Wednesday, February 20, 2008

histology made easy













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BASIC HISTOLOGY
Histology – study of tissues
Tissues – group of cells with similar functions and morphology
Fundamental or Basic Tissues of the Human Body:
Epithelial
Connective
Muscular
Nervous

EPITHELIAL TISSUE:
I - Characteristics:
Formed by epithelial cells
Cells are close together or packed together.
Cells are extremely cohesive and relatively strong force is necessary to separate them.
Provided with a basement membrane / basal lamina on their basal surface.
Avascular tissue.
Maybe derived from 3 germ layers:
Ex. Ectoderm – epidermis of skin; epithelium of cornea
Mesoderm – lining epithelium of kidneys, male & female reproductive
tracts
Endoderm – lining epithelium of gastrointestinal tract
II - Functions:
Protection – covering and lining surfaces of the body ex. Epidermis
Absorption – lining epithelium of intestines
Secretion – glands
Excretion – lining epithelium of tubules of kidney
Filtration – lining epithelium of kidneys
Lubrication – glands secreting mucus ( goblet cells, Brunner’s gland, esophageal glands)
Sensory receptors – neuroepithelium
III – Classification:
Covering / Surface Epithelium – membranous layers that cover the external surfaces or line the cavities of the body
Glandular Epithelium

COVERING / SURFACE EPITHELIUM:
Subtypes:
According to the number of cell layers:
Simple – lined by single layer of cells
According to cell shape:
simple squamous – single layer of flat cells
ex. Endothelium of blood vessels
Mesothelium of body cavities
Thin loop of Henle in kidneys
Parietal layer of Bowman’s capsule
- well adapted for exhange and filtration functions
simple cuboidal – single layer of cuboidal cells
ex. Tubules of kidneys
Thyroid follicles
Covering of Ovary
Pigment epithelium of Retina
simple columnar – single layer of columnar cells
ex. Lining epithelium of Intestines and Gall bladder
Lining epithelium of Uterus and Oviducts
Stratified – lined by several layer of columnar cells
well adapted for protection purposes
According to cell shape:
Stratified squamous
1. Stratified squamous keratinized / cornified
Ex. Epidermis of skin
2. Stratified squamous non-keratinized / non-cornified
Ex. Lining epithelium of Esophagus, Mouth , Anal canal,
Vagina
Stratified cuboidal
Ex. Ducts of sweat glands
Developing ovarian follicles
Stratified columnar
Ex. Parts of male urethra
Pseudostratified - a. Modification of simple epithelium. b. All cells are in contact with the basal lamina but not all of them reach the apical surface.
c. Cell shapes are variable.
d. False stratification
ex. Respiratory epithelium – Pseudostratified columnar epithelium with Goblet cells
Transitional –
Modification of stratified epithelium
The number of cells varies with the functional state of the organ
Also called as Uroepithelium.
Ex. Lining epithelium of excretory passages of the Urinary system
GLANDULAR EPITHELIUM:
Classification:
According to number of cells
Unicellular gland – single secreting cell; Goblet cell of the lining of respiratory and intestinal tracts
Multicellular gland
According to manner of secretion
Exocrine gland – provided with ducts
Ex. Gastric glands, Salivary glands
Endocrine gland – “ductless gland”
Ex. Pituitary gland, Thyroid gland
According to fate of secretion
Apocrine gland – partial destruction of secretory cells
Ex. Mammary gland
Holocrine gland – total destruction of secretory cells
Ex. Sebaceous gland
Merocrine gland – no destruction
Ex. Sweat gland
According to type of secretion
Serous gland – thin and watery secretion
Ex. Sweat gland
Mucous gland – thick and viscous
Ex. Sebaceous gland
Mixed gland – Muco-serous secretion
Ex. Sublingual and Submaxillary glands
Cytogenic gland – secretion produces cells
Ex. Testis and Ovary
According to morphology
Simple –
Simple tubular –simple epithelium lined tubules w/c open to the surface; entire tubule in a straight course
Ex. Intestinal glands
Simple coiled tubular – deeper portion of the tubule is coiled or convoluted
Ex. Sweat glands
Simple branched tubular – deeper portion of the tubule divides into tube-like structures
Ex. Uterine glands
Simple branched alveolar / acinar – made up of numerous sac-like structures
Ex. Sebaceous glands
Compound –
Compound tubular – