*ngea$e+us

/ su$$*ALL musces o!har*n+ %?C%P' $"%O&!'R"NG()$

* musceso sot $aate%?C%P' (N$ORV(%I &'%'INI

Su$erior ar*ngeaner1e

-nternaar*ngea ner1e 3S%NS*(3 to ar*n+

E+ternaar*ngea ner1e 3*NL3 &*'*( to

CRICO!"ROI#

" roots

Cranial root 3 rombrainstem

uguar oramen

Neck

/ &2M

Foramen

magnum

/ %ra$eJius

S+inal root 3 2'to 2P



&caa '*m$ani

Membranes

(eissner>s

Basiar

NASAL CA4#'3

Lateral nasal wall

su$erior turbinate

midde turbinate

-nerior turbinate

&eial nasal wall

se$ta cartiage

$er$endicuar $ate o ethmoid1omer

&N%&*N#C

/ iss Litte $irs ASS

/ iessebach>s $e+us

Litte>s Area

$reater !aatine arter*

Anterior Ethmoida arter*

S$heno$aatine arter*

Su$erior abia arter*

PA(ANASAL S#N0S%S

&$henoida sinus

Ethmoida sinus

Anterior Midde

!osterior

Fronta sinus

Ma+iar* sinus

5(A#NA$%

S+henoethmoial recess

&$henoida sinus

Su+erior meatus

!osterior ethmoida sinus

&ile meatus

Fronta sinus

Anterior ethmoida sinus

Midde ethmoida sinus

Ma+iar* sinus

#nferior meatus

Nasoacrima duct&uscles of Facial %2+ression

-nner1ated b* termina branches o acia ner1e

'em$ora

<*gomatic

Bucca

&andibuar

Cer1ica

2Ten ebras 4it 5y 0hee67

F(%3 S3N5(*&%

!ost/gustator* s0eating due to damage to auriculotemporal and

great auricular nerve ( traumasurger*)

Both 4bers ma* inner1ate a s0eat gand

A stimuus intended or sai1a $roduction resuts to s0eat secretion

instead

'(*0BL%S*&% BL%%5#N$ AF'%( A '*S#LL%C'*&3

Damage to external palatine vein ocated 5ust atera to the tonsis

at the tonsiar ossa

*(AL CA4#'3 L%S#*NS

60#NC/%7S 5#S%AS% 4S 60#NS3

Quincke>s disease 3 angioedema of uvula

Quins* 3 peritonsillar abscess

&uscles of &astication

• &asseter

• %em$orais & 3 Munching

• &edia !ter*goid

• Latera !ter*goid L / Lo0ers

'riangles of the Neck

Posterior 'riangle

• #cci$ita triange

• &u$raca1icuar triange

Anterior 'riangle

• 2arotid triange

• Digastric triange

• &ubmenta triange

• Muscuar triange

Posterior 'riangle

Bounaries

• 'ra+eius ($osterior)

• Sternocleiomastoi (anterior)

• 2a1ice (inerior)

5i.ie b* *moh"oi into

• #cci$ita triange

• &u$raca1icuar triange

Floor

• Anterior scalene

• &ile Scalene

• Posterior Scalene

• Le.ator sca+ulae

• S+lenius Ca+itis

Posterior 'riangle

Contents

-n scalene inter.al (bet0een anterior R midde scaene)

• 'hree ,=- trunks of brachial +le2us

• Subcla.ian arter"S+inal accessor" ner.e (CN ?#) to

• &ternoceidomastoid

• %ra$eJius

Phrenic ner.e (anterior surace o anterior scaene)

2utaneous branches o cer1ica $e+us

• greater auricuar,

• esser occi$ita,

• trans1erse cer1ica,

• su$raca1icuar ner1es

Anterior 'riangle

Bounaries

Anterior border o sternoceidomastoid

Anterior midine

Bod* o mandibe

SubtrianglesDigastric triange

&ubmenta triange

Muscuar triange

2arotid triange

5igastric 'riangle

Bounaries

• Lo0er border o mandibe

• !osterior be* o digastric

• Anterior be* o digastric

Contents

• &ubmandibuar gand

• &ubmandibuar duct

• &ubmandibuar *m$h node

• 2N --

• 2er1ica mandibuar branch o 2N --

• &ubmenta branch o acia 1esses

Submental 'riangle

Bounaries

Mentum o mandibe

Anterior beies o digastric musces

H*oid bone

Foor M*oh*oid

A$e+ Mandibuar s*m$h*sis

Contents

&ubmenta *m$h nodes

&uscular 'riangle

Bounaries

• Midine o neck

• &u$erior be* o omoh*oid

• Anterior border o sternoceidomastoid

=oo &tra$ musces



Contents

4iscera of neck

• %h*roid gand

• &u$erior ar*ngea ner1e

• =ecurrent ar*ngea ner1e

• %rachea

• Eso$hagus

Caroti 'riangle

Bounaries

&ternoceidomastoid

!osterior be* o digastric

&u$erior be* o omoh*oid

Contents 2arotid sheath

&N%&*N#C

CA(*'#5 S)%A') C*N'%N'S

- &ee 3 -nterna 2arotid Arter*

'C 3 agus Ner1e

cc 3 2ommon 2arotid Arter*

- 3 -nterna uguar ein

Fascial La"ers

Su+er!cial cer.ical fascia

%hin a*er encosing

$at*sma musce

2utaneous ner1es

&u$eri4ca 1eins

&u$er4cia *m$h nodes

Fascial La"ers

5ee+ cer.ical fascia &u$$orts musces, 1esses, 1iscera o neck

2ondenses to orm

1D #n.esting la"er

%ra$eJius

&ternoceidomastoid

;D Pretracheal la"er

Lar*ngea cartiages

%h*roid

!arath*roid

-nrah*oid musces

Fascial La"ers

5ee+ cer.ical fascia

=D Pre.ertebral la"er

#1er $re1ertebra musces, 1ertebra coumn

Forms A2illar" Sheath

ED Caroti Sheath

2ommon carotid arter*

-nterna carotid arter*

-nterna 5uguar 1ein

agus ner1e

(etro+har"ngeal s+ace

“5anger s+ace”

(etro+har"ngeal abscess airwa" com+ression

%racking to thora+ and mediastinum

%2ternal Caroti Arter"

Branches9

S"( F)' S5

Su$erior th*roid

Ascending $har*ngea

Lingua

Facia

*cci$ita

Posterior auricuar Su$er4cia tem$ora

&a+iar*

'h"roi $lan

-sthmus is at e1e o ;n =r Eth trachea ring

Bloo Su++l"9

&u$erior th*roid arter*

-nerior th*roid arter*

%h*roidea ima

4enous rainage

&u$erior th*roid 1ein

Midde th*roid 1ein

-nerior th*roid 1ein

PA(A')3(*#5 $LAN5

Four () se$arate gands

&ecretes Parath"roi )ormone

Bood &u$$*

• Su+erior

th"roi arter"D

• #nferior

th"roi arter"

Lar"n2

2artiages

= un+aire9

%h*roid

2ricoid

E$igottis

= +aire9

Ar*tenoid

2ornicuate

2uneiorm

#ntrinsic Lar"ngeal &uscles

'%NS%S 3 2=-2#%H:=#-D

(%LA?%S 3 %H:=#H:#-D (#2AL-& )

AB50C'*( 3 !#&%E=-#= 2=-2#A=:%EN#-D

A550C'*(S 3 %=AN&E=&E A=:%EN#-D

#BL-QE A=:%EN#-D

Latera cricoar*tenoid

Phar"n2Parts

Naso$har*n+

#ro$har*n+

Lar*ngo$har*n+ (h*$o$har*n+ )

Circular &uscles

&u$erior constrictor

Midde constrictor

-nerior constrictor

Longituinal muscles

&t*o$har*ngeus

&a$hingo$har*ngeus

F*(%#$N B*53 #N$%S'#*N

P3(#F*(& S#N0S

most common site or the odging o ingested shar$ oreign bodies (

8shbones )

C%(4#CAL PL%?0SAnterior rami C1:CE s$ina ner1es

Cutaneous

Lesser occi$ita

7reater auricuar

%rans1erse cutaneous

&u$raca1icuar

C%(4#CAL L3&P)N*5%S

Le.el 1 &ubmenta &ubmandibuar

Le.el ; $$er 5uguar

Le.el = Mid 5uguar

Le.el E Lo0er 5uguar

Le.el &ubocci$ita

Le.el G 2entra

%HE END

Back an S+ine

Loubomir E. Antonio, MD

4ertebral Column

2entra $iar o the bod*

!rotects the s$ina cord

&u$$orts 0eight o the head and trunk

%ransmits to hi$ bones and o0er imbs

Fe+ibe, &egmented

• ertebrae

• -nter1ertebra discs

4ertebral Column

2ur1atures ()



2er1ica !osterior conca1it* (Lordosis)

%horacic !osterior con1e+it* (S*$hosis)

Lumbar !osterior conca1it* (Lordosis)

&acra !osterior con1e+it* (S*$hosis)

4ertebral Column

Parts

Bod*

ertebra arch

Peicles

Laminae

$rocesses

&$inous (') %rans1erse (")

Articuar ()

4ertebral Column

• &$inous $rocess

– Directed $osterior*

• unction o t0o aminae

• %rans1erse $rocess

– Directed atera*

• unction o aminae and $edices

Function

– e1ers

– attachment or musces, igaments

4ertebral Column

Articuar !rocess

ertica* arranged

▪ %0o su$erior

▪ %0o inerior

!edices are notched on u$$er and o0er borders

▪ &u$erior 1ertebra notch

▪ -nerior 1ertebra notch

Forming -nter1ertebra oramen

▪ %ransmit s$ina ner1es

▪ And bood 1esses

Cer.ical 4ertebra

2haracteristics

ertebra oramen

▪ Large

▪ %rianguar

&u$erior articuar $rocesses

▪

&ma▪ Fat

▪ Face back0ard, R u$0ard

-nerior articuar $rocesses

▪ Face do0n0ard R or0ard

Cer.ical 4ertebra

2haracteristics

Foramen trans.ersarium

▪ %rans1erse $rocess

▪ !assage o the .ertebral arter" an

.eins

&$ines

▪ &ma

▪ Bi4d

At"+ical Cer.ical 4ertebrae

First cer1ica 1ertebra (Atas)

No bod*, No s$inous $rocessAnterior arch

!osterior arch

Latera mass (each side)

Articuar suraces

$$er as$ect (#cci$ita cond*es o sku)

Lo0er as$ect (A+is)

At"+ical Cer.ical 4ertebrae

&econd cer1ica 1ertebra (A+is)

#dontoid $rocess

$eg/ike

!ro5ects u$0ard rom su$erior surace o bod*

=e$resents body of atlas that has fused /ith the axis

At"+ical Cer.ical 4ertebra

&e1enth cer1ica 1ertebra

Longest s$inous $rocess

N*' bi4d

Large trans1erse $rocess

&ma oramen trans1ersarium

5*%S N*' transmit 1ertebra arter*

Cer.ical 4ertebral Fracture

>eHerson7s fracture 3 disru$tion o the ring o atas 0 dis$acement

o atera masses

)angman7s fracture 3 racture o the odontoid and $edices o a+is

'horacic 4ertebra2haracteristics

Bod*

Medium siJed, heart/sha$ed

ertebra Foramen

&ma, circuar

&$ines

Long, incined do0n0ard

2haracteristics

Costal facets

▪ !resent on sides, and on trans1erse

$rocess

▪ %'', %'" T no acets on trans1erse

$rocess

&u$erior articuar $rocess

▪ Facets ace back0ard, atera*

-nerior articuar $rocess▪ Facets ace or0ard, media*

Lumbar 4ertebrae

• 2haracteristics

– Bod*

• Massi1e, kidne* sha$ed

– !edices

• &trong

– Laminae

• %hick

– ertebra oramina

• %rianguar

– %rans1erse $rocesses

• Long, sender

Lumbar 4ertebrae

2haracteristics

&$inous $rocesses▪ &hort, Kat, uadranguar, $ro5ect

back0ard

&u$erior articuar $rocesses

▪ Facets ace media*

-nerior articuar $rocesses

▪ Factes ace atera*

No rib acets, no oramina in the trans1erse $rocesses

Sacral 4ertebrae

&acrum

Fi1e rudimentar* 1ertebrae used together

&inge 0edge sha$ed bone

Sacral 4ertebrae

2haracteristics

&acra $romontor*

Anterior u$$er margin o 'st sacra 1ertebrae

Buges or0ard into $e1ic ca1it*

-m$ortant obstetric andmark

Sacral 4ertebrae

2haracteristics

&acra cana

Formed rom sacra oramina

2ontains

!art o cauda euina

Meninges (u$ to o0er border &")

Lo0er sacra ner1e roots

2occ*gea ner1e roots

Fium terminae

Sacral 4ertebrae

2haracteristics

&acra Hiatus



Faiure o the Pth and sometimes th sacra 1ertebra to meet in the

midine

Anterior R !osterior sacra oramina

!assage o anterior and $osterior rami o the u$$er our s$ina ner1es

Sacral 4ertebrae

Articuations

$$er border (base)

Pth umbar 1ertebrae

Narro0 inerior end

2occ*+

Latera*

%0o hi$ bones

&acroiiac 5ointsCocc"geal 4ertebrae

2occ*+

Four () used together

&inge

&ma

%rianguar

4rst cocc*gea 1ertebra common* not used 0ith "nd

Atlanto:occi+ital >oints

bet0een

#cci$ita cond*es

Latera masses o the atas

Ligaments

Anterior Atanto/occi$ita membrane

!osterior Atanto/occi$ita membrane

&o.ements , 3%S >oint -

Fe+ion

E+tension

Latera Ke+ion

N* rotation

Atlantoa2ial >oints

bet0een

#dontoid $rocess and anterior arch o atas (')

Latera masses o bones (")

&o.ement , No >oint -

=otation i atas 0 head on a+is

Ligaments

A$ica 3 rom dens to anterior margin oramen

magnum

Aar 3 atera to a$ica igament

2ruciate 3 dens to atas and oramen magnum

Membrana tectoria 3 u$0ard e+tension o $osterior

ongitudina igament >oints Between 'wo 4ertebral Boies

2o1ered b* thin $ate o h*aine cartiage

-nter1ertebra disc o 4brocartiage in bet0een

Ligaments

Anterior longituinal ligaments

Posterior longituinal ligaments

2ontinuous bands do0n the anterior and $osterior surace o the

1ertebra coumn

rom the sku to the sacrum

#nter.ertebral 5iscs

2haracteristics

1@Eth of length o 1ertebra coumn

%hicker in cer.ical and lumbar regions

Annulus !brosus orms $eri$her* o the disc

Fibrocartiage

2oagen 4bers arranged in aternating concentric a*ers

#nter.ertebral 5iscs 2haracteristics

Nucleus +ul+osus orms centra $art o disc

▪ #1oid mass o geatinous materia

▪ Norma* under $ressure

▪ 6ith ad1ancing age,

▪ decrease in 0ater content

▪ =e$aced b* 4brocartiage

No discs

▪ bet0een 4rst t0o cer1ica 1ertebrae

▪ -n sacrum

▪ -n cocc*+

#nter.ertebral 5iscs

Herniation o the nuceus $u$osus

Freuent* occurs in the

▪ Lower lumbar region ,&ost

common-

Due to sudden increase in com$ression oad on

1ertebra coumn

=u$ture o annuus 4brosus

Nuceus $u$osus herniates posteriorly into

1ertebra cana

2om$ression o s$ina ner1e roots, s$ina ner1e, or

s$ina cord

>oints Between 'wo 4ertebral Arches

&*no1ia 5oints

Bet0een ad5acent su$erior and inerior articuar

$rocessesLigaments

&u$ras$inous igament

▪ 2onnect ad5acent s$ines

-nters$inous igament

▪ 2onnect ad5acent s$ines

Ligamentum Ka1um

▪ 2onnect ad5acent aminae

Ligamentum Nuchae

▪ 2er1ica region

▪ %hickening o su$ras$inous and

inras$inous igaments

&o.ements of 4ertebral Column

%*$e and range in regions de$end on

%hickness o inter1ertebra discs

&ha$e and direction o the articuar $rocesses

2er1ica region most mo1abe&uscles of the Back

7rou$ings

&u$er4cia

2onnected 0ith shouder girde

-ntermediate

-n1o1ed 0ith mo1ements o the thoracic cage

Dee$ or !ost1ertebra

ertebra coumn

Post.ertebral &uscles

2assi4cation

&u$er4cia* running musces

Erector s$inae

-iocostais

Longissimus

&$inais

Post.ertebral &uscles2assi4cation

-ntermediate obiue running musces

%rans1ersos$inais

&emis$inais

=otatores

Muti4dus


2assi4cation

Dee$est Musces

-nters$inaes

-ntertrans1ersari


&uscles of longest length lie su+er!ciall"

From sacrum to rib anges, trans1erse $rocesses,

u$$er 1ertebra s$ines

#ntermeiate length run obliIuel" From trans1erse $rocesses to the s$ines

Shortest an ee+est muscles

From s$ines and trans1erse $rocesses o ad5acent

1ertebrae

&uscular 'riangles

Auscultator" triangle

&ite on back 0here breath sounds most easi* hear 1ia stethosco$e

Boundaries

Latissimus dorsi

%ra$eJius

Media border o &ca$ua

=homboid ma5or (Koor)

&uscular 'riangles

Lumbar 'riangle

&ite 0here $us ma* emerge rom the abdomina 0a



Boundaries

Latissiumus dorsi

!osterior border o the e+terna obiue

-iac crest

S+inal Cor

2*indrica in sha$e

From &eulla *blongata (o brain)

Begins su$erior* at

Foramen magnum

End inerior* at

Lo0er border 'st umbar 1ertebrae (Aduts)

#ccu$ies u$$er "?rds o the 1ertebra cana

S+inal Cor&urrounded b* three (?) meninges

Dura mater

Arachnoid mater

!ia mater

Additona $rotection b*

2erebros$ina Kuid

&ubarachnoid s$ace

S+inal Cor

• Enargements

– 2er1ica

• #rigin o brachia $e+us

– Lumbar

• #rigin o umbar $e+us

• Lo0er end

– 2onus meduaris – Fium terminae

• $ia mater $roongation

• From conus meduaris to back o cocc*+

S+inal Cor

Fissures

Anterior median 4ssure

Midine on the anterior surace o the cord

!osterior median 4ssure

Midine on the $osterior surace o the cord

S+inal Cor

=oots (?' $airs)

