SYSTEMIC

ANATOMY
 ANATOMICOMEDICAL TERMINALOGY
TERMS EXPLANATION
Details:
 Definition: The body position as  Standing erect
ANATOMICAL if a person were standing upright,  Head, eyes, toes directed forward
POSITION regardless of the actual postures  The upper limbs by the sides of the trunk
or positions.  Palm is facing forward (supinated)
 Lower limbs together with toes pointing forward
 Median Plane (midline)  E vertical pl. passing longitudinally through e body, divides it into right n left halves
 Sagital Plane  E vertical plane passing through e body parallel e median pl.
 Frontal Plane (coronal)  E vertical plane passing trough e body at right angles to median pl., dividing e body into ant. n post. parts.
ANATOMICAL  Tranverse Plane  E pl. passing through e body at right angles to median n frontal pl., dividing e body into sup. n inf. part.
PLANES  Sections:
- Longitudinal S.  Run lengthwise or parallel to e long ax. of e body or of any of its part.
- Tranverse S.  Cross sect. or slices of e body or its parts that r cut at right angles to e long. ax. of e body or any of its part.
- Oblique S.  Slices of e body or any of its part that r not cut along one of e anatomical pl.
1) - Medial  Nearer to medial pl.
- Lateral  Farther from medial pl.
2) - Anterior  Nearer to e front
TERMS OF - Posterior  Nearer to e back
RELATIONSHIP 3) - Superior  Nearer to head
- Inferior  Nearer to feet
N 4) - Proximal  Nearer to trunk or point of origin
COMPARISONS - Distal  Farther from trunk or point of origin
5) - Superficial  Nearer to surface
- Intermediate  Between a superficial n a deep surface
- Deep  Farther from surface
1) - Flexion  Bending/decreasing e angle between e bones or parts of body
- Extension  Straightening/increasing e angle between e bones or parts of body
2) - Supination  Rotational movement of e forearm n hand that swings e radius laterally around its long. ax.
- Pronation  Rotational movement of e forearm n hand that swings e radius medially around its long. ax.
3) - Eversion  Moves e sole of e foot away from e median pl.
- Inversion  Moves e sole of e foot towards e median pl.
4) - Medial Rotation  Brings ant. surface of limb closure to median pl.
-Lateral Rotation  Takes ant. surface of limb from e median pl.
5) - Adduction  Moving towards e median pl. in a frontal pl.
TERMS OF -Abduction  Moving away from e median pl. in a frontal pl.
MOVEMENT 6) - Opposition  E movement by which e pad of e 1st digit is brought to another digit pad
-Reposition  E movement of e 1st digit from e position of opposition back to its anatomical position
7) - Potusion  A movement anteriorly as in protruding e mandle, lips, or tongue
-Retrusion  A movement posteriorly as in protruding e mandle, lips, or tongue
8) - Elevation  Raises or moves a part superiorly
-Depression  Lowers or moves a part interiorly
9) – Dorsiflexion  Flexion at ankle joint
-Plantarflexion  Turns e foot or toes towards the planner surface
 A circular movement that is a combination of flexion, extension, abduction, n adduction occurring in such a way that e distal end of
10) - Circumduction
e part moves in a circle
THORACIC
CAVITY
 CHEST WALL
PROPERTIES EXPLANATION
DEFINITION  Thorax: Region of e trunk between e neck n abdomen.
 Thoracic wall includes: thoracic cage, e muscles, e sternum, e vertebrae, n mediastinum.
 Protects vital organs from external forces.
 Resists e –ve internal pressures generated by e elastic recoil of e lungs n inspiratory movement.
GENERAL FUNCTIONS  Provides attachment for n support e weight of upper limbs.
 Provides e anchoring attachment (origin) of many of e muscle that move
 Maintain e position of e upper limbs relative to e trunk.
 Upper Boundary : Thoracic Inlet
1) Post. – Sup. Border of T1 vertebrae. 3) Ant. - Sup. Border of Sternum.
2) Anterolaterally – Medial borders of 1st ribs n cartilages.
THORACIC BOUNDRIES  Lower Boundary : Thoracic Outlet
1) Post. – T12 vertebral body. 3) Ant. – Xiphisternal Junction.
2) Inferolaterally – 12th ribs n tips of 11th n 12th ribs. 4) Anterolaterally – Cartilages of 7th to 10th ribs.
1) E Ribs - consist of head, neck, tubercle, angle, n body (shaft).
- 2 classifications - typical: 3rd-9th ribs - true: 1st-7th: attached directly to sternum.
st th
- Atypical: 1 , 10th-12 : I facet, articulate with 1 vertb. - false: 8th-10th: attached in directly to sternum
2nd: rough area. 11th-12th: floating ribs.
THORACIC SKELETON 2) Sternum – 3 parts – Manubrium: thickest, roughly trapezoidal bone, jugular notch: palpated concave centre, both sides of JN: smaller clavicular notch(T3-T4).
Body: longer, narrower, n thinner than manubrium, located at T5-T9.
Xiphoid Process: smallest, most variable, thin, n elongated. E process is blunt, bifid, curved, deflected to one side or ant. (Inf. B. of T9).
3) Thoracic Vebtebrae – typical – T2-T9: 2 costal facets (CF), in between: crest of head.
- atypical – T1: 1 typical inf. CF. T10: 1 bilateral pair of CF on its body n pedicle. T11-T12: 1 pair of CF on pedicle.
1) Manubriosternal Jt. – b/w manubrium n body of sternum, attached to 2nd ribs via 2nd costal notch.
2) Xiphisternal Jt. – b/w body of sternum n xiphoid process, attached to 7th ribs via 7th costal notch.
THORACIC JOINTS 3) Sternocostal Jt. – b/w costal cartilages of e ribs n sternum.(T4/T5 IV) 5) Costovertebral Jt. – b/w e body of ribs n costal cartilages.
4) Costotranverse Jt. – b/w e head of ribs n transverse 6) Interchondral Jt. – b/w costal cartilages of 8th, 9th, n 10th with 7th costal cart.
process of e vertebrae. 7) Sternoclavicular Jt. – b/w manubrium and clavicle via clavicular notch.
THORACIC MUSCLES 1) E thoracoappendicular (upper limbs) muscles:
 Pectoralis Major n Minor, subclavius ,serratus ant., n scalene muscles – accessory muscles of deep n forceful respiration, helping elevate e ribs.
 Latissimus Dorsi Muscles, anterolateral abdominal muscles.
THORACIC LANDMARK (SKIN) 3) Thoracic Wall muscles:
1) Ant. Median (midsternal) Line (AML) – e intersection of e median pl. with Muscles Sup. Attachment Inf. Attachment Innervations Main Action
e ant. thoracic wall. Serratus Post. Sup. Nuchal Ligament, spinous Sup. Borders of 2nd n 4th ribs 2nd to 5th intercostals nerves Elevate ribs
2) Midclavicular Line (MCL) – passes through e middle point of clavicle, processes of C7-T3
parallel to AML.
Serratus Post. Inf. Spinous Processes of T11-L2 Inf. borders of 8th- 12th ribs near angles Ant. Rami of T9-T12 spinal nerves Depress ribs
3) Ant. Axillary Line (AAL) – runs vertically along e ant. axillary fold.
4) Midaxillary Line (MAL) – runs from e apex of e axillary fossa ,parallel to Levator Costanum Tranverses Pro. Of T7-T11 Subjacent ribs between tubercle-angle Post. primary rami of C8-T11 nerves Elevate ribs
AAL. External Inc. Inf. border of ribs Sup. border of rib below -elevates ribs (forced insp.)
5) Post. Axillary Line (PAL) – parallel to AAL, runs vertically along e post. Internal Inc. -Interosseous: depress ribs
axillary fold. Innermost Inc. Intercostal nerves Interchondral: elevate ribs
6) Post. Median (Midvertebral) Line (PML) – e vertical line along e tips of e
Subcostal Internal surf. of lower ribs Sup. borders of 2nd/3rd ribs below -active forced respiration-
spinous process of e vertebrae
7) Scapular Line (SL) – parallel to e posterior median line n intersect e inf. Tranverse Thoracic Post. surf. of lower sternum Internal surf. of costal cartilage Weakly depress ribs
angles of scapula.
 Definition: spaces between adjacent ribs
 Contains 3 muscles: external, internal, n innermost intercostal muscles
V
INTERCOSTAL SPACES Replaced by external n internal membranes at ant. n post. parts respectively. A
 Between internal n innermost intercostal muscles, neurovascular bundle is located directly below sup. rib according to VAN. N
 Small colaterral bundle is located directly at top of inf. rib according to NAV.
 Thoracentesis: needle is inserted at e inferior part of ICS to avoid jeopardize e IC neurovascular bundle. (to remove air/fluid from pleural cavity).
 THE DIAPHRAGM
PROPERTIES EXPLANATION
SHAPE RELATIONS VERTEBROCOSTAL DOMES CENTRAL TENDON
TRIGONE
- From infront: Right n left dome. - Upper surf.: covered by pleura n - area of the diaphragm superior to - Right dome: upper border of 5th - Shape: 3 leaves (trifoliate) with no
- From side: Inverted J. pericardium. the lateral arcuate ligament rib (4th ICS) bony attachment.
GROSS - From above: Kidney shape. - Lower surf.: covered by -here, e diaphragmatic muscle is - Left dome: lower border of 5th - B/w 2 central tendons: pericardial
ANATOMY -Inf. view: Origins: sternal, costal, peritoneum (except when directly deficient n e trigone is closed rib (5th ICS): due to e liver. sac. Closure to e ant. part of thorax.
vertebral: right crus – L1,2,3, left crus: related to liver). primarily by the inf. and sup. fascia - Right dome is 1 cm higher than - At level of xiphisternal joint.
L1,2, n arcuate ligaments (AL): median, - Sup. relation: heart n lungs. of e diaphragm. It is a significant left.
medial, lateral -Inf. relation: liver, stomach, area for hernias. -quiet breathing: excursion of 0.5
- Insertion: central tendon spleen, n kidneys. cm, deep: 10 cm.
1. Divides e thoracic n abdominal cavities. 5. Helps in urination (micturation).
2. Forms upper part of post. abdominal wall. 6. Supports e vertebral column during heavy lifting.
FUNCTIONS 3. Primary muscle of respiration. 7. Thoracoabdominal pump – e decreased intrathoracic pressure n increased abdominal pressure that
4. Increases abdominal pressure (forced contraction). accompany decent of e diaphragm facilitate e return of blood to e heart.
Vertebral Origin
Costal Origin - Lt crus: from L1-L2. (smaller n shorter). of tranverse process of L1.
Sternal Origin
Slips arising from inner - Rt crus: from L1-L3. (a sling of fibers from Rt crus -Lateral AL: thickening of QL fascia ,from trans.
ORIGINS Slips attached to post aspect of
aspects of cartilages n loops around esophageal hiatus in e fiber of Lt crus). process of LV1 to middle of lower border of 12th rib.
xiphoid process.
bones of e lower six ribs. - Medial AL: thickening of psoas fascia between body - Median AL: Tendinous fibers from e medial edge of
each crus unite with 1 another infront of aorta at T12.
Oesophagus Other Structures
- At e level ofT10.
Aorta
Inferior Vena Cava - In the muscular Rt. crus of diaphragm n Lt. - behind medial AL - symph trunk, psoas major.
- At e level of T12.
- At e level of T8. to median pl. - behind lateral AL - subcostal vessels n n., quadratus
- Structures accompanying:
- Structures accompanying: - Structures accompanying: lumborum.
1) Aortic orifice: Thoracic duct,
OPENINGS 1) Vena caval orifice: phrenic n. n inf. vena 1) Esophageal Orifice: Rt. n Lt. vagus n.,
azygos vein, aorta. -b/w sternal n costal - sup. epigastric vessels.
cava. esophagus, esophageal branches of Lt. origins
2) Aortic Hiatus: located post. to
2) Hiatus of e IVC: located b/w e middle n right gastric arteries, n veins. - piercing cruca - planichnic n., IC lymph.
e median arcuate ligament of e
leaves of central tendon of e diaphragm. 2) Esophagal Hiatus: located superior to n to - piercing L dome - Lt. phrenic n.
diaphragm (outside diaphragm).
e Lt. of aortic hiatus. -piercing costal o. - VAN of T7-T7 ICS.

Costal Margin Sup. Surface Inf. Surface

BLOOD SUPPLY - by lower 5 intercostal n subcostal arteries - By e sup. pherenic arteries : thoracic aorta. - By inferior phrenic arteries from abdominal
- By musculophrenic n pericardiophrenic arteries: Int. thoracic arteries. aorta.
Veins:
• motor supply = phrenic n. only (C3-C5)
NERVES SUPPLY 1. Superior surface: - Musculorphrenic n pericardiocophrenic veins : int. thoracic veins.
• sensory supply = central part by phrenic nerve
- Sup. phrenic veins (Rt. side): IVC.
(INNERVATION) peripheral part by lower 6 IC
2. Inferior surface: - Inf. phrenic veins: - Rt. veins into IVC.
nerves
- Lt. veins doubled n into IVC n suprarenal veins.
- Diaphragmatic hernias:
- Accumulation of infected materials, pus or blood in subphrenic spaces.
- The abnormalities seen in a chest film and a plain abdomen film of patients
CLINICAL - A hiccup is caused by a spasmodic, involuntary contraction of the diaphragm.
with a large diaphragmatic hernia are:
- Phrenic nerve paralysis- in unilateral paralysis, elevation of diaphragm
CORRELATION         1. Shift of the heart and mediastinum to the opposite side.
and paradoxical movement
        2. Bowel loops in the hemithorax
- Referred pain
        3. Fewer bowel loops in the abdomen than normal.
 ARTERIAL SUPPLY OF CHEST WALL

Ant. Arterious Supply Post. Arterious Supply

Int. Thoracic Arteries Descending Aorta

Origin: Subclavian Arteries
Post. to costal cartilage, lateral to sternum
No artery in lowest 2 ICS.

Supreme Intercostal Arteries Thoracic Aorta Subcostal Artery

(1st-2nd ICS) (3rd-11th ICS) (12th IC Ribs)
Ant. ICT arteries
(1st-6th ICS) Bifurcation at 6th ICS
othoracic fascia between parietal pleura n Int. ICM.
6th ICS: separated by slips of trans. M

Musculophrenic Arteries Epigatric Arteries - give rise to small collateral branch (sup. border)
Anastomoses between sup. n inf. epigastric vessels. - accompany e IC nerves
(7th-9th ICS)
- have terminal n collateral branch that anatomose ant. with ant. ICA.
- 1st: run b/w parietal pleura n int. ICM.
- then: run b/w int. ICM n innermost ICM.

