GROSS ANATOMY
1st Unit Exam Reviewer
V I T A L I S 2021 Dr. Allan Librando| Aug. 8 2017
INTEGUMENTARY SYSTEM
The skin provides:
 Protection of the body from environmental
effects, such as abrasions, fluid loss, harmful
substances, ultraviolet radiation, and invading
microorganisms.
 Containment for the body’s structures (e.g.,
tissues and organs) and vital substances
(especially extracellular fluids), preventing
dehydration, which may be severe when
extensive skin injuries (e.g., burns) are
experienced.
 Heat regulation through the evaporation of
sweat and/or the dilation or constriction of
superficial blood vessels.
 Sensation (e.g., pain) by way of superficial
nerves and their sensory endings.
 Synthesis and storage of vitamin D. The skin,
the body’s largest organ, consists of the
epidermis, a superficial cellular layer, and the
dermis, a deep connective tissue layer.
The epidermis is a keratinized epithelium—that is, it has
a tough, horny superficial layer that provides a protective
outer surface overlying its regenerative and pigmented
deep or basal layer. The epidermis has no blood vessels
or lymphatics. The avascular epidermis is nourished by
the underlying vascularized dermis.
The dermis is a dense layer of interlacing collagen and
elastic fibers. These fibers provide skin tone and account
for the strength and toughness of skin. Arteries that enter
its deep surface to form a cutaneous plexus of
anastomosing arteries supply the dermis.
The skin is also supplied with afferent nerve endings that
are sensitive to touch, irritation (pain), and temperature.
Most nerve terminals are in the dermis, but a few
penetrate the epidermis.
The tension lines (also called cleavage lines or Langer
lines) tend to spiral longitudinally in the limbs and run
trans- versely in the neck and trunk. Tension lines at the
elbows, knees, ankles, and wrists are parallel to the
transverse. The elastic fibers of the dermis deteriorate
with age and are not replaced; consequently, in older
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people, the skin wrinkles and sags as it loses its
elasticity.
The deep layer of the dermis contains hair follicles, with
associated smooth arrector muscles and sebaceous
glands.
Contraction of the arrector muscles of hairs (L.
musculi arrector pili) erects the hairs, causing goose
bumps.
The evaporation of the watery secretion (sweat) of the
sweat glands from the skin provides a thermoregulatory
mechanism for heat loss (cooling).
Small arteries (arterioles) within the dermis, involved in
the loss or retention of body heat are the.
o They dilate to fill superficial capillary beds to
radiate heat (skin appears red) or constrict to
minimize surface heat loss (skin, especially of
the lips and fingertips, appears blue).
Located between the overlying skin (dermis) and
underlying deep fascia, the subcutaneous tissue
(superficial fascia) is composed mostly of loose
connective tissue and stored fat and contains sweat
glands, superficial blood vessels, lymphatic vessels, and
cutaneous nerves
The subcutaneous tissue provides for most of the body’s
fat storage, so its thickness varies greatly, depending on
the person’s nutritional state.
Subcutaneous tissue participates in
o Thermoregulation,
o Insulation,
o Retaining heat in the body’s core.
o Padding that protects the skin from compression
by bony prominences, such as those in the
buttocks.
Skin ligaments (L. retinacula cutis), numerous small
fibrous bands, extend through the subcutaneous tissue
and attach the deep surface of the dermis to the
underlying deep fascia.
o Skin ligaments are longer and sparse
o Skin is more mobile, such as on the back of the
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hand.
o Skin is firmly attached to the underlying deep
fascia, such as in the palms and soles
o The skin ligaments are long but particularly well
developed in the breasts, where they form
weight-bearing suspensory ligaments.
INTEGUMENTARY SYSTEMSkin Color
Signs in Physical Diagnosis
Blood flow through the superficial capillary beds of the
dermis affects the color of skin. When the blood is not
carrying enough oxygen from the lungs, the skin can
appear bluish (cyanotic).
This occurs because the oxygen-carrying hemoglobin of
blood is bright red when carrying oxygen (as it does in
arteries and usually does in capillaries), and appears
deep, purplish blue when depleted of oxygen, as it does
in veins.
Evident where skin is thin
o Lips,
o Eyelids
o Deep to the transparent nails.
Skin injury
o Exposure to excess heat,
o infection,
o inflammation,
o allergic reactions may
Causes the superficial capillary beds to become
engorged, making the skin look abnormally red, a
sign called erythema.
A yellow pigment called bilirubin builds up in the
blood, giving a yellow appearance to the whites of
the eyes and skin, a condition called jaundice.
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Skin Incisions and Scarring
The skin is always under tension. In general, lacerations
or incisions that parallel the tension lines usually heal
well with little scarring because there is minimal
disruption of fibers.
o The uninterrupted fibers tend to retain the cut
edges in place.
o Laceration or incision across the tension lines
disrupts more collagen fibers. May heal with
excessive (keloid) scarring.
Stretch Marks in Skin
The collagen and elastic fibers in the dermis form a
tough, flexible meshwork of tissue. Marked and relatively
fast size increases,
such as
o Abdominal enlargement
o Weight gain accompanying pregnancy
can stretch the skin too much, damaging the collagen
fibers in the dermis. Stretch marks generally fade after
pregnancy and weight loss, but they never disappear
completely.
Skin Injuries and Wounds
Lacerations. Accidental cuts and skin tears are
superficial or deep. Superficial lacerations violate the
epidermis and perhaps the superficial layer of the
dermis; they bleed but do not interrupt the continuity of
the dermis. Deep lacerations penetrate the deep layer of
the dermis, extending into the subcutaneous tissue or
beyond; they gape and require approximation of the cut
edges of the dermis (by suturing, or stitches) to minimize
scarring.
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Thermal trauma, ultraviolet or ionizing radiation, or Nines” in which the body is divided into areas that are
chemical agents cause burns. Burns are classified, in approximately 9% or multiples of 9% of the total body
increasing order of severity, based on the depth of skin surface.
injury:
FASCIAS, FASCIAL COMPARTMENTS, BURSAE,
1st-degree (superficial) burn (e.g., sunburn): damage
is limited to the epidermis; symptoms are erythema (hot AND POTENTIAL SPACES
red skin), pain, and edema (swelling); desquamation
Fascias (L. fasciae) constitute the wrapping, packing,
(peeling) of the superficial layer usually occurs several
and insulating materials of the deep structures of the
days later, but the layer is quickly replaced from the
body. Underlying the subcutaneous tissue (superficial
basal layer of the epidermis without significant scarring.
fascia) almost everywhere is the deep fascia.
2nd-degree (partial-thickness) burn: epidermis and
The deep fascia
superficial dermis are damaged with blistering
(superficial 2nd degree) or loss (deep 2nd degree);
o Dense
nerve endings are damaged, making this variety the
o Organized connective tissue layer
most painful; sweat glands and hair follicles are not
o Devoid of fat
damaged and can provide the source of replacement
o Covers most of the body parallel to (deep to)
cells for the basal layer of the epidermis along with cells
the skin and subcutaneous tissue.
from the edges of the wound; healing will occur slowly (3
o Extensions from its internal surface invest
weeks to several months), leaving scarring and some
deeper structures, such as individual muscles
contracture, but it is usually complete.
and neurovascular bundles, as investing
fascia In the limbs
3rd-degree (full-thickness) burn: the entire thickness
o Groups of muscles with similar functions
of the skin is damaged and perhaps underlying muscle.
sharing the same nerve supply are located in
There is marked edema and the burned area is numb
fascial compartments
since sensory endings are destroyed. A minor degree of
o Separated by thick sheets of deep fascia, called
healing may occur at the edges, but the open, ulcerated
intermuscular septa, extends centrally from
portions require skin grafting: dead material (eschar) is
the surrounding fascial sleeve to attach to
removed and replaced (grafted) over the burned area
bones.
with skin harvested (taken) from a non-burned location
(autograft) or using skin from human cadavers or pigs, or
The deep fascia itself never passes freely over bone;
cultured or artificial skin.
where deep fascia contacts bone, it blends firmly with
the periosteum (bone covering). Blood is thus pushed
According to the American Burn Association’s
out as the veins of the muscles and compartments are
classification of burn injury, a major burn includes 3rd-
compressed. Valves within the veins allow the blood to
degree burns over 10% of body surface area; 2nd-
flow only in one direction (toward the heart), preventing
degree burns over 25% of body surface area; or any 3rd-
the backflow that might occur as the muscles relax.
degree burns on the face, hands, feet, or perineum (area
including anal and uro- genital regions). When the burn
Thus deep fascia, contracting muscles, and venous
area exceeds 70% of body surface area, the mortality
valves work together as a musculovenous pump to
rate exceeds 50%. The surface area affected by a burn
return blood to the heart, especially in the lower limbs
in an adult can be estimated by applying the “Rule of
where blood must move against the pull of gravity .
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Near certain joints (e.g., wrist and ankle), the deep fascia
becomes markedly thickened, forming a retinaculum
(plural = retinacula) to hold tendons in place where they
cross the joint during flexion and extension, preventing
them from taking a shortcut, or bow stringing, across the
angle created.
Subserous fascia, with varying amounts of fatty tissue,
lies between the internal surfaces of the musculoskeletal
walls and the serous membranes lining the body
cavities. These are the endothoracic, endoabdominal,
and endopelvic fascias; the latter two may be referred to
collectively as extraperitoneal fascia.
Bursae (singular = bursa; Mediev. L., a purse) are
closed sacs or envelopes of serous membrane (a
delicate connective tissue membrane capable of
secreting fluid to lubricate a smooth internal surface).
Bursae are normally collapsed. Unlike three-dimensional
realized or actual spaces, these potential spaces have
no depth; their walls are apposed with only a thin film of
lubricating fluid between them that is secreted by the
enclosing membranes.
o Bursae enable one structure to move more
freely over another.
o Bursae occasionally communicate with the
synovial cavities of joints.
o Not easily noticed or dissected in the laboratory.
It is possible to display bursae by injecting and
distending them with colored fluid.
Collapsed bursal sacs surround many important organs
(e.g., the heart, lungs, and abdominal viscera) and
structures (e.g., portions of tendons). This configuration
is much like wrapping a large but empty balloon around
a structure, such as a fist. the peritoneal sac.
The inner layer of the balloon or serous sac (the one
adjacent to the fist, viscus, or viscera) is called the
visceral layer
The outer layer of the balloon (or the one in contact with
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the body wall) is called the parietal layer.
FASCIASFascial Planes and Surgery
In living people, fascial planes (interfascial and
intrafascial) are potential spaces between adjacent
fascias or fascia-lined structures, or within loose areolar
fascias, such as the subserous fascias. In some
procedures, surgeons use extrapleural or extraperitoneal
fascial planes, which allow them to operate outside the
membranes lining the body cavities, minimizing the
potential for contamination, the spread of infection, and
consequent formation of adhesions (adherences) within
the cavities. Unfortunately, these planes are often fused
and difficult to establish or appreciate in embalmed
cadavers.
SKELETAL SYSTEM
The skeletal system may be divided into two functional
parts
1. Axial skeleton consists of the bones of the head
(cranium or skull), neck (hyoid bone and cervical
vertebrae), and trunk (ribs, sternum, vertebrae, and
sacrum).
- Vertebral column (32-34 bones; sacral and cocygeal),
- Rib cage (12 pairs of ribs and the sternum)
- Skull (22 bones and 7 associated bones, ear ossicles)
2. Appendicular skeleton consists of the bones of the
limbs, including those forming the pectoral (shoulder)
and pelvic girdles.
Cartilage and Bones
The skeleton is composed of cartilages and bones.
Cartilage is a resilient, semirigid form of connective
tissue that forms parts of the skeleton where more
flexibility is required.
 Articulating surfaces (bearing surfaces) of
bones participating in a synovial joint are capped
with articular cartilage that provides smooth,
low-friction, gliding surfaces for free movement.
 Blood vessels do not enter cartilage (i.e., it is
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avascular)
 Its cells obtain oxygen and nutrients by
diffusion.
 The proportion of bone and cartilage in the
skeleton changes as the body grows
-The younger a person is, the more cartilage he
or she has.
-The bones of a newborn are soft and flexible
because they are mostly composed of cartilage.
Bone, a living tissue, is a highly specialized, hard form
of connective tissue that makes up most of the skeleton.
Bones of the adult skeleton provides:
• Support for the body and its vital cavities; it is the chief
supporting tissue of the body.
• Protection for vital structures (e.g., the heart).
• Mechanical basis for movement (leverage).
• Storage for salts (e.g., calcium).
• Continuous supply of new blood cells (produced by
the marrow in the medullary cavity of many
bones). A fibrous connective tissue covering
surrounds each skeletal element like a sleeve,
except where articular cartilage occurs;
­ Surrounding bones is periosteum)
­ Surrounding cartilage is perichondrium.
The periosteum and perichondrium nourish the
external aspects of the skeletal tissue. They are capable
of laying down more cartilage or bone (particularly during
fracture healing)
 Provide the interface for attachment of tendons and
ligaments.
The two types of bone are compact bone and spongy
(trabecular) bone.
Spongy Bone- composed of interconnected trabeculae .
Bony trabeculae surround cavities filled with bone
marrow.
Compact bone provides strength for weight bearing. In
long bones designed for rigidity and attachment of
muscles and ligaments. It has no trabeculae or bone
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marrow cavities.