Anterior

▪ Motor

!osterior

▪ &ensor*

▪ 0 $osterior root gangion =oots in regions

$$er cer1ica region

▪ &hort, run amost horiJonta*

Lumbar, &acra beo0 e1e o termination o cord

▪ ertica eash o ner1es around !lum

terminale

▪ Caua eIuina

S+inal Cor

=oots

!ass though inter1ertebra oramina

nite to orm s+inal ner.es 0hich di1ides into

Anterior ramus (arge)

!osterior ramus (smaer)

Both contain motor and sensor* 4bers

Bloo Su++l" of S+inal Cor

Arteries!osterior s$ina arteries

Arise direct* or indirect* rom the 1ertebra arteries

&u$$* $osterior '?rd o s$ina cord

Bloo Su++l" of S+inal Cor

Arteries

Anterior s$ina arteries

Arise rom 1ertebra arteries

nite to orm a singe arter*

&u$$* anterior "?rds o s$ina cord

!osterior s$ina arteries

Arise direct* or indirect* rom the 1ertebra arteries

&u$$* $osterior '?rd o s$ina cord

=adicuar arteries

Branches o regiona arteries

=einorce anterior and $osterior s$ina arteries

4eins

Drain into interna 1ertebra 1enous $e+us

&eninges of S+inal Cor

Dura Mater

E+terna membrane,

Dense 4brous tissue

Encoses s+inal cor and caua eIuina

Abo1e, continuous 0ith dura co1ering brain

Beo0, dura ends on !lum terminale

▪ at e1e o lower borer of the ;n

sacral .ertebra

7i1es sheaths to a s$ina ner1e roots

&eninges of the S+inal Cor

Arachnoid Mater

Deicate, im$ermeabe membrane

Lies 0ithin the dura, outside the $ia

&e$arated rom $ia mater b* subarachnoi s+ace (4ed 0ith

cerebros+inal Jui)


Arachnoid Mater

Abo1e, continuous 0ith arachnoid co1ering the

brain

Beo0, end on the !lum terminale

▪ At the e1e o lower borer of the ;n

sacral .ertebra

2ontinues aong s$ina ner1e roots orming sma

atera e+tensions o subsrachnoid s$ace


!ia Mater

ascuar membrane

2ose* co1ers s$ina cord

%hickened on either side bet0een ner1e roots

(ligamentum enticulatum)

E+tends aong each ner1e root as ar as the s$ina

ner1e

-nerior* $roonged oO the o0er end o the s$ina

cord as the !lum terminale

Lumbar +uncture

,S+inal 'a+-

!atient on the side 0ith 1ertebra coumn 0e Ke+ed

Abo1e or Beo0 th umbar s$ine

Lies 0ithin imaginar* ine bet0een highest $oints on iiac crests

Lumbar +uncture

,S+inal 'a+-

Neede $asses through the oo0ing structures to

subarachnoi s+ace

&kin

Fascia

&u$ras$inous igament

-nters$inous igament

Ligamentum Ka1um

Fatt* tissue (interna 1ertebra 1enous $e+us)

Dura mater

Arachnoid mater

%HE END

'hora2

Loubomir E. Antonio,M.D.

Bones of the 'horacic all

&ternum

Manubrium

Bod* o the &ternum

i$hoid !rocess

=ibs

%*$ica =ib

At*$ica =ib

2er1ica =ib

2osta 2artiages

B*N% &A((* B#*PS3

&%E=NM

&ite o red hemato$oiesis throughout ie

S'%(NAL AN$L% *F L*0#S



Articuation o manubrium 0ith the bod*

Landmark

;n costa cartiage

-nter1ertebra disc between Eth an th thoracic .ertebrae

unction o Ascending aorta and aortic arch

unction o aortic arch and descending thoracic aorta

Biurcation o the trachea

unction o the su$erior mediastinum and inerior mediastinum

(ibs

'" $airs

Attached $osterior* to thoracic 1ertebrae

(?) categories

%rue ribs ( ribs ' to )Fase ribs ( ribs 8 to 'C )

Foating ribs ( ribs '' and '" )

'3P#CAL (#BS 3 ribs ? to

A'3P#CAL (#BS 3 ribs ',",'C,'','"

PA('S *F A '3P#CAL (#B

)ea 3 attached to 1ertebra bod*

Neck

'ubercle 3 attached to trans1erse $rocess

&hat

Ange

Cer.ical rib

2ongenita 1ariation

C.PU o $eo$e

From trans1erse $rocess o Kth cer1ica 1ertebra

'horacic outlet s"nrome

!ressure on the o0er trunk o the brachia $e+us or subca1ian arter*(#B F(AC'0(%S

(ibs to 1

Most common* ractured ribs

Se.ere localie +ain

/ most im$ortant s*m$tom

Flail Chest

/ section o chest 0a disconnected to the thoracic 0a

/ $arado+ic breathing

/ under*in ung contusion

&uscles of the 'horacic all

Dia$hragm

-ntercosta Musces

E+terna -ntercosta

Fibers T do0n0ard, or0ard

-nterna -ntercosta

Fibers T do0n0ard, back0ard

-nnermost -ntercostaFibers T trans1erse, incom$ete a*er

Le1atores costarum ('")

&erratus $osterior

&u$erior

-nerior

5ia+hragm

#rigin

i$hoid $rocess,

o0er @ costa cartiages

'/? umbar 1ertebrae b* crura and media and atera arcuate

igaments

-nsertion

2entra tendon

Embr*onic #rigin

&N%&*N#C9 Se.eral Parts Buil 5ia+hragm

Se$tum trans1ersum Peuri$eritonea od

Bod* 0a

5orsa mesenter*

5ia+hragmatic )ernias

Congenital

-ncom$ete usion o the se$tum trans1ersum, $euro$eritonea od,

and dorsa mesenter* rom the bod* 0a

? sites

'. at the back, usua* et 3 Bochdaek>s hernia

". in ront 3 Morgagni>s hernia

?. thru eso$hagea hiatus

AcIuire

/ 0eakness in the muscuature

'. &iding

". !ara eso$hagea

5ia+hragm

Action

&*S' #&P*('AN' musce o IN$&IR'ION

-ncreases 1ertica diameter o the thora+ b* $uing do0n centra

tendon

Assists in raising the o0er ribs

-nner1ation

Phrenic ner.e ,C=:C-

Neele 'horacentesis

Liesa1ing or tension $neumothora+

Drain Kuid, bood or $us

Ma* be done 'N(RIOR and %'(R'% at ;n #CS, AB*4% the ?rd rib

'ube 'horacostom"

Eth or th #CS

$reerred site at anterior a+iar* ine

Ma* be done at a o0er -2& but N*' L*%( than th rib on either

side ( dome o dia$hragm )

#ntercostal S+aces

&$aces bet0een ribs contain

E+terna intercosta

-nterna intercosta

-ntercosta 1ein

-ntercosta arter*

-ntercosta ner1e

;4AN< V do0n0ard

-nnermost intercosta

Lined interna* b* enothoracic fascia, R

+arietal +leura5ia+hragm

Actions

eight iting musce

Abdomina straining

#ns$iration

'horaco/abdomina $um$

(%&%&B%(M

2% ate 9#, ten 9;<# E**s ""T twelve 9;=#7

#2 , right $hrenic(%8)

%so$hagus, 1a$us ner1es (%'C)

Aorta, AJ*gous 1ein, 'horacic duct (%'")

2 8

E 'C

A '"

Paral"sis of the 5ia+hragm

%raumatic%hra$eutic sectioning o the $hrenic ner1eMa* ha1e to incude the accessor* $hrenic ner1e rom 2P ( ner1e to

subca1ius )

SN#FF '%S'

Penetrating #nuries to the 5ia+hragm

An* $enetrating in5ur* BEL#6 the N-!!LE anterior* and the -nerior

ange o the &2A!LA

Associated intra abdomina in5uries

#ntercostal 4essels

Each intercosta s$ace

(') arge !osterior intercosta arter*

(") sma Anterior intercosta arteries

!osterior intercosta 1ein

Drain aJ*gous or hemiaJ*gous 1eins

Anterior intercosta 1eins

Drain into the interna thoracic and muscuo$hrenic 1eins

Posterior #ntercostal Arteries

First "

/ branches o su+erior intercostal arter",

branch o costocer.ical trunk o subcla.ian arter"

Last

/ branches o the thoracic aorta

Anterior #ntercostal Arteries

First @

/ branches o the internal thoracic arter"

Last P

/ branches are rom the musculo+hrnic arter",

a termina branch o internal thoracic arter"

#nternal 'horacic Arter"

From 4rst $art o subcla.ian arter"

Descends direct* behind the !rst si2 costal cartilages

-n ront o the +arietal +leura



Lies a 4nger breath atera to sternum

%erminates in Gth intercostal s+ace, di1iding to

Su+erior es+igastric arter"

&usculo+hrenic arteries

L*m$hatic Drainage o the thora+

Ner.es of 'horacic wall

-ntercosta ner1es

Anterior rami o !rst ele.en ,11- thoracic s$ina ner1es

Enters intercosta s$ace

=uns inerior* to intercosta 1esses (AN)

-n intercosta groo1e

Bet0een innermost and interna intercosta musces

#ntercostal ner.esFirst si+ (@) ner1es

distributed 0ithin their intercosta s$aces

th, 8th, th intercosta ner1es

Lea1e anterior ends o the intercosta s$aces

!assing dee$ to costa cartiages

Enter abdomina 0a

'Cth, ''th intercosta ner1es

!ass or0ard direct* into abdomina 0a

-ntercosta ner1es

First intercosta ner1e

Large branch

oins anterior ramus o the 8th cer1ica ner1e

Forms o0er trunk o brachial +le2us

=emainder is sma

-ntercosta ner1es

&econd intercosta ner1e oined b* media cutaneous ner1e o the arm b* intercostobrachial

ner.e

&u$$ies skin o arm$it, and u$$er media side o arm

area of +ain referre to b" coronar" arterial isease

(%F%((%5 PA#N

!neumonia!umonar* thromboemboism

/ abdomina $ain, tenderness and rigidit*

'horacic ca.it"

Di1ided into meiastinum media*, and $eurae and ungs atera*

Abo1e T 'horacic outlet

Anterior* su$erior border o the manubrium sterni

!osterior* 4rst thoracic 1ertebra

Latera* media borders o the 4rst ribs and costa cartiages

Ao0s $assage

Eso$hagus

%rachea

Man* 1esses, ner1esiening of the &eiatinum

G PCU or G 8cms

Norma* LE&& %HAN PCU o the trans1erse diameter o the chest

&een in cardiomega*, $ericardia eOusion, $ericardia tam$onade

Shifting of the &eiastinum

#PS#LA'%(AL

/ side o ateectasis

C*N'(ALA'%(AL

/ &ide o tension $neumothora+

&eiastinal #nfections

From a dee$ inection in the neck

From an eso$hagea $eroration

Mediastinits

&eiastinosco+"

2hamberain $rocedure

/ obtain sam$es o tracheobronchia *m$nodes through thesubsterna s$ace

'rachea

Mobie, cartiaginous membranous, 4broeastic tube

/sha$ed rings

A$$ro+ in. ('?cm) in ength, 1in (".Pcm) in diameter

2ontinuation o ar*n+ at o0er border o cricoi cartilage ,Gth

cer.ical .ertebra-

Descends in midine o neck

Ends in thora+ e1e o sterna ange (bet0een %/%P) di1iding into

=ight $rinci$a (main) bronchi

Let $rinci$a (main) bronchi

Com+ression of the 'rachea

Enarged th*roid

Aortic arch aneur*sm

Bronchi

=ight $rinci$a (main) bronchus

ierO shorterO more .ertical

Beore entering hium, gi1es oO

&u$erior obar bronchus

#n entering the hium, di1ides to

Midde obar bronchus

-nerior obar bronchus

Bronchi

Let $rinci$a (main) bronchus

NarrowerO longerO more horiontal

!asses beo0 arch of the aorta

-n ront o eso+hagus

#n entering hium, di1ides to&u$erior obar bronchus

-nerior obar bronchus

#nhale Foreign Bo"

2ommon on chidren

!ins, scre0s, nuts, bots, peanuts, chicken bones, to*s, tooth

sua* enters the =-7H% $rimar* bronchus

Pleurae

%0o serous sacs surrounding and co1ering the ungs

!arts

Parietal +leura

Lines thoracic 0a

%horacic surace o dia$hragm

Latera surace o mediastinum

&ensiti1e to pain0 temperature0 touch0 pressure

4isceral +leura

#uter suraces o ungs-nterobar 4ssures

&ensiti1e to stretch

Pleurae

!eura ca1it* ($eura s$ace)

&itike s$ace that se$arates $arieta and 1iscera $eurae

2ontains sma amount o +leural Jui

Lubricates a$$osing $eura suraces

Costoia+hragmatic recess

%o/est area o $eura ca1it* into 0hich the ungs e+$and during dee$

ins$iration

LN7 H-LM

(ight

most su$erior structure !rimar* bronchus

“e+arterial”

Left most su$erior structure !umonar* arter*

$rimar* bronchus beo0 the arter* hence9

“h"+arterial”

Cer.ical 5ome of the Pleura an A+e2 of Lungs

unerabe to stab 0ounds at the root o the neck

Damage b* anesthetist neede in brachia $e+us ner1e bock

Lung an Pleural (eJections

Lungs Pleura

&icla.icular rib @ 8

&ia2illar" 8 'C

Para.ertebral 'C '"

Lungs, obes and 4ssures

=ight ung

&ight* arger

*bliIue !ssure

)oriontal !ssure

Di1ides right ung into

$$er obe

Midde obe

Lo0er obe

Lungs, obes and 4ssures

Let ung

#n* one 4ssure (obliIue !ssure)

%0o obes

$$er obe

Lo0er obe

Broncho+ulmonar" segments

2haracteristics

&ubdi1ision o a ung obe

!*ramida in sha$e, a$e+ to0ard ung root

&urrounded b* connecti1e tissue



Has o0n

segmenta bronchus,

segmenta arter*,

*m$h 1esses,

autonomic ner1es

Segmental .ein N*' inclue

in connecti1e tissue bet0een ad5acent segments

Diseased segment can be remo1ed surgica*

Bloo Su++l" of the Lungs

!umonar* arteries

Deo+*genated bood to a1eoi

Bronchia arteries

/ o+*genated boodPericarium

Midde mediastinum

Fibroserous sac encosing

Heart

=oots o great 1esses

!arts

Fibrous $ericardium

&erous $ericardium

!ericardia sinuses

Ner1e su$$*

!hrenic ner1es

Pericarial Lesions

!ericarditis

inKammation o the serous $ericardium

)amman7s sign ( $ericardia riction rub )

!ericardia tam$onade accumuation o Kuid or bood in the $ericardia s$ace

Beck7s tria ( h*$otension, neck 1ein distention, distant heart

sounds )

Pericariocentesis

Neede is introduced to the left o the +i$hoid $rocess in an u+war

and backwar direction in an ange E egrees to the skin

!re1ents damage to the $eura and ungs due to the $resence o

cardiac notch

)eart

• Hoo0 muscuar organ

• Midde mediastinum

• !*ramida

• %hree (?) suraces

– &ternocosta (anterior)

– Dia$hragmatic (inerior)

– Base ($osterior)

• A$e+

– Directed do0n0ard, or0ard, to the et

– Pth et intercosta s$ace

– A$$ro+ =Din ,cm- from miline

)eart

&tructure

Di1ided b* 1ertica se$ta into our () chambers

=ight atria (anterior)

Let atria ($osterior)

=ight 1entrice (anterior)

Let 1entrice ($osterior)

6as 0 three (?) a*ers

%+icarium outer 1iscera a*er o serous $ericardium

&"ocarium thick a*er o cardiac musce

%nocarium thin inner a*er

(ight Atrium

2onsists o2a1it* and

Aurice

unction is e+terna 1ertica groo1e (sulcus terminalis), 0hich

#n the inside orms a ridge (crista terminalis)

5unction bet0een sinus 1enosus and right atrium $ro$er

!art $osterior to ridge T smooth 0aed

-nterior o aurice T roughened b* bundes o musce 4bers (musculi

+ectinati)

(ight atrium

#$enings

&u$erior 1ena ca1a

$$er $art o the right atrium

a1eess

-nerior 1ena ca1a

Larger

Lo0er $art o right atrium

=udimentar* 1a1e

2oronar* sinus

Bet0een inerior 1ena ca1a and atrio1entricuar ori4ce

=udimentar* 1a1e

=ight atrio1entricuar ori4ce

Anterior to inerior 1ena ca1a

'ricus+i .al.e

(ight atrium

Feta remnants

Fossa o.alis

&hao0 de$ression

&ite o foramen o.ale (etus)Annulus o.alis

$$er margin o ossa o1ais

ie on atria se$tum, se$arating right rom et atrium

=ight 1entrice, $a$iar* musces

• 'rabeculae carneae

– !a$iar* musces

• Attached b* bases to 1entricuar 0a

• A$e+ to 4brous cords (chorae

tenineae) to cus$s o tricus+i .al.e

– &oerate ban

• Large ridge attached to

– &e$ta 0a

– Atrio1entricuar 0a

• 2on1e*s $art o right bunle branch

o conducting s*stem

–

&im$e $rominent $ro5ectionsLeft atrium

Main ca1it* and

Aurice

-nterior contains muscuar ridges (simiar to right)

#$enings

!umonar* 1eins ()

" rom each ung

!osterior 0a

a1eess

Atrio1entricuar ori4ce

&itral .al.e

Left .entricle

Large* behind right 1entrice, 0 sma $ortion $ro5ecting on the et

orms et heart margin and a$e+

#$enings

Atrio1entricuar ori4ce

Aortic #ri4ce

Aortic .estible, beo0

6as

?+ thicker than right 1entrice

'rabecular carneae

; +a+illar" muscles

N* moerator ban

Heart sounds

• First sound

– 2ontraction o 1entrices

– 0losure of tricuspid and mitral valves

• &econd sound

– Sharp closure of aortic and pulmonary valves

• Best heard

– 'ricus+i .al.e T right ha o o0er end o bod*

o sternum

– &itral .al.e T a$e+ beat – Pulmonar" .al.e T media end o "nd et

intercosta s$ace

– Aortic .al.e T media end o "nd right intercosta

s$ace

Conucting s"stem

Modi4ed 2ardiac Musce Bood &u$$*

&inoatria node ($acemaker) both

Atrio1entricuar node =2A

Atrio1entricuar bunde =2A

=ight branch L2A

Let branch both

Bood su$$* o the heart

Arteria su$$*

=ight coronar* arter*

Let coronar* arter*



enous drainage

2oronar* sinus

7reat cardiac 1ein

&ma cardiac 1ein

Midde cardiac 1ein

Anterior cardiac 1ein

enae cordae minimae

=ight 1s Let Dominance

;=ight dominance<

Posterior inter.entricular arter"