NERVES OF CHEST WALL

Nerves of thorax

Posterior Ramus Anterior Ramus

1st ICS Ventral Rami (IC nerves) 12th Ribs

-1st: no ant. cutaneous - subcostal nerves
branch n often no lateral
cutaneous branch (supply
skin of axilla).
- divided into 2: sup.- 2nd-3rd ICS Branches: 7th-11th ICS
upper limbs, inf.- 1st ICS -form large lateral - motor to ICM - 7th-9th leave e ant. ends
cutaneous branch: - sensory branches to parietal pleural 4th-6th ICS of e ICS to enter e
-1st-2nd ICN course on e
intercostobrachial-sensory
n. branches to peritoneum (T7-T12) -typical nerves. abdominal wall (skin n
int. surface of e 1st-2nd
ribs. -motor to muscles of abdominal wall (T7-T12) -supply only
- supplies e floor muscles)
(skin n subcutaneous -cutaneous to skin of lateral n ant. thorax thoracic wall n - e 10th-11th nerves pass
tissues) of axilla n its associated forward directly into e
medial n post. muscles. abdominal wall.
surface of arm. -becomes
thoracoabdominal n.

VENOUS SUPPLY OF CHEST WALL CLINICAL

CORRELATION -Int. thoracic artery used for origin of coronary
bypass shunt.
IC Veins
-Herpes: viral infection of peripheral n.
-Poliao: viral attack of phrenic n IC motoneurons.
- Rib fracture n Cervical Rib.

Ant. Veins
Post. Veins

Internal -Musculo-
1st ICS: 2nd-3rd ICS: 4th-11th ICS: Thoracic phrenic
to -right to -right to Veins veins
barchioceph azygos veins azygos veins (1st-6th ICS) (7th-11th ICS)
alic veins -left to left -left to Subcostal
barchioceph hemiazygos -Vein(12th
alic veins veins rib)

Hemiazygos veins to aygos veins to superior vena cava veins Drain into Barchiocephalic Veins
 ARTERIAL SUPPLY OF THE HEART
ARTERY ORIGIN COURSE DISTRIBUTION ANASTOMOSES
Rt. Coronary Follows coronary (AV) groove b/w atria n Rt. atrium, SA n AV nodes, n Circumflex n ant. IV branches of Lt.
Rt. aortic sinus
Artery(RCA) ventricle post. part of IVS coronary artery
RCA near its origin
SA Nodal (60%)
Ascends to SA node Pulmonary trunk n SA node

Rt. Marginal RCA Passes to inf. margin of heart n apex Rt. ventricle n apex IV branches

Rt. n Lt. ventricles n post. third of Ant. IV branch of Lt. coronary artery
Post. Interventricular RCA (67%) Runs post. IV groove to apex
IVS (at apex)

RCA near origin of post.

AV Nodal IV artery
Passes to AV node AV node

Lt. Coronary Runs in AV groove n gives off ant. IV n Most of Lt. atrium n ventricle,
Lt. aortic sinus RCA
Artery(LCA) circumflex branches IVS, AV bundles
Circumflex branch Ascends on post. surface of Lt. atrium to SA
SA Nodal (40%) node
Lt. atrium n SA node

Rt. n Lt. ventricles n ant. 2 thirds

Ant. Interventricular LCA Passes along ant. IV groove to apex
of IVS
Post. IV branch of RCA (at apex)

Passes to Lt. in AV groove n runs to post.

Circumflex LCA
surface of heart
Lt. atrium n ventricle RCA

Lt. Marginal Circumflex branch Follows Lt. border of heart Lt. ventricle IV branches
Rt. n Lt. ventricles n post. third of
Post. Interventricular LCA Runs in post. IV groove to apex
IVS
Ant. IV branch of LCA (apex)

Posterior interventricular a. Marginal a.

Posterior sinus
Ascending aorta
Rt. Coronal a.

Rt. Coronal a. Circumflex a.

Anterior sinus

Ascending aorta
Lt. Coronal a.

Anterior sinus
Posterior sinus

Lt. Coronal a.
Posterior interventricular a.

Anterior interventricular a.
Circumflex a. Anterior interventricular a.
Marginal a.

VENOUS DRAINAGE OF THE HEART Great Cardiac Vein

- Begins near e apex n ascends with e ant. IV
Oblique vein of Lt. atrium branch of LCA.
Small, merges with great cardiac vein to - Its 2nd part runs along Lt. side of heart with e
form coronary sinus. circumflex of LCA to coronary sinus.
- Drain most areas supplied by LCA

Coronary Sinus
Middle Cardiac Vein
- accompanies post. IV artery
branch
- Post. interventricular artery

Ant. Cardiac Vein

- drains ant. aspect of
Rt. atrium n ventricle Post. Lt. ventricular vein
before crossinf RCA
to enter Rt. atrium