CLASSIFICATION OF BONES
Bones are classified according to their shape.
• Long bones are tubular (e.g., the humerus in the arm).
• Short bones are cuboidal and are found only in the
tarsus (ankle) and carpus (wrist).
• Flat bones usually serve protective functions (e.g., the
flat bones of the cranium protect the brain).
• Irregular bones have various shapes other than long,
short, or flat (e.g., bones of the face).
• Sesamoid bones (e.g., the patella or knee cap)
develop in certain tendons and are found where
tendons cross the ends of long bones in the
limbs; they protect the tendons from excessive
wear and often change the angle of the tendons
as they pass to their attachments.
Bone Markings and Formations
Bone markings
• Capitulum: small, round, articular head (e.g.,
capitulum of the humerus).
• Condyle: rounded, knuckle-like articular area, often
occurring in pairs (e.g., the lateral and medial
femoral condyles).
• Crest: ridge of bone (e.g., the iliac crest).
• Epicondyle: eminence superior or adjacent to a
condyle (e.g., lateral epicondyle of the humerus).
• Facet: smooth flat area, usually covered with cartilage,
where a bone articulates with another bone
(e.g., superior costal facet on the body of a
vertebra for articulation with a rib).
• Foramen: passage through a bone (e.g., obturator
foramen).
• Fossa: hollow or depressed area (e.g., infraspinous
fossa of the scapula).
• Groove: elongated depression or furrow (e.g., radial
groove of the humerus).
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• Head (L. caput): large, round articular end (e.g., head
of the humerus).
• Line: linear elevation (e.g., soleal line of the tibia).
• Malleolus: rounded process (e.g., lateral malleolus of
the fibula).
• Notch: indentation at the edge of a bone (e.g., greater
sciatic notch).
• Protuberance: projection of bone (e.g., external
occipital protuberance).
• Spine: thorn-like process (e.g., the spine of the
scapula).
• Spinous process: projecting spine-like part (e.g.,
spinous process of a vertebra).
• Trochanter: large blunt elevation (e.g., greater
trochanter of the femur).
• Trochlea: spool-like articular process or process that
acts as a pulley (e.g., trochlea of the humerus).
• Tubercle: small raised eminence (e.g., greater
tubercle of the humerus).
• Tuberosity: large rounded elevation (e.g., ischial
tuberosity).
BONE DEVELOPMENT
Most bones take many years to grow and mature. The
humerus (arm bone), for example, begins to ossify at the
end of the embryonic period (8 weeks); however,
ossification is not complete until age 20. All bones derive
from mesenchyme (embryonic connective tissue) by two
different processes:
1) intramembranous ossification (directly
mesenchyme)
In intramembranous ossification (membranous bone
formation), mesenchymal models of bones form during
the embryonic period, and direct ossification of the
mesenchyme begins in the fetal period.
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2) endochondral ossification (from cartilage derived from
mesenchyme)
In endochondral ossification (cartilaginous bone
formation), cartilage models of the bones form from
mesenchyme during the fetal period, and bone
subsequently replaces most of the cartilage. A brief
description of endochondral ossification helps explain
how long bones grow.
VASCULATURE AND INNERVATION OF BONES
Bones are richly supplied with blood vessels. Most
apparent are the nutrient arteries (one or more per
bone) that arise as independent branches of adjacent
arteries outside the periosteum and pass obliquely
through the compact bone of the shaft of a long bone via
nutrient foramina.
BONESAccessory
(Supernumerary) Bones
Accessory (supernumerary) bones develop when
additional ossification centers appear and form extra
bones.
Heterotopic Bones
Bones sometimes form in soft tissues where they are not
normally present (e.g., in scars). Horse riders often
develop heterotopic bones in their thighs (rider’s bones)
Trauma to Bone and Bone Changes
-Unused bones, such as in a paralyzed limb, atrophy
(decrease in size).
from
-Bone may be absorbed, which occurs in the mandible
when teeth are extracted.
-Bones hypertrophy (enlarge) when they support
increased weight for a long period.
-Fracture, trauma to a bone may break it. broken ends
must be brought together, to their normal position. This is
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called reduction of a fracture.
-During bone healing, the surrounding fibroblasts
(connective tissue cells) proliferate and secrete collagen,
which forms a collar of callus to hold the bones
together. The callus is resorbed
-green stick fractures (incomplete breaks caused by
bending of the bones).
Osteoporosis
A reduction in the quantity of bone, or atrophy of skeletal
tissue. Bones become brittle, lose their elasticity, and
fracture easily.
Sternal Puncture
Examination of bone marrow provides valuable
information for evaluating hematological (blood)
diseases. Because it lies just beneath the skin.
During a sternal puncture, a wide-bore (large diameter)
needle is inserted through the thin cortical bone into the
spongy bone..
Bone Growth and Assessment of Bone Age
Determining bone age can be helpful in predicting adult
height in early or late maturing adolescents. Assessment
of bone age also helps establish the approximate age of
human skeletal remains in medicolegal cases.
Effects of Disease and Diet on Bone Growth
Some diseases produce early epiphysial fusion
(ossification time); other diseases result in delayed
fusion. Proliferation of cartilage at the metaphyses slows
down during starvation and illness, but the degeneration
of cartilage cells in the columns continues, producing a
dense line of provisional calcification. These lines later
become bone with thickened trabeculae, or lines of
arrested growth.
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Displacement and Separation of Epiphyses
The edges of the diaphysis and epiphysis are smoothly
curved in the region of the epiphysial plate. Bone
fractures always leave a sharp, often-uneven edge of
bone. An injury that causes a fracture in an adult usually
causes the displacement of an epiphysis in a child.
Avascular Necrosis
Loss of arterial supply to an epiphysis or other parts of a
bone results in the death of bone tissue— avascular
necrosis (G. nekrosis, deadness).
Joints
Joints (articulations) are unions or junctions between
two or more bones or rigid parts of the skeleton. Some
joints have no movement, such as the epiphysial plates
between the epiphysis and diaphysis of a growing long
bone; others allow only slight movement, such as teeth
within their sockets; and some are freely movable, such
as the glenohumeral (shoulder) joint.
CLASSIFICATION OF JOINTS
Three classes of joints are described, based on the
manner or type of material by which the articulating
bones are united.
1. The articulating bones of synovial joints are united
by a joint (articular) capsule (composed of an outer
fibrous layer lined by a serous synovial membrane).
The joint cavity of a synovial joint, like the knee, is a
potential space that contains a small amount of
lubricating synovial fluid, secreted by the synovial
membrane.
2. The articulating bones of fibrous joints are united by
fibrous tissue. The amount of movement occurring at a
fibrous joint depends in most cases on the length of the
fibers uniting the articulating bones. The sutures of the
cranium are examples of fibrous joints
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-A syndesmosis type of fibrous joint unites the bones
with a sheet of fibrous tissue, either a ligament or a
fibrous membrane.