Large branch o right coronar* arter*

;Let dominance<

Posterior inter.entricular arter"Branch o et coronar* arter*

Coronar" Arter" 5isease

Functiona end arteries

Acute thrombosis on to$ o chronic atheroscerosis

&%EM- 1s N&%EM-

4enous rainage

=ight Atrium

Main 1enous drainage C*(*NA(3 S#N0S

#NL: " drains direct* to right atrium

anterior cariac .ein

.enae coris minimae ;hebesian veins<

Ner.e su++l" of the heart

Autonomic ner1ous s*stem 1ia cariac +le2uses

S"m+athetic !bers

&inoatria node, atrio1entricuar node, cardiac musces, coronar*

arteries2ardiac acceeration

-ncrease orce o contraction

Diation o coronar* arteries

Ner.e su++l" of the heart

Autonomic ner1ous s*stem 1ia cariac +le2uses

Paras"m+athetic !bers

agus ner1es

&inoatria node, atrio1entricuar node, coronar* arteries

=educed rate

=educed orce o contraction

2onstriction o coronar* 1esses

$ross anatomic changes in fetal circulation at birth

2osure o foramen o.ale due to

decreased $ressure in inerior 1ena ca1a

-ncreased $umonar* bood Ko0

2onstriction o uctus arteriosus ligamentum arteriosus

Dimished $umonar* 1ascuar resistance&hit Ko0 across rom right to et (etus) to et to right (neonate)

2onstriction o uctus .enosus V ligamentum .enosum

Large .eins of the thora2

Barchioce$haic 1eins

&u$erior 1ena ca1a

AJ*gous 1ein

-nerior hemiaJ*gous 1ein

&u$erior hemiaJ*gous 1ein

-nerior 1ena ca1a

!umonar* 1eins

A"gous .ein

Has 1ariabe origin

2ommon* ormed b* union o

right ascening lumbar .ein and

right subcostal .ein

Ascends throughaortic o+ening in the dia$hragm at the

e1e o the th thoracic .ertebra

Arches or0ard to 5oin su+erior .ena ca.a

#nferior hemia"gous .ein

Formed b* union o

Let ascending umbar 1ein

Let subcosta 1ein

Ascends through et crus o the dia$hragm to 5oin the aJ*gous 1ein

Su+erior hemia"gous .ein

Formed b* union o

Fourth intercosta 1ein

Eighth intercosta 1ein

oins aJ*gous 1ein

Large arteries of the thora2

Aorta

Ascending aorta

Arch o the aorta

Descending aorta

!umonar* trunk

Aorta

• Di1ided into our $arts

'. Ascending aorta

". Arch o ascending aorta

?. Descending aorta

. Abdomina aorta

First ? $arts, are in the thora+

Ascening aorta

Arises rom et 1entriceAscends behind sternum to e1e o sterna ange

2ontinuous 0ith the arch o the aorta

%hree (?) buges behind each aortic cus$ sinuses of the aorta

;sinuses of Valsalva<

Branches

(ight coronar" arter" (anterior aortic sinus)

Left coronar" arter"

($osterior aortic sinus)

Arch of the Aorta

2ontinuation o ascending aorta

Arches u$0ard, back0ard, and to the et

Behind the manubrium sterni and

-n ront o the trachea

Le1e o the sterna ange

2ontinous 0ith descending aorta

=eated inerior* toroot o the et ung

Ligamentum arteriosum

Let recurrent ar*ngea ner1e

Biurcation o the $umonar* trunk

Arch o the Aorta

%hree (?) Branches rom con1e+ surace

Brachioce$haic arter*

Let common carotid arter*

Let subca1ian arter*

5escening Aorta

2ontinuation o the arch o the aorta

Let side o o0er border o the bod* o the Eth thoracic .ertebra

,sternal angle-

Descends through +osterior meiastinum unti

anterior surace o 1;th thoracic .ertebra

Enters the abdomen behind the dia$hragm

Becomes continous 0ith abdomina aorta

5escening aorta

Branches

!osterior intercosta arteries

!ass to the o0er nine intercosta s$aces

&ubcosta arteries

Aong o0er border o '"th rub to enter abdomina 0a

!ericardia arteries

Eso$hagea arteries

Bronchia arteries

L"m+h .essels

%horacic duct

=oot o the et side o neck

L*m$h rom

Lo0er imbs

!e1ic ca1it*

Abdomina ca1it*Let side o thora+

Let side o head, neck

Let u$$er imb

At termination, recei1es

left >ugular, subclavian, mediastinal lymph trun6s

But these 1esses ma* drain inde$endent* into neighboring great

1eins

L"m+h .essels

'horacic uct

Begins in abdomen as

Cisterna ch"li (a diated sac)

Ascends through aortic o$ening in dia$hragm

right sie of the escening aorta

=eaches left borer of eso+hagus

Foo0s eso$hagus to root o neck



%urns atera* behind carotid sheath

Enters beginning o left brachioce+halic .ein

L"m+h .essels

(ight l"m+hatic uct

=oot o right side o neck,

beginning o right brachioce$haic 1ein

Drains *m$h rom

=ight side head, neck

=ight u$$er imb

=ight side o thora+

&ometimes absent

Large ner.es of the thora2

agus ner1e!hrenic ner1e

%horacic $art o s*m$athetic trunk

4agus ner.es

(ight .agus ner.e

2rosses anterior to subcla.ian arter"

Descends laterall" to the trachea

&eial to a"gous .ein

=uns behin root o right ung

2ontributes to the +ulmonar" +le2us

Posterior to eso+hagus

2ontributes to eso$hagea $e+us

Lea1es thora+ and enters abdomen through eso$hagea o$ening

4agus ner.es

Left .agus ner.e

Descends into thora+ between

Left common carotiLeft subcla.ian arteries

Descends behin root o et ung

2ontributes to +ulmonar" +le2us

Anterior to eso+hagus

2ontributes to eso+hageal +le2us

Enters abdomen through eso$hagea o$ening

Phrenic ner.es

From anterior rami o ?rd, th, Pth cer1ica ner1es

(ight +hrenic ner.e

Descends in thora+ aong right side o 1ena ca1a

-n front of root o right ung

!asses o1er $ericardium into the dia$hragm

Phrenic ner.es

Left +hrenic ner.e

descends aong et side o et subca1ian arter*

2rosses et side o the aortic arch and et 1agus ner1e

!asses in front of root o et ungDescends on $ericardium into dia$hragm

Phrenic ner.es

%he #NL: motor su$$* to the dia$hragm

&ensor* branches to

!ericardium

Mediastina $arieta $eura

!eura co1ering u$$er and o0er suraces o dia$hragm

'horacic +art of s"m+athetic trunk

Most atera structure in the mediastinum

''/'" segmenta* arranged gangia

stellate ganglion

First gangion oten used 0ith inerior cer1ica gangion

Do0n0ard on heads o the ribs

Lea1es thora+ $assing behind media arcuate igament

2ontinuous 0ith umbar $art o s*m$athetic trunk

'horacic +art of s"m+athetic trunk Branches

2ardiac, Aortic,!umonar*, Eso$hagea branches

From 4rst 41e gangia

&$anchnic ner1es

&u$$* abdomina 1iscera

7reater s$anchnic

7angia P/

Lesser s$anchnic

7angia 'C/''

Lo0est s$anchnic

Last thoracic gangion

%so+hagus

Muscuar tube

A$$ro+ 'Cin ("Pcm)

2ontinuous 0 $harn*+

#$$osite @th cer1ica 1ertebrae

!asses through dia$hragm

Le1e o 'Cth thoracic 1ertebra

%hree (?) constrictions

Beginning

2rossing o et bronchus

!iercing the dia$hragm

%so+hagus

Bood su$$*

$$er ?rd

inerior th*roid arter*

-nerior th*roid 1ein

Midde ?rdbranches rom descending thoracic aorta

AJ*gous 1ein

Lo0er ?rd

Let gastric arter*

Let gastric 1ein

V tributar* to $orta 1ein

V +ortos"stemic anastomosis

'h"mus

Fattened

Biobed structure

Bet0een sternum and $ericardium

2ontinues to gro0 unti $ubert*

-m$orant source o

%/*m$hoc*tes

%he End

Abomen


Surface &arkings

; 4ertical lines

/ mid $oint o A&-& and s*m$h*sis $ubis

; )oriontal lines

&ubcosta $ane9 L=

-ntertubercuar $ane L

(egions

E$igastrium

= and L H*$ochondriac

mbiica

= and L Lumbar

H*$ogastric

= and L -iac

'rans+"loris Plane- 'ddison1s plane

- Le1e o L1 , th costal cartilage -

Structures

undus o 7B

termination o adut s$ina cord

$*orus o stomach

neck o $ancreas

hium o kidne*

AN'%(#*( AB5*&#NAL ALL

Skin

Su+er!cial fascia

supercial fatty 3Camper1s fascia4

deep membranous 3$carpa1s fascia4

/ ades atera* and abo1e

/ inerior* uses 0ith dee$ ascia o the thigh

/ orms a tubuar sheath or the $eniscitoris

/ attached to the sides o $ubic arch ( 2oe>s

ascia )

/ uses 0ith $erinea bod* and $erinea

membrane

5ee+ fascia

&uscles

Ner.es

Skin

Ner.e Su++l"

From Anterior =ami o

• lower si2 ,G- thoracic

– Lo0er P intercosta ner1es

– &ubcosta ner1es



• First lumbar ner.es

– -ioh*$ogastirc

– -ioinguina ner1es

Skin

Bloo Su++l"

Arteries

• Midine

– &u$erior e$igastric arter*

– -nerior e$igastric arter*

• Fanks

– -ntercosta

– Lumbar

– Dee$ circumKe+ iiac arteries

Skin

Bloo Su++l"

eins

• Abo1e

– A+iar* 1ein

– 1ia Latera thoracic 1ein

• Beo0

– Femora 1ein

ia

– &u$er4cia e$igastric 1ein

– 7reat sa$henous 1eins

Skin

Bloo Su++l"

eins

2onnection bet0een su+erior an inferior .ena ca.aeSmall +araumbilical .eins

Aong ligamentus teres to +ortal .ein

;0aput 5edusae7

Skin

L"m+h 5rainage

&u$er4cia

2utaneous

Abo.e umbilicus

Anterior a+iar* *m$h nodes

Below umbilicus

&u$eri4cia inguina *m$h nodes

(ectus Sheath

Long 4brous sheath a$oneuroses

Contents9

=ectus abdominis

Anterior rami o o0er @ thoracic ner1esL*m$h 1esses

&u$erior and inerior e$igastric 1esses

!*ramidais

(ectus Sheath

Between Costal margin an AS#S

-nterna obiue s$its to co1er rectus abdominis

Below AS#S an Abo.e +ubis

A a$oneuroses $ass anterior*

De4cient $osterior*

Arcuate line of 5ouglas

/ o0er crescent sha$ed edge o the $osterior 0a

(ectus Sheath

Linea alba

Fibrous band

Fusion o a$oneurosis at midinerom 2i+hoi +rocess to +ubic s"m+h"sis

'rans.erse 'eninous intersections

(') Le1e o +i$hoid

(') in bet0een

(') Le1e o umbiius

Linea Semilunaris

“S+iegelian Line”

Lateral ege o the rectus abdominis

2rosses margin o ti$ o the ninth costa cartiage

Conoint 'enon

#nternal obliIue

Lo0er ree border

Lo0est tendinous 4bers

5oined b* trans.ersus abominis

&trengthens media ha o $osterior 0a o inguina cana

#nguinal Ligament

Pou+art7s ligament

Lo0er border o E+terna obiue a$oneurosis

2onnects Anterior &u$erior -iac &$ine (A&-&) to $ubic tuberce

Media end lacunar ligament ,$imbernat7s ligament-

2ontinuous 0ith +ectineal ligament ,Coo+er7s ligament-

T thickening o $eriosteum

Lo0er border,

Attached to ascia ata

Fascia 'rans.eralis

%hin a*er o ascia ining trans1erais musce

2ontinuous 0ith ascia iiaca (o iacus musce) %ogether orms emora sheath

Femoral sheath Q F' R F#

#nguinal Canal

Length A$$ro+ '.Pin (cm)

!arae and abo1e inguina igament

5ee+ inguinal ring

#1a o$ening in %rans1erais ascia

Abo1e inguina igament

Margins attachment or interna s$ermatic ascia

Su+er!cial inguinal ring

%rianguar sha$ed deect on E+terna obiue a$oneurosis

Abo1e and media to $ubic tuberce

Margins gi1e attachment to e+terna s$ermatic ascia

#nguinal Canal

alls

Anterior• E+terna obiue a$oneurosis

• -nterna obiue

Posterior

• 2on5oint tendon, media*

• Fascia trans1erais, atera*

Su+erior

• Arching 4bers o the interna obiue and trans1ersus

#nferior

• -nguina and acunar igaments

#nguinal Canal

Function

Ao0s structures to $ass

rom %estes to Abdomen S+ermatic cor

terus to abium ma5us (oun ligament of uterus

Both se+es transmit #lioinguinal ner.e

)esselbach7s 'riangle&eiall"9

=ectus abdominis

#nferiorl"9

-nguina igament

Laterall"9

-nerior e$igastric 1esses

#nguinal )ernia

&ite o $otentia 0eakness in both se+es

Abo.e inguinal ligament

/ lateral to inerior e$igastric 1esses

-ndirect -nguina Hernia

/ meial to inerior e$igastric 1esses

Direct -nguina Hernia

Below inguinal ligament

Femora hernia

S+ermatic Cor Contents&N%&*N#C9 Protruding Pies 5on>t Contribute 'o A $ood Se+ Lie

Pam$iniorm $e+us

Processus 1aginais remnants

5eerens, 1as

Cremasteric arter*

'esticuar arter*

Arter* to 1as

$enita branch, genitoemora ner1e

S*m$athetics

L*m$hatics

Processus .aginalis

!eritonea di1erticuum ormed in etus

!asses through o0er $art o anterior abdomina 0a to orm inguina

cana

S+ermatic cor



Co.erings

%2ternal s+ermatic fascia

From e+terna obiue

Attached to margins o su$er4cia inguina ring

Cremasteric fascia

From interna obiue

#nternal s+ermatic fascia

From ascia trans1ersais

Attached to margins o dee$ inguina ring

$ubernaculum testis

Muscuoigamentous cord

2onnects eta testis 0 Koor o scrotum

-m$ortant roe in descent o testisHomoog &ound ligament of ovary and uterus

Scrotum

#ut$ouching o o0er $art o anterior abdomina 0a

2ontains

%estes

E$idid*mis

Lo0er ends o s$ermatic cord

Scrotum

La"ers

'. Skin

". Su+eri!cal fascia “5artos muscle”

?. %2ternal s+ermatic fascia

. Cremasteric fascia

P. #nternal s+ermatic fascia

@. 'unica .aginalis

N*'%9 ransversus abdominis has N* contribution to the ormation oscrota 0a

'estes

!aired o1oid organs

!roduce

&$ermatoJoa

%estosterone

'unica albuginea

#uter 4brous ca$sue o testis

%+ii"mis

Lies $osterior to testis

2oied tube a$$ro+ "Ct (@m) ong

!arts

)ea

Bo"

'ail

4as eferens emerges rom tai

%+ii"misBloo Su++l"

'esticular arter"

• From abdomina aorta

'esticular .ein

• From testis and e$idid*mis (+am+iniform +le2us)

• =educed to singe 1ein though inguina cana

(#$)'9

• -2

L%F'9

• Let =ena ein

Peritoneum

• &erous membrane

• Lubricates suraces T ree mo1ement

Parietal la"er

• Lines 0as

4isceral la"er• 2o1ers organs

Peritoneal ca.it"

• !otentia s$ace in bet0een

– Maes Close

– Femaes 2ommunicates through uterus, 1agina

Peritoneum

$reater sac

• Main com$artment

• From dia$hragm to $e1is

Lesser Sac

• &maer

• Lies behind stomach

%+i+loic foramen

• Ao0s ree communication bet0een both

Peritoneal 5eri.ati.es

" a*ered ods

Ligaments

#mentum

Mesenter*

Lesser Sac

Behin stomach and esser omentum

Left margin

&$een

7astros$enic omentum

&$enicorena igament

(ight margin

7reater sac (main $art o $eritonea ca1it*)

%hrough e+i+loic foramen%+i+loic Foramen

Bounaries

Anterior

• Free border o esser omentum

Bile uct9 Anterior

)e+atic arter"9 Posterior to the L

Portal .ein9 Posterior to the (

Posterior

• -nerior 1ena ca1a

Su+erior

• 2audate obe o the i1er

#nferior

• First $art o the duodenum

Peritoneal S+aces

Sub+hrenic s+aces

,et/een diaphragm and liver (ight anterior

Left anterior

Posterior sub+hrenic s+ace

Clinically5 provide sites for the accumulation of pus

Peritoneal $utters

Paracolic gutters

Lie on atera and media sides o ascending and descending coons

!ro1ide channes or mo1ement o inected Kuid in the $eritonea ca1it*

Ner.e Su++l" of the Peritoneum

Parietal +eritoneum

Lower G thoracicO !rst lumbar ner.es

!ain, tem$erature, touch, $ressure

4isceral +eritoneum

Autonomic ner.es on mesenteries

&tretch

Stomach

PartsFunus

• dome/sha$ed

Bo"

• rom cardiac ori4ce to incisura angularis

P"loric Antrum

• incisura anguaris to $*orus

P"lorus

• Most tubuuar $art o stomach

• %hick muscuar 0a (+"loric s+hincter)

• 2a1it* (+"loric canal)