Small cardiac vein

- Open directly to chambers of heart(atria).
- Marginal branch of RCA
 RESPIRATORY MECHANISMS
INSPIRATION
INVOLUNTARY FORCED
Diaphragm contracts. Diaphragm contracts more.
It moves downward External intercostal muscles contract
Volume of thoracic cavity increases in more.
vertical dimension. Move e ribs upward.
Air pressure in lungs falls. Increase volume of thoracic cavity.
2) Air is drawn into e lungs. Increase e space within lungs.
Air pressure in lungs falls by 2 or 3
mm/Hg below e air pressure outside e
body.
Sternocleidomastoid elevates sternum.
Pectoralis minor contracts.
Elevates ribs:
- True/upper ribs (1-7):
Increase in
anteroposterior
dimension.
Movement at 2nd-6th
costovertebral joints
about a side to side axis
results in raising e
sternal ends of e ribs
(pump-handle
movement).
- False/lower ribs (8-11):
Movement at 7th-10th
costovertebral joints
about an anteroposterior
axis results in raising e
middle of e ribs (bucket-
handle movement).
5) Air is drawn into e lungs.
EXPIRATION
INVOLUNTARYY FORCED
Diaphragm relaxes. Abdominal wall muscles contract n
Abdominal organs recoil n press compress abdominal organs.
diaphragm upward. Abdominal organs force diaphragm
Decreases e thoracic cavity. higher.
Raising e pressure in e lungs. Internal intercostal muscles contract.
Air is exhaled out of e lungs. Push diaphragm up: Volume of
thoracic cavity decrease in vertical
dimension.
Pull ribs downward.
- True/upper ribs (1-7):
Decrease in
anteroposterior
dimension.
Movement at 2nd-6th
costovertebral joints
about a side to side axis
results in lowering e
sternal ends of e ribs
(pump-handle
movement).
- False/lower ribs (8-11):
Movement at 7th-10th
costovertebral joints
about an anteroposterior
axis results in lowering e
middle of e ribs (bucket-
handle movement).
Air is exhaled out of e lungs.
Other function of diaphragm:
- Forced contraction (voluntary)
- Used for defecation, urination, labor
- Increases pressure in abdominal cavity
Pushes on abdominal organs to move contents out
 PHARYNX
PROPERTIES EXPLANATION
GENERAL 1) Funnel shaped fibromuscular tube (15 cm long). 3) Extends from cranial base down to inf. border of cricoid cartilage (C6) n continued by esophagus.
2) Posterior to nasal n oral cavities n to larynx. 4) Widest at opposite e hyoid (5 cm) n narrowest at its inf. end (1.5 cm).
DIVISIONS Ant. Post. Sup. Inf. SPECIAL FEATURES APPLIED ANATOMY
1) Function: purely respiratory function
1) Adenoids:
2) Pharyngeal tonsil: collection of lymphoid tissue in e mucous membrane in e roof n post. wall.
 Enlargement of tubal n pharyngeal tonsils.
3) Salphingopharyngeal fold: extends inf. from medial end of pharyngotympanic tubes in vertical
 They have sufficient size to obstruct
fold of mucous membrane. Covers salphingopharyngeus muscle which opens e pharyngeal
breathing through nose.
orifice of e tube during swallowing.
 May prevent PT tube orifice because of
2 Choanae Basilar pt. of 4) Pharyngotympanic (PT) tube: found in lateral wall post. to inf. nasal meatus, surrounded by 2
NASOPHARYNX (nose opening). occipital bone.
Spenoid Bone Soft palate
folds – salpingopalatine folds (ant.) n salphingopharangeal folds (post.).
gradual absorption of air in middle ears
2) Otitis Media:
5) Torus tubarius: cartilaginous portion of e medial end of PT tube, projects inward creating e
 Inflammation of middle air cavity.
bump sup. to the Pharngeal orifice.
 Ear ache: caused by bacteria spreading.
6) Tubal tonsil: Collection of lymphoid tissue in e submucosa near PT tube.
3) Pharyngeal Recess: Most of nasopharyngeal
7) Pharyngeal recess (Fossa of Rosenmuller): a slit-like lateral projection of e pharynx post. to
cancers start here.
pharyngeal orifice n salpingopharyngeal fold.
1) Palatine tonsils:
1) Fauces: E boundry between e oral cavity n oropharynx.
 Max. size in early childhood.
2) Isthmus of fauces: Bounded sup. by soft palate, inf. by root of tongue, laterally by
 After puberty: gradually atrophy.
palatoglossal n palatopharyngeal arches.
Laterally:  Blood supply: branches of external carotid
3) Palatine tonsils: Collection of lymphoid tissue on each side of oropharnyx in tonsillar fossa
palatoglossal n artery. Sup. pole: tonsillar branch of
Sup. border of (between e 2 arches). Surface covered by epithelium with crypts.
OROPHARYNX palato- C2 to C3 Soft palate
epiglottis 4) Tonsilar bed: Floor of palatine tonsils which formed by sup. constrictor of pharynx n e thin,
ascending pharyngeal n lesser palatine.
pharyngeal Inf. pole: ascending palatine n branches
fibrous sheet of pharyngobasilar fascia (blends with e peristoneum of cranial base).
arches from lingual n facial arteries.
5) E root of tongue (ROT): post. 1/3 of e tongue.
2) Tonsilitis: Common sites of infection are in
6) Lingual tonsil: Lymphoid nodules in e submucosa, on e sup. surface of ROT.
palatine tonsils.
7) Vallaculae:Area between tongue base n epiglottis(small food scraps may stuck here).
3) Parasatonsillar:Common site for bleeding
C4 to C6, 1) Piriform Fossa: 1) Any lodgement of foreing body at piriform
laterally by inf. Inf. border of  A small depression of e laryngopharyngeal cavity of either side of e laryngeal inlet. fossa could damage e nerves.
LARYNGOPHAR Sup. border of
Larynx n middle circoid  Separated from laryngeal inlet by aryepiglottic fold. Communicates with e vallecular fossa. 2) Recurrent laryngeal n. is e major nerve of
YNX epiglottis
constrictor cartilage  Acts like a through n directs food around larynx. Common site for food stuck. larynx which produces a change in voice
muscles  Branches of laryngeal n recureent laryngeal n. lie deep to its mucous membrane. quality.
Naso: ascending pharyngeal, ascending Oro: lingual artery n tonsilar branch of Veins: Pharyngeal plexus to Int.
BLOOD SUPPLY - Arise indirectly from external carotid artery
palatine, n pharyngeal branch of maxillary. facial.
Laryngo: ascending pharyngeal artery.
jugular.
Provided through the pharyngeal plexus 2) Sensory: - Pharyngeal branch of CN V2 to nasopharynx
INNERVATION 1) Motor: - All by CN X except the stylopharyngeus muscle by CN IX - CN IX to oropharynx (with one exception the soft palate (Lesser Palatine which is a branch of V2)
- Inf. constrictor m. receives innervation from external n recurrent laryngeal branches of vagus n. - CN X to laryngopharynx (internal laryngeal nerve)
Nasopharynx - retropharyngeal nodes Oropharynx - retropharyngeal nodes Laryngopharynx - retropharyngeal nodes
LYMPHATIC
- lateral pharyngeal - superior deep cervical - lateral pharyngeal Waldeyer’s ring
DRAINAGE - deep jugular chain - jugular nodes - deep and jugular nodes
Longitudinal muscle (inner):
Circular muscle layer (outer):
1) Salpingopharyngeus m. 3) Stylopharyngeus m. – Elevate larynx n shorten pharynx
MUSCLES 1) Sup.: Origin- skull, mandible, n sides of tongue. 3) Inf.: Origin- thyroid n crisoid cartilage. – Contract involuntarily
during
2) Middle: Origin- hyoid bone - Insertion: into median raphe post.
2) Palatopharyngeus m. speaking n swallowing.
1) Gap between sup. constrictor m. n e cranium: 2) Gap between sup. n inf. m.: Passageways of 3) Gap between middle n inf. constrictor m.: 4) Gap inf. to inf. constrictor m.: Passageway of
GAPS Passageway of ascending palatine a., levator veli stylopharyngeus, glosopharyngeal n., n styloid ligament to Passageway of int. laryngeal n., n sup. recurrent laryngeal n. n inf. laryngeal artery to
palatine m.,n PT tube pass to inf. aspect of pharyngeal wall. laryngeal a. n v. to pass to larynx. pass sup. to larynx.
1) Mucous membrane: lines pharynx n 3) Pharyngobasilar fascia: fibrous layer 5) Buccopharyngeal fascia: thin connective
4) Muscular layer: composed of inner
LAYERS continuous with mucous membranes in all 2) Submucosa: loose connective tissue which attaches sup. constrictor to cranial
longitudinal n outer circular pt.
tissue which permits movement of pharynx
chambers that pharynx communicates. base. n contains pharyngeal plexus of n. n v.
2) Retropharyngeal space:area between pharynx n prevertebral fascias. Infection can be spread through e space n affects pericardial sac-cardiac
SPACES 1) Parapharyngeal space: potential space lateral to upper pharynx.
temponade.
RESPIRATORY SYSYTEM
LARGE INTESTINE
PROPERTI EXPLANATION
ES
OVERVIEW - Extends from terminal Ileum to anus (Ileocecal junc.).
FUNCTIONS - Reabsorption of water. – Synthesis of vitamin K. – Movement n defecation.
- Teniae coli: thickened band of longitudinal smooth muscle (3 types: mesocolic: tranverse n mesocolon attach, omental: omental appendices attach, n free: neither 2 attach).
UNIQUE - Haustra: sacculations of e wall of colon between e teniae.
FEATURES - Omental (epiploic) appendages: small, fat-filled, omentum-like projection.
- Semilunar fold: folding of inner ephitelium surface in large intestine.
LYMPHATIC N
PARTS OVERVIEW RELATIONSHIP BLOOD SUPPLY
INNERVAYION APPLIED ANATOMY
- Blind intestinal pouch n 7.5 cm in length n breadth. - In Rt. lower quadrant, in iliac fossa inf. to e
- Distended with feces or gas. ileocecal junc. n lies within 2.5 cm of inguinal lg. - Supplied by ileocolic artery, e - Lymphatic drainage:
- Has ileocecal valve with 2 lips (sup. n inf.) at ileal orifice which form - Peritoneal n can be lifted freely. terminal branch of SMA. Mesoappendix lymph - Palpable through anterolateral
CECUM ileal papilla. E folds meet laterally to form ridges called frenula - Terminal ileum enters obliquely n invaginates into - Ileocolic vein, tributaries of SMV nodes → Ileocolic lymph abdominal wall.
(contracts to prevent reflux from cecum into ileum – in living person: it. drains it. nodes (at ileocolic artery)
usually non-functional). → SM lymph nodes
- Arises from posteromedial aspect of cecum inf. to - Nerve supply by Appendicitis:
- Blind intestinal diverticulum (5-15 cm). - Supplied by appendicular artery
ileocecal junc. mesenteric plexus. - Inflammation of appendix due to
- Contains masses of lymphoid tissues. (branch of ileocolic artery).
- Attaches to Mc Burney’s point: 3 teniae coli of e Sympathetic: lower occlusion of orifice. Swellin result.
- Has short triangular mesentry: mesoappendix, derived from post. - Runs in free edge of
cecum converge at e base of appendix n form a thoracic pt. of spinal cord, - Referred pain to umbilicus
side (Lt. layer) of mesentry of terminal ileum. mesoappendix which is short n runs
APPENDIX - Mesoappendix attaches to cecum n proximal pt. of appendix.
complete outer longitudinal coat for it.
directly on appendix in distal part.
parasympathetic: vagus (streches of T10 by visceral
- Ileocecal fold (Bloodless of Treves) arises from nerves. Afferent nerve peritoneum).
- Position: varies, dominant: retrocecal (74.1%). End artery – prone to gangrene.
ant. terminal ileum to e front of mesoappendix. It is follows sympathetic n. to - Parietal peritoneum contracts
- Lumen relatively wide in infant n gradually narrows throughout life. - Ileocolic vein, tributaries of SMV
not an avascular structure n contains blood T10 of spinal cord. causes sharp localized pain at Rt.
Often becomes obliterated in elderly. drains it.
vessels. lower quadrant.
- Supplied by ileocolic n Rt. colic - Volvulus of colon: an obstruction
- Passes sup. on Rt. side of abdominal cavity from e cecum to e Rt. - Ant.: Coils of small intestine n greater omentum. - Epicolic LN → paracolic
areteries (anastomoses with each of intestine results from twisting.
lobe of liver. - Post.: Muscle of post. abdominal wall n lower pole LN → ileoclic LN→ Rt.
ASCENDING other n Rt. branch of middle colic Occurs if inf. pt. of ascending
- Narrower than cecum n retroperitoneal along Rt. side of post. of Rt. kidney. colic LN→ SM LN.
COLON a.) colon has mesentry, result in
abdominal wall. Covered by peritoneum anteriorly n on its sides. - Hepatic flexure: Rt. lobe of liver. - Innervated by SM nerve
- Drained by ileoclic n Rt. colic abnormally mobile cecum n
- Separated from anterolateral abdominal wall by greater ommentum. - Rt. paracolic gutter lateral: deep vertical groove. plexus.
veins. proximal pt. of colon.
- 15 inches, longest, n most mobile from Rt. hepatic flexure to Lt. - Middle colic LN →SM LN
- Post. to greater momentum n ant. to coils of - Supplied by middle colic artery.
splenic flexure (higher, > acute, < mobile, attaches to diaphragm - Periarterial plexus of Rt.
jejunum n ileum. - May also receives from Rt. n Lt.
TRANVERSE through phrenicocolic ligament). n Lt. colic a. → SM
- Its root of mesocolon lies along inf. border of colic arteries via anastomoses,
COLON - Attached by greater momentum, which attaches to e stomach, plexus.
pancreas n is continuous with parietal peritoneum forming marginal artery.
droops far down into abdominal cavity, comes back to tranverse - Transmit vagal, visceral
posteriorly (Intraperitoneal). - Drained by SMV.
colon. afferent, n sympathetic n.
- Occupies 2ndry retroperitineal position b/w Lt. colic flexure n Lt. iliac - LV in descending n
- Ant.: Coils of small intestine n greater momentum.
fossa, where it continuous with sigmoid colon. sigmoid colon → Epicolic
- Post.: Muscle of post. abdominal wall n lateral
DESCENDIN - Peritoneum covers it ant. n laterally n binds it to post. abdominal n paracolic LN →
border of Lt. kidney.
G COLON wall. intermediate colic LN →
- Splenic plexure: Phrenicocolic lg. n spleen. - Supplied by Lt. colic n sigmoid
- As it descends, it passes ant. to lteral border of Lt. kidney. IM LN (SM LN also).
- Lt. paracolic gutter. arteries (branches of IMA).
- Has paracolic gutter on e Lt. on its lateral aspect. - Abdominal aortic p. →
- Drained by IMV into portal vein
parietal p.→ (sympathetic Diverticulosis:
- S-shaped loop, variable length (usually 40 cm), intraperitoneal. - Extends from iliac crest to rectosigmoid junc. at e through splenic vein.
n. via lumbar splanchnic - Vasa recta enter colon wall b/w
SIGMOID - Teniae coli r wider n meet to clothe e terminal pt. in a complete level of S3 (sacrum). nerve to sympathetic trunk teniae coli muscle n produce
COLON longitudinal coat. Omental appendages r very long n well developed. - Root of sigmoid mesocolon has inverted V- or parasympathetic n. from potential area of weakness.
- Feces is stored here befor defecation. shaped attachment: pelvic splanchnic n. via inf. Colonic pressure:90 mm Hg
- 18 – 20 cm, has an ill-defined anatomical beginning. - Ends at anorectal junc.: puborectalis muscle - Supplied n drained by IMA n IMV hypogastric p.).
- External appearance: absence of messentry, omental appendages, encircles post. n lateral aspects of e jucn., forming respectively. - Visceral aff. conveying
RECTUM n haustra n teniae coli disappear to form longitudinal muscle coat. anorectal angle. pain sensation pass
- Lower dilated pt.: ampulla (stores feces). - Peritoneal on ant., Lt. n Rt. sides in proximal 1/3, retrogradely with
- Valve of Houston: Lt., Rt., n Lt. above downward. its front on middle 1/3, absence at distal 1/3. sympathetic fibres to
- 4 cm, from puborectalis to anus. - Anal column: longitudinal colums on walls of thoracolumbar spinal
ANAL
- 2 sphincters: 1) internal: involuntary, circular smooth muscle, sup. rectum contain branches of sup. rectal arteries. sensory ganglia.
CANAL -reflex info via vagus n.
2/3 of anal canal. 2) external: voluntary, inf. 2/3 of anal canal, - Anal valves: flaps below e columns.
 - Anal sinuses: above valves, secrete mucus, help
voluntary, skeletal muscle.
expel faeces.
GASTROINTESTINAL
SYSTEM
URINARY
SYSTEM
CARDIOVASCULAR
SYSYTEM
 AUTONOMIC NERVE SUPPLY OF THE HEART ELECTRICAL SYSTEM OF
THE HEART SA node (sinuatrial node) =
Pace maker of the heart
- Specialized type of cardiac Impulse from SA AV node→ Av → IV (membranous) inf.
Sympathetic Supply Cardiac Plexus Parasymphathetic Supply muscle fibers. 5mm at its node → atria’s bundle → fibrous border (lies inf. to septal
widest part. Develops from e muscles (contract) skeleton cusp of 3cuspid valve
wall of the sinus venosus of e
developing heart. supplied by
Superficial Deep Cardiac both divisions of e ANS. → Junction of
Presynaptic fibers Cardiac Plexus Plexus - From presynaptic fibers of Regulates the heart to beat at membranous n
- Cell bodies in intermediolateral - lies on aortic - lies to e Rt. of Vagus nerves. 70 beats/min. Lies in the Right muscular
columns (IMLs) of sup. 5/6 arch b/w phrenic ligamentum - Postsynaptic cell bodies in atrium just below the S.V.C.
segments of spinal cord. n vagus nerves arteriosum, inf. atrial wall n interatrial septum near e top of crista terminalis.
Postsynaptic fibers n medial aortic near SA n AV nodes n along →Rt. Branches →
- Cell bodies in e cervical n sup. arch. coronary artery. AV node(atrioventricular node) septomarginal
thoracic paravebtebral ganglia of - Lies in e interatrial septum above band
sympathetic trunk. and to e left of the opening of e
coronary sinus. AV Bundle = Atrio-
ventricular bundle of (His) Purkinje →ant. papillary muscle→ant.
Vagus cardiac - Decrease: bundle: wall of ventricle→Purkinje fibre
branches: 1) Heart rate Runs through the membranous →beneath endocardium
Increase: - Traverse - Sup. n inf. from 2) Force of contraction part of e IVS. Bridge between e
1) Rate of polarization of SA node. cardiopulmonary cervical region. - Constrict coronary artery: atrial and e ventricular muscle
2) Atrioventricular conduction. splanchnic nerves n - Recurrent Saving energy b/w periods of tissue. divided into Rt. And Lt. Results: →chordae →Lt. branches→
3) Atrial n ventricular contractility. cardiac plexus to end laryngeal nerve. increased demand. Limbs at the junction between e contraction of tendinae→drawing septal endocardium→
4) Coronary artery dilatation. in SA n AV nodes. membranous and muscular part of ventricular muscles AV valves together papillary muscle
IVS. Supply: anterior papillary
muscle + ventricles walls

PERICARDIUM OF THE HEART

PROPERTIES EXPLANATION
Pericardium 1) A fibro serous membrane that covers e heart at e beginning of its great vessels. 3) A closed sac composed of 2 layers: ext. – fibrous, int. - serous
2) Influenced by e movement of e heart n great vessels, sternum, n diaphragm.

Fibrous Layer 1) Tough ext. layer. 4) Bound post. by loose connective tissue to structures in post. mediastinum.
2) Continuous inf. with central tendon of diaphragm (pericardiophrenic ligament. 5) Attached ant. to e post. surface of sternum by sternopericardial ligament.
(FP) 3) Continuous sup. with e tunica adventitia of great vessels entering n leaving the 6) Protects heart against sudden overfilling (it’s unyielding, closely related to great
heart n pretracheal layer of deep cervical fascia. vessels).

Serous Layer Serous layer (general):
A single layer of flattened
(SP) mesothelium cells forming
simple squamous ephitelium
that lines both int. surface of
fibrous p. n ext. surf. of heart.
Parietal layer:
- Lines with e int. surface of
fibrous pericardium.
- Reflected onto heart at great
vessels: aorta, pulmonary trunk,
IVC., n SVC.
Visceral layer:
- Makes up e epicardium (outermost).
- Extend onto e beginning of great vessels.
- Tranverse pericardial sinus: lies b/w group of aorta
n pulmonary trunk n group of SVC, IVC, n
pulmonary veins n e reflection of SP around them.
- Oblique pericardial sinus: Bounded laterally by
pericardial reflection surrounding pulmonary vein n
IVC n post. by pericardium overlying e ant. aspect of
esophagus. It’s a blind sac.
- It’s a wide pocket-like recess in pericardial cavity
post. to e base of heart, formed by Lt. atrium.

Pericardial 1) Is a potential space b/w parietal serous layer n visceral serous layer.
2) Contains a thin film of fluid that enables e heart to move n beat in a frictionless movement.
Cavity (PC)
Arterial Supply 1) Branch of internal thoracic cavity: pericardiophrenic artery. 3) Bronchial, esophageal, n sup. phrenic artery of thoracic aorta.
2) Musculophrenic artery: branch of internal thoracic artery. 4) Coronary arteries.

Venous Supply 1) Pericardiophrenic veins: tributaries of barchiocephalic veins.

2) Variable tributaries of e azygos venous system.