-A dento-alveolar syndesmosis (gomphosis or socket)
is a fibrous joint in which a peg-ike process fits into a
socket articulation between the root of the tooth and the
alveolar process of the jaw.
3. The articulating structures of cartilaginous joints are
united by hyaline cartilage or fibrocartilage.
-In primary cartilaginous joints, or synchondroses, the
bones are united by hyaline cartilage, which permits
slight bending during early life. Usually temporary
unions, permit growth in the length of a bone. When full
growth is achieved, epiphysial plate converts to bone
and the epiphyses fuse with the diaphysis.
-In Secondary cartilaginous joints, or symphyses, are
strong, slightly movable joints united by fibrocartilage.
The fibrocartilaginous intervertebral discs between the
vertebrae consist of binding connective tissue that joins
the vertebrae together. These joints provide strength and
shock absorption as well as considerable flexibility to the
vertebral column (spine).
Synovial joints, the most common type of joint, provide
free movement between the bones they join; they are
joints of locomotion, typical of nearly all limb joints.
Reinforced by accessory ligaments that are either
separate (extrinsic) or are a thickening of a portion of the
joint capsule (intrinsic).
Six major types of synovial joints are classified
according to the shape of the articulating surfaces and/or
the type of movement they permit:
1. Plane joints permit gliding or sliding movements in
the plane of the articular surfaces. Plane joints are
numerous and are nearly always small (ie,
acromioclavicular joint between the acromion of the
scapula and the clavicle)
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2. Hinge joints permit flexion and extension only,
movements that occur in one plane (sagittal) around a
single axis that runs transversely; are uniaxial joints. The
joint capsule of these joints is thin and lax anteriorly and
posteriorly where movement occurs; however, the bones
are joined by strong, laterally placed collateral ligaments.
(ie, elbow joint)
3. Saddle joints permit abduction and adduction as well
as flexion and extension, movements occurring around
two axes at right angles to each other; saddle joints are
biaxial joints that allow movement in two planes, sagittal
and frontal. The carpometacarpal joint at the base of the
1st digit (thumb) is a saddle joint
4. Condyloid joints permit flexion and extension as well
as abduction and adduction; condyloid joints are also
biaxial. metacarpophalangeal joints (knuckle joints) are
condyloid joints.
5. Ball and socket joints allow movement in multiple
axes and planes: flexion and extension, abduction and
adduction, medial and lateral rotation, and
circumduction; thus ball and socket joints are multiaxial
joints
6. Pivot joints permit rotation around a central axis; thus
they are uniaxial. The median atlantoaxial joint is a pivot
joint in which the atlas (C1 vertebra) rotates around a
finger-like process, the dens of the axis (C2 vertebra),
during rotation of the head.
JOINT VASCULATURE AND INNERVATION
Joints receive blood from articular arteries that arise
from the vessels around the joint. Articular veins are
communicating veins that accompany arteries (L. venae
comitantes) and, like the arteries, are located in the joint
capsule, mostly in the synovial membrane.
Joints have a rich nerve supply provided by articular
nerves with sensory nerve endings in the joint capsule.
The Hilton law states that the nerves sup- plying a joint
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also supply the muscles moving the joint and the skin
covering their distal attachments.

Articular nerves transmit sensory impulses from the joint

that contribute to the sense of proprioception, which
provides an awareness of movement and position of the
parts of the body. The synovial membrane is relatively
Muscular System
insensitive. Muscle cell  Muscle fibers  Specialized contractile
cells.
JOINTSJoints of Newborn Cranium Distinct Characteristics:
 Voluntary vs. Involuntary
The bones of the calvaria (skullcap) of a newborn  Striated vs. Smooth/Unstraited
infant’s cranium do not make full contact with each other.  Somatic vs. Visceral
At these sites, the sutures form wide areas of fibrous 3 Muscle Types:
tissue called fontanelles. The anterior fontanelle is the  Skeletal
most prominent; laypeople call it the “soft spot.”  Cardiac
 Smooth
Normally, the anterior fontanelle is flat. A bulging
fontanelle may indicate increased intracranial pressure; Skeletal Muscle
however, the fontanelle nor- mally bulges during crying.
Location: attached to skeleton and fascia of limbs, body
Pulsations of the fontanelle reflect the pulse of cerebral wall, and head/neck.
arteries. A depressed fontanelle may be observed when
Appearance (Cell): large, very long, unbranched,
the baby is dehydrated (Swartz, 2001). transverse striations arranged in bundles, multiple
peripherally nuclei.
Degenerative Joint Disease Activity: intermittent contraction, produce movement,
controls relaxation, maintain/resist gravity or other
Heavy use over several years can cause degenerative resisting force.
changes. Degenerative joint disease or osteoarthritis is Stimulation: Voluntary (somatic nervous system)
often accompanied by stiffness, discomfort, and pain.
Cardiac Muscle
Osteoarthritis is common in older people and usually
affects joints that support the weight of their bodies. Location: myocardium (muscle of heart) and adjacent
portion of great vessels (aorta, vena cava)

Arthroscopy Appearance (cell): shorter, branching, transverse

The cavity of a synovial joint can be examined by
inserting a cannula and an arthroscope (a small
telescope) into it. This surgical procedure— arthroscopy
—enables orthopedic surgeons to examine joints for
abnormalities, such as torn menisci (partial articular
discs of the knee joint).
striations running parallel connected by complex
junctions, single central nucleus.
Activity: strong, quick, continuous rhythmic contraction.
Acts to pump blood from heart
Stimulation: Involuntary (autonomic nervous system)
Smooth Muscle
Location: walls of hollow viscera, iris and cilliary body of
eye, arrector muscle of hair.
Appearance: agglomerated, small, spindle-shaped
fibers, no striations, single central nucleus

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Activity: weak, slow, rhythmic/sustained contraction,
propel substances (peristalsis), restrict flow
(vasoconstriction and sphincteric activity)
Stimulation: Involuntary (autonomic nervous system)
Muscles – are organs of locomotion
- Provides static support
- Give form to the body
- Provides heat
Aponeuroses – tendons form flat sheet of some muscles,
which anchors the muscle of the skeleton and/or deep
fascia, or to another aponeuroses.
CLASSIFICATION OF MUSCLES
 Flat muscles – parallel fibers often with aponeurosis.
Ex. External Oblique (broad flat muscles)
Sartorius (narrow flat muscles)
 Pennate muscles – feather-like
Ex. Unipennate (extensor digitorium longus)
Bipennate (rectus femoris)
Multipennate (deltoid)
 Fusiform muscles – spindle shaped with round, thick
belly and tapered ends.