Stomach

Parts

Lesser cur.ature

• =ight border o stomach

• 2onnected to li.er b* lesser omentum

$reater cur.ature• Longer

• From et cardiac ori4ce aong et border o stomach

• $astros+lenic omentum@ ligament e+tends rom u$$er

$art to s+leen

• $reater omentum e+tends rom o0er $art to trans.erse

colon

Stomach

Parts

Cariac ori!ce

N# anatomic s$hincter

!h*sioogic s$hincter

P"loric ori!ce

Anatomic and $h*sioogic +"loric s+hincter ormed

&tomach, Bood &u$$*

Arteries



Lesser cur.ature

• =ight gastric

• Let gastric

$reater cur.ature

• =ight gastroe$i$oic

• Let gastroe$i$oic

Funus

• &hort gastric arteries W s$enic arter*

&tomach, Bood &u$$*

4eins

Drain into Portal Circulation

=ight gastric 1ein

Let gastric 1einS+lenic .ein

&hort gastric 1ein

Let gastroe$i$oic 1ein

Su+erior mesenteric .ein

=ight gastroe$i$oic

5uoenum

2/sha$ed tube

A$$ro+ 'Cin ("Pcm)

2ur1es around head o $ancreas

Begins at +"loric s+hincter

Ends b* becoming the eunum

;n =r an Eth +ortion9 retro+eritoneal

5uoenum

First +art

• %rans$*oric $ane

•

Le.el of L1MSecon +art

• 6ain pancreatic ducts $ierce media 0a V unite to orm

am+ulla ,of 4ater- o$ening into maor uoenal +a+illa

,of irsung-

• 'ccessory pancreatic duct0 o$ens to &inor uoenal

+a+illa ,of Santorini-

5uoenum

'hir +art

• HoriJonta in ront o the 1ertebra coumn

• Anterior* crossed b*

– (oot of mesenter" of small intestine

– Su+erior mesenteric .essels

Fourth +art

• $0ard and et to uoenoeunal Je2ure

• hed in $ostion b* Ligament of 'reit

>eunum #leum

>eunum

• a$$ro+ 8t (".Pm)

• $$er et

• 6ider

• %hicker

• =edder in coor

&eckel7s 5i.erticulum

2ongenita anoma*

!ersistent $ortion o the .itellointestinal uct

antimesenteric border o ieum

(ule of ;s

; ft from iliocecal unction

; inD in length

;T of ini.iuals

Beeding ma* occur rom ad5acent iea mucosa

N*' the di1erticuum

CecumBind/ended $ouch 0ithin right iiac ossa

2om$ete* co1ered 0 $eritoneum

oined on et side b* terminal ilieum

at 5unction o cecum and ascending coon

A$$endi+ at +osteromeial surace

#leocecal 4al.e

%0o horiJonta ods o mucous membrane

Around ori4ce o ieum

#leocecal s+hincter

&$hincter that contros Ko0 o contents rom ieum into coon

A++eni2

Narro0 muscuar tube

Large amount o *m$hoid tissue in its 0a

A$$ro+ 'in (".Pcm)

2om$ete $eritonea co1ering

#0n &esoa++eni2 0

• A$$endicuar 1eses and ner1es

'aniae coli o cecum con1erge to orm its continuous muscuar coat

Ascening colon

A$$ro+. Pin ('?cm) ong

2ecum to inerior surace o right obe o i1er ((ight colic Je2ure)

2ontinuous 0ith trans1erse coon

!eritoneum co1ers ront and sides

'rans.erse Colon

• A$$ro+ 'Pin (?8cm) ong

• mbiica, and h*$ogastric regions

Left colic Je2ure

• higher than the right• Hed u$ b* Phrenocolic ligament

'rans.erse mesocolon

• Attached to su$erior border o trans1erse coon

• &us$ends it rom $ancreas

$osterior a*ers o greater omentum, attached to inerior border

'rans.erse mesocolon

Arteries

!ro+ima "?rds

• &ile colic arter" W su+erior mesenteric arter"

Dista '?rd

• Left colic arter" W inferior mesenteric arter"

4eins

• &u$erior mesenteric 1ein

• -nerior mesenteric 1ein

'rans.erse Colon

L"m+h rainage!ro+ima "?rds

Colic noes su+erior mesenteric noes

Dista '?rd

#nferior mesenteric noe

'rans.erse Colon

Ner.e su++l"

!ro+ima "?rds

• Su+erior mesenteric +le2us

– &*m$athetic

– aga

Dista '?rd

• #nferior mesenteric +le2us

• $e1ic s$anchnic ner1es

– &*m$athetic

– !aras*m$athetic

5escening Colon

A$$ro+ 'Cin ("Pcm) ong

From et coic Ke+ure to $e1ic brim

!eritoneum co1ers ront and sides

Sigmoi Colon

A$$ro+ 'C/'Pin ("P/?8cm) ong

From escening colon in ront o +el.ic brim

%o rectum in ront o =r sacral .ertebra

Attached to $osterior $e1ic 0a b* an/sha$ed sigmoi mesocolon

Li.er

Largest organ o bod*

Di1ided b* falciform ligament into

&ma left lobe

Large right lobe

(ight lobe urther di1ided b*

gall blaerO !ssure of ligamentum teresO #4CO !ssure of

ligamentum .enosum into

6uarate lobe Cauate lobe

Li.er

Porta )e+atis ,hilus-

• !osteroineior surace o i1er

• $$er $art esser omentum attached to margins

2ontains

• (ight an left he+atic ucts

• (ight an left branches of he+atic arter"

• Portal .ein

• Ner.es

• L"m+h .essels

Li.er

Fissure for the ligamentum teres

Bet0een et obe and uadrate obe

Ligamentum teres X 4brous remains o umbilical .ein



Fissure for the ligamentum .enosum

Bet0een et obe and caudate obe

Ligamentum .enosum X Fibrous remains o the uctus .enosus

Li.er

$roo.e for the inferior .ena ca.a

Bet0een right obe and caudate obe

He$atic 1eins 5oin inerior 1ena ca1a

Fossa for the $allblaer

Bet0een right obe and uadrate obe

N# $eritoneum bet0een the gabadder and right obe o i1er

!eritonea Ligaments

Falciform ligament

Attaches i1erto dia$hragm abo1e

%o anterior abdomina 0a beo0

&icke/sha$ed ree margin

contains ligamentum teres

Peritoneal Ligaments

Coronar" ligament

Attaches i1er to dia$hragm

La*ers 0ide* se$arated orming ;bare area< o i1er de1oid o

co1ering

(ight triangular ligament

/sha$ed od

right e+tremit* o the coronar* igament

2onnects $osterior surace o the right obe o i1er to dia$hragm

Left triangular ligament

reKection rom u$$er surace o the et obe o the i1er to the

dia$hragmLesser *mentum

Attached abo1e to the margins o the

$orta he$atis

Fissure or the igamentum 1enosum

Attached beo0 to esser cur1ature o stomach

$allblaer

!ear/sha$ed sac

Lies in undersurace o i1er

A$$ro+ ?Cm

Parts

• Fundus

• Bod*

• Neck

– 2ontinuous 0 c"stic uct

Bile 5ucts

)e+atic 5uct

(ight an left he+atic ucts (rom each obe bie canaicui 1ia

+orta he+atis) V orm common he+atic uct

oined b* c"tic uct common bile uct

C"stic uct

&/sha$ed

2onnects neck o gallblaer 0 Common he+atic uct

Forming Common bile uct

“S+iral .al.e of )eister”

Common Bile 5uct

nion o c*tic duct 0ith common he$atic duct

oins main +ancreatic uct am+ulla of .ater maor uoenal

+a+illa ,of irsung-

“S+inchter of *i”

2ircuar smooth musce

&urrounds both ducts and am$ua

Pancreas

Parts)ea

Disc sha$ed 0ithin conca1it* o 2/sha$ed duodenum

0ncinate +rocess

!ro5ection to et rom o0er $art to head behind su$erior mesenteric

arteries

Neck

Narro0

2onnects head to bod*

-n ront o beginning o $orta 1ein

Pancreatic uct

&ain +ancreatic uct ,irsung-

• #$ens to second $art o duodenum

• 6ith bie duct

• ia am+ulla of .ater

Accessor" uct ,Santorini-

• #ten absent

• Drains u$$er ha o head

• #$en into duodenum on the minor uoenal +a+illa

S+leen

Largest singe mass o *m$hoid tissue

Lies beneath dia$hragm, thO 1thO 11th rib

#1oid 0 notched anterior border

&urrounded b* $eritoneum

$astros+lenic ligament

• From hius to stomach

• 2ontains short gastric, et gastroe$i$oic 1esses

S+lenicorenal ligament

• %o et kidne*• 2ontains s$enic 1esses, tai o $ancreas

Bloo Su++l"

Celiac arter" ,foregut-

• Lo0er third o eso$hagus to

• Midde second o duodenum

Su+erior mesenteric arter" ,migut-

• Midde second $art o duodenum to

• Dista third o trans1erse coon

#nferior mesenteric ,hingut-

• Dista third o trans1erse coon to

• Ha 0a* do0n ana cana

Celiac arter" ,'runk-

From ront o abdomina aorta, through dia$hragm

'erminal Branches

Let gastric

&$enicHe$atic

Left gastric arter"

=uns to cardiac end o stomach

7i1es oO a e0 eso$hagea branches

%urns right aong lesser cur.ature

Anastomoses 0ith right gastric arter"

S+lenic arter"

Largest branch o ceiac trunk

=uns

aong u$$er border o $ancreas

Behind stomach

Enters s+lenicorenal ligament to hium o s$een

S+lenic arter"O branches

1D Pancreatic branches

;D Left gastroe+i+loic arter"

• From Near hium o s$een

• %o greater cur1ature o stomach

• 6ithin gastros$enic omentum, 7reater omentum

• Anastomoses 0ith right gastroe+i+loic

S+lenic arter"O branches

=D Short gastric arteries

• P/@ in no.

• %o undus o stomach

• =un 0ithin gastros$enic omentum

• Anastomose 0ith left gastric arter"

• Left gastroe+i+loic arter"

)e+atic arter"

Ascends 0ithin lesser omentum

-n ront o o$ening o lesser sac

Let o the bie duct

Front o $orta 1ein

At +orta he+atis Di1ides into

right he+atic arter"left he+atic arter"

)e+atic Arter"O branches

(ight gastric arter"

%o et in esser omentum, aong esser cur1ature

Anastomoses 0ith et gastric arter*

$astrouoenal arter"

Descends behind 4rst $art o duodenum

Di1ides into

(ight gastroe+i+loic arter" V greater cur1ature

Su+erior +ancreaticouoenal arter" V "nd $art duodenum, head

o $ancreas

(ight he+atic arter"

7i1es oO c"stic arter"

Left he+atic arter"

Su+erior &esenteric Arter"



=eations

From ront o abdomina aorta

Behind neck o $ancreas

Front o ?rd $art o duodenum

Do0n0ard to right in root o mesenter* o sma intestine

Su+erior &esenteric Arter"O Branches

#nferior +ancreaticouoenal arter"

$$er border o the ?rd $art o duodenum beo0 the head o $ancreas

&ile colic arter"

-n trans1erse mesocoon V trans1erse coon

=ight branch anastomoses 0ith right colic

Let branch anastomoses 0ith left colic

Su+erior &esenteric Arter"O Branches(ight colic arter"

• Branch o ieocoic

• &u$$ies ascening colon

#leocolic arter"

• 7i1e oO

Su+erior branch V anatomoses 0ith right coic

#nferior branch V anastomoses 0ith end o su$erior mesenteric arter*

• 7i1es rise to

– Anterior cecal arter"

– Posterior cecal arter" V A++enicular arter"

Su+erior &esenteric Arter"

>eunal an #leal branches

'"/'P in number

Arise rom et side o su+erior mesenteric arter"

Arteries di1ide and unite to orm arcades

&ma, straight branches su$$* intestine#nferior &esenteric Arter"

Arises rom abdomina aorta

A$$ro+ '.Pin (?.8cm) abo1e aortic biurcation

Arter* runs do0nard and to the et

2rosses et common iiac arter*

Becomes su+erior iliac arter"

#nferior &esenteric Arter"O Branches

Left colic arter"

• Di1ides into ascending and descending branches

• &u$$*

– istal =r of trans.erse colon

– Left colic Je2ure

– 0++er +art of escening colon

Sigmoi arteries

• "/? in number

• &u$$ies escening sigmoi colon

#nferior &esenteric Arter"O Branches

Su+erior rectal arter"

• 2ontinuation o inferior mesenteric arter"

• Descends into $e1is behind rectum

• &u$$ies

– (ectum

– 0++er half of anal canal

• Anastomoses 0ith

– &ile (ectal Arter" W #ntenal #liac Arter"-

and

– #nferior (ectal Arter" ,W #nternal Puenal-

&arginal arter"

Anastomosis o coonic arteries

Aong conca1e margin o arge intestine

Begins at ieocoic 5unction

End at 5unction o sigmoid coon and rectum

Portal .enous s"stemPortal .ein

A$$ro+. "in (Pcm) ong

nion o

• Su+erior mesenteric .ein

• S+lenic .eins

Ascends to +orta he+atis

• Behind 4rst $art o duodenum

• -n ree margin o lesser omentum

• Di1ides to right and et termina branches

Portal .enous s"stem

Portal .ein

Drains bood orm 7astrointestina tract

• %o/er end of esophagus

• o half/ay do/n anal canal

• As 0e as rom

– Pancreas

– $allblaer

– Bile ucts

– S+leen

Portal 4enous S"stem 'ributaries

1D S+lenic .ein

=ecei1es

• &hort gastric

• Let gastroe$i$oic

• -nerior mesenteric

• !ancreatic

;D #nferior mesenteric .ein=ecei1es

• &u$erior recta

• &igmoid

• Let coic

Portal 4enous S"stem 'ributaries

=D Su+erior mesenteric .ein

=ecei1es

• e5una

• -ea

• -eocoic

• =ight coic

• Midde coic

• -nerior $ancreaticoduodena

• =ight gastroe$i$oic

ED Left gastric .ein

Drains et $ortion o esser cur1atureDista $art o eso$hagus

D (ight gastric .ein

Drains right $ortion o esser cur1ature

GD C"stic .ein

Drains gabadder

Portal:S"stemic Anastomosis

#&P*('AN'M

'. Dista ?rd, Eso$hagea branches o et gastric 1ein (!orta)

V Midde ?rd, eso$hagea branches o aJ*gous 1eins (&*stemic)

“%so+hageal .arices”

". &u$erior recta 1eins (!orta)

V Midde and -nerior recta 1eins (&*stemic)

“)emorrhois”

Portal:S"stemic Anastomosis

#&P*('AN'M

?. Paraumbilical .eins (in falciform ligament 0 ligamentum

teres) rom et branch o $orta 1ein ($orta)

&u$er4cia 1eins o anterior abdomina 0a (&*stemic)

“Ca+ut meusae”

. eins o ascending and descending coon, duodenum, $ancreas i1er

($orta)

V rena, umbar, $hrnenic 1eins (s*stemic)

/ine"s

• !aired organs

• =etro$eritonea

=ight kidne* o0er than et due to i1erY

)ilus

• 2onca1e border o kidne*

• E+tends to ca1it* o renal sinus

%ransmits

• =ena 1ein

• =ena arter*

• reter• &*m$athetic ner1e 4bers

;.A..A.<

/ine"s

2o1erings rom 0ithin to 0ithout

Fibrous ca+sule

• %rue ca$suerena ca$sue

• 2ose* a$$ied to outer surace

Perirenal fat

• Fat co1ering 4brous ca$sue

(enal Fascia

• ;$erotas fascia<

• Encoses kidne* and su$rarena gands

Pararenal fat

• E+terna to rena ascia



/ine"sO Structure

*uter corte2

• E+tends into medua bet0een ad5acent $*ramids ((enal

columns)

#nner meulla

• '" rena $*ramids (base to0ard corte+9 a$e+ / renal +a+illa

oriented media*)

• &eullar" ra"s

&triations rom bases o $*ramids to corte+

/ine"sO Structure

(enal Pel.is

$$er e+$anded end o ureter

Di1ided into 'wo maor cal"ces&ubseuent* di1ided into ;:= minor cal"ces

Each minor ca*+ indented b* a$e+ o rena $*ramid (renal +a+illa)

/ine"sO Bloo Su++l"

Arter"

• =ena arter*

4ein

• =ena 1ein

L"m+h rainage

• Latera aortic *m$h nodes

– Around rena arter* origin

Ner.e su++l"

• =ena s*m$athetic $e+us

0reters

Muscuar tubes e+tend rom kidne*s to $osterior surace o urinar*

badder

A$$ro+ 'Cin ("Pcm) ong(enal +el.is

Lies 0ithin renal hilus

$$er e+$anded end o ureter

recei1es ma5or ca*ces

0reteric Constrictions

'. unction o $e1is and ureter

". 2rossing o $e1ic brim

?. !iercing o badder 0a

0reter

Arteries

$$er end

• (enal arter"

Midde

• 'esticular@ o.arian arter"

-nerior end

• Su+erior .esicular arter"

4einseins corres$ond to arteries

Su+rarenal ,Arenal- $lans

Located to u$$er $oes o kidne*s

=etro$eritonea

&urrounded b* rena ascia

&e$arated rom kidne*s b* $erirena at

Has

Corte2 (*eo0 coored)

&eulla (bro0n coored)

Su+rarenal ,Arenal- $lans

Arteries

#nferior +hrenic arter"

Aorta

(enal arteries

4eins

(ight su+rarenal .ein inferior .ena ca.aLeft su+rarenal .ein left renal .ein

Aorta

Abominal aorta

Enters through aortic o$ening in dia$hragm ,'1;-

Di1ides into common iiac ,LE-

Aorta

Branches

'. 'hree ,=- anterior .isceral

• 2eiac arter*

• &u$erior mesenteric

• -nerior mesenteric

". 'hree ,=- lateral .isceral

• &u$rarena arter*

• =ena arter*

• %esticuar o o1arian arter*

Aorta

Branches

?. Fi.e ,- lateral abominal

• -nerior $hrenic arter* (')

• Four umbar arteries ()

. 'hree ,=- terminal

• %0o common iiac arteries (")

• Median sacra arter* (')

Common #liac Arteries

%ermina branches o abdomina aorta

=un do0n0ard and atera*

Di1ide into e+terna and interna iiac arteries

2rossed anterior* b* ureter on each side#nferior .ena ca.a

Formed b* union o common iiac 1eins (LP)

!ierces centra tendon o dia$hragm at (%8)

%o right atrium

#nferior .ena ca.aO tributaries

'ributaries

' %0o (") anterior 1iscera

• He$atic 1eins

". %hree (?)atera 1iscera

• =ight su$rarena 1ein

• =ena 1eins

• =ight testicuaro1arian 1ein

Let drains to et rena

#nferior .ena ca.aO tributaries

'ributaries

?. Fi1e (P) atera abdomina 0a tributaries-nerior $hrenic 1ein (')

Four umbar 1eins ()

. %hree (?) 1eins o origin

%0o common iiac 1eins (")

Median sacra 1ein (')

L"m+hatics on +osterior abominal wall

C"sterna Ch"li ,thoracic uct-

Eongated sac in abdomen

Lies on right side o aorta (L'/L")

=ecei1es

-ntestina trunk

=ight and Let umbar trunks

L*m$h 1esses rom o0er $art o thora+

Lumbar Ple2us Branches, L1L;L=LE -

&N%&*N#C9 # ;2 $et Lai *n Fria"

#ioinguina (L')

#ioumbar (L')

$enita branch, genitoemora ner1e (L'L")

Latera cutaneous ner1e o the thigh (L"L?)