Nerve Supply 1) Phrenic nerves (C3-C5) (sensory fibres). 3) Sympathetic trunks for vasomotor function.
2) Vagus nerves

THE HEART.
CHARACTERISTI EXPLANATION
CS
Anterior (sternocostal) surface: Diaphragmatic (inf. surface): Rt. Pulmonary surface: Lt. Pulmonary surface:
SURFACES - Mainly by Rt. ventricle. - Mainly by Lt. ventricle, n partly Rt. ventricle. - Mainly by Rt. atrium. - Mainly by Lt. ventricle (cardiac impression of Lt. lung).
Inf. border (oblique, nearly
Rt. border (slightly convex) : Lt. border (nearly vertical): Sup. border:
horizontal):
BORDERS - b/w Rt. atrium
- Mainly by Rt. ventricle, n slightly by
- Mainly by Lt. ventricle n - By Lt. n Rt. atria n auricle in ant. view.
- extending b/w SVC n IVC Slightly by Lt. auricle. - Post. to aorta n pulmonary trunk n ant. to SVC, inf. to T. sinus.
Lt. ventricle.
- Formed by inferolateral part of Lt. ventricle. - Remain motionless throughout cardiac cycle.
APEX - Lies post. to e Lt. 5th interostal space n 9 cm from median pl. - Place where sound of mitral valve closure are maximal (apex beat).
- Heart’s post. aspect (opposite apex). - Faces post. towards e bodies of vertebrae T6-T9 n is separated from them by pericardium, oblique sinus, esophagus, n
aorta.
BASE - formed mainly by Lt. atrium, lesser by Rt. atrium. - Extends sup. to e bifurcation of pulmonary trunk n inf. to coronary groove.
- Receives pulmonary veins on Rt. n Lt. side of Lt. atrial n sup. n inf. venae cavae at sup. n inf. ends of its Rt. atrial position.
Properties:
Functions:
- Complex framework of dense collagen forming 4 fibrous rings.
FIBROUS - Surround e orifices of e valves, Rt. n Lt. trigone, membranous
1) Keep e AV orifices n semilunar valves patent n prevent them from overly distended by ↑ blood volume
SKELETON 2) Provides attachment for leaflets n cups of valves as well as for myocardium.
part
3) Forms an electrical insulator by separating myenterically conducted impulses of atria n ventricles.
of interartrial n interventricular septa.
3) Epicardium:
1) Endocardium: 2) Myocardium:
LAYERS OF - Thin internal layer (endothelium n subendothelium). - Thick, helical middle layer.
- Thin external layer (mesothelium).
WALL - Formed by visceral layer of serous
- Lining membrane of heart: covers its valves. - Composed of cardiac muscle.
pericardium.
Interior surface of Rt. atrium:
Part: Openings: Others:
- has smooth, thin walled, post,
- Receives venous blood from SVC, IVC, n 1) SVC: into sup. part at 3rd costal 1) Fossa ovalis: - Oval, thumbprint depression
part (sinus venarum).
coronary sinus. cartilage. of IA septum.(Surrounding ridge: Limbus FO).
- has rough, muscular ant. wall
CHAMBERS - Rt. auricle: conical muscular pouch that
of musculi pectinati.
2) IVC: into inf. part at 5th costal cartilage. 2) SA node: at sup. end of sulcus terminalis,
RIGHT ATRIUM projects from this chamber: Increasing capacity 3) Coronary sinus: b/w Rt. AV orifice n near junction with Rt. side of SVC.
- separated by ext: sallow
of atrium as it overlaps e aorta. IVC orifice. 3) AV node: at IA septum, above attachment of
vertical groove, sulcus
- Has Rt. AV orifice where Rt. atrium 4) Tricuspid O., Ant. carciad vein, n Venae septal cusp of 3cuspid valve n to e Lt. of
terminalis, int: crista
discharges e blood to Rt. ventricle. cordis minimae. opening of coronary sinus.
terminalis.
Interior surface of Lt atrium: Others:
Lt. auricle:
- Larger, smooth-walled part: sinus venarum. - A slightly thicker wall than that of e right atrium.
- Tubular, muscular, n its wall trabeculated with
- rough, muscular part: musculi pectinati ( ori. Auricular - 4 pulmonary veins (2 sup. n 2 inf.) entering its
LEFT ATRIUM pectinate muscle (musculi pectinati).
chamber of embryonic heart). smooth post. wall.
- Form sup. part of heart, n overlaps root of pulmonary T.
- Semilunar (oval thin) depression in IA setum: Fossa ovalis - has IA septum that slopes post. n to e right
- E remains of Lt. part of primodial atrium.
(surrounding ridge is valve of fossa ovalis). - Mitral V. replaces its ant. wall n leads to Lt. ventricle.
Moderator Band
VENTRICLES Walls AV Valves Papillary Muscle (PM)
(MB)
Blood Pathway

1) Ant. PM: largest n more

- A curved muscular
- Guards AV orifice,AVO(4th-5th ICS) prominent, from ant. wall, CT - U-shaped pathway.
-Sup. - Conus arteriosus: an arterial cone bundle that
- Bases attached to fibrous ring which attaches to ant. n post. cusps of - Inflow of blood into
which leads to pulmonary trunk traverses Rt.
keeps e caliber of orifice constant. 3cuspid valve Rt.
(infundibulum). ventricular chamber
- Chordae tendineae (CT) attached to 2) Post. PM: smaller, consists of Ventricle enters post.
RIGHT - Int. - Trabeculae carnae: Irregular
cups at free edges n ventricular surfaces several pt., from inf. wall, CT
from inf. pt. of IVS
through AVO. When
VENTRICLE muscular elevations, 3 pt. PM, CT, n MB. to e base of PM,
n arises from e apices of PM. attaches to post. n septal cusps of ventricle contracts, e
- Supraventicular crest: separates inflow carries pt of
- Attachment to 2 cups prevents their 3cuspid V outflow of blood into
(rough) pt. from outflow (smooth) pt. Rt. branch of AV
separation n inversion when tension is 3) Septal PM: from IV septum, CT pulmonary T. leaves
-Rt. ventricle less thick n lower in pressure. bundle.
applied to chordae tendinae. attaches to ant. n septal cusp of sup. n to e Lt.
3cuspid valve.
LEFT - 2 to 3 times as thick as of that Rt. ventricle. - Double mitral valves,: post to sternum - Ant. n Post. PMs are larger than Rt. Other: - V-shaped pathway.
VENTRICLE - Mostly covered with trabeculae carnae: (4th costal cartilage), 2 cups: ant. n post. ventricle. - Aortic orifice: - As blood traverses Lt.
finer n > numerous than Rt. ventricle. - 3 PM n CT support MV to resists e Lies in its Rt. ventricle, it undergoes 2
- A conial cavity longer than Rt. ventricle. pressure during contraction of Lt. V. posterosuperior pt. Rt. angle turns, which
 n surrounded by
result in 180o change in
- CTs become taut before n during systole fibrous ring to
- Inflow (rough) pt. from outflow (smooth) direction. This reversal
to prevent cusps into Lt. atrium. which Rt., post., n
pt. takes place around ant.
- Ant. cup larger than post. cusp: Lt. cusps of aortic
cusp of MV.
attached to fibrous ring. valve r attached-
aorta begins
PLEURA
PROPERTIES EXPLANATION
Parietal: Viscera:
Pulmonary Cavity:
-Lines e pulmonary cavities, - covers e lungs n adherent to all its surfaces Pulmonary Ligament:
- Potential space b/w layers of pleura.
thereby adherent to e thoracic including surfaces within fissures. - Extending b/w e lung n e mediastinum,
PARTS surf. of diaphragm n lateral surf. of - provides lung with smooth slippery surface to
- Contains capillary layer of serous pleural fluid: lubricates pleural surfaces n
immediately ant. to e esophagus.
allow layers of pleura to slide smoothly during respiration. Its surface tension
mediastinum. move freely on parietal pleura. - A narrow fold inferior to e root of e lungs.
provides cohesion that keeps e lung surface incontact with thoracic wall.
-> substantial than visceral p - Continuous with parietal pleura at hilum.
SURFACE Cervical (dome) of pleura = Apex: Ant. margin: In. margin (both):
Post. margin (both): - Curve line which crosses
ANATOMY - Curve line, convex upwards, 1) Rt. Pleura: runs down behind sterno-clavicular joint almost
- Extends along e  8th rib in midclavicular line
- Lines of pleural buldges upward into neck. reaching e middle behind sternal angle- up to Xiphisternal joint
vebtebral column from e  10th rib in midaxillary line
reflection n its limit - From sterna-clavicular joint to a 2) Similar but at 4th IC cartilage deviates laterally
dome to e end of e inf.  12th rib in adjacent to vertebral column
where it closes to body point 1” above e junction of n extend down to lateral margin of sternum
margin.
surface medial n middle 3rd of clavicle. up to Xiphisternal joint.
2) Mediastinal Part: 4) Cervical Pleura:
- covers lateral aspects of mediastinum (partition b/w 3) Diaphragmatic Part: - Dome-shaped cap of pleural sac n sup. continuation of
1) Costal Part:
pulmonary cavities) - Covers e sup. surf. of e diaphragm, except along its costal n mediastinal pt.of parietal pleura.
PARIETAL - covers int. surf. of thoracic wall (TW).
- Continuous - sup.: root of neck as cervical pleura. costal attachment, n e part fused with pericardium. - Covers e apex of lungs.
PLUERA - separated from int. surf. TW by
- ant. n post.: costal pleura. - Contacts to muscular fibres of diaphragm by - Reinforced by supraplueral membrane (attaches to int.
endothoracic fascia.
- inf.: diaphragmatic pleura. phrenicopleural fascia. border of 1st rib n tranverse p. of C7 vertebrae.
- at hilum: continuous with parietal pleura. - E summit is 2-3 cm sup. to e apex of luns.
Definition:
LINES OF 1) Sternal Line: 2) Costal Line: 3) Vertebral Line:
- E relatively abrupt lines along which e
- Sharp n abrupt n occurs where - Sharp n occurs where e costal pleura becomes continuous with - Much rounder, gradual reflection n occurs where e costal p.
PLEURA parietal p. changes direction as it
costal p. becomes continuous diaphragmatic pleura inf. becomes continuous with mediastinal p. post.
REFLECTION passes from 1 wall of pleural cavity 2
with mediastinal p. ant.
another.
Costodiaphraghmatic Recess: Costomediastinal Recess:
Definition:
PLEURA - Extends inf. b/w e thoracic wall n lateral n post. parts of - Smaller recess which is located post. to sternum where e costal pleura is in contact
Part of pleural cavities which are
RECESSES diaphragm. (2”= scapular line, 3-3 ½” = midaxillary line, 1-1 ½” with mediastinal pleura.
not occupied by e lungs except in full inspiration.
= midclavicular line). - Lt recess is larger due to e cardiac notch.
1) Plueral Cavity: 2) Segmental pleura: 3) Lower limit of pleural reflection may be damaged 4) Causing dullness at a lung base:
CLINICAL - Air: pneumothorax Pus: empyemathorax - Segmental innervation of IC nerves. during nephrectomy operation due to e damage - Pleural effusion, pleural thickening,
CORRE- consolidation,
LATION - Blood: haemothorax Water: hydrothorax - Pleuritis: cut distribution of these nerve pains. of pleura crosses 12 th rib through incision in e loin. n collapse of e lung, n raised Hemi-
diaphragm.

Lymphatic Drainage Blood supply Nerve Supply

Parietal Pleura: Visceral Pleura: Arterial: Venous: Parietal Pleura: Visceral Pleura:
- Sternal nodes. - Superficial efferent - Int. thoracic artery - Similar - Costal: segmentally - Autonomic vasomotor
- Diaphragmatic that drain lung tissue. - Intercostal artery - SVC by IC nerves. supply by vagus n.
nodes. - Musculophrenic - Diaphragm: dome - Symphatetic supply via
- Post-mediastinal artery (phrenic n.), periphery pulmonary plexus that
nodes. - Thymic artery (lower IC n.). lie near hilum of e lungs
- Pericardial artery Media: phrenic n. (insentitive to common
- Pulmonary artery sensation such as touch n
- Bronchial artery pain).
 THE LUNGS
SHAPE - Conical shape (triangle).
SITE - Located in the Lt. n Rt. side of thoracic region (surrounding mediastinum).
WEIGHT -Rt. lung: 600 gm, Lt. lung: 550 gm (Rt. lung is shorter n weightier than Lt. lung).
COLOR - Children: yellowish pink, -Adult: molted appearance.
SURFACE 1) Ant. border:
- Lt. lung: lies adjacent to ant. line of reflection of parietal pleura between 2nd n 4th costal cartilage. Here, e margin of Lt. pleural reflection moves
ANATOMY laterally n inf. at cardiac notch to 6th costal cartilage.
- Rt. lung: line continues from 2nd to 6th costal cartilage.
2) Inf. border:
-reaches midclavicular line at 6th rib, mid-axillary line at 8th line, n scapular line at 10th rib towards spinous process of T 10.
SURFACES 1) Apex: 2) Costal surface: 3) Mediastinal surface: 4) Diaphragmatic / base surface:
- E blunt sup. - Large, smooth, n convex. - Concave due to e presence of heart n - Concave due to diaphragm.
end of e lung - related to costal pleura which pericardium. - Deeper in e Rt. lung because e higher
ascending separates it from ribs, costal - includes hilum n root of e lung (where pleura position of e Rt. diaphragmatic dome
above e level of cartilage, n innermost ICM. forms pleural sleeve). (overlies liver).
e 1st rib into e - Post. part related to bodies of - Rt. lung: grooves of cardiac impression, - Bounded by a thin, sharp margin
root of neck n is thoracic vertebrae (vertebral esophagus, n azygos vein. that projects into costodiaphragmatic
covered by pt.). - Lt. lung: grooves of arch of aorta, thoracic recess.
cervical pleura. aorta, cardiac impression n small esophagus.
.MARGINS 1) Ant. border: 2) Inf. border: 3) Post. border:
- Where e costal n mediastinal surface meet ant. n - Circumscribes diaphragmatic - Where e costal n mediastinal surfaces meet
(BORDERS) overlap e heart(cardiac notch at Lt. lung). surface n separates this surface from post., broad n rounded n lies in cavity at side of
costal n mediastinal surfaces. thoracic region of vertebral column.
FISSURES - 2 Fissures: - Lt. lung:
1) Oblique fissure - a line drawn from e root of e spine of scapula 1) Oblique fissure - Sup. lobe lies above n ant. to this line.
obliquely, downward, laterally, n ant., following e course of 6th rib - Inf. lobe lies below n post. to this line.
th th
to 6 costal cartilage. (from spinous process of T2 post. until 6 - Rt. lung:
costal cartilage ant.). 1) Oblique fissure - Middle lobe lies above.
2) Horizontal fissure – a line drawn horizontally along e 4th costal - Inf. lobe lies below.
cartilage to meet e oblique fissure in e mid-axillary line. 2) Horizontal fissure - Above: Sup. lobe, Below: Middle n Inf. lobes.
LOBES - Rt. lung: - Lt. lung:
1) Sup. lobe: Apical, post. n ant. 1) Sup. lobe: Apical, post. ant., sup., n inf. (lingula: thin, tounge-
2) Middle lobe: Lateral n medial. like process due to e presence of cardiac notch).
3) Inf. lobe:Sup., ant. basal, medial basal, lateral basal, n post. basal 2) Inf. lobe: Sup., ant. basal, medial basal, lateral basal, post. basal.
ROOT OF - Means: Structures entering or leaving e lungs.
- Made up of: bronchi, pulmonary artery n vein, lymph vessels, bronchial vessels, n nerves.
THE LUNGS - Surrounded by a sheath of pleura, which joins e mediastinal pleura to visceral pleura covering e lungs.
(ROL) - Order (Sup. to inf.) in Rt. lung n Lt. lung:
→ Pulmonary arteries, bronchus, lymph nodes n pulmonary veins.
FUNCTION - To oxygenate e blood by bringing inspired air into close relation with venous blood in pulmonary capillaries.
BLOOD 1) Bronchial artery (BA): 2) Bronchial veins (BV): 3) Pulmonary artery (PA): 4) Pulmonary veins (PV):
- supply blood for nutrition of - drain blood supplied to lung - Both parts arise from pulmonary - Carry well-oxygenated blood.
SUPPLY structures making up ROL, by BA at ROL. trunk at sternal angle level. - PV → unite to form larger
supporting tissues, n visceral p. - Rt. BV drains into azygos - Carry poorly oxygenated blood to vessels→ systemic veins
- 2 Lt. BAs arise from thoracic vein lungs for oxygenation.
aorta, Rt. BA arises from aorta. - Lt. BV drains into accessory - PA → Main bronchus → Lobes →
- Small BA supplies post. aspects hemizygos vein or Lt. sup. segmental arteries.
of main bronchi. ICV.
NERVE - Pulmonary plexus:at root of each lung, forms from e branches of symphatetic trunk n receives parasymphatetic fibers from vagus nerve
- Symphatetic efferent: broncho-dilatation n vasoconstriction. – All impulses derived from bronchial musous membranes n from
SUPPLY - Parasymphatetic efferents: broncho-constriction n vasodilatation. Stretch receptors in alveolar wall pass to CNS in both PSN n SN.
LYMPHATIC - Deep lymphatic plexus is located at submucosa of bronchi n in peribronchial connective tissues- drains structure from lung roots into pulmonary
lymph nodes (along e lobar bronchi)→ bronchopulmonary lymph nodes, → sup. n inf. tracheobronchial lymph nodes (Rt. lung into Rt. side n Lt.
DRAINAGE lung to Lt. side) → Rt. n Lt. bronchomediastinal lymph trunk → Rt. side to Rt. lymphatic duct n Lt. side to thoracic duct.
CLINICAL 1) Apex of lung: injured if stab wound or bullet injury in neck area. 3) Segmental resection: if lesion of lung restricted to
2) Fractured ribs can penetrate lungs. a bronchopulmonary segment.
IMPORTANC
E

TRACHEOBRONCHIAL TREE.
Rt. main bronchus
- Wider, shorter, runs
> vertically as it passes
directly to e hilum.