Ex. Biceps, branchii
 Convergent muscles – broad area and converge to
form a single tendon
Ex. Pectoralis Major
 Quadrate muscles – four equal sides
Ex. Rectus abdominis
Tendinous intersections
 Sphincteral muscles – body opening or orifice,
constricting it when contracted
Ex. Orbiculis oculi (closes the eyelids)
 Multiheaded muscles – have more than one head of
attachment or more than one contractile belly.
Ex. Biceps (2 heads)
Triceps (3 heads)
Digastric and gastrocnemius (2 bellies)
CONTRACTION OF MUSCLES
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 Skeletal muscles function by contracting; they pull
and never push.
Exemption to the rule:
 “pooping of the ears”  equalize the pressure
 Musculovenous pump  expansion of muscle
bellies. When a muscle contracts and shortens, one
of its attachments usually remains fixed while the
other attachment is pulled toward it.
 Origin – usually the proximal end of the muscle,
which remains fixed during muscle contraction
 Insertion – usually the distal end of the muscle,
which is movable.
 Reflexive contraction – aspects of their activity are
automatic (reflexive)
Ex. Diaphragm
Myotatic reflex – results in movement after a
muscle stretch produced by tapping a tendon with a
reflex hammer
 Tonic contraction – even when “relaxed”; slight
contraction, called muscle tone (tonus), does not
produce movement or active resistance but gives
muscle firmness, assist stability of joints, and
maintenance of posture while keeping the muscle
ready to response to stimuli.
-usually absent only when unconscious (deep sleep
or general anaesthesia) or after a nerve lesion
(result: paralysis)
 Phasic (active) contraction – two main types
 Isotonic contraction – muscles change length in
relationship to production of movement
 Isometric contraction – muscle length remains the
same – no movement occurs but the muscle tension
increase to resist gravity or other antagonistic force
Two types of isotonic contraction:
 Concentric contraction – result of the muscle
shortening
Ex. Lifting a cup, pushing a door, striking a blow
 Eccentric contraction – result of the muscle
lengthens
-controlled or gradually relaxation while continually
exerting.
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Ex. Playing a rope, walking, running and setting
objects down.
Structural unit of muscle  skeletal striated muscle fiber
Functional unit of muscle  motor unit (motor neuron
and muscle fibers it controls)
Motor neurons  initiates impulses that causes the
muscle fibers contract simultaneously
FUNCTIONS OF MUSCLES
 Prime movers (agonist)
- The main muscle responsible for producing a
specific movement of the body.
- Contracts concentrically to produce the desired
movement doing most of the work (expending most
of the energy)
 Fixators
- Steadies the proximal parts of a limb through
isometric contraction while movements are occurring
in distal parts.
 Synergist
- Directly (providing a weaker or less mechanically
advantaged components of movement) or indirectly
(serving as a fixator of an intervening joint when
prime mover passes over more than one joint) assist
the prime movers
 Antagonist
- Opposes the action of another muscle
- Active movers concentrically contracts to produce
movement, while antagonist eccentrically contracts,
relaxing progressively in coordination to produce a
smooth movement.
 Shunt muscle – acts to maintain contact between the
articular surfaces of the joint it crosses.
Ex. When arms are at one sides
 Spurt muscle – rapid and effective movement.
Ex. Muscles have initiated abduction of the arm.
NERVES AND ARTERIES TO MUSCLES
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Motor nerves supplies the skeleton muscles by usually
entering the fleshy portion of the muscle, almost always
from the deep aspect.
Exemptions are the sensory branches that innervates
the skin of the back after penetrating the superficial
muscles of the back.
The blood supply of muscle is not as constant as the
nerve supply and is usually multiple. Arteries generally
supply the structure they contact.
CARDIAC STRIATED MUSCLE
Myocardium, the muscular wall of the heart formed by
cardiac striated muscles. Cardiac muscle is also located
in walls of aorta, pulmonary vein and superior vena cava.
Heart rate is regulated intrinsically by pace-maker, an
impulse-conducting system composed of specialized
cardiac muscle fibers; are influence by the autonomic
nervous system (ANS).
To support continuous level of high activity, the blood
supply to cardiac muscle is twice as rich as that to
skeletal muscle.
SMOOTH MUSCLE
- Named from the absence of striations.
- It occurs in all vascularized tissue
- Makes-up the muscular parts of the walls of the
alimentary tract and duct
-found in skin, forming the arrector muscle of the hair
and in the eye ball which controls lens thickness and
pupil size
- Involuntary but is directly innervated by the ANS.
- can also be stimuli by hormonal stimulation or by local
stimuli (stretching).
-response slowly and with delay and leisurely contraction
- can undergo longer periods of partially contraction and
can elongate without suffering paralyzing injury.
- smooth muscle is responsible for peristalsis, rhythmic
contractions that propel the contents along tubular
structures.
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BLUE BOX
Absence of Muscle Tone
- The absence of muscle tone in an unconscious patient
may allow joints to be dislocated as he or she is being
lifted or positioned.
- When muscles denervated (loses its nerve supply), it
becomes paralyzed (lacking both its tonus and its ability
to contract on demand or reflexively)
- May cause antagonist muscle of a limb to assume an
abnormal resting position.
- Denervated muscle will become fibrotic and lose its
elasticity.
Muscle Soreness and “Pulled” muscles
Eccentric contraction excessive  delayed-onset
muscle soreness
Muscle stretching  lengthening type of eccentric
contraction  produce microtear (causes when muscles
are exerted. The body repairs these tears in a way that
adapt those muscles for a heavier level of stimulus.
Skeletal muscles cannot elongate beyond 1/3 of their
resting length without sustaining damage
Growth and Regeneration of Skeletal Muscle
Fibers cannot divide itself but can be replaced
individually by new muscle fibers from satellite cells of
skeletal muscle.
Satellite cells  potential source of myoblasts 
precursors of muscle cell capable of fusing with each
other  to form ne skeletal muscle fibers
Hypertrophy of existing fibers  skeletal muscles able to
grow larger in response to frequent stenuous exercise,
not from addition of new fibers.
Hypertrophy increase myofibrils  increase the
amount of work the muscle can perform
Electromyography (EMG)  the electrical stimulation of
muscles.
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Hypertrophy of the Myocardium and Myocardial
Infarction
Compensatory hypertrophy  increase demand
increase size of the fibers
Heart attack loss of blood supply  damage cardiac
muscle tissue become necrosis (dies) fibrous scar
tissue forms  develops to myocardial infarct (area of
myocardial necrosis)
Hypertrophy and hyperplasia of smooth muscle
In pregnancy:
Hypertrophy – increase in size of fiber
Hyperplasia – increase in number
Cardiovascular System
- Blood carries nutrients, oxygen, and waste products to
or from the cells.