*bturator (L"L?L)

Femora (L"L?L)

A arise lateral to $soas %?C%P'9

7enita branch, genitoemora ner1e ( anterior )

#bturator ner1e ( medial )

S"m+athetic trunk

Enters abdomen behind media arcuate igament

=uns do0n0ard aong media border o $soas musce

#n bodies o umbar 1ertebrae

Enter $e1is behind common iiac 1esses

!ossess /P segmenta* arranged gangia

&uscles of Posterior Abominal all

!soas

Quadratus umborum-iacus

Ner1e su$$* Lumbar $e+us E2E!% -iacus ( emora ner1e )

%HE END

• Pel.is an Perineum

• Loubomir E. Antonio, M.D.

• Bon* !e1is

Four ,E- bones

• %0o (") hi$s bones

• &acrum

• 2occ*+

Pel.ic brim com+ose of9

• &acra $romontor* ($osterior*)

• -io$ectinea ines (atera*)



• &*m$h*sis $ubis (anterior*)

5i.ies +el.is into9

• False +el.is (greater $e1is) / AB#E

• 'rue +el.is (esser $e1is) / BEL#6

• 'rue Pel.is

Pel.ic #nlet

• &acra $romontor* ($osterior*)

• -io$ectinea ines (atera*)

• &*m$h*sis $ubis (anterior*)

*utlet

• 2occ*+ ($osterior*)

• -schia tuberosities (atera*)

• !ubic arch (anterior*)Ca.it"

• Bet0een inet and outet

• &hort cur1ed cana

• &hao0 anterior 0a

• Dee$er $osterior 0a

• %rue $e1is

Ligaments

• &acrotuberous igament

• &acros$inous igament

Di1ide sciatic notches to

$reater sciatic foramen

Lesser sciatic foramen

• Sacroiliac oint

• &trong s*no1ia 5oint

Between

•

&acrum• -iac bones

Su++orte b"

• !osterior sacroiiac igament

• -nterosseous sacroiiac igament

• Anterior sacroiiac igament (thin)

%ransmit 0eight o bod* rom 1ertebra coumn to bon* $e1is

Ner.e Su++l"

• &acra $e+us

• S"m+h"sis +ubis

2artiagenous 5oint

Bet0een t0o $ubic bones

• Articuar surace co1ered b* h*aine cartiage

• 2onnected b* 8brocartilagenous disc

• oint surrounded b* igaments

• No mo1ement $ermitted

• Sacrococc"geal oint

2artiagenous 5oint

Bet0een sacrum and cocc*+

2ornua o sacrum and cocc*+ 5oined b* igaments

7reat dea o mo1ement $ossibe

Ligaments rea+ed during $regnanc*

• &e+ diOerences o $e1is

• alls of the +el.is

Anterior wall

• Bodies o $ubic bone

• !ubic rami

• &*m$h*sis $ubis

• &acrotuberous igament

• &trong

From

• Lateral +art of Sacrum an Cocc"2 and

• Posteroinferior #liac s+ine

%o V• #schial tuberosit"

$re1ent o0er end o sacrum rom being rotated b* the bod*

• &acros$inous igament

&trong

%rianguar sha$ed

Base lateral +art of sacrum an cocc"2

A$e+ s+ine of ischium

!re1ent o0er end o sacrum rom being rotated b* the bod*

• -nerior $e1ic 0a (!e1ic Foor)

• &u$$ort $e1ic 1iscera

Formed b* +el.ic ia+hragm

• Le1ator ani musce

• &ma cocc*gea musces

• !e1ic asciae

-ncom$ete anterior*

• Ao0s $assage o urethra (and 1agina)

• !EL-2 F=A2%=E

• Musces o the !e1ic 6as and Foor

• !iriormis

• #bturator internus

• Le1ator ani

– !uborectais

– !ubococc*geus

– -iococc*geus

• 2occ*geus

• !e1ic Fasciae

Parietal +el.ic fascia• Line $e1ic 0as

• 2ontinuous 0ith ascia ining abdomina 0as

• !e1ic Fasciae

4isceral +el.ic fascia

• 2o1ers a $e1ic 1iscera

• Parametrium 3 ascia around cer1i+

• !e1ic $eritoneum

• Lines $e1ic 0as

• =eKected onto $e1ic 1iscera

• 2ontinuous 0ith 1iscera $eritoneum

• Ner1es o the !e1is

• &acra !e+us

• Branches o umbar $e+us

• Autonomic ner1es

• Sacral +le2us

#n $osterior $e1ic 0a-n front of +iriformis

Formed b* anterior rami of LE:LO S1:SE ner.es

Lumbosacral trunk ,Lumbar +le2us-

• 2ombination o L and LP

• !asses into $e1is

• oins sacra ner1es

• Sacral Ple2us Branches

&N%&*N#C9 N* Priests See$s Sound* #nside Nuns 6uarters

Ner1e to *bturator internus

Posterior cutaneous ner1e o the thigh

Sciatic ner1e

Su$erior gutea ner1e

#nerior gutea ner1e

Ner1e to 6uadratus emoris

,ranches that leave the pelvis through Greater sciatic foramen

• Sacral Ple2us Branches

,ranches to the pelvic muscles0 viscera and peritoneum

!udenda ner1e

Ner1e to $iriormis musce

!e1ic s$anchnic ner1es ( &"&?& )

• Lumbar Ple2us

&N%&*N#C9 # ;2 $et Lai *n Fria"

#ioinguina

#ioumbar

$enita branch, genitoemora ner1e

Latera cutaneous ner1e o the thigh

*bturator

Femora


Pel.ic +art of s"m+athetic trunk

2ontinuous 0ith umbar $art

%0o trunks come together in rom o cocc*+

&*m$athetic trunk has /P segmenta gangiaBranches

• $ra" rami communicantes

– $acral nerves

– Coccygeal nerves

• Fibers to h"+ogastric +le2uses


Pel.ic s+lanchnic ner.es

• &arasympathetic part of autonomic nervous system

• From S;O=OE

• !regangionic 4bers V gangia o h*$ogastric $e+uses

• Autonomic Ner.es

Su+erior )"+ogastric Ple2us

#n front of +romontor"

Di1ides to



• =ight h*$ogastric ner1e

• Let h*$ogastric ner1e

2ontinuation o

• Aortic $e+us and

• Branches o ?rd, th umbar s*m$athetic gangia

• 2ontains

– Sympathetic

– Sacral parasympathetic

– -isceral a?erent

• Autonomic Ner.es

#nferior )"+ogastric Ple2us

From

• h"+ogastric ner.e (o su$erior h*$ogastric $e+us)• Pel.ic s+lanchnic ner.e

2ontains

• &ostganglionic sympathetic

• &re*and*post ganglionic parasympathetic

• Visceral a7erent

&u$$*

• Large bo0e rom left colic @exure to upper half of anal

canal

• Arteries of Pel.is

False Pel.is

• 2ommon -iac arter*

• E+terna -iac arter*

'rue Pel.is

• -nterna -iac arter*

– Anterior di1ision

–

!osterior di1ision• &u$erior =ecta arter*

• #1arian arter*

• Median sacra arter*

• Common #liac Arter"

Ends at $e1ic inet in ront o the sacroiiac 5oint

Di1ides into

• E+terna iiac

• -nterna iiac

• %2ternal #liac

Media border o $soas

Foo0s $e1ic brim

Branches

• #nferior e+igastric

• 5ee+ circumJe2 iliac

Lea1es ase $e1is as femoral arter"

• #nternal #liac

Lea1es $e1is thorugh greater sciatic foramen

Di1ides into

• Anterior i.ision

• Posterior i.ision

&u$$*

• &elvic viscera

• &erineum

• &elvic /alls

• ,uttoc8s

• #nternal #liac Arter" Branches

&N%&*N#C9 # &iked *ur #nsatiabe -nterns 0dders 0nder the 5esk

#nerior gutea

&idde recta

*bturator

#nerior 1esica

#nterna $udenda

0mbiica &u$erior 1esica0terine agina

the

5eerentia

• Posterior 5i.ision of #nternal #liac

#ioumbar arter*

Latera sacra arteries

Su$erior gutea arteries

• Su+erior (ectal Arter"

Direct continuation o inerior mesenteric arter*

&u$$ies

• mucous membrane o rectum

• $$er ha o ana cana

• *.arian Arter"

From abdomina aorta (L' e1e)

!asses do0n0ard behin the $eritoneum

Enters sus+ensor" ligament of o.ar"

!asses into broad igament

Enters o1ar* through meso1arium

• &eian Sacral Arter"

• Biurcation o the aorta (LLP )

• Descends o1er anterior surace o the sacrum and cocc*+

• eins o the !e1is

Fase !e1is

• E+terna -iac 1ein

%rue !e1is

• -nterna -iac 1ein

• &u$erior recta 1ein• #1arian 1ein

• Median &acra 1ein

• %2ternal #liac 4ein

• Begins behind inguina igament

• 2ontinuation o emora 1ein

• =uns media* to arter*

• oins interna iiac 1ein V common iliac .ein

• =ecei1es

– #nferior e+igastric

– 5ee+ circumJe2 iliac

• #nternal #liac 4ein

• nion o tributaries corres$onding to branches o internal

iliac arter"

• ascends in ront o sacroiiac 5oint

• oins e+terna iiac V common iliac .ein

•

Su+erior (ectal 4ein5rains

• =ecta mucous membrane

• Mucous membrane o u$$er ha o ana cana

#m+ortantM +ortal:s"stemic anastomosis

as it unites 0ith inferior mesenteric vein

• *.arian 4ein

(ight o1arian 1ein

drains into inferior vena cava

• &eian Sacral 4ein

• &ma

Drains into

• #nferior .ena ca.a or

• Left common iliac .ein

• Sigmoi Colon

• 'C/'Pin ("P/?8cm) ong

• From +el.ic brim to S=

• Attached to $osterior $e1ic 0a b* sigmoid mesocoon

• (ectum

A$$ro+. Pin ('?cm) ong

From &? to ti$ o cocc*+

!ierces $e1ic Koor V ana cana

'eritoneum only co.ers upper =!3rds

• (ectum

(ectal am+ulla

• Diated o0er $ortion

'rans.erse fols , )ouston7s .al.es-

• %hree (?) semicircuar ods

su+erior : L

mile : (

inferior : L

• (ectum

Arteries

• &u$erior recta arter* W inerior mesenteric arter*• Midde recta arter* W interna iiac arter*

• -nerior recta arter* W interna $udenda arter*

• (ectum

4eins

• &u$erior recta 1ein V $orta s*stem

• Midde recta 1ein V s*stemic s*stem

• -nerior recta 1ein V s*stemic s*stem

• (ectum

L"m+h rainage

• !ararecta nodes

• V inerior mesenteric nodes

• V interna iiac nodes

• =ectum

Ner.e Su++l"



• -nerior h*$ogastric $e+uses

– &*m$athetic

– !aras*m$athetic

• 0reters

Muscuar tube rom kidne* to $osterior surace o badder

Enter $e1is crossing biurcation o common iiac arteries

• =uns do0n atera 0a o $e1is

Enters atera ange o badder

• In males, crossed b* .as eferens

• In females, turns or0ard meiall" beneath broa

ligament

• crossed b* uterine arter"

• 0reteric Constrictions %hree (?) constrictions

'. 6here rena +el.is oins ureter

". 6here it is kinked as it crosses the +el.ic brim

?. 6here it +ierces the blaer wall

• 0rinar" Blaer

Ma+ ca$acit* a$$ro+ PCCm

!*ramida

A+e29

• connected to umbilical ligament (remains o urachus)

Base9

• aces $osterior*

• trianguar

Neck9

• $oints inerior*

Su+ralateral angles9

•

entr* o ureters#nferior angle9

• e+it o urethra

Su+erior surface9

• co1ered 0 $eritoneum

• 0rinar" BlaerO #nterior

'rigone

• -nterna surace

&mooth mucous membrane adheres to under*ing musce

0reteral *+enings

&ma sit ike o$ening at atera anges

#nterureteric rige runs in bet0een

• orms u$$er imit o trigone

• 0rinar" BlaerO #nterior

#$ening o urethra beo0

-n maes, median obe o $rostate buges sight* u$0ard

0.ula .esicae

• &0eing behind urethra ori4ce

• 0rinar" BlaerO muscular coat

5etrusor muscle

• %hree (?) interacing a*ers o smooth musce 4bers

S+hincter .esicae

• 2ircuar musce at neck o badder

• 0rinar" blaerO ligaments

Ligaments rom $e1ic ascia

Hod badder neck in $ace

Pubo+rostatic ligament

• maes

Pubo.esical ligament

• emaes

• 0rinar" Blaer

Arteries

Internal Iliac artery 9

• &u$erior 1esica arter*• -nerior 1esica arter*

4eins

Internal Iliac vein

• 0rinar" Blaer

L"m+h rainage

• -nterna -iac nodes

• E+terna -iac nodes

Ner.e Su++l"

Inferior !ypogastric plexus

• &*m$athetic

• !aras*m$athetic

• 4as 5eferens

• %hick/0aed tube

• A$$ro+ '8in (Pcm) ong

• From o0er endtai o e$idid*mis

• %hrough inguina cana

• 2rosses ureter to reach $osterior badder

• E+$ands orming am+ulla

• oins seminal .esicle

• V eaculator" uct

• %aculator" uct

• %0o (")

From union o

• 4as eferens

• 5uct of seminal .esicle

• #$en into +rotastic urethra

• Seminal 4esiclesMuch coied tube embedded in connecti1e tissue

Located on

• !osterior surace o badder

• Latera $art o 1as deerens

2ontribute

• Fluid

• Fructose

• "scorbic acid

• "mino acids

• 'rostaglandins

• Prostate

7anduar

&urrounds $rostatic urethra

• Beo0 neck o badder

• Abo1e urogenita dia$hragm

Fibrous ca$sue• And 4brous sheath X 1iscera a*er o $e1ic ascia

Base9

• ies su$erior* against badder neck

A+e29

• ies inerior* against urogenita dia$hragm

• Prostate

• E5acuator* ducts o$en into $rostatic urethra at atera

margins o Prostatic utricle

Lobes

• Anterior

• &ile@meian

– Behind urethra, abo1e e5acuator* ducts

• (ight lateral

• Left lateral

• Prostate

Arteries

• -nerior 1esica

• Midde recta

• Prostate

L"m+h rainage

• -nterna -iac nodes

Ner.e Su++l"

• -nerior h*$ogastric $e+us

• *.aries

Found in *.arian fossa

• De$ression near atera 0a o $e1is

• Bounded b* external and internal iliac arteries

&eso.arium

• Attaches o1ar* to back o broad igament

)ilum

• Entr* o o1arian 1esses and ner1es

• *.aries

$erminal e+ithelium• Modi4ed area o $eritoneum co1ering o1ar*

• %hin 4brous ca$sue ('unica albugina) beneath

*uter Corte2

• 2ontains o.arian follicles

#nner &eulla

• Ligaments of *.aries

Sus+ensor" Ligament

• Latera $art o broad igament

• 2onnects meso1arium to atera $e1ic 0a

• 2ontains

– Bood

– L*m$hatic 1esses

– Ner1es

(oun Ligament



• =emains o u$$er $art o gubernaculum

• (Round ligament of uterus : lo/er part;

• Media margin o o1ar* to atera 0a o uterus

• *.aries

Arteries

• #1arian arter* W abdomina aorta

• eins

*.arian .ein

V (right) inerior 1ena ca1a

V (et) et rena 1ein

• 0terine tubes

$$er border o broad igament

2onnects $eritonea ca1it* in region o o1ar* 0ith ca1it* o uterusPro.ies

• Conuit or s$ermatoJoa to reach o1um

• &ite or fertiliation o the o1um (usua* the am+ulla)

• Nourishment or ertiiJed o1um

• 'rans+orts o1um to ca1it* o uterus

• 0terine 'ubes

Four 9A# parts

1D #nfunibulum

• Funne/sha$ed

• 0 4mbrae dra$ed o1er o1ar*

;D Am+ulla

• 6idest $art

=D #sthmus

• Narro0est $ortion o tube

• ust atera to uterus

ED #ntramural• !ierces uterine 0a

• 0terine tubes

Arteries

• terine and o1arian arteries

4eins

• terine and o1arian 1eins

L"m+h rainage

• -nterna iiac

• !ara/aortic nodes

Ner.e su++l"

• &u$erior h*$ogastric $e+us


&*m$athetic, !aras*m$athetic

• 0terus

Funus

• Abo1e entrance o uterine tubes

Bo"

• Beneath entrance o uterine tubes

Cer.i2

• !ierces anterior 0a o 1agina

• #nternal os

– terine o$ening

• %2ternal os

– agina o$ening

• 0terus

!ositions

Ante.ersion

• For0ard bending o uterus on ong a+is o 1agina

AnteJe2ion

• For0ard bending o uterus aong ong a+is o bod* o uterus

on cer1i+

• 0terine Su++ort

Pel.ic ia+hragm/ Most -m$ortant

!erinea bod*

%rans1erse cer1ica ( cardina ) igaments

!ubocer1ica igament

&acrocer1ica igament

• Broa ligaments

%0o/a*ered ods o $eritoneum

Latera margins o uterus VLatera $e1ic 0as

Contains

• 0terine tube (in u$$er ree border)

• (oun ligaments o o1ar* and o the uterus

• 0terine an o.arian

– Bloo .essels

– L"m+h .essels

– Ner.es

Litte su$$ort or the uterus

• (oun ligament of uterus

&u$eroatera ange o uterus

inguina cana

subcutaneous tissue o abium ma5us

Assists in uterine

• Ante1ersion

• AnteKe+ion

• 0terus

Arteries

• terine arter* W interna iiac

• #1arian arter*4eins

• terine 1ein

• #1arian 1ein

• 0terus

L"m+h rainage

Fundus

#1arian arter* V

• !ara/aortic nodes (e1e L')