Larynx Trachea
-supported by c- - Trunk of tree Lobar bronchi Segmental
Lt. main bronchus (20). bronchi (30).
shaped rings of - bifurcates at
- Phave an NFL that
hyaline cartilage. sternal angle level.
CNN and asses
inferolaterally, inf. to
arch of aorta, n ant. to
esophagus n thoracic
aorta.

Mediastinum Inf. mediastinum

Sup. mediatinum - Means: meddle-standing - Ant. , middle, n post inf. mediastinum.
- E area located b/w sternum ant., vertebral bodies post., n lungs laterally
 MEDIATINUM.
PROPERTIE EXPLANATION
S
1) Upper boundary: plane of thoracic inlet( jugular notch, 1s rib, n T1). 3) Lateral boundaries: mediastinal pleura
2) SUP. MED. 2) Lower boundary: plane of sternal angle( sternal angle to T4). 4) Ant. boundary: manubrium of sternum
- BORDERS 5) Post. boundary: T1-T4.
CONTENTS 1) Thymus gland → Brachiocephalic veins (SVC) → Arch of aorta → Trachea → Esophagus → Thoracic duct → Azygos vein.
(ANT. TO 2) Nerves: Phrenic nerves, Vagus nerves, Lt. recurrent laryngeal nerve. 3) Ligament: Ligamentum arteriosum.
POST.)
2) INF. MED. 1) Upper boundry: sternal angle plane. 3) Lateral boundries: mediastinal pleura 5) Post boundary: vertebral bodies of T5-T12.
- BORDERS 2) Lower boundary: diapraghm 4) Ant. boundary: body of sternum.

1) Ant. mediastinum (AM): 2) Middle mediastinum (MM): 3) Post. mediastinum (PM):

- Fatty tissue, lymph nodes (sternal), - Pericardium, heart, root of great vessels, - thoracic aorta, esophagus, azygos n
CONTENTS branches of int. thoracic arteries, sterno- bifurcation of trachea,arch of azygos vein, hemiazygos veins, thoracic duct, vagus
pericardial ligaments. phrenic nerve, deep part of cardiac plexus, nerve, symphatetic trunk, splanchnic
n lymph nodes. nerve, n lymph nodes.
- 10 lymphoid organ located in e inf. part of neck n ant. part of sup. mediastinum but post. to manubrium, ant. to fibrous pericardium.
THYMUS - Arterial supply: ant. IC n ant. mediastinal branches of int. thoracic arteries. – Lymphatic drainage: end in parasternal,
- Venous supply: end in Lt. brachiocephalic, int. thoracic, n inf. thyroid veins. brachiocephalic, n tracheobronchial lymph nodes.
BRACHIO- - Post. to sternoclavicular(SC) joints by union of int. jugular n subclavian veins. - Shunt blood from head, neck, n Lt. upper limb to
CEPHALIC - At level of inf. border of 1st costal cartilage unite to form SVC. Rt. atrium.
- Lt. BCV is > twice longer because it passes from Lt. to Rt. side. - Triburtaries: Inf. thyroid veins, Int. thoracic veins, n
VEINS pericardiaco-phrenic veins.
(BCV)
- Returns blood from all structures sup. to diagphragm except heart n lungs. – Lies in Rt. side of sup. mediastinum, anterolateral to
SVC - Passes inf. n ends at e level of 3rd costal cartilage (entering Rt. artrium). Trachea, posterolateral to ascending aorta.
ASCENDING - 2.5 cm in diameter. – Branch: coronary artery (from aortic sinus).
AORTA - Begins at aortic orifice. – Intraperidical n lies inf. to e transverse thoracic p.

ARCH OF - begins post. to 2nd Rt. sternocostal joint n arches sup., post., n to e Lt., n then inf.
- ascends ant. to Rt. pulmonary artery n bifurcation of trachea, reaching its apex at e Lt. side of trachea n esophagus as it passes over e
AORTA root of Lt. lung. Descends post. to e root of lung on Lt. side of T4. – Branches: brachiocephalic trunk, Lt. common carotid artery,
(AOA). - ends by becoming thoracic aorta post. to 2nd Lt. sternocostal joint. N Lt. subclavian artery.
1) Brachiocephalic trunk 2) Lt. common carotid artery(LCCA) 3) Lt. subclavian artery
- largest branch, arises post. to manubrium, - arises post. to manubrium, post. to Lt. - arises from post. part of AOA, post. to Lt.
BRANCHES ant. to trachea,post. to Lt. brachiocephalic v part of brachiocephalic trunk. common carotid artery.
OF AOA - ascends superolaterally to reach Rt. side of -ascends ant. to Lt. subclavian artery, ant. - ascends lateral to trachea n LCCA
trachea n SC joint where it divides to Rt. to trachea n then to its Lt. - As it leaves thorax, n enters e root of neck,
common carotid artery n Rt. subclavian a. - enters neck by passing post. to Lt. SCJ. it passes to Lt. SC joint.
- Begins on e Lt. side of inf. border of T4 n descends in post. mediastinum on Lt. side of T5-T12 (approaches median pl., displaces
esophagus to e Rt. Lies post. to e root of e lung, pericardium, n esophagus. Enter abdominal cavity through aortic hiatus.
THORACIC - Tributaries: 1) 9 pairs of post. ICA n subcostal arteries.
AORTA 2) Sup. phrenic arteries: pass anterolaterally to e sup. surface of e diaphragm.
3) Bronchial, esophageal, pericardial(sends twigs to pericardium), n mediastinal( supply lymph nodes in PM) branches.
- descends ant. to esophagus, inclining a little to e Rt. of median plane. – ends at level of sternal angle by dividing into Lt. n Rt.
TRACHEA - Post. surface is flat where it is applied to esophagus. bronchi.
- A fibromuscular tube that extends from pharynx to stomach. Located b/w trachea (ant.) n T1-T4 (post.).
- Flattened antreroposteriorly n inclines to e Lt. but pushed back to median plane by AOA n is compressed ant. by root of Lt. lung.
ESOPHAGU - Descends post. n to e Rt. of AOA, n post. to e pericardium n Lt. atrium. Has 1o post. relationship with e base of e heart.
S - Deviates to e Lt. n passes through esophageal hiatus at T10.
- Compressed by 3 structures: AOA, Lt. main bronchus, n diaphragm (> evident in lateral view).
- Lies on e ant. aspect of 7 inf. thoracic vertebrae n e largest lymphatic channel. – Thin walled, dull white, beaded because of
- Conveys most lymph to venous system (all but Rt. sup. quadrant). Its numerous valves.
- Originates from cisterna chyle (abdomen) n ascend through aortic hiatus in diaphragm. – Receives branches from middle n sup. ICS
THORACIC - Ascends in post. mediastinum among thoracic aorta on its Lt., azygos on its Rt., (both sides) through collecting trunks n
DUCT esophagus ant., n vertebral bodies post. from post. mediastinal structures.
- Near termination, receives from jugular subclavian n bronchomediastinal lymphatic trunks.
- Empties into Lt. int. jugular n subclavian veins.
1) Azygos vein: 2) Hemiazygos vein: 3) Acessory hemiazygos vein:
- Drains e back, thoracoabdominal walls, n - Arises from e Lt. side by e junction of Lt. - begins at medial end of 4th or 5th ICS
mediastinal pleura. subcostal n ascending lumbar veins. - descends on e Lt. side of T5-T8.
- form collateral pathway b/w SVC n IVC - Ascends on Lt. site of vertebral column, - receives tributaries from veins in 4th-8th
AZYGOS - ascends in post. mediastinum, close to e post. to thoracic aorta n T9. Here, it crosses ICS n from Lt. bronchial veins.
SYSTEM Rt,. side of 8 inf. thoracic vertebrae. to e Rt., post. to aorta, thoracic duct,n - Crosses over T7-T8 vertebrae, post. to
- Arches over e sup. aspect of Rt. lung root esophagus to join azygos vein. thoracic aorta n thoracic duct, to join
to join SVC. - Receives e 3 inf. post. ICV, inf esophageal azygos veins.
- communicates with vertebral venous veins, n small mediastinal veins. - connected to e Lt. sup. ICV which drain
plexus that drain e back n vertebrae. 1st-3rd ICS to AHV to Lt.Brachiocephalic v

URINARY BLADDER
PROPERTIES EXPLANATION
- A hollow viscus with strong muscular walls. - Shape: pyramid or boat shaped. – Maximal holding capacity: 1L.
OVERVIEW - A temporary reservoir for urine. – Characterized by its distenbility. – Fulness sensation starts: 200-300 mL.
- In pediatrics: empty n full in abdominal cavity.
- In adults: empty in pelvic cavity (in lesser pelvis: superior surface level with superior margin of pubic symphysis. Partially sup. to n
LOCATION partially post. to pubic bones with retropubic space b/w them), full ½ in abdominal cavity (ascends in extraperitoneal fatty tissue of
ant. abdominal wall), ½ in pelvic cavity.
a) Superior surface c) Inferolateral surface
- Covered with peritoneum b) Base or posterior surface - Slope downwards n medially
which sweeps upward on e - Triangular. to meet its fellow, lying against d) Apex
ant. abdominal wall. - E 2 vas deferens lie side by front pt. of pelvic diaphragm n - remains of urachus.
- At post. margin in male side in post. surf. n separate obturator internus.
peritoneum: continues on to seminal vesicles from each - Below apex is a space behind e) Neck
SURFACE uppermost of base n continued side. pubic bones n symphysis pubis - Site where base n inferolateral
backward as floor of - Superolateral angle joined by called retopubic space of surf. meet.
rectovesical pouch. In female: ureters n inf. angle gives rise to Retzius containing fatty tissue - Facing prostate n urogenital
peritoneum reflected from urethra. n fibromuscular pubuvesical diaphragm.
post. margin on to - Lowest pt: trigone. lg. extend from bladder neck to
undersurface of uterus. inf. aspect of pubic bone.
Male:
RELATION - Post. relation: rectovesical pouch, Denonvillier’s fascia, n lower
Female:
- Post. relation: uterovesicle pouch n ant. wall of vagina.
1/3 of rectum.
- On each side: pubic bones n fascia covering e levator ani n e sup. obturator internus lie in contact with inferolateral surf.
- Superior surf is covered with peritoneum.
- In males: base is separated from rectum centrally by only e fascial rectovesical septum n laterally by seminal glands n ampullae of
BLADDER BED ductus deferentes.
- In females: base has a firm connective tissue union with ant. vaginal wall n upper pt. of uterine cervix.
- Bladder is enveloped by a loose connective tissue visceral fascia.
- In males: Toward e neck, e muscle fibers form involuntary internal urethral sphincter (contracts during ejaculation to prevent
BLADDER ejaculatory reflux) of semen into bladder. Some run radially n assist in e opening e internal urethral orifice. Muscle fibers r continuous
WALL with fibromuscular tissue of prostate.
- Composed chiefly - In females: these fibers are continuous with muscle fibers in e wall of e urethra.
by Detrusor Muscles. - E ureteric orifice n internal urethral orifice r at e angle of e trigone of e bladder.
- E ureteric orifices r encircled by loops of detrusor musculator that tighten when bladder contracts to prevent urine reflux into ureter.
- In males is called puboprostatic lg. n in females is called pubovesicle lg.
- Specialized region of endopelvic fascia.
LIGAMENTS - Important in maintaining e position of bladder with respect to urogenital diaphragm n levator ani muscle.
- Usually contain some muscle fibers.
- Laterally, along e sides of bladder, they r connected to e obturator fascia, forming e lateral true lg.
- A condensation of tissue (dense connective tissue), the rectovesical fascia which intervenes between rectum and base of bladder and
prostate.
DENONVILLIE - It is connected to floor of rectovesical pouch above and to apex of prostate and perineal body below.
R’S FASCIA - In foetus the floor of rectovesical pouch descended to bottom of pelvis and this fascia has been considered to represent the fused
peritoneal layers of the lower end of pouch.
- Provide a limited barrier to the local spread of cancer eg. of the rectum to the prostate or vice versa.
- At e base of bladder, lying b/w 2 ureteral orifices (above n lateral) n internal urethral orifice (centrally n below) n is e least mobile pt.
- Smooth wall n firmly attached to underling muscle.
TRIGONE OF - Ureteric orifices r connected by a transverse ridge, interureteric bar, n shape of ureteric orifice is oblique slit.
BLADDER - Uvula vesicae are a small elevation immediately behind urethral orifice that is produced by underlying median lobe of prostate.
- Mucous membrane of e remaining bladder is thrown into folds when empty that disappear when full.
Venous Supply:
Arterial Supply:
- In males: vesical venous plexus is continuous with prostatic
- Mainly supplied by branches of internal iliac arteries.
venous plexus n e combined plexus complex envelops base of
- E sup. vesical arteries supply anterosuperior parts of bladder.
bladder n prostate, seminal gl., ductus deferentes, n inf. end of
- In males: inf. vesical arteries supply e base n neck of bladder.
BLOOD SUPPLY - In females: vaginal arteries replace inf. vesicle arteries n send
ureter. It also receives blood from deep dorsal vein of penis.
- E vesical venous plexus drains into internal iliac veins.
small branches to posteroinferior part of bladder.
- In females: Vesicles venous plexus envelops e pelvic pt. of
- Obturator n inf. gluteral arteries also send small branches to
urethra n e neck of bladder, receives blood from dorsal vein of
bladder.
clitoris, n communicates with vaginal/uterovaginal venous plexus.
- Efferent Sympathetic L12 segment through sup. n inf hypogastric plexuses: vasomotor, inhibitory to detrusor muscle,motor to
superficial trigonal muscle n muscle of bladder neck (Sphincter vesicae or internal urethral sphincter).
- Efferent parasympathetic S2, 3, 4 is motor to detrusor muscle.
NERVE SUPPLY - Sense of bladder fullness is through parasympathetic.
- Pain fibers follow both.
- Somatic nerves: Pudendal nerves S2, 3, 4: give perineal branch which supplies external urethral sphincter.
- External urethral sphincter is under voluntary control after 2 years age. This has to do with growth of spinal cord n appropriate nerve
- From superolateral aspects of bladder: pass to external iliac lymph nodes
LYMPHATIC - From base n neck: pass to internal iliac lymph nodes. Some vessels from e neck of bladder drain into sacral or common iliac lymph
DRAINAGE nodes.
1) Cystocele - Hernia of e bladder: loss of bladder support in females by damage to perineal muscles or their associated fascia
APPLIED can result in herniation of bladder into vaginal wall.
ANATOMY 2) Rupture of e bladder: ruptured by injuries to inf. part of e ant. abdominal wall or by fractures of e pelvis.
 URETHRA
PROPERTI MALES FEMALES
ES
OVERVIEW - Muscular tube (18-22 cm) long. - Approximately 4 cm long n 6 mm in diameter.
- Convey urine from int. orifice urethral orifice of urinary - Passes anteroinferiorly from int. urethral orifice of
bladder to external urethral orifice (at tip of penis). urinary bladder, post. n then inf. to pubic symphysis, to
- Provide an exit for semen. ext. urethral orifice.
- In flaccid state, urethra has a double curvature. 1 st at e bulb
of penis, n 2nd at e proximal end of e free pendulous pt. of
penis (can be reduced during catheterization by lifting e
penis.