Vascular Circuits
2 muscular pump: pulmonary and systemic circulation
 R ventricle  propels low-oxygen blood returning from
the systemic circulation into the lungs
 Capillaries of the lungs  where CO2 is exchange for
O2
 Pulmonary veins  only oxygenated vein
 Pulmonary artery  only unoxygenated artery
Pulmonary Circulation:
R ventricle  pulmonary valve  pulmonary artery 
pulmonary capillaries  pulmonary veins  L atrium
Systemic Circulation:
L ventricle  aortic valve  aorta  systemic circulation
 superior/inferior vena cava  R atrium
Blood vessels
Arteries  carries oxygenated blood; carries blood
under relatively high pressure
Three types of ARTERIES:
1. Larger elastic arteries
 Many elastic layers
 Initially receive the cardiac output
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 Ex. Aorta, branches (brachiocephalic trunk,
subclavian, carotid arteries)
2. Medium muscular arteries
 Wall consist of smooth muscle fibers
 Ability to decrease their diameter (vasoconstrict)
 Regulates the flow of the blood to different parts of
the body
 Ex. Brachial and Femoral arteries
3. Small arteries/arterioles
 Narrow lumina and thick muscular wall
 Regulates the degree of tonus of the arteriolar wall
 If tonus is above normal, hypertension
 Can be observed only under magnification
Anastomoses  branches of an artery provide
numerous potential detours for blood to ensure collateral
circulation.
*arteries that do not anastomose with adjacent arteries
are true (anatomic) terminal arteries (end arteries)
 Terminal arteries that supplies the retina
Veins  carries unoxygenated blood / low-oxygen
blood
 Lower blood pressure thus thinner walls
 Do not pulsate and do not squirt/spurt blood
Three sizes of Veins:
1. Venules
 Resemble wide capillaries, drains into small veins
that open into larger veins
 Unites small veins and larger veins to form venous
plexus
 Magnification is required to observe venules
2. Medium veins
 Drains venous plexuses and accompany medium
arteries
 Other locations where the flow of blood is opposed by
the pull of gravity
 Ex. Cephalic and Basilic veins of upper limb and
saphenous veins of the lower limb)
3. Large veins
 Wide bundle of longitudinal smooth muscle and well
developed tunica adventitia.
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 Ex. Superior/Inferior vena cava
Capillaries  site where interchange of oxygen,
nutrients and waste products
 Are relatively impermeable, however to plasma
proteins
Three coats/tunics of the blood vessel:
 Tunica intima  inner lining consist of single layer of
extremely flattened epithelial cell, endothelium\
 Capillaries only consist of this tunic.
 Tunica media  middle layer consisting primarily of
smooth muscles.
Most variable coat; blood vessels are distinguish by
the thickness of this layer
 Tunica adventitia  outer connective tissue
layer/sheath
BLUE BOX
Arteriosclerosis: ischemia and infarction
Arteriosclerosis  hardening of arteries; loss of elasticity
of the arterial wall. Ex. Fat deposits
Atheroma/atheromatous plague  calcium deposits
Thrombus  formation of a local intravascular clot
Embolus  plug occluding the vessel
Ischemia  reduction of blood supply to a region
Infarction  local death or necrosis of an area of tissue
Varicose Veins
 abnormally swollen twisted veins – most often seen in
the legs
 have incompetent valves, thus exerts more pressure
 have incompetent fascia, incapable of containing the
expansion of contracting muscles – thus musculovenous
pump is ineffective.
Lymphoid System
 “Overflow system”
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 Provides for the drainage of surplus tissue fluid and
leaked plasma proteins to the bloodstream
 Removal of debris from cellular decomposition and
infection
Edema  excess of interstitial fluid, manifesting swelling
Important components of the lymphoid system:
1. Lymphatic plexuses
 Originate blindly in the extracellular space of tissues
 Plasma proteins, bacteria. Cellular debris, and even
whole cells (lymphocytes) can readily enter them
2. Lymphatic vessels
 Abundant lymphatic valve
 Not found in ex. Teeth, bone, bone marrow, and CNS
 Excess fluid in CNS is drained in cerebrospinal fluid
3. Lymph
 The tissue fluid that enters lymph capillaries
 Similar composition to blood plasma
4. Lymph nodes
 Lymph is filtered on its way to the venous system
5. Lymphocytes
 Circulating cell of the immune system that reacts to
foreign materials
6. Lymphoid organs
 Produces lymphocytes
 Ex. Thymus, red bone marrow, spleen, tonsils
Right lymphatic duct
 Drains lymph from the body’s right upper quadrant
 Ex. Right side of the head, neck, thorax and upper
limb
Thoracic duct
 Drains lymph from the remainder of the body
 Lymphatic trunks draining the lower half of the body
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Additional Function of the Lymphoid System:
 Absorption and transport of dietary fat
 Formation of a defense mechanism
BLUE BOX
Spread of cancer
Cancer  invades the body by contiguity (growing in
adjacent tissue)
Metastasis  dissemination of tumor cells to sites distal
 Degree to which cancer spread
Metastasis occurs in three ways:
1. Direct seeding (serous membrane)
 Often a thin fascial sheet/serous membrane can
deflects tumor invasion
 Directly seeding of cavities
2. Lymphogenous spread (lymphatic vessels)
 Most common route for initial dissemination of
carcinomas (epithelial tumors)
 Most common type of cancer
 Lymph-borne cells are the secondary cancer sites
 Cancerous nodes enlarge as the tumor cells within
increase, but they are not usually painful when
compressed
3. Hematogenous spread (blood vessels)
 Most common of metastasis of less common
sarcomas (connective tissue cancers)
 Liver and lungs are the most common sites of
secondary sarcomas
Lymphangitis, lymphadenitis, and lymphedema
Lymphangitis and lymphadenitis are secondary
inflammation of lymphatic vessels and nodes
 Involves chemical or bacterial transport after severe
injury or infection
 Apparent as red streaks in the skin and nodes
painfully enlarge
 Uncontained infection may lead to septicaemia (blood
poisoning)
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neurons comprising the

Lymphedema nervous system.
1.) Multipolar Motor Neurons –
 Localized type of edema have two or more dendrites
and a single axon that may
 Occurs when lymph does not drain from an area of
have one or more collateral
the body branches.
 Solid cell growths may permeate lymphatic vessels a. Most common type of
and form minute cellular emboli (plugs) neuron in the nervous
system
NERVOUS SYSTEM b. All of the motor
neurons that control
 Enables the body to react to continuous the skeletal muscle and
changes in its internal and external those comprising the
environments. ANS.
2.) Pseudounipolar Sensory
 Controls and integrates the various activities of
Neurons – have a short,
the body such as circulation and respiration.
apparently single but actually
 Structurally divided into the Central Nervous
double processes extending
System and the Peripheral Nervous System.
from the cell body.