Bod* and 2er1i+

• -nterna and e+terna iiac nodes

Ner.e Su++l"


&*m$athetic, !aras*m$athetic

• 4agina

Femae genita cana

•

E+cretor* duct or menstrua Ko0• Birth cana

Muscuar tube bet0een 1u1a and uterus

2er1i+ $ierces anterior 0a

)"men

• Mucosa od ound in 1irgins

• !erorated at center

• 4agina

Area surrounding cer1i+

Four fornices

• Anterior

• !osterior

• =ight atera

• Let atera

=eations

+pper half:

bet0een

• $e1is (anterior*) and

• rectum ($osterior*)

(ower half:

0ithin $eritoneum

• rethra (anterior*)

• Ana cana ($osterior*)

• 4aginaO Su++ort

0++er thir

• Le1atores ani musces

• %ranscer1ica igament

• !ubocer1ica igament

• &acrocer1ica igament

&ile thir

• rogenita dia$hragm

Lower thir

• !erinea bod*

• 4aginaArteries

• agina arter* W interna iiac arter*

• agina branch o uterine arter*

4eins

• -nterna iiac 1eins

• 4agina

L"m+h rainage

$$er ?rd

V interna R e+terna iiac nodes

Midde ?rd

V interna iiac nodes

Lo0er ?rd

V su$eri4cia inguina nodes

Ner.e Su++l"




• 4isceral +el.ic fascia

2o1ers su$$orts $e1ic 1iscera

2ondensed to orm

• !ubocer1ica igament

• %rans1erse cer1ica igament

• &acrocer1ica igament

Parametrium

• !e1ic ascia in region o uterine cer1i+

• Peritoneum in the Female Pel.is

!asses o1er

• rinar* badder

• terus• agina

• Front o rectum

(ectouterine +ouch ,of ouglas-

• !eritonea $ouch bet0een 1agina and rectum

• Most inerior $art o $eritonea ca1it*

• Perineum

Beo0 $e1ic dia$hragm

Diamond/sha$ed

Boundaries

Anteriorl"9

• s*m$h*sis $ubis

Posteriorl"

• ischia tuberosities

5i.ie into two b"

• imaginar* ine bet0een tuberosities

Anterior triangle U urogenita triangePosterior triangle U ana triange

• 0rogenital 'riangle

0rogenital ia+hragm

Muscuoascia dia$hragm

Fis ga$ bet0een $ubic arch

Formed b*

• Sphincter urethrae

• 1eep transverse perineal muscles

(bet0een su$erior and inerior ascia a*ers)

#nferior $erinea ascia X +erineal membrane

• 0rogenital 'riangle

Perineal bo"

&ma mass o 4brous tissue

• Attached to center o the posterior margin of the urogenital

diaphragm

Larger in emaes

• !ro1ides su$$ort to $osterior 1agina 0a

• !ro1ides attachment to musces in the $erineum

• Perineal Pouches

• &u$er4cia $erinea $ouch

• Dee$ $erinea $ouch

• Su+eri!cial Perineal Pouch

Close +osteriorl" an laterall"

Anteriorl"9

&$ace communicates ree* 0ith $otentia s$ace bet0een

• su$er4cia ascia o anterior abdomina 0a (ScarpaBs

fascia) and

• anterior abdomina musces

• S0P%(F#C#AL P%(#N%AL P*0C) ,contents-

;B - 7 & &<

Bubos$ongiosus-schioca1ernosus

7reat 1estibuar gands (Barthoin>s)

&u$er4cia trans1erse $erinei

&crota ner1es

• 5%%P P%(#N%AL P*0C) ,contents-

Dorsa ner1e o $enis (men)

&$hicter urethrae

Bubourethra gands (2o0$er>s) (men)

Membranous $art o urethra

!udenda 1esses and ner1es

Dee$ trans1erse $erinei

;5ont Sto$ Banging &* Perineum 5ear<

• &ale %2ternal $enitalia

#nterior

%hree (?) c*inders o erectie tissue

6ithin tubuar sheath o ascia

Cor+ora ca.ernosa

• %0o (")

• Dorsa

Cor+us s+ongiosum

• #ne (')

• entra

• Forms 7ans !enis

• 2ontains $enie $art o urethra

• &ale %2ternal $enitalia

(oot of +enis

-n supericial perineal pouch

? masses o erectie tissue• Bulb V Cor+us s+ongiosum

• Midine

• %ra1ersed b* urethra

• 2o1ered b* bulbos+ongiosus muscle

• (ight an Left crura V cor+ora ca.ernosa

• Attached to side o $ubic arch

• 2o1ered b* #schiocar.ernosus muscle

• &ale e2ternal genitalia

Arteries

• Dee$ arteries o $enis

• Branches o dorsa arter*

4eins

• Dee$ dorsa 1ein

• L*m$h Drainage

7ans

•

Dee$ inguina• E+terna iiac

&kin

• &u$e4cia inguina nodes

Erectie tissue

• -nterna iiac

Ner.e Su++l"

• !udenda ner1e

• Bulbourethral

,Cow+er7s $lans-

• %0o (") sma gands

• Dee$ $erinea $ouch

• Fibers o s$hincter urethrae musce

• #$en into $enie urethra

• Prostatic 0rethra

iestO &ost ilatable

0rethral crest

• Longitudina ridge on $osterior 0a

Prostatic sinus

• on sides o crest

• #$ening o $rostatic gands

Prostatic utricle

• Anaogue o uterus and 1agina

• Edge o mouth (") e5acuator* ducts

• &embranous 0rethra

• %hrough urogenita dia$hragm

• &urrounded b* s$hincter urethrae

• ShortestO Least ilatable

• Penile 0rethra

E+terna meatus

• Narrowest $art o entire urethra

Fossa terminais (na1icuar ossa)

• rethra 0ithin bub o $enis

• Bubourethra gands• #$en to $enie urethra beo0 urogentia dia$hragm

• Female %2ternal $enitalia ,4ul.a-

• Mons $ubis

• Labia ma5ora

• Labia minora

• 2itoris

• 7reater 1estibuar gands

• 4estibule of the 4agina

• &$ace bet0een abia minora

A$e+

• 2itoris

Foor

• #$enings o the urethra

• agina



• Ducts o greater 1estibue gands

• $reater 4estibular $lans

%0o (")

• Mucus/ secreting gands

Duct o each gand V groo1e bet0een h*men and $osterior $art o

abium minus

• Female 0rethra

From badder neck V e+terna meatus

• '.Pin (?.8cm) ong

%hrough

• rogenita dia$hragm

• &$hincter urethrae

#$ens into surace below citoris-n ront o 1agina

• &uscles of 0rogenital 'riangle

• &u$er4cia trans1erse $erinea musce

• Bubos$ongiosus

• -schioca1ernosus

• Dee$ trans1erse $erinea musce

• &$hincter urethrae

A su$ied b* $erinea branch o $udenda ner1e

• Anal Canal

• '.Pin (cm) ong

• Beo0 $e1ic dia$hragm

• =ecta am$ua V anus

Anal Columns

• ertica ods on mucous membrane

• #n $$er ha o ana cana (Lo0er ha is smooth)

Anal 4al.es • &ma semiunar ods

• 2onnect ana coumns together

• Anal Canal

Musce coat

• #uter ongitudina a*ers

• -nner circuar a*er o smooth musce

#n.oluntar" #nternal s+hincter

• %hickening o circuar a*er at u$$er end

4oluntar" %2ternal s+hincter

• &urround interna s$hincter 0ith coar o stri$ed musce

!arts

• $ubcutaneous

• $upercial

• #eep

• Anal Canal

Puborectalis

• &ing ormed rom 4bers o le.ator ani muscle

• Attached anterior* to $ubic bone

• Around 5unction o rectum and ana cana

• !us or0ard to make ange more acute

Anorectal ring

Distinct ring at anorecta 5unction, rom

• #nternal s+hincter

• 5ee+ +art of e2ternal s+hincter

• Puborectalis

• Anal Canal

Arteries

$$er ha

• Su+erior rectal arter"

Lo0er ha

• #nferior rectal arter"

4eins

$$er ha • &u$erior recta 1ein V inerior mesenteric 1ein

Lo0er ha

• -nerior recta 1ein V interna $udenda 1ein

• Anal Canal

L"m+h rainage

$$er ha

• !ararecta nodes V inerior mesenteric nodes

Lo0er ha

• Media grou$ o su$er4cia inguina nodes

• Anal Canal

Ner.e Su++l"

$$er ha

(and internal anal s+hincter)

• sensiti1e to stretch

V hypogastric plexus

Lo0er ha

(and e2ternal anal s+hincter)

• !ain

%em$erature

%ouch

!ressure

• V inferior rectal nerves

• #schiorectal Fossa

6edge/ sha$ed s$ace on each side o ana cana

Base9

• &u$er4cia9 skin

%ge9• 5unction o media and atera 0as

&eial all9

• e1ator ani musce

• Ana cana

Lateral wall9

• Lo0er $art o obturator internus musce and $e1ic ascia

• #schiorectal Fossa

Fat/4ed,

Ao0s distention during deecation

Puenal canal

• Fascia cana

• Media side o ischia tuberosit*

• !assage

– !udenda ner1e

– -nterna $udenda 1esses

•

&uscles of Anal 'riangle%2ternal Anal s+hincter

• &ubcutaneous $art

• &u$er4cia $art

• Dee$ $art

Ner1e &u$$* $erinea branch o &

Puborectalis muscle

Ner1e &u$$* !erinea branch o &

!erinea branch o $udenda ner1e

$$er E+tremit*


Bones of the Shouler $irle

2a1ice

&ca$ua

Fractures

Cla.icular fracture

Most common* ractured bone in the bod*

Fa on the shouder or outstretched hand

unction o m?rd and dista ?rd

Dista ragment goes do0n0ard, media and or0ard b* $ectorais

ma5or

Media end $ued u$0ard b* &2M

Fractures

&ca$uar racture

=esut o se1ere trauma

=un/o1er accident 1ictims, 1ehicuar crashes

=euire itte treatment

Bone of the Arm

Humerus

Head

Anatomica neck

7reater tuberosit*

Lesser tuberosit*Bici$ita groo1e (bice$s tendon)

&urgica neck

Detoid tuberosit*

Bone of the Arm

Humerus

&$ira groo1e (radia ner1e and dee$ arter* o arm

Media e$icond*e

Latera e$icond*e

2a$ituum (head o radius)

%rochea (trochear notch o una)

=adia ossa

2oronoid ossa (coronoid $rocess o una)

#ecranon ossa

Fractures



Humera head

7reater tuberosit* 3 $ued b* &,-,%

Lesser tuberosit* 3 $ued b* &

&urgica neck / most common site

Humera shat

$ro+ima to detoid insertion

$ro+ima ragment adducted b*

!M,LD,%M

dista ragment $ued b* D,BB,%B

dista to detoid insertion

$ro+ima ragment abducted b* D

dista ragment $ued b* BB, %B

/ radia ner1e at risk4olkmann7s #schemic Contracture

2ontracture o musces o the orearm oo0ing ractures o the distal

end o the humerus

/ brachia arter* s$asm eading to ischemic

necrosis

Bones of the Forearm

• =adius

Latera bone o orearm (sca$hoid and unate)

– Head (circuar)

– Neck

– Bici$eta tuberosit* (bice$s brachii)

– &hat

• -nterosseous border

• -nterosseous membrane

– &t*oid $rocess

–

nar notch – Dorsa tuberce

Bones of the Forearm

na

Media bone o orearm

#ecranon

%rochear notch

2oronoid $rocess

&hat

-nterosseous border

Head

&t*oid $rocess

Fractures of the Forearm

Colle7s fracture

racture o the dista end o the radius 0ith the dista ragment

dis$aced dorsa* ; dinner for8 deformity ;

Smith7s fracture

racture o the dista end o the radius 0ith the dista ragment

dis$aced 1oar*

$aleai7s fracture

racture o the $ro+ima end o the radius 0ith disocation o D=

&onteggia7s fracture

racture in the shat o una 0ith anterior disocation o the radia head

and ru$ture o annuar igament

Bones of the rist

2ar$a bones

;Scared (overs T ry 'ositions T hat T hey 0annot /andle4

'. Sca$hoid (na1icuar)

". Lunate

?. 'riuetra

. Pisiorm

P. 'ra$eJium

@. 'ra$eJoid

. Ca$itate8. )amate

Bones of the )an

• Metacar$a Bones

– Base

– &hat

– Head

• !haanges

– ? or each Digit

• !ro+ima

• Midde

• Dista

– E+ce$t %humb (")

• !ro+ima

• Dista

Shouler >oint

• &houder 5oint

(7enohumera 5oint)

– 7enoid ca1it*

• &hao0

• 7enoid abrum (4brocartiagenous)

– &*no1ia Ba/and/socket 5oint

– 2a$sue

• 7enoid abrum

• Anatomica neck

• &trengthened b* tendons o =otator cuO

musces

Shouler >oint

• Ligaments – 7enohumera

• ? bands that strengthen anterior $art o

ca$sue

• &u$erior band and -nerior band 3

$rimar* igamentous su$$ort

• Midde 3 strongest stabiiJing igament

– %rans1erse humera Ligament

• 7a$ bet0een grater and esser

tuberosities

• Hods tendon o the bice$s musce in

$ace

Shouler >oint

• Ligaments

– 2oracohumera Ligament

• E+tends rom the root o the coracoid

$rocess to the greater tuberosit* o thehumerus

• &trengthens ca$sue abo1e

– Accessor* Ligament

• 2oracoacromia igament

• !rotects su$erior as$ect o 5oint

Shouler Lesions

Shouler 5islocation

/ most common* disocated arge 5oint

/ 'nterior more common than $osterior

/ im$ingement o axillary nerve

Shouler Se+aration

/ acromioclavicular dislocation due to tearing o the

coracoclavicular ligament

: cases o se1ere bo0 to the $oint o the shouder

Shouler mo.ements

=:;:1 ASS rule

E1er* ? degree abduction o arm X " degree abductiion o shouder

5oint

' degree b* rotation o sca$ua

At '"Cdegree abduction

7reater tuberosit* o humerus hits atera edge o acromion

%lbow >oint

Ebo0 5oint

%rochea and ca$ituum o humerus

%rochear notch and head o the radius

&*no1ia hinge 5oint

Encosed b* ca$sue

Ebo0 oint

Mo1ements

Fe+ion

E+tension

2arr*ing Ange

6hen e+tended'C degrees in maes

'@ degrees in emaes

Disa$$ears on Ke+ion

%lbow >oint

-m$ortant =eations

Anterior*

Median Ner1e

Brachia Arter*

Media*

nar ner1e as it $asses behind the media e$icond*e o humerusY

Su+erior (aioulnar >oint

&u$erior =adiounar 5oint

Head o radius and annuar igament

=adia notch o una

&*no1ia $i1ot 5oint (trochoid)



&*no1ia membrane

Lines ca$sue

2ontinuous 0ith that o ebo0 5oint

Su+erior (aioulnar >oint

Mo1ements

!ronation

&u$ination

More $o0eru than $ronation

#nferior (aioulnar >oint

-nerior =adiounar oint

Head o una

nar notch o radius

&*no1ia $i1ot 5oint2a$sue

Encoses 5oint

&trengthened b* anterior and $osterior igaments

#nferior (aioulnar >oint

Mo1ements

!ronation

&u$ination

rist >oint

6rist 5oint (=adiocar$a 5oint)

Dista end o radius (trianguar cartiaginous

articuar disc)

&ca$hoid, Lunate, %riuetra

&*no1ia cond*oid oint

Bia+ia

Ba and socket but 0 no rotation

rist >oint Ner1e &u$$*

Anterior interosseous ner1e (rom Median ner1e)

Dee$ branches o =adia and nar ner1es

Mo1ements

Fe+ion

E+tension

Abduction

Adduction

N* (otation (done b* radiounar 5oint $ronation/

su$ination)

rist >oint

-m$ortant =eations

Anterior

Median ner1e

nar ner1e

Latera*=adia arter*

Car+ometacar+al >oints

2ar$ometacar$a oints

2ar$a bones

Metacar$a bones

&*no1ia giding 5oints

Ligaments

Anterior

!osterior

-nterosseous

Car+ometacar+al >oint of 'humb

%humb car$ometacar$a 5oint

%ra$eJium

&adde sha$ed base o 4rst metacar$a bone

&*no1ia sadde 5oint (bia+ia)

Mo1ement Fe+ion

E+tension

Abduction

Adduction

=otation (#$$osition)

&etacar+o+halangeal >oints

Metacar$o$haangea 5oints

2on1e+ heads o metacar$as

2onca1e bases o $ro+ima $haanges

&*no1ia cond*oid 5oint

#nter+halangeal >oint

-nter$haangea 5oint

!ro+ima

Midde

Dista

&*no1ia hinge 5oints

&imiar structure as metacar$o$haangea 5oint

Mo1ements

Fe+ion

E+tension

&uscles of the Shouler (egion

2onnect u$$er imb to 1ertebra coumn

&N%&*N#C9 'he Lone (anger Likes (iding

'ra$eJius

Latissimus Dorsi

(homboid minor

Le1ator &ca$uae

(homboid ma5or

Ner.e Su++l"

%ra$eJius 2N'', 2?2

Latissimus dorsi %horacodorsa ner1e

=homboid minor

Le1ator sca$ua Dorsa sca$uar ner1e

=homboid ma5or

&uscles of the Shouler (egion

2onnecting u$$er imb to thoracic 0a

!ectorais ma5or

!ectorais minor

&ubca1ius

&erratus anterior

Ner.e Su++l"

!ectorais minor Media $ectora ner1e

!ectorais ma5or Media and Latera $ectora ner1e

&N%&*N#C9 %he Ma5or has ", %he minor

on* '

&edia 3 more ( both )

Latera 3 less ( Ma5or on* )

&ubca1ius ner1e to subca1ius

&erratus anterior ong thoracic ner1e

'he La" Between 'wo &aors

-N&E=%-#N

%eres ma5or 3 at medial i$ bici$ita groo1e

Latissimus dorsi 3 <oor o bici$ita groo1e

!ectorais ma5or 3 lateral i$ bici$ita groo1e

&uscle of the Shouler (egion

2onnecting sca$ua to humerus

Detoid

=otator cuO &u$ras$inatus

-nras$inatus

%eres minor

&ubsca$uaris

%eres ma5or

Ner.e Su++l"