PARTS a) Prostatic urethra (3-4 cm): Descends through ant. - Ext. urethral orifice is located in vestibule, ant. to
- E epithelial lining prostate, forming a gentle anteriorly concave curve, bounded vaginal orifice.
begins as anteriorly by a vertical trough-like part of ext. urethral - Lies ant. to vagina (forming an elevation in ant. vaginal
transitional then sphincter. – wall).
chages to - Widest n most dilatable pt. Features: urethral crest with - Urethra passes with vagina → ext. urethral sphincter →
stratified or seminal colliculus, flanked by prostatic sinuses into which perineal membrane.
psuedostratified prostates duct open, ejaculatory ducts open ionto colliculus, - Urethral glands r present in sup. pt. of urethra, eg:
columnar then urinary n reproductive tracts merge here. paraurethral glands.
stratified - Lined by stratified squamous epithelium for most of its
squamous. b) Membranous urethra (1-1.5 cm): Passes through deep length, except near bladder: transitional epithelium.
perineal pouch, surrounded by circular fibers of external
urethral sphincter, penetrates perineal membrane.
- Narrowest n least distensible part.

c) Penile (spongy) urethra (~15 cm): Courses through corpus

spongiosum, initial widening occurs in e bulb of penis, widens
again distally as navicular fossa (in glan penis).
- Longest n most mobile, bulbourethral glands open into
bulbous pt., distally, urethral glands open into small urethral
lacunae entering lumen of this pt.

ARTERIAL - Supplied by prostatic branches of inf. vesicle n middle - Supplied by int. pudendal n vaginal arteries.
SUPPLY rectal arteries.

VENOUS - Drains into prostatic nerve plexus. - Drains into int. pudendal n vaginal veins.
DRAINAGE

INNERVATIO - Supplied by prostatic plexus: sympathetic, parasympathetic, - Most pass to sacral n internal iliac lymph nodes n few
N n visceral afferent fibers. from distal urethra drain into inguinal lymph nodes.

LYMPHATIC - Drains into int. n ext. iliac lymph nodes. - Arise from vesical (nerve) plexus n pudendal nerve.
DRAINAGE - Visceral afferents run in pelvic splanchnic nerve, but
termination receives somatic afferents from pudendal
nerves.
 URETER
PROPERTIES EXPLANATION
- 25 cm long, ½ abdominal n ½ pelvic n retroperitoneal. – Inf. ends are surrounded by vesical venous plexus.
OVERVIEW
- Narrow lumina that carries urine from kidney to urinary bladder.
(1) In abdominal cavity:
Run inf. from apex of renal pelvis → hila of kidneys → narrows down to form ureter proper → passes caudally lying on psoas
muscle → crosses over bifurcation of common iliac artery, sacroiliac joint, n at e apex of sigmoid mesocolon → passes over e
pelvic brim
COURSE (2) In pelvic cavity:
Entering lesser pelvic → run on e lateral wall of pelvis (parallel to e ant. margin of greater sciatic notch, b/w parietal pelvic
peritoneum n internal iliac arteries → Opposite ischial spine, curves anteromedially n sup. to levator ani → moves inferomedially
through e wall of e bladder (entering e outer surf. of bladder 5 cm apart, but their internal opening into e lumen of empty
bladder is separated by 2.5 cm).
(a) Rt. ureter: Crossed by gonadal vessels, Rt. colic n ileocolic (b) Lt. ureter: lateral to inf. mesenteric vessels n is crossed
branch of sup. mesenteric artery by root of mesentery. anteriorly by Lt. colic n gonadal vessels.
- Relations of ureter in e abdomen:
RELATION a) Ureter runs down over psoas major muscle. c) Ureter passes over e bifurcation of iliac vessel.
b) Genitofemoral nerve passes behind e ureter.
- Relations of ureter in pelvic cavity:
a) Ureter is only 2 cm away from cervix. b) Yellow water runs under red bridge.
(a) Male: Ductus dererens pass b/w ureter n peritoneum (b) Female: Ureter passes medial to e origin of uterine artery
within e ureteric fold of peritoneum. Ureter lies n continuous to e level of ischial spine, where it is crossed
GENDERS posterolateral to ductus deferens n enters e posterosuperior superiorly by uterine artery. It then passes close to e lateral
angle of bladder, just sup. to seminal gland. pt. of e fornix of e vagina n enters posterosuperior angle of
urinary bladder.
- Posterior abdominal wall:
Surface making of ureter is e line joining a point of 5 cm lateral to e L1 spinous process n e post. superior iliac spine. E ureters
SURFACE occupy a sagital plane that intersects e tips of e transverse processes of e lumbar vertebrae.
ANATOMY - Superior abdominal wall:
It can be marked from tip of 9th costal cartilage to e bifurcation of commion iliac artery. E bifurcation into internal n external
iliacs is 3 cm from midline, level with tubercles of e iliac crest (intertubercular line).
a) At pelviureteric jucn. (Where renal pelvis forms ureter proper).
CONSTRICTI b) Where e ureter crosses e pelvic brim over e bifurcation of e common iliac artery.
ON c) Where ureter passes obliquely through e bladder wall.
- These constrictions are potential sites of obstruction by ureteric (kidney) stone.
1) Passive compression of e distal submucosal portion of e ureter against detrusor muscle as a result of bladder filling
SPHINTERIC impedes vesicoureteral reflux (VUR) by closing e ureter.
MECAHNISM 2) E contraction of bladder musculature acts as a sphincter preventing e reflux of urine into ureters. When bladder
contracts during micturation, internal pressure of bladder wall increases, prevents reflux of urine.
- Supplied by 4 main sources:
a) E aorta: 3rd 1/4 c) Gonadal artery: 2 nd 1/4 - E vessels join an anastomosing network (within
BLOOD
adventitia) n gives small branches to inner muscularis
SUPPLY
b) E renal artery: 1st 1/4 d) Vesicle artery (sup. n inf.): last ¼ n mucosa, running e length of ureter. Each can be lost
w/o affecting ureter.
- E lymphatic run back alongside e arteries:
LYMPHATIC
a) e abdominal portion drains into paraaortic nodes
DRAINAGE
b) e pelvic portion drains into common iliac n internal iliac nodes.
- Nerve fibers derived from renal, aortic, n sup. n inf. hypogastric plexus.
- Sources of fibers: lower 3 thoracic, 1st lumbar, n 2nd to 4th sacral nerves.
- Afferent fibers carry infomartion concerning distension of e ureter.
NERVE
- Referred pain of blocked ureter: excruciating n radiates to e flank, top of e thigh n labium majus (females), n to scrotum n
SUPPLY penis (males).
- Pain reffered to dermatomes of e source of innervation i.e. to T10-T12 n L1 on e affected side. Pain fibers accompany
sympathetic nerves, n any movement of psoas muscle moves e ureter n aggravates e pain.
a) Endangers of ureter:
- In e surgical removal of uterus, hysterectomy, a ureter may be mistakenly ligated n cut instead of uterine artery.
- It may be involved in local spread of cancer.
APPLIED
- May be injured when ovarian vessels are tied (in oopherectomy) because ureter is behind e ovarian vessels at pelvic brim.
ANATOMY
- May be injured during clearing of sigmoid mesocolon in sigmoidectomy because Lt. ureter crosses pelvic brim at e apex of
sigmoid mesocolon.
b) Ureter shows peristaltic activity when gentle pinched with forceps.