 Functionally divided into the Somatic Nervous a. Common process
System and Autonomic Nervous System. separates into a
peripheral process,
conducting impulses
from receptor organ.
(eg. Touch, pain,
temperature) toward
the cell body
b. Located outside the
CNS in sensory ganglia
and are thus part of the
PNS.

o Neuroglia or Glial Cells – 5x as

 Nervous tissue consists of two main cell types:
o Neurons or Nerve Cells – structural
and functional units of the nervous
system for rapid communication.
I. Central Nervous System
 Composed of a cell body with
processes called dendrites
and an axon, which carry
impulses to and away from the
cell body
 Myelin, layers of lipid and
protein substances form
Myelin Sheath around some
axons, increasing the velocity
of impulse conduction.
 Two types of neurons that
constitute that majority of
abundant as neurons. Non-neural, non-
excitable cells that form a major
component or nervous tissue,
supporting, insulating and nourishing
the neurons.
 In the CNS, include
oligodendroglia, astrocytes,
ependymal cells, and microglia.
 In the PNS, satellite cells
around the neurons and
autonomic ganglia and
Schwann (neurolemma) cells.
 consists of the brain and the spinal cord
 roles of the CNS are to integrate and
coordinate incoming and outgoing neural
signals
 to carry out higher mental functions such as
thinking and learning
 A nucleus is a collection of nerve cells bodies
in the CNS.

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 Tract is a bundle of nerve fibers within the CNS
connecting neighboring or distant nuclei of the
cerebral cortex.
 Nerve cell bodies lie within and constitute the
gray matter.
 The interconnecting fiber tract systems form
the white matter.
 In transverse sections of the spinal cord, the
gray matter appears roughly as an H shaped
area embedded in a matrix of white matter.
 The struts of the H are horns.
 The meninges and the cerebrospinal fluid
surround and protect the CNS.
 The membranous layers collectively constitute
the Meninges:
o Pia Mater – innermost meningeal layer.
A delicate, transparent covering.
 A thin connective tissue
membrane that covers the
brain surface and extends into
sulci and fissures and around
blood vessels throughout the
brain
 Extends into the transverse
cerebral fissure under the
corpus callosum
 Forms the tela choroidea of the
third and lateral ventricles and
combines with the ependyma
and choroid vessels to form the
choroid plexus of these
ventricles
 Pia mater + arachnoid
membrane = leptomeninges
o Arachnoid Mater – middle meningeal
layer.
 Delicate avascular membrane
that covers the subarachnoid
space
 An impermeable membrane
covering the brain and lying
between the pia mater
internally and the dura mater
externally
 The subdural space is a
potential space filled by a film
of fluid that separates the dura
and arachnoid membrane
 The subarachnoid space is
filled with CSF that separates
the arachnoid membrane and
pia mater
 Subarachnoid space becomes
much wider in areas at the
base of the brain –the cisterns
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o Dura Mater – outermost meningeal
layer. Intimately related to the internal
aspect of the bone of the surrounding
neurocranium.
 A.k.a. pachymeninx
 Tough fibrous structure with an
inner (meningeal) and an outer
(periosteal) layer
 Possesses numerous sensory
endings that are sensitive to
stretching which produce the
sensation of headache
 Numerous arteries supply the
dura mater from the internal
carotid, maxillary, ascending
pharyngeal, occipital, and
vertebral arteries
 From a clinical standpoint, the
most important is the middle
meningeal artery, which can be
damaged in head injury
 The Dura Mater of the spinal cord is separated
from the surrounding bone of the vertebral
column by a fat-filled epidural space.
II. Peripheral Nervous System
 Consists of nerve fibers and cell bodies outside
the CNS that conduct impulses to or away from
the CNS.
 Organized into nerves that connect the CNS
with peripheral structures.
 A nerve fiber consists of an axon, its
neurolemma and surrounding endoneurial
connective tissue.
 The neurolemma consists of the cell
membranes of Schwann cells that immediately
surround the axon, separating it from other
axons.
 In the PNS, the neurolemma may take two
forms, creating two classes of nerve fibers:
o Neurolemma of Myelinated Fibers
consists of Schwann cells specific to an
individual axon, organized into a
continuous series of enwrapping cells
that form myelin.
o Neurolemma of Unmyelinated Fibers is
composed of Schwann Cells that do not
make up such an apparent series;
multiple axons are separately
embedded within the cytoplasm of
each cell. These Schwann cells do not
produce myelin.
 A nerve consists of
o A bundle of nerve fibers outside the
CNS or a bundle of bundles (fascicles)
in the case of a larger nerve.
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o Connective tissue coverings that
surround and bind the nerve fibers and
fascicles together.
o Blood vessels (vasa nervorum) that
nourish the nerve.
 Connective Tissue Covering:
o Endoneurium – delicate connective
tissue immediately surrounding the
neurolemma cells and axons.
o Perineurium – later of dense connective
tissue that encloses a fascicle of nerve
fibers, providing an effective barrier
against penetration of the nerve fibers
by foreign substances.
o Epineurium – a thick connective tissue
sheath that surrounds and encloses a
bundle of fascicles, forming the
outermost covering of the nerve;
includes fatty tissue, blood vessels, and
lymphatics.
 A collection of neuron cell bodies outside the
CNS is a ganglion.
 There are both motor and sensory ganglia.
III. Types of Nerves
 PNS is automatically and operationally
continuous with the NCS
 Its Afferent Fibers convey neural impulses to
the CNS from the sense organs.
 Its Efferent Fibers convey neural impulses from
the CNS to effector organs
 CRANIAL NERVES exit the cranial cavity through
the foramina in the cranium.
 Only 11 out of 12 pairs of cranial nerves arise
from the brain, the other 1 arise from the
superior part of the spinal cord
 SPINAL NERVES exit the vertebral column
through the intervertebral foramina.
 Spinal nerves arise from in bilateral pairs from
a specific segment of the spinal cord.
 Spinal Nerves initially arise from the spinal cord
as rootlets. Then the rootlets converge to form
two nerve roots.
o ANTERIOR NERVE ROOT – consisting of
motor fibers passing from nerve cell
bodies in the anterior horn of spinal
cord gray matter to effector organs
o POSTERIOR NERVE ROOT – consisting
of sensory fibers from cell bodies in the
spinal or posterior root ganglion that
extend peripherally to sensory endings
and centrally to the posterior horn of
spinal cord.
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 The posterior and anterior roots unite, within or
just proximal to the intervertebral foramen to
form a mixed motor and sensory spinal nerve.
 Unilateral area of skin innervated by the
sensory fibers of a single spinal nerve is called
a dermatome
 As spinal nerves emerge from the
intervertebral foramina, they divide into two
rami.
o POSTERIOR RAMI OF SPINAL NERVE –
supply nerve fibers to the synovial
joints of the vertebral column . they
remain separate from each other.
o ANTERIOR RAMI OF SPINAL NERVES –
supply nerve fibers to the much larger
remaining area, consisting of the
anterior and lateral regions of the trunk
and the upper and lower limbs.