Detoid A+iar* ner1e

&u$ras$inatus &u$rasca$uar ner1e

-nras$inatus

%eres minor A+iar* ner1e

&ubsca$uaris $$er and o0er subsca$uar ner1e

%eres ma5or Lo0er subsca$uar ner1e

(otator CuH &uscles

A inserts into the greater tuberosit* %?C%P' Subsca+ularis ( esser

tuberosit* )

&u$ras$inatus Abducts

-nras$inatus and %eres minor Latera* rotates&ubsca$uaris Media* rotates

(otator CuH 'eninitis

$ubacromial bursitis

E+cessi1e o1erhead acti1it* o the u$$er imb

Degeneration o subacromia bursa e+$oses the su$ras$inatus to

riction at the acromion

/ pain on mid abduction o the arm ( to 1= egrees )

Su+ras+inatus 'enon (u+ture

/ inabiit* to initiate abduction o the arm

/ i assisted in the rst => degrees o abduction, the detoids

can com$ete the abduction to right ange

#m+orant Lanmark

6uarangular s+ace

%ocated immediately belo/ shoulder ?oint



&u$erior &ubsca$uaris

-nerior %eres ma5or

Latera &urgica neck o humerus

Media Long head o trice$s

%ransmits A2illar" ner.e and Posterior humeral circumJe2 arter"

'riangular S+aces

0++er 'riangular S+ace

/ &u$erior %eres minor

/ -nerior %eres ma5or

/ Latera Long head trice$s

%ransmits circumJe2 sca+ular .essels

Lower 'riangular S+ace

: &u$erior %eres ma5or/ Media Longhead trice$s

/ Latera Media head trice$s

%ransmits (aial ner.e an Profuna brachii

&uscles of the 0++er arm

Anterior Fascia com$artment

Bice$s brachii

2oracobrachiais

Brachiais

!osterior Fascia com$artment

%rice$s

Cubital fossa

• &kin de$ression

– %rianguar sha$ed

– -n ront o ebo0

• Boundaries

– Latera* Brachioradiais – Media* !ronator teres

– Base imaginar* ine bet0een e$icond*es o

humerus

2ontents from meial to lateral

Median ner1e

Brachia arter*

%endon o bice$s brachii

=adia ner1e

Anterior Fascial Com+artement of Forearm

'. !ronator teres

". Fe+or car$i radiais

?. !amaris ongus

. Fe+or car$i unaris

P. Fe+or digitorum su$er4ciais

@. Fe+or $oicis ongus

. Fe+or digitorum $roundus8. !ronator uadratus

Forearm anterior com+artment

-nner1ated b* Median ner1e %?C%P'9

Fe+or car$i unaris

Fe+or digitorum $roundus (media ha unar ha)

/ LNA= NE=E

Lateral fascial com+artment of forearm

'. Brachioradiais

". E+tensor car$i radiais ongus

Both su$$ied b* radia ner1e

Posterior Fascial Com+artment of the Forearm

'. E+tensor car$i radiais bre1is

". E+tensor digitorum

?. E+tensor digiti minimi

. E+tensor car$i unaris

P. Anconeus

@. &u$inator

. Abductor $oicis ongus

8. E+tensor $oicis bre1is

. E+tensor $oicis ongus

'C. E+tensor indicis

A su$$ied b* the =adia ner1e

=adia Ner1e

Abductor $oicis ongus

Brachioradiais

Anconeus

'rice$s

%+tensors

Su$inator

ANA%#M-2AL &NFFB#

Bounaries

AnteriorLatera A!#L E!B

!osteriorMedia E!#L

Car+al 'unnel

2ontains

Media ner1e

Fe+or digitorum su$er4ciais tendons ()

Fe+or digitorum $roundus tendons ()

Fe+or $oicis ongus tendon

Small muscles of han

Lumbricals ()

Fe+es M2!, E+tends -! ( )

#nterossei (8)

!amar ()

Dorsa ()

AC'#*N9 !AD DAB

Pamar 3 Aducts

5orsa / Abducts

Palmaris bre.is

-m$ro1es gri$

Ner.e Su++l"

-ntrinsic Musces o the Hand

A nar ner1e %?C%P'9 %ateral t/o %umbricals

'henar )"+othenar &uscles

&N%&*N#C9 *ne For A And / A For *ne

%henar Musces H*$othenar Musces

/ *$$onens $oicis / Abductor digiti minimi

/ Fe+or $oicis bre1is / Fe+or digiti minimi

/ Abductor $oicis bre1is / *$$onens digiti minimi/ Adductor $oicis

6edian nerve E2E!% 'll )lnar nerve

Auctor +ollicis

( )lnar nerve )

'humb &uscles #nner.ation

SnuObo+ grou$ A =adia ner1e

A!#L E!B E!#L

'henar Musces A Median E2E!%

Adductor $oicis ( unar )

#$$onens $oicis

Fe+or $oicis bre1is

Abductor $oicis bre1is

Adductor $oicis

Fe+or $oicis ongus Median ner1e

A2illar" arter"

2ontinuation o subca1ian arter*

Begins at lateral borer of !rst rib, unti

Lower borer of teres maor musce (brachia arter*)

=eated to the cors o the brachia $e+us

Encosed 0ith them in the a+iar* sheath

A2illar" arter"

Di1ided into ? $arts b* the +ectoralis minor

&N%&*N#C9 Scre0 'he La0*er Sa1e A Patient

'st $art

/ Su$reme or Highest %horacic Arter*

"nd $art

/ 'horacoacromia Arter*

/ Latera %horacic Arter*

?rd

$art/ Subsca$uar Arter*

/ Anterior Humera 2ircumKe+ Arter*

/ Posterior Humera 2ircumKe+ Arter*

Shouler >oint Arterial Anastomosis

'st $art o subca1ian arter*

&u$er4cia cer1ica arter*

%h*rocer1ica trunk

Anastomose 0ith

?rd $art o a+iar* arter*

&ubsca$uar arter*

Anterior circumKe+

!osterior circumKe+

Brachial arter"



Begins at lower borer of teres maor (rom a+iar*

arter*)

Descends through anterior com$artment o arm on

brachialis muscle

Enters cubita ossa

Ends at e1e o neck of raius, di1ides into

=adia arter*

nar arter*

Brachial arter"

Branches

Muscuar branches

Nutrient arter* (to humerus)

Profuna brachii arter"

▪ Large branch

▪ Foo0s radia ner1e in s$ira groo1e

▪ !osterior com$artment o arm

&u$erior unar coatera arter*

▪ Foo0s unar ner1e

-nerior unar coatera arter*

▪ !art o anastomosis around ebo0 5oint

(aial arter"

&maer than unar arter*

Begins at cubita ossa, neck o radius

=adia $useY

Latera* tendon o brachioradiais

Media* tendon o Ke+or car$i radiais

(aial arter" 6rist T 0inds around atera side o the car$us to the

$ro+ima s$ace bert0een 'st and "nd metacar$a bones

!asses anterior* into $am bet0een t0o heads o 4rst dorsa

interosseous musce

oins dee$ branch o the unar arter* V

ee+ +almar arch

0lnar arter"

Larger than radia arter*

Begins at cubita ossa, neck o radius

Descends through

Anterior com$artment

Enters $am in front of Ke+or retinacuum

6ith unar ner1e

Ends b* orming su+er!cial +almar arch V su$er4cia

$amar branch o radia arter*

4eins of u++er limb&u$er4cia 1eins

Dorsa 1enous net0ork

2e$haic 1ein

Basiic 1ein

Median cubita 1ein

Median 1ein o the orearm

Dee$ 1eins

enae comitantes

A+iar* 1ein

4ein Catheteriation

Basiic 1ein

ein o choice or centra 1ein catheteriJation

-ncreases in diameter as it ascends the arm and is in direct ine 0ith

the a+iar* 1ein

A2illar" .ein

Formed b* union o 1enae comitantes o brachia arter* 0basiic 1ein

Ascends aong media border to 4rst rib

=ecei1es tributaries corres$onding to branches o the a+iar*

arter*

Aso recei1es ce$haic 1ein

A2illar" l"m+h noes

Drain *m$h rom

$$er imb

Latera $art o breast

&u$er4cia *m$h 1esses rom throacoabdomina

0a abo1e e1e o umbiicus

"C/?C *m$h nodes

A2illar" L"m+hnoe Le.els

Le.el #

&ubsca$uar or !osterior

E+terna mammar* or Anterior

A+iar* 1ein or Latera

Le.el ##

2entra

-nter$ectora ; =otter>s nodes<

Le.el ###

-nra or subca1icuar

Su+ratrochlear ,Cubital- l"m+h noes

-n su$er4cia ascia o cubita ossa

2ose to trochea

L*m$h rom meial 4ngers, media hand, orearm

Ascend to the atera a+iar* *m$h nodes$$er imb *m$hatic drainage summar*

Brachial +le2us

;&oT on1a 0u4ao<

(oots (P)

'runks (?)

5i1isions

(? anterior, ? $osterior)

Cords (?)

Branches

(P termina branches)

Brachial Ple2us

=oots

Enter base o the neck bet0een

▪ &caenius anterior

▪ &caenius medius

%runks and di1isions

2ross $osterior triange o neck

2ords

Arranged around a+iar* arter* in the a+ia

Encosed in a+iar* sheath 0ith a+iar* arter* and

1ein

(oots ,-

P roots (anterior rami o 2P,2@,2,28,%')

Branches

Dorsa &ca$uar (2P)

=homboid minor

=homboid ma5or

Le1ator sca$uae

Long thoracic (2P/2@/2)

&erratus anterior

'runks ,=-

&u$erior&u$sca$uar ner1e (2P/2@)

&u$ras$inatus

-nras$inatus

Ner1e to &ubca1ius (2P/2@)

&ubca1ius

Midde

-nerior

Cors ,=-

&eial cor

Media $ectora ner1e !ectorais ma5or

minor

Media cutaneous ner1e o the arm

Media cutaneous ner1e o the orearm

Lateral cor

Muscuocutaneous ner1e Anterior arm

com$artment musces

Latera $ectora ner1e !ectorais

ma5or

Posterior cor

&ubsca$uar ner1e

$$er

&ubsca$uaris

Lo0er

&ubsca$uaris %eres ma5or

%horacodora ner1e Latissimus

dorsi

A+iar* ner1e Detoid and

%eres minor

=adia ner1e ABA%E&

Branches

From atera to media



&N%&*N#C9 &* Aunt (a$ed &* 0nce

&uscuocutaneous ner1e

A+iar* ner1e

(adia ner1e

&edian ner1e

0nar ner1e

Brachial +le2us inuries

0++er trunk lesions

%rb:5uchenne Pals"

Dis$acement o head to the o$$osite side and

de$ression o the shouder on same side

Fas on shouder

-nants during diIcut dei1er* ;waiter7s ti+<

▪ Hangs b* side

▪ Media* rotated

▪ Forearm $ronated


Lower trunk lesions

/lum+ke7s +als"

%raction in5ur*

E+cessi1e abduction o the arm

First thoracic ner1e usua* torn

&ma musces o hand $ara*Jed

;Claw han<


Long thoracic ner.e (2P/2@/2) esion

Bo0s or surgica in5ur* to ner1e

!ara*sis o serratus anterior;inge sca+ula<

DiIcut* raising the arm abo1e the head


A2illar" ner.e (2P/2@) esion

-nerior disocation o the shouder 5oint

Fracture o the surgica neck o the humerus

Quadranguar s$ace

Detoid $ara*sis and atro$h*

Loss o cutaneous sensation o1er o0er ha o

detoid


(aial ner.e (2P/2@/2/28/%') esion

Midshat humera racture

Ner1e in s$ira groo1e

;rist ro+<

nabe to e+tend 0ristnabe to e+tend 4ngers


&eian ner.e (2P/2@/2/28/%') Lesions

&u$racond*ar ractures o the humerus

6ounds $ro+ima to Ke+or retinacuum

;A+elike han<

▪ %humb rotated

▪ %humb adducted

▪ %henar eminence

▪ !ara*sis

▪ Atro$h*

▪ Fattening


0lnar ner.e (28/%') Lesions

Behind media e$icond*e o humerus

-n ront o Ke+or retinacuum o 0rist Hand sma musce $ara*is

▪ e+ce$t or (median ner1e)

▪ thenar eminence musces

▪ 4rst t0o umbricas

%humb cannot be adductedY

Metacar$o$haangea h*$ere+tension

?rd and th umbrica $ara*sis

-nterosseous $ara*sis

-nter$haangea 5oint Ke+ion

;Claw han<

%HE END

Lo0er E+tremit*


)i+

-ium

-schium

!ubis

meets at the acetabuum

Bones of the thigh

Femur

!atea

Femur

Head

Hemis$heric ("?)

Fo1ea ca$itis

Ligament o the head

▪ #bturator arter*

Neck

7reater trochanter

Lesser trochanter

-ntertrochanteric ine

▪ -ioemora igament

-ntertrochanteric crest

▪ Quadrate tuberce

Femur

&hat

Linea as$era

Media su$racond*ar ridge

Adductor tuberce

Latera su$racond*ar ridge

7utea tuberosit*

!o$itea surace

2ond*es

Media cond*e

Latera cond*e

-ntercond*ar notch

Media e$icond*e

Latera e$icond*e

A.ascular Necrosis of the Femoral )ea

2ommon in A50L'S 0ith emora neck ractures

%he sma branch o the obturator artery 0ithin the igamentum teres

emoris is insuIcient to su$$* the emora head

ncommon in a chid due to ree anastomoses bet0een media emora

circumKe+ arter* and the obturator arter*

Co2a .alga .sDCo2a .ara

Norma ange bet0een emora neck and shatAduts '"P degrees

2hidren '@C degrees

2o+a 1aga -N2=EA&ED

2ongenita disocation o the hi$

Adduction is imited

2o+a 1ara Decreased

Femora neck ractures and

&i$$ed ca$ita emora e$i$h*ses

Abduction is imited

Femoral Neck Fracture

Patella

Largest sesamoi bone (de1eo$s 0ithin a tendon)

%endon o the Iuarice+s femoris

%rianguar sha$ed

Ligamentum $ateae

connects to tibia tuberosit*

!osterior surace

Articuates 0ith cond*es o emur

'ibia

LargeO weight bearingO meial bone of leg

Latera cond*e

#1a articuar acet or head o 4bua

Media cond*e

Latera meniscus

Media meniscus

-ntercond*ar eminence

%ibia tuberosit*

Media maeous

Fibula

Musce attachment



No articuation 0ith knee

Head

&t*oid $rocess

Articuar surace

&hat

-nterosseous membrane

Latera maeous

Bones of the foot

%arsa bones

2acaneum

%aus

Na1icuar

2uboid2uneiorm bones

Metatasa bones and $haanges

Calcaneum

Largest bone o the oot

Articuations

Abo1e taus

Front cuboid

!osterior surace

!rominence o the hee

Media surace

Large sheKike ridge

“Sustentaculum tali”

▪ Assists in su$$orting the taus

Cuboi

Articuation

Anterior end o cacaneum5ee+ groo.e on inferior as+ect

&eroneus longus tendon

Cuneiform bones

%hree (?)

&ma

6edge/sha$ed

&aintenance of trans.erse arch of foot

Articuations

!ro+ima* na1icuar

Dista* 4rst ? metatarsas

&etatarsal bones

Fi1e (P)

Numbered media to atera

Head

&hat

Base th metatarsal

%uberce

&eroneus brevis tendon attachment

)i+ oint

Articuation

Head o emur

Acetabuum

&*no1ia ba/and/socket 5oint

)i+ oint

#liofemoral ligament of Bigelow

&trongestY Most im$ortantY

-n1erted :

Base anteroinerior iiac s$ine

Limbs u$$er and o0er $art o intertrochanteric ine o emur

=esists

H*$ere+tension o hi$Latera rotation o hi$

)i+ oint

Ner1e su$$*

Femora

#bturator

&ciatic

Ner1e to uadratus emoris

Mo1ements

Fe+ion

E+tension

Abduction

Adduction

Latera rotation

Media rotation

2irumduction

)i+ >oint

-m$ortant reations

Anterior*

emora 1esses

Femora ner1e

!osterior*

&ciatic ner1e

/nee oint

&*no1ia hinge 5oint

Bet0een emur and tibia

&*no1ia giding 5oint

Bet0een $atea and emur

/nee >oint Ca+suleEncoses the knee 5oint

%2ce+t anteriorl" (ca$sue de4cient)

&*no1ia membrane $ouches u$0ard beneath uadrice$ts tendon

2Suprapatellar bursa7

/nee oint

%2tra ca+sular Ligaments

Ligamentum $ateae

Latera coatera igament

Media coatera igament

#biue $o$ititea igament

#ntraca+sular ligaments

2ruciate igaments

▪ Anterior cruciate igament

▪ !osterior cruciate igament

/nee oint

Latera coatera igament$eparated rom the atera meniscus b* the popliteus muscle

/nee oint

Media 2oatera Ligament

Strongl" attache to meial meniscusM

Cruciate

&N%&*N#C9 PA&7s APPL%S

Posterio cruciate $asses Anterior and &edia

Anterior cruciate $asses Posterior and Latera

nha$$* %riad o #>Donoghue

&edia coatera

igament

Anterior cruciate

&edia meniscus

Bursae

Su+ra+atellar Bursa

▪ Largest▪ 'l/ays communicates 0ith knee 5oint

Pre+atellar Bursa

▪ Housemaid>s knee!rostitute>s knee

#nfra+atellar Bursa

▪ 2erg*man>s kneeicar>s

knee

Ankle oint

#nferior trans.erse tibio!bular ligament dee$ens

socked into 0hich taus 4ts

&*no1ia hinge 5oint

Encosed b* ca$sue

Ankle oint ligaments

&eial ,5eltoi- ligament

▪ &tronger than ateraY

▪ Attachments

▪ A$e+ ti$ o media maeous▪ Beo0 dee$ 4bers to media

surace o the bod* o the

taus

▪ &u$er4cia 4bers

media side o taus

sustentacuum tai

!antar

cacaneona1icuar

igament

%uberosit* o

na1icuar bone

Ankle oint

&*no1ia membrane ines ca$sue

Ner1e su$$*



Dee$ $eronea

%ibia

Mo1ements

DorsiKe+ion (toes $oint u$0ard)

!antar Ke+ion (toes $oint do0n0ard)

#ntertarsal oint

'alocalcaneona.icular oint

Articuation

▪ =ounded head o the taus

▪ $$er surace o sustentacuum tai o

cacaneum

▪ !osterior conca1e surace o na1icuar

bone &*no1ia 5oint

Plantar calcaneona.icular ,s+ring- ligament

▪ Anterior border o sustentacuum tai to

▪ -nerior surace and tuberosit* o the

na1icuar bone

▪ Su++orts hea of talus

#ntertarsal oints

&ubtaar, %aocacaneona1icuar,cacaneocuboid)

#n.ersion

▪ Mo1ement o oot so that soe aces

media*

%.ersion

▪ Mo1ement o oot so that soe aces

atera*

in1ersion more e+tensi1e than e1ersion

$luteal (egion Bounded

&u$erior* iiac crest

-nerior* od o the buttock

7utea musces

Fascia

&u$er4cia ascia

▪ %hick

▪ es$ in 0omen, and im$regnated 0ith

arge uantities o at.)

Dee$ ascia

▪ 2ontinous beo0 0ith ascia ata o thigh

▪ &$its to encose guteus ma+imus

musce

#m+ortant ligaments

&tabiiJe the sacrum

!re1ent its rotation b* 0eight o the 1ertebra coumn Sacrotuberous ligament

!osteroinerior iiac s$ine, atera $art o sacrum,

cocc*+ to

ischia tuberosit*

Sacros+inous ligament

Latera $art o the sacrum, cocc*+ to

&$ine o the ischium

#m+ortant foramina

7reater sciatic oramen

!iriormis musce

&ciatic ner1e

!osterior cutaneous ner1e o thigh

&u$erior gutea ner1e

-nerior gutea ner1e

Ner1e to obturator internus

Ner1e to uadratus emoris

!udenda ner1e

&u$erior gutea arter* and 1ein

-nereior gutea arter* and 1ein

-nterna $udenda arter* and 1ein

#m+ortant foramina

Lesser sciatic foramen

!udenda ner1e

-nterna $udenda 1esses

Ner1e to obturator internus

%endon o obturator internus

$luteal &uscles

&N%&*N#C9 $ods $reatest $it 'o Peo$e iS *utstanding # 6

$uteus ma+imus

$uteus medius

$uteus minimus

'ensor ascia atae

Piriormis

Su$erior gemeus

*bturator internus

#nerior gemeus

6uadratus emoris

%rendeenburg>s %est

Factors that determine hi$ stabiit* 0hen standing in one eg

7uteus mediusminimus

Head o the emur ocated inside acetabuum

-ntact emora neck and

ange

$luteal &uscles

#nferior gluteal ner.e

7uteus ma+imus E+tends and atera*

rotates thigh

E+tends knee 5oint

Su+erior gluteal ner.e

7uteus medius Abducts thigh, tits $e1is

7uteus minimus

%ensor ascia atae Assists 7. ma+imus in e+tending

thigh

Sacral Ple2us

Small lateral rotators of the thigh

!iriormis

&u$erior gemeus

#bturator internus

-nerior gemeus

Quadratus emoris

'high

&a$henous o$ening

!assage

▪ 7reat sa$henous 1ein

▪ &ma branches o emora arter*

▪ L*m$h 1esses

▪ 2ribiorm ascia (oose connecti1e

tissue)

Femoral 'riangle

Boundaries

&u$erior* inguina igament

Latera* sartorious musce

Media* the adductor ongus musce

2ontains NA4%L rom atera to media

Femora ner1e

Femora arter*

Femora .ein

%m$t* s$ace

-nguina l*m$h nodes ( Rosenmuller1s-Clo@uet1s

node)

Aemoral nerve is outside the emora sheath

Floor of Femoral 'riangle

-io/$soas

!ectineus

Adductor ongus

Femoral Canal

&ma media com$artment o the emora sheath occu$ied b*

*m$haticsA$$ro+ ength

C.Pinches('.?cm) in

!otentia* 0eak area in 0a o abdomen

Femora hernia

Femoral (ing

$$er o$ening o the emora cana

Fied b* e+tra$eritonea at

;emora se$tum<

-m$ortant reations

Anteriorl"9

▪ inguina igament ( !ou$art>s igament )

Posteriorl"9

▪ $ectinea igament ( 2oo$er>s igament

Laterall"9



▪ emora 1ein

&eiall"9

▪ acunar igament ( 7imbernat>s

igament)

'high &uscles

Anterior Com+artment

&artorius

-io$soas

!ectineus

Quadrice$s emoris

&eial Com+artment

7raciis

Adductor ongusAdductor bre1is

Adductor magnus

#bturator e+ternus

Posterior Com+artment

Bice$s emoris

&emitendinosus

&emimembranosus

Adductor magnus

$eneralities of thigh muscles

Anterior com+artment

Femora ner1e %?C%P' Psoas (umbar $e+us)

%high Ke+ors %?C%P' 4astus musces (eg e+tensors)

%0o musces that crosses both hi$ 5oint and knee 5oint

Sartorius ;ailor1s muscle<

(ectus femoris

$eneralities of thigh muscles&eial com+artment

#bturator ner1e

%high adductors %?C%P' obturator e2ternus (atera* rotates thigh

at hi$ 5oint)

Adductor magnus aso recei1es inner1ation rom sciatic

$eneralities of thigh muscles

Posterior com+artment

&ciatic ner1e tibia $ortion %?C%P' short hea bice+s femoris

(common $eronea ner1e)

Leg Ke+ors %?C%P' auctor magnus (e+tends thigh at hi$)

/nee region

!o$itea ossa

Boundaries

▪ Laterall"

▪ Abo1e

bice$s emoris

▪ Beo0

Latera head o

gastronemius

Latera head o

$antaris

▪ &eiall"

▪ Abo1e

&emimembranosus

&emitendinosus

▪ Beo0

Media head o the

gastrocnemius

Anterior Com+artment of the Leg

Peroneus tertius

%+tensor digitorum ongus

'ibiais anterior

%+tensor haucis ongus

Ner1e &u$$* Dee$ $eronea ner1e

Lateral Com+artment of the Leg

Peroneus ongus

Peroneus bre1is

Ner1e &u$$* &u$er4cia $eronea ner1e

Posterior Com+artment of the Leg

&u$er4cia grou$

7astrocnemius

!antaris

&oeus

Dee$ grou$

!o$iteus

Fe+or digitorum ongus

Fe+or haucis ongus

%ibiais $osterior

Ner1e &u$$* %ibia ner1e

$eneralities of Leg Com+artments

Anterior

Dee$ $eronea ner1e

DorsiKe+ors o the oot

Lateral

&u$er4cia $eronea ner1e

!antar Ke+ors

Posterior

%ibia ner1e

!antar Ke+ors

Peroneus .s 'ibialis &uscle;n letter rule

!eroneus musces

%.erts oot

!antar Ke+

%ibiais musces

#n.erts oot

!antar Ke+

&uscle on the 5orsum of the Foot

%2tensor igitorum bre.is

#rigin

▪ 2acaneum

-nsertion

▪ Four tendons into the $ro+ima $haan+

o the big toe (sometimes caed

e+tensor haucis bre1is)

▪

Long e+tensor tendons into "nd

,?rd

, th

toes

Action

▪ E+tends 'st, "nd,?rd, th toes

-nner1ation

▪ Dee$ $eronea ner1e

Sole of foot

Dee$ ascia

!antar a$oneurosis

Foot arches (?)

Media ongitudina arch

Calcaneona.icular ,s+ring- ligament

Latera ongitudina arch

%rans1erse arch

&uscles of the Sole

First la"er

Abductor haucis M!N

Fe+or digitorum bre1is M!N

Abductor digiti minimi L!N

Secon la"er

Lumbricas 'M!N, "?L!N

Quadratus $antae L!N

&uscles of the Sole

'hir la"er

Fe+or haucis bre1is M!N

Adductor haucis L!N

Fe+or digiti minimi bre1is L!N

Fourth la"er

%ibiais $osterior %N

-nterossei L!N

dorsa

? $antar

!eroneus ongus &!NArches o the Foot

&eian longituinal

/ argest

/ most im$ortant

Latera ongitudina

%rans1erse

Mechanism o Arch &u$$ort

&ha$e o the stone

-nerior edges tied together

%ie beam

&us$ension bridge

Femoral Arter"

2ontinuation o the e+terna iiac arter*



Begins

behind inguina igament

Mid0a* bet0een anterosu$erior iiac s$ine and

s*m$hisis $ubis ,“femoral +ulse”-

Descends through emora triange and adductor

cana,

Enters $o$itea s$ace as +o+liteal arter"

Femora Arter* Branches

&N%&*N#C9 Si+ S0eet Se+* Ladies Put &* Pants 5o0n 5ai*

Su$er4cia circumKe+ iiac

Su$er4cia e$igastric

Su$er4cia e+terna $udenda

Latera emora circumKe+Prounda emoris

&edia emora circumKe+

Perorators

5ee$ e+terna $udenda

5escending genicuar

Arterial Anastomoses

'rochanteric Anastomosis

Su$erior gutea

Latera emora circumKe+

#nerior gutea


Cruciate Anastomosis


#nerior gutea

Latera emora circumKe+

First $erorating branch o $rounda brachii

Po+liteal arter"

2ontinuation o emora arter*

#$ening o adductor magnus to o0er border o $o$iteus musce

Di1ides into anterior an +osterior tibial arteries

Anastomosis aroun the knee

5escening genicular arter"

Lateral femoral circumJe2 arter"

Po+liteal arter"

Anterior tibial arter"

Posterior tibial arter"


From biurcation o tibia arter*

!asses or0ard bet0een tibia and 4bua through the u$$er

$art o the interosseous membrane

Enters anterior com$artment o eg

Descends 0ith ee+ +eroneal ner.e

ront o anke, becomes orsalis +eis arter"


“Anterior tibial +ulse”

Anke, mid0a* bet0een maeoi,

Media* %endon o e+tensor haucis ongus

Latera* %endons o e+tensor digitorum ongus

5orsalis +eis arter"

Begins ront o anke, continuation o anterior tibia arter*

Ends entering soe through $ro+ima $art o s+ace between

1st an ;n metatarsal bones

oins lateral plantar artery0 com$etes $antar arch

5orsalis +eis arteries

Branches

Latera tarsa arter*Dorsum o oot

Arcuate arter*

Latera* across bases o metatarsa bones, gi1es oO branches to the

toes

First dorsa metatarsa arter*

Both sides o big toe

5orsalis +eis arter"

“orsalis +eis +ulse”

Latera* tendons o e+tensor digitorum ongus

Media* tendon o e+tensor haucis ongus


From biurcation o $o$itea arter* in $oitea ossa

Descends in $osterior com$artment o the eg

Accom$anied b* tibial ner.e

Arter* terminates behin meial malleolus

Media and atera $antar arteries

“+osterior tibial +ulse”

▪ Bet0een media maeous and hee


Branches

Peroneal arter"

/ Largest branch

Muscuar branches

Nutrient arter*

Anastomotic branches


%ermina branches

&eial +lantar arter"&maer than atera $antar arter*

For0ard aong media border o oot

0ith medial plantar nerve


%ermina branches

Lateral +lantar arter"

Larger

For0ard, dee$ to abductor haucis and Ke+or digitorum bre1is

Bith lateral plantar nerve

End cur1ing media* to orm lateral +lantar arch

!erorating arteries

Metatarsa artereis

Digita arteries

5orsal .enous network

Dorsum o oot

DrainedMedia* great sa+henous .ein

Latera* small sa+henous .ein

$reat sa+henous .ein

Ascends in front o media maeous

Accom$anied b* sa+henous ner.e

Ascends in eg in su$er4cia ascia

!asses behind knee

2ur1es around media side o thigh $asses through

sa$henous o$ening in dee$ ascia

oins emora 1ein

$reat sa+henous .ein

!osseses numerous valves

2onnected to

&ma sa$henous 1ein

▪ b* branches $assing behind the knee

Dee$ 1eins▪ ia $erorating 1eins, media side o ca

'ributaries

&u$er4cia circumKe+ iiac 1ein

&u$er4cia e$igastric 1ein

&u$er4cia e+terna $udenda 1ein

Small sa+henous .ein

From atera side o dorsa 1enous net0ork o oot

Ascends behin atera maeous

Accom$anies sural ner.e

!asses u$ back o eg, $ierces dee$ ascia entering $o$itea

ossa

Drains into $o$itea 1ein

4enae commitantes

Dee$ 1eins accom$an*ing res$ecti1e arteries

Dee$ 1eins o anterior an +osterior tibial arteries unite to or

+o+liteal .einPo+liteal .ein

Formed b* union of anterior an +osterior tibial

arteries .enae comitantes

End b* $assing through o$ening o adductor magnus to

become femoral .ein

=ecei1es man* tributaries incuding rom small sa+henous

.ein

Femoral .ein

2ontinuation o +o+liteal .ein through o$ening o adductor

magnus

Ascends through adductor cana and emora triange

Accom$anied b* femoral arter"

Ascends behind inguina igament

2ontinous 0ith e2ternal iliac .ein



=ecei1es great sa+henous .ein

Su+er!cial inguinal noes

-n su$er4cia ascia beo0 inguina igament

Drain into dee$ inguina nodes

)oriontal grou+

&u$er4cia *m$h 1esses

▪ anterior abdomina 0a beo0 umbiicus

▪ !erineum

▪ E+terna genitaia (not testes)

▪ Lo0er ha o ana cana

▪ &kin o buttocks

Su+er!cial inguinal noes

4ertical grou+Lies aong termina $art o great sa$henous 1ein

=ecei1es most o the su$er4cia *m$h 1esses o o0er imb

%?C%P'

back and atera side o ca

Latera side o oot

(!o$itea nodes)

5ee+ inguinal noes

sua* three (?) in number

Aong media side o emora 1ein

-n emora cana

=ecei1e a *m$h rom

su$er4cia inguina nodes and

dee$ structures o o0er imb

Drain into e+terna iiac nodes

Po+liteal l"m+h noes

&ituated in the $o$itea ossa

=ecei1e su$er4cia *m$h 1esses accom$an*ing sma

sa$henous 1ein

5rain lateral sie of foot

Back an lateral sie of calf

Drain into dee$ inguina nodes

Ner.es of the lower limb

Femora ner1e

#bturator ner1e

&ciatic ner1e

%ibia ner1e

2ommon $eronea ner1e

Femoral ner.e

Lumbar $e+us

L;:L=:LE

Enters thigh behind inguina igament

Lies atera to emora 1esses %erminates into anterior and $osterior di1isions

Femoral ner.eO branches

2utaneous branches

&eial cutaneous ner.e of thigh

▪ &kin on media side o thigh

#ntermeiate cutaneous ner.e of thigh

▪ &kin on anterior side o thigh

Sa+henous ner.e

▪ -nra$atear branch to skin

▪ &kin on media side o eg

▪ &kin on media side o oot as ar as ba

o big toe

*bturator ner.e

Lumbar $e+us

L;:L=:LE

Latera side o $e1is to reach obturator cana$$er $art o obturator oramen

Di1ides into anterior and $osterior di1isions

Sciatic ner.e

From sacra $e+us

LE:L:S1:S;:S=

!asses through greater sciatic oramen

Below +iriformis

Co.ere b" gluteus ma2imus

!osterior com$artment o thigh

Di1ides into

%ibia ner1e and

2ommon $eronea ner1e

'ibial ner.e

Descends through $o$itea ossa

!osterior com$artment o eg

Dee$ to gastrocnemius and soleus

Di1ides into meial an lateral +lantar ner.es

'ibial ner.eO branches

2utaneous branches

Sural ner.e

&kin on ca

&kin on back o eg

Latera border o oot

Latera side o itte toe

&eial calcaneal ner.e

&kin o1er media side o hee

'ibial ner.eO branches &eial +lantar ner.e

(dee$ to haucis musce 0 media $antar arter*)

2utaneous branch

▪ Media $art o soe

▪ Media ?.P toes and nai beds

Muscuar branch

▪ Abductor haucis

▪ Fe+or digitorum bre1is

▪ Fe+or haucis bre1is

▪ First umbrica

'ibial ner.eO branches

Lateral +lantar ner.e

(dee$ to abductor haucis, Ke+or digitorum bre1is, 0 atera $antar

arter*)

2utaneous branch

▪ Latera $art o soe▪ Later '.P toes and nai beds

Muscuar branch

Fe+or digitorum accessorius

Abductor digiti minimi

Fe+or digiti minimi bre1is

Adductor haucis

-nterosseous musces

"nd, ?rd, th umbricas

Common +eroneal ner.e

%hrough $o$itea ossa

Latera* aroun neck of !bula

!iercing $eroneus ongus

Di1ides into

&u$er4cia $eronea ner1e

Dee$ $eronea ner1e

Lower Limb Ner.e #nuriesFemoral ner.e lesions

&tab

7unshot 0ounds

!entrating in5uries

Quadrice$s $ara*Jed

No knee e+tension

&ensor* oss

Media side o o0er $art o eg

Media border o oot at ar as ba o the big toes

*bturator Ner.e

=are* in5ured in $enetrating in5uries

Behing the Koor o emora triange

2om$ressed in

Anterior hi$ disocations

!arturition

#bturator hernia)owshi+7s (omberg Sign

: $aresthesia o media as$ect o the thigh

/ $ara*sis o adductor musces e+ce$t adductor magnus

$ortion

Sciatic Ner.e

Sciatic ner.e lesion

Bad* $aced intramuscuar in5ections in gutea

region

Fracture disocations o hi$

Hamstring musce $ara*sis

6eakend knee Ke+ion

A musces beo0 knee, $ara*Jed

“F**' 5(*P”



6eight o oot causes it to assume a $antar Ke+ed

$osition

Loss o skin sensation beo0 the knee, E+ce$t or

▪ narro0 $art o eg

▪ Media border o the oot as ar as the

ba o the big toe

Sciatica

!ain aong the distribution o sciatic ner1e

$osterior thigh

$osterior and atera sides o eg

atera side o oot

- 2om$ressed b*

herniated nuceus $u$osusintra$e1ic tumorinKammation

Common Peroneal Ner.e

E+$osed at the area o the neck o 4bua

Fractures, casts, s$ints

Anterior and atera com$artment musces $ara*Jed

'ali+es %Iuino.arus eformit"

Foot is Plantar Je2e and #n.erte

'ibial Ner.e

=are* in5ured in $enetrating in5uries

Dee$ to gastrocnemius and soeus

'ali+es Calcaneo.algus eformit"

“clubfoot”

Foot is 5orsiJe2e : %.erte

'enon (eJe2es

&N%&*N#C9

'/" bucke m* shoe &'&"

?/ kick the door L?LP/@ $ick/u$ sticks 2P2@

/8 shut the gate 228

%HE END