KIDNEY
PROPERTIE RIGHT KIDNEY LEFT KIDNEY
S
OVERVIEW - Reddish brown in color, size: 12x6x3 cm, weight: 150 gm.
- 2 surf.: ant. n post., 2 poles: upper n lower, 2 borders: medial (concave) n lateral (convex).
LOCATION - Lie retroperitoneally on posterior abdominal wall on each side of vertebral column in paravertebral gutter position, under
floating ribs (11 n 12) n at e level of T12-L3 vertebrae. Rt. kidney is slightly inf. due to its relation to liver.
SURFACE - Hilum of e Lt. kidney lies near transpyloric pl., 5 cm from median pl.
ANATOMY - Transpyloric pl. passes through sup. pole of Rt. kidney, which is 2.5 cm lower than Lt. kidney.
- Inf. pole of Rt. kidney is a finger’s breadth sup. to ileac crest.
- Posteriorly, sup. pt. of each kidney lie deep to 11 th n 12th ribs.
- In deep breathing, kidneys move 2-3 cm in vertical direction during e movement of diaphragm.
- Palpation of Rt. kidney is possible because it is 1-2cm lower than Lt. one, while Lt. kidney can be palpated when enlarged or
displaced inf.
POSITION - Slope of underlying psoas muscles make e lower poles farther from e spine than e upper poles.
- E protrusion of lumbar vertebral column into abdominal cavity causes kidneys to be obliquely placed in anteromedial direction,
lying at an angle to each other.
- Renal vessels make an angle of almost 90 degrees b/w kidneys, aorta, n IVC.
- Lumbar lordasis causes kidneys to be obliquely placed with upper poles towards post. direction while lower pole towards ant.
direction.
ANTERIOR - Caudal n lateral portion: hepatic flexure of e colon. - Caudal n lateral portion: splenic flexure of e colon.
RELATION - Upper pole is against post. surf. of Rt. lobe of liver. - Related to stomach (lesser sac by gastrosplenic lg.), spleen
- Related to liver, duodenum, ascnding colon. (greater sac by leinorenal lg.: contain vessels), pancreas,
jejunum, n d. colon.
POSTERIOR - Subcostal, iliohypogastric n ilioinguinal n., n vessels descend diagonally across e post. surf. of kidneys.
RELATION - > inferiorly, post. surface is related to quadratus lumborum muscle.
- Kidney bed: Psoas major n minor muscles, iliacus muscle, transverses abdominis muscle, n lumbosacral trunk.
SUPERIOR - Associated with diaphragm, which separates kidneys from pleural cavities n 12 th pair of ribs.
RELATION
OTHERS - Renal angle or costovertebral angle: angle b/w 12 th rib n sacrospinalis muscle.
FUNCTIONS - Removes excess water, salts, n wastes of protein metabolism from e blood through urine.
- Returning nutrients n chemical to blood.
COVERINGS 1) Fibrous capsule: surrounds e kidney n is closely applied to it outer surf.
2) Perirenal fat: covers e fibrous capsule.
3) Renal fascia (Gerota’s fascia): e condensation of connective tissue that lies outside perirenal fat, n enclosed kidney n
suprarenal glands.
4) Pararenal fat: lies external to renal fascia n is often in large quantity. It forms pt. of retroperitoneal fat.
5) a) Upper pole: peritoneum b) Other parts: transversalis fascia.
SEGMENTS 5 segments: apical, upper, middle, lower, n posterior.
HILUM - A vertical cleft at e concave medial margin of kidneys.
- Part where renal vessels (vein is ant. to artery) n renal pelvis (flattened, funnel-shpaed expansion of e sup. end of ureter) leave
renal sinus (entrance to renal vessels, pelvis, calices, nerves, n fat).
- From front to backward (at transpyloric pl.): renal vein → 2 branches of renal artery → ureter → 3rd branch of renal artery
(V.A.U.A).
- Lobes of kidney (pyramid n cortex) → renal papilla (apex) → 2/3 minor calices → 2/3 major calices → renal pelvis → ureter.
SPACES 1) Retroperitoneal space: lies on post. abdominal wall behind e parietal peritoneum. Extends from T12 n 12 th rib to sacrum
n iliac crest. E floor is formed form medial to lateral psoas, quadratus lumborum, n origin of transverses abdominis
muscle. Ant. surf. is covered by transversalis fascia.
2) Hepatorenal pouch (Morisson’s pouch.): e cleft b/w upper pole against post. surf. of Rt. lobe of liver, lowest in part, n
fluid will be drained here when lying down.
BLOOD Aorta → Renal artery → Segmental artery → Lobar artery → Interlobar artery → Arcuate artery → Interlobular artery →
SUPPLY Afferent arteriole → Glomerulus → Efferent arteriole → Peritubular capillaries n Vasa Recta → Interlobular vein → Arcuate
vein → Interlobar vein → Lobar Vein → Segmental vein → Renal vein → IVC.
NERVES - Innervated by renal plexus which is supplied by: fibers from celiac ganglion (lowest splanchnic n.), aorticorenal ganglion, n aortic
SUPPLY plexus.
- Pathway: Renal plexus at renal artery → Vessels of kidney → glomeruli → tubules.
- Pain pathway: Calyces → Renal pelvis → celiac plexus → by splanchnic n. to sympathetic trunk or via white rami communicantes
to T12-L1 spinal n. → poat. nerves roots → spinal cord.
- Referred pain: to back n lumbar region n radiate to ant. abdominal wall n down to external genitalia.
LYMPHATI - No lymphatic nodes in medulla. E lymphatic vessels form 3 plexuses: 1) 1 in e substance of kidneys, 2) 1 under fibrous capsule, 3)
C 1 in e perirenal fat. 4 or 5 lymphatic trunks leave e renal hilum n r joined by vessels from e capsule. Lymphatic vessels follows
DRAINAGE renal vein to e lumbar (caval n aortic) LN.
 SMALL INTESTINE (SI)
PARTS EXPLANATION
- C-shaped (around e head of pancreas), 1st, shortest (25 cm), widest, n most fixed part.
- Begins at e pylorus on e Rt. side n ends at duodenojejunal junc. (Level of L2, 2-3 cm to e Lt. of e midline n takes e form of acute angle called
DUODENUM duodenojejunul flexure).
- Sup. 2 cm part: - Considered as partially retroperitoneal.
> Called ampulla Superior (1st) part. Descending (2nd) part. Horizontal (3rd) part. Ascending (4th) part.
(duodenal cap). - Short (5 cm), ascends from - Runs inferiorly, curving around - 10 cm long. - Runs superiorly n along e Lt. side of e
> Immediately distal pylorus. HOD, 7.5-8 cm long, n - Retroperitoneal aorta to reach e inf. border of BOP (2.5
to pylorus. - No circular folds and contains retroperitoneal - Runs transversely to e Lt., cm).
> Has mesentery submucosal mucous glands. - Initially, it lies to e Rt. of n passing over IVC, aorta, n L3 - Here, it curves ant. to join jejunum at
- Proximal part: parallel to IVC. vertebrae. duodenojejunal junc., supported by e
> Mobile.
a) Sup.: Hepatoduodenal lg. - Bile n main pancreatic duct enter - Crossed by SMA n vein n attachment of suspensory muscle of e
- Remaining part: b) Inf.: Greater Omentum. its posteromedial wall n unite to root of mesentery of jejunum duodenum (ligament of Treitz).
> Have no mesentery - Peritoneum covers ant. aspect, form hepatopancreatic ampulla n ileum. - e suspensory muscle passes post. to
> Immobile because n bare post. except e ampulla. which enters major duodenal papilla - Ant. surf. of horizontal part pancreas n splenic vein n ant. to e Lt.
retroperitoneal. (posteromedially in 2nd part) is covered with peritoneum renal vein n attached to the right crus of
- Ant. surf. of proximal n distal except e crossing. diaphragm.
thirds covered with peritoneum.
Peritoneum, gallbladder, Transverse colon n mesocolon, coils SMA, SMV, coils of SI. - Beginning of root of mesentery, coils
ANTERIOR
quadrate lobe of liver. of SI. of jejunum.
Bile duct, gastroduodenal a., Hilum of Rt. kidney, renal vessels, Rt. psoas major, IVC, aorta, Lt. psoas major, Lt. margin of aorta.
POSTERIOR
portal vein, IVC. ureter n psoas major Rt. ureter.
Head of pancreas (HOP), bile n HOP.
MEDIAL
pancreatic ducts.
Anterolateral to L1 on Rt. of L2-L3 vertebrae. Ant. to L3 vertebrae. Lt. of L3 vertebrae.
VERTEBRAL LEVEL
transpyloric plane.
Neck of gallbladder. SM Vessels, HOP, uncinate Body of pancreas.
SUPERIOR process of pancreas.

INFERIOR Neck of pancreas.

Jejunum Ileum
- Plicae circularis: series of transverse fold. – Plicae n villi are tall n closely packed in proximal jejunum (most absorption),
- Mucosa has small fingerlike projection (villi), low n sparse in proximal ileum, n totally absent in terminal ileum.
GENERAL
which covered by simple columnar epithelium, - Absorptive surface area is roughly 250 m2 (size of a tennis court).
n carpeted by microvilli.
- Begins at duodenojejunal flexure. - Ends at ileocecal junc. (3.5 m long).
- Most lies in e Lt. upper quadrant of e infracolic compartment. - Most of e ileum lies in e Rt. lower quadrant.
OVERVIEW
- 2.5 m long. - Terminal ileum lies in e pelvis from which it ascends, ending in medial
aspect of cecum.
COLOR Deeper red Paler pink
CALIBER 2-4 cm 2-3 cm
WALL Thick n heavy Thin n light
VASCULARITY Greater Less
VASA RECTA Long Short
ARCADES A few large loops Many short loops
FAT IN Less – has windows More – no windows
MESENTERY
PLICAE Large, tall, n closely packed Low n sparse, absent in distal part
CIRCULARES
PEYER PATCHES Few Many (present in mucous membrane found along ant-mesenteric border)
- Fan-shaped fold of peritoneum. – Average breadth of mesentery from its root to intestinal border is 20 cm
- Attaches jejunum n ileum to e post. abdominal wall. – Root of mesentery crosses ascending n horizontal part of duodenum,
MESENTERY - E root of mesentery (15 cm long) is directed obliquely, abdominal aorta, IVC, Rt. ureter, Rt. psoas major, n Rt. testicular vessels.
inferiorly, n to e Rt., n extends from duodenojejunul – Between 2 layers of mesentry are SM vessels, lymph nodes, fat, n
junc. n Rt. sacroiliac joint. autonomic nerves.
- This is a 0.4‚ 4.8 inch (1.12 cm) long pouch that protrudes from the wall of the ileum.
MECKELS - It is present at birth and represents the yolk stalk of the embryo. In most persons, the stalk structure disappears at birth.
DIVERTICULU - It is not unusual, however, for Meckel's diverticulum to persist; it does not usually require treatment unless it becomes inflamed or bleeds.
M - 2 inches long, 2 feet away from ileocaecal junction, 2% of people-2/3 only true.
- Gastric or pancreatic mucosa is sometimes found in an ileal diverticulum.
- Complications: Diverticulitis, intestinal obstruction and intususception.

Blood supply of
duodenum Lymphatic drainage of
Veins duodenum
Artery
Abdominal Aorta
 Blood supply of Small Intestine
Blood supply of Small
Intestine
Portal Vein Vein
Abdominal Aorta

Lacteals (intestinal
Splenic Vein

Superior Mesenteric Artery

- Arises from abdominal aorta at L1, 1cm Lymphatic Plexus (wall of SI)
Superior Mesenteric Vein
inf. to celiac trunk, runs between e layer of
- Drains jejunum n ileum.
mesentery.
- Lies ant. n to e right of SMA.
- Sends 15-18 branches to jejunum n ileum. Lymphatic Vessels (layers of
- Ends post. to e neck of pancreas
mesentery)

Arterial Arcades
- Loops of arteries Vasa Recta
- Straight arteries Juxta-intestinal lymph nodes
(close to intestinal wall)
Perivascular nerve plexus (along SMA to e intestinal) →
Symphatetic nerves (T8-T10) through symphatetic trunk n
splanchnic nerves (synapse in celiac n sup. mesenteric ganglia) & Ileocolic Lymph Nodes Superior central nodes (along
Parasymphatetic nerves derives from posterior vagal trunk (synapse proximal pt. of SMA)
in myenteric n submucosa plexus)
→ Superior Mesenteric Plexus
a) Symphatetic: reduces intestine’s motality n secretion
(vasoconstriction). Sup. Mesenteric Mesenteric Lymph nodes
b) Increases intestine’s motality n secretion, restoring Lymph nodes (among arterial arcades)
digestive ability.
 OESOPHAGUS
PROPERTIES EXPLANATION
- Hollow muscular tube: length 25 cm n diameter 2.5 cm.
OVERVIEW
- Starts at C6: pharyngoesophageal junc. n end at cardio-oesophageal junc.
1) Propulsion of food from pharynx to stomach: peristalsis. 3) Prevents reflux of food at bottom end: LES.
FUNCTION
2) Prevents air entry at top end: UES.
Midline (neck) → incline to Lt. (root of neck) → slightly to Lt. – crossed by Lt. main bronchus (thorax) <cervical oeso-Lt.
CURVATURES approach> → deviated to Rt. by aortic arch (T6) < middle 1/3 Rt. approach > → curved to Lt. (esophageal opening) < lower
1/3 Lt. approach >.
2) Thoracic (broncho-aortic)
1) Cervical constriction. 3) Diaphragmatic constriction.
constriction.
- 15 cm from incisor teeth. - 40 cm from incisor teeth.
CONSTRICTIO - 25 cm from incisor teeth.
- At pharyngoesophageal junc. - At oesophageal hiatus.
NS - Caused by -Aortic arch: 22.5 cm.
- Caused by cricopharyngeal sphincter - Diaphragmatic n sphincter
- Lt. main bronchus: 25.5
C6. constriction.
cm.
CERVICAL THORACIC ABDOMINAL
- Ant: Trachea, Post: Vertebra column. - Extends from suprasternal notch. - From esophageal hiatus to orifice
- Laterally: carotid sheath n thyroid - Pass through sup. n post. mediastinum. of cardia at stomach – 3 cm.
gland. - Enter abdomen through esophageal - Lies in esophageal groove on post.
- Either side: common carotid arteries n hiatus at Rt. crus of diaphragm, Lt. to Lt. surface of liver.
recurrent laryngeal nerves. median pl. n T10 vertebrae. - Lower 3-4 cm of esophagus can be
PARTS - Related to subclavian artery n - Ant.: trachea, trachea bifurcation,Lt. functionally regarded as sphincter.
terminal pt. of thoracic duct on Lt. main bronchus, pericardium, Lt. atrium, - e muscle is thickened n marked by
- Consists of skeletal muscle. esophageal nerve plexus, n diaphragm. Z line on endoscopy.
- Post.: thoracic vertbera n duct, - Consists of smooth muscle.
azygos vein.
- Consist both of skeletal n smooth
muscle
- Artery: Inf. thyroid artery from - Artery: Esophageal branches of - Artery: Esophageal branches of
BLOOD thyrocervical trunk. thoracic aorta. Lt. gastric artery.
SUPPLY - Veins: Inf. thyroid vein. - Vein: Azygos n hemiazygos v. - Vein: Esophageal branches of Lt.
gastric artery.
- Recurrent laryngeal n cervical - Vagal trunk n esophageal plexus n - Vagal trunk <ant. n post. gastric
symphatetic trunks. symphatetic trunk. n.>, thoracic symphatetic trunk,
NERVE
greatr n lesser splanchnic nerves n
SUPPLY
plexus at Lt. gastric n inf phrenic
artery.
LYMPHATIC - Deep cervical lymph nodes. - Mediastinal lymph nodes. - Gastric lymph nodes.
DRAINAGE
1) Mucosa folds at oesophagogastric junc. at as a valve. 4) Arrangement of muscle fibers of stomach around cardia
acts as sphincter
2) E acute angle of entry of oesophagus into stomach or maintains acute angle of cardio-esophageal junc.
REFLUX
produces a valve-like effects. 5) Rt. crus of diaphragm acts as a pinch-cock to lower
PREVENTIONS
pt. as it pierces this
3) E circular muscle of lower pt. is a physiological sphincter. muscle.
6) E positive intra-abdominal pressure compresses e wall of short segment of intra-abdominal oesophagus.
1) Oesophagogastric junctions: 2) Phrenicoesophageal ligament:
- Junc. of esophageal squamos n gastric columnar. - Fascia at diaphragmatic hiatus.
- E point at which tubular esophagus joins gastric pouch. - Extends from deep surface of diaphragm to join fascia
OTHERS
- E junc. of esophageal cicular muscle layer with oblique sling propria n oesophagus at about 2-3 cm above
fiber of stomach (loop of Willis or collar of Helvetius) – Z oesophagogastric junction.
line.

LIVER
PROPERTIES EXPLANATION
OVERVIEW - Largest gland, weight: 1.5 kg (2.5% of body weight). - Wedge shaped, 1.5 ml bllod flow per minute (30% CO).

FUNCTIONS 1) Stores glycogen n secretes bile. 3) Lipid metabolism. 5) Protein metabolism. 7) Processing of drugs n hormones.
2) Centre for digested foods. 4) Carbohydrate metabolism. 6) Excretion of bilirubin. 8) Detoxification of ammonia.
 SURFACES a) Diaphragmatic surface. b) Visceral surface.
- Convex, smooth, n doom-shaped related to - Concave n covered by peritoneum except at fossa of gallbladder n porta
concavity of inf. surface of diaphragm. hepatis (transverse fissure of vessels, hepatic bile duct n nerve plexus).
- Covered with visceral peritoneum except in bare - Bears multiple fissures n impressions from contact with other organs.
area (direct contact to diaphragm). - H structures: Rt. sagittal fissures – ant.: fossa for gallbladder, post.: IVC.
- Bare area is demarcated by Rt. triangular ligament n Lt. sagittal fissures – ant.: fissure for ligamentum teres,
ant. n post. layers of Rt. coronary ligament. post.: fissure for ligamentum venosum.
- Near e apex, ant. n post. layers of Lt. coronary Transverse fissure: Lesser omentum – enclosing portal triad.
ligament form Lt. triangular ligament. - Impressions: Lower pt. of esophagus, Rt. side of ant. aspect of stomach (gastric
- IVC traverses a deep groove for vena cava within e n pyloric area), sup. part of duodenum, lesser omentum, gallbladder, Rt. colic
bare area. flexure n Rt. ransverse colon, n Rt. kidney n suprarenal gland.
SURFACE - Lies in e Rt. upper quadrant of abdomen. - Protected by thoracic cage n diaphragm.
ANATOMY - Rt side: 6th to 10th costal cartilage. - Lt side: 6th to 7th costal cartilage (e tip is under Lt. nipple).
- Occupies most of Rt. hypochondrium, upper - Located > inf. when one is erect because of gravity.
episgastrium, n extends into Lt. hypochondrium. - Liver can be palpated during deep inspiration due to inf movement of diaphragm
RECESSES a) Subphrenic recesses b) Hepatorenal recess (Morison pouch).
- contains enough - Sup. extension of peritoneal cavity. - Posterosuperior extension of subhepatic space (portion of supracolic
peritoneal fluid to - Between diaphragm n sup. n ant. aspect of compartment of peritoneal cavity inf. to e liver).
lubricate adjacent diaphragmatic surf. of liver. - Between Rt. pt. of visceral surf. n Rt. kidney n suprarenal gland.
peritoneal membranes. - Separated into Rt. n Lt. recesses by falciform ligament. - A gravity-dependent pt. of peritoneal cavity in supine post.
- Communicates ant. with Rt. subphrenic recess.
LIGAMENTS Falciform Ligament Coronary Ligament. Ligamentum Ligamentum Teres Lesser Omentum
(FL). - Reflection of peritoneum from Venosum. - Fibrous remnant of - Passes from liver to
- Extends between e diaphragm to bare area - Fibrous remnant of umbilical vein. lesser curvature of
liver n ant. - 2 layers: ant. n post., of Rt. n fetal ductus venosus, - Round ligament n stomach n 1st 2cm of
abdominal wall. Lt. side of diaphragmatic surf. which shunted blood small paraumbilical sup. pt. of duodenum.
- Divide liver into - Ant. layer is continuous on e from umbilical vein veins course in e free - 3 parts:
anatomically Rt. n Lt. with Rt. layer of FL n post. to IVC, short- edge of falciform -hepatoesophageal lg.
Lt. lobes. layer is continuous with Rt. circuiting e liver. ligament. -hepatogastric lg.
-Attached liver to layer of lesser omentum. -hepatoduodenal lg.
diaphragm n ant.
abdominal wall.
LOBES N a) Anatomical lobes b) Surgical Lobes
SEGMENTS - Liver is divided into 2 topographical lobes n 2 accessory lobes. - Liver is divided to independent Lt. n Rt. lobes by Cantlie line
- Diaphragmatic surf. is divided to large Rt. lobe n small Lt. lobe (line joining IVC n gallbladder).
by falciform ligament. - Each lobe receives its own 1o branch of hepatic artery, portal
- Visceral surf. is divided to caudate lobe post. n sup. n quadrate vein, n hepatic duct.
lobe ant. n inf. by tranverse porta hepatic. These lobes are - These lobes are further divided into 8 Couinaud segments.
surrounded by Rt. n Lt. sagittal fissures. - Caudate lobe is independent of e bifurcation of portal triad n is
drained by 1 or 2 small hepatic vein n directly to IVC.
APPLIED Cirrhosis – Progressive destruction of hepatocytes n replacement of them with fat n fibrous tissue. Fibrous tissue surrounds e
ANATOMY intrahepatic blood vessels n biliary ducts, making e liver firm, n impeding e circulation of blood through it (Portal Hypertension). Liver
will be enlarged due to fatty changes n fibrosis. Causes: alcoholism, CCl4, n other hazard chemicals. Treatment: Surgical creation of
portosystemic or portocaval shunts (anastomosing e portal n systemic venous system).

3 lobules

Classical Lobules Acinar Lobules

Portal Lobules
 - Roughly hexagonal block of tissues of 2 mm
BILIARY DUCTS & GALLBLADDER - Ellipsoidal mass of hepatocytes aligned around the
PROPERTIES
long n 1mm diameter that has at its centre e - A triangular unit with the portalEXPLANATION
canal at center, three hepatic arterioles and portal venules & drained by a
terminal hepatic venules (central veins) n at its central veins surrounding a portal triad. terminal branch of bile duct.
GALLBLADDER
- Contains parts of three adjacent hepatic lobules. It - Diamond shaped area with central veins on the ends of
corner e portal canal (hepatic artery, portal
vein, n bile duct that- run7-10
OVERVIEW cm long,
in tandem withinlies
thein e fossa of consists
gallbladder on visceral
of hepatic tissue thatsurface ofby
is drained liver
a bile(fossa
duct lies at e junc. of Rt.
the long axis,nand
Lt. portal
lobestriads
of liver).
on the ends of the short
- Natural position: Lies ant. to e duodenum,
liver parenchyma). n its
of portal area. neck exocrine
Stresses n cysticliver
duct are immediately sup. to duodenum.
function longitudinal axis.
- Pear shaped n can hold 50 ml bile. - Hepatocytes are arranged in 3 concentric elliptical zones
- Hartmann Pouch: infundibulum of gallbladder – gallstones collecting part of gallbladder. around short axis: Z1 (closest), Z2 (middle), n Z3
- Stores Hepatocytes
n concentrates bile from liver n drain it to duodenum when needed trough ampulla of Vater. (farthest).
FUNCTIONS
, 20 to 30um, radiate from central vein n distributed in cords; one cell thick.This maximizes the area of contact between hepatocytes & plasma. - Provides best correlation among blood perfusion,
large and round & usually- occupy
Nuclei areRELATIONS Very intimate
the centerrelation tocytoplasm
of cell. The duodenum. is generally acidophillic.
ar surface located directly opposite e- Hepatic
basolateralsurface
region, of gallbladder
& lateral surface isattaches
prominenttointercellular
liver (bedjunctions(gap
of gallbladder) bytight
junction, connective tissue of Glisson’s
junction, desmosome) designed capsule (fibrous
to fascilitate capsule)
intercellular of liver. betwee
communication
PARTS a) Neck: b) Body: Liver Parenchyma c) Kuffer’s
Fundus: cells
- Narrow n tapered. - Contact visceral surf. of liver, - Wide end of e organ. - Phagosytic
- Directed toward porta hepatis. transverse colon, n sup. part of - Projects from inf. border- of Nuclei
liveraren larger n > ovoid.
completely surrounded by
- Makes an S-shaped bend. duodenum. peritoneum n binds e body n neck to e liver.
- Joins e cystic duct. - Located at tip of 9th costal cartilage in midclavicular line.
CYSTIC - 3-4 cm long, connects e neck to e common hepatic duct.
DUCTS - E mucosa of neck spiral into spiral fold to: - keep e duct opens, thus bile can easily be diverted into gallbladder when e distal end of e
bile duct is closed by sphincter of e bile duct (hepatopancreatic sphincter).
- ensure bile can pass to duodenum when gallbladder contracts.
- offer add. resistance to sudden dumping of bile when sphincter is closed n intra-abdominal
is suddenly increased during sneeze or cough.
- Passes between e layers of lesser omentum, parallel to common hepatic duct, which it joins to form e bile duct.
CYSTIC - Most often (75%) arises as a single trunk within e hepatocystic triangle n rarely larger than 3mm in size.
ARTERY - Rises from Rt. hepatic a. in e angle between common hepatic duct n cystic duct n divides into a superficial branch on the free surface of e
gallbladder and a deep branch in e gallbladder bed.
- 25% of e time there are independent origins of e two branches, and they may originate outside of the hepatocystic triangle.
- Can be traced by finding e Cystohepatic triangle of Callot: Liver, Cystic duct, n Common hepatic duct.
BILE DUCT (COMMON BILE DUCT)
OVERVIEW - Forms in e free edge of lesser omentum by e union of cystic duct n common hepatic duct (4 cm long n 4 mm in diameter).
- 8 cm long n 8 mm in diameter n descends post. to e sup. part of duodenum n lies in a groove on e post. surf of e head of pancreas.
- Comes into contact with main pancreatic duct on Lt. side of descending duodenum. These ducts run obliquely n unite to form
hepatopancreatic ampulla where they open into duodenum through e major duodenal papilla. Muscle thickening at distal end form a
sphinter that control bile flow into duodenum.
- 3 parts: a) Supraduodenal Third - most accessible position for surgery in free edge of lesser omentum, infront of portal vein & to rt of
hepatic artery.
b) Retroduodenal Third
c) Lower or Paraduodenal Third
BLOOD - Supplied by: a) Cystic Artery n Cystic Veins (Drain into liver): proximal part.
SUPPLY b) Rt. hepatic Artery: middle part.
c) Post. sup. pancreaticoduodenal n gasteroduodenal arteries n veins (drain into portal veins): Retroduodenal part.
LYMPHATIC - Lymphatic vessels in bile duct → Cystic Lymph nodes (neck of gallbladder) → Node of Omental Foramen → Hepatic Lymph nodes →
DRAINAGE Celiac Lymph nodes → Cisterna Chyle

Arterial Supply
Relaxation
of sphincter
Blood Supply of Gallbladder Contraction at hepato-
Celiac trunk of pancreatic
gallbladder ampulla
Venous Supply

Common Hepatic Artery Portal Vein

Celiac plexus Vagus Nerves

(Symphatetic n (Parasymphatetic
Proper Hepatic Artery Lt. Portal Vein visceral afferent Fibers)
fibers)

Rt. Hepatic Artery Cystic Veins

Innervation of
Gallbladder
Cystic Artery Posterior Cystic Veins

Anterior Cystic Veins Rt. Phrenic Nerve (somatic

afferent fibers)

Cystic Lymph nodes

(located near e neck) Referred Pain
Hepatic Lymph nodes - Pain from liver, gallbladder or bile ducts passes centrally in Rt. greater splanchnic
nerves, entering spinal cord through 7-8 thoracic dorsal roots. Pain is referred to Rt.
Lymphatic hypochondric & Rt. infrascapular region.
Drainage of - Disease of liver or gallbladder may irritate peritoneum covering diaphragm.
Gallbladder Resulting pain is referred to tip of right shoulder. B/C phrenic nerve originate from
Celiac Lymph nodes segments C3-5.
 Abdominal Aorta
Hepatic blood flow:
Sources, pathway, n
Celiac Trunk returning to the heart.
Splenic Arteries
Portal Vein

Lt. Gastric Arteries Common Hepatic Artery

Branches of Portal Vein

(Interlobular veins in
Gasteroduodenal Rt. Gastric Proper Hepatic portal canal)
Artery Artery Artery

Rt. Hepatic Lt. Hepatic Venules

Artery Artery
Path of bile flow from
the liver into the
duodenum Sinusoids

Hepatocytes Bile Capillaries Central Veins

Rt. n Lt. Hepatic Duct Canal of Hearing Sublobular Veins

Common Hepatic Duct Cystic Duct Hepatic Veins

IVC
Ampulla of Vater Common Bile Duct

Hepatic Innervation

Lymphatic Drainage of
Celiac Plexus
the Liver

Hepatic Plexus
- accompanies branches of hepatic artery n portal vein to the liver
Perisinusoidal space
(Space of Disse) Superficial Lymphatics from
post. aspect of diaphragmatic
n visceral surf.

Deep lymphatics in Symphatetic Fibers Parasymphatetic Fibers

surrounding Bare Area of the Liver
intralobular portal
triads
Celiac Plexus
Anterior n Posterior Vagal Trunk
Phrenic Lymph nodes

Porta hepatis Sinusoids

- Liver capillaries.
- Lined by: Space of Disse
Post. Mediastinal Lymphfenestrated
a) Discontinuous, endothelial
- Between cells with
hepatocyte andno basement
sinusoidal membrane.
Billiary
lining . Space
Hepatic Lymph nodes b) Phagocytic Kupffer cells,
Nodes
nuclei of the Kupffer cells, which tend to be larger and more ovoid than the flattened endothelial3. Sitecells.
of lymph formation
(along hepatic vessels n 4. Lipocytes (Vitamin A storing cells) lie in the Space of Disse. Lipocyte activation has b
ducts in lesser omentum)
Spaces in Liver
Rt. Lymphatic Duct

Celiac Lymph nodes

Thoracic Duct Lymphatic Space

Cisterna Chyle
le n ascending aorta, post. to Lt. side of sternum at 3rd ICS. Cardiac Referred Pain (CRP).
- Obliquely placed
- Post., Rt., n Lt. - At e apex of conus arteriosus at 3rd costal cartilage.
- Ant., Rt., n Lt.

-Pain originating at nociceptors at one site in e body (deep/visceral) is sensed as originating at another site (
Aortic Valve Pulmonary Valve
- Referred to superficial regions sharing e same dorsal root as e deep/visceral site from which e pain actuall
- E pain of angina pectoris n myocardial infraction radiates from:
1) Substernal region
2) Lt. pectoral region to Lt. shoulder
Semilunar Valves 3) Medial aspect of e Lt. arm.
- E heart is insentitive to:
1) Touch 3) Cold
Characteridtics: 2) Cutting 4) Heat
Concave when viewed sup, n don’t have CT to support - Ischaemia
them. n accumulation of metabolic products stimulate pain endings in myocardium.
Smaller in area than e cusps of AV valves.- CRP: Lt. side of chest n medial aspect of Lt. arm.
Force exerted on them is less than half that exerted on - Commissural
AV valves. neurons may make synaptic contacts with e Rt. side of e comparable area of e cord.
E cusps project into artery but are pressed toward This why CRP may be referred to Rt. or both sides.
its wall.
e reversed blood flow, coming together to completely close e orifice, supporting each other n preventing any returning blood.
E edge of each cusp is thickened (contact region) forming lunule.
e origin of pulmonary T. n ascending aorta b/w dilated wall of vessel n each cusp of e semilunar valves.
Rt. n Lt. aortic sinus: Rt. n Lt. coronary artery. No artery at pulmonary sinus.

Ant.
Ant.View
View Post. View

Coronary
CoronarySinus
Sinus
Right
Right coronary
coronary a. a.

Anterior
Anterior interventricular
interventricular a. a.

Great
GreatCardiac
CardiacVein
Vein

Marginal a.

Ant.
Ant.Border
Border
Rt ventricle
Lt Auricle

Rt atrium

Rt ventricle Lt Ventricle
Lt. Surface
Lt ventricle

Rt. Border

Lt atrium

Lt. Border Apex

Inf. View Inf. Border

Borders of the Heart