 The majority of the anterior
rami merge with one or more
adjacent anterior rami, forming
the major somatic nerve
plexuses in which their fibers
intermingle and from which a
new set of multisegmental
peripheral nerves emerges.
 The spinal nerves lose their identity as they
split and merge in the plexus.
 Some cranial nerves convey only sensory
fibers, some only motor fibers and some carry
mixture of both.
 Communication occurs between cranial nerves
and between cranial nerves and upper cervical
nerves.
 Cranial nerves that convey sensory fibers into
the brain bear sensory ganglia
IV. Somatic and Visceral Fibers
 SOMATIC
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 General Sensory Fibers – transmit
sensations from the body to the CNS.
o May be exteroreceptive sensations
from the skin (eg. Pain,
temperature, touch)
o Or Proprioreceptive sensations from
muscles, tendons, and joints (eg.
Subconsciousness)
 Somatic Motor Fibers – transmit impulses to
skeletal muscles.
 VISCERAL
 Visceral Sensory Fibers – transmit pain or
subconscious visceral reflex sensations
from hollow organs and blood vessels to
the CNS.
 Visceral Motor Fibers – transmit impulses ti
smooth muscle and glandular tissue.
 Both types of sensory fibers are pseudounipolar
neurons with cell bodies located outside of the
CNS in spinal or cranial sensory ganglia.
 The motor fibers of nerves are axons of
multipolar neurons.
 The cell bodies of somatic motor and
presynaptic visceral motor neurons are located
in the gray matter of the spinal cord.
 Some cranial nerves also convey special
sensory fibers for the special senses.
V. Somatic and Autonomic Nervous System
SOMATIC NERVOUS SYSTEM
 provides sensory and motor innervation to all
parts of the body, except the viscera in the
body cavities, smooth muscle and glands.
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 The Somatic Sensory system transmits
sensations of touch, pain, temperature and
position from sensory receptors.
 Only innervates the skeletal muscle,
stimulating voluntary and reflexive movement
by causing the muscle to contract.
AUTONOMIC NERVOUS SYSTEM
 Classically described as the visceral nervous
system or visceral motor system.
 Consists of motor fibers that stimulate smooth
muscle, modified cardiac muscle cells.
 The efferent nerve fibers and ganglia of the
ANS are organized into two systems.
 Conduction of impulses from the CNS to the
effector organ involves a series of two
multipolar neurons.
 The nerve cell body of the first presynaptic
neuron is located in the gray matter of the
CNS.
 Its fiber synapses only on the cell body of a
postsynaptic neuron
 The anatomical distinction between the
sympathetic and parasympathetic divisions of
the ANS is based primarily on
o The location of the presynaptic cell
bodies
o Which nerves conduct the presynaptic
cell fibers from the CNS
 Norepinephrine by the sympathetic division
and Acetylcholine by the parasympathetic
division.
VI. Sympathetic Division of ANS
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 Cell bodies of the presynaptic neurons of the

sympathetic division of the ANS are found in VII. Parasympathetic Division of ANS
the intermediolateral cell columns.
 Paravertebral Ganglia are linked to form right  Presynaptic parasympathetic nerve cell bodies
and left sympathetic trunks on each side of the are located in two sites within the CNS.
vertebral column and extend essentially the  In the gray matter of the brainstem, the fibers
length of this column. exit the CNS within the cranial nerves III, VII, IX
o The superior paravertebral ganglion les and X; these fibers constitute the cranial
at the base of the cranium. parasympathetic outflow
o The ganglion impar forms inferiorly
where the two trunks unite at the level
 The gray matter of the sacral segments of the
of the coccyx. spinal cord, the fibers exit the CNS through the
anterior roots of sacral spinal nerves S2-4 and
 Prevertebral Ganglia are in the plexuses that
the pelvic splachnic nerves that are from their
surround the origins of the main branches of
anterior rami; constitute the sacral
the abdominal aorta
parasympathetic outflow.
 Because they are motor fibers, the axons of
 In terms of the innervation of the thoracic and
presynaptic neurons leave the spinal cord
abdominal viscera, the cranial outflow through
through the anterior rami of spinal nerves.
the vagus nerve is dominant.
 All the presynaptic sympathetic fibers leave the
 The parasympathetic system distributes only to
anterior rami of these nerves and pass to the
the head, visceral cavities of the trunk and
sympathetic trunks through the white rami
erectile tissues of the external genitalia.
communicantes.
 Presynaptic sympathetic fibers provide  Presynaptic parasympathetic fibers synapse
innervation within the head, neck, body wall, with postsynaptic cell bodies which occur singly
limbs and thoracic cavity. in or on the wall of the target organ (intrinsic or
 Postsynaptic sympathetic fibers greatly extrinsic ganglia)
outnumber the presynaptic fibers.
 Each presynaptic sympathetic fiber synapses
with 30 or more postsynaptic fibers. VIII. Functions of Divisions of ANS
 Those postsynaptic fibers destined for
distribution within the neck, body wall, and  Sympathetic system is catabolic (energy-
limbs pass from the paravertebral ganglia of expending) system that enables the body to
the sympathetic trunks to andjacent anterior deal with stresses (eg. Fight or flight response)
rami of spinal nerves through gray rami  The parasympathetic system is primarily a
communicantes. homeostatic or anabolic (energy-conserving)
 Postsynaptic sympathetic fibers stimulate system, promoting the quiet and orderly
contraction of the blood vessels (vasomotion) processes of the body. (eg. Feeding)
and arrector muscles associated with hair  Blood vessels throughout the body are tonically
(pilomotion) and to cause sweating innervated by the sympathetic nerves,
(sudomotion) maintaining a resting state of moderate
 Postsynaptic sympathetic fibers that perform vasoconstriction.
these functions in the head all have their cell  The vessels of the skeletal muscles and the
bodies in cervical ganglion at the superior end external genitalia, sympathetic stimulation
of the sympathetic trunk. results in vasodilation.
 They pass from the ganglion by means of a
cephalic arterial branch to form peri-arterial
plexuses of nerves.
 Splachnic nerves convey visceral efferent and
afferent fibers to and from the viscera of the
body cavities.
 Postsynaptic sympathetic fibers destined for
the viscera of the thoracic cavity pass through
cardiopulmonary splanchnic nerves to enter
the cardiac, pulmonary and esophageal
plexuses.
 Presynaptic sympathetic fibers involved in the
innervation of viscera of the abdominopelvic
cavity pass to the vertebral ganglia through
abdominopelvic splanchnic nerves.

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REFERENCES:
1. Lecture Notes
2. PPT
3. Moore, 7thed.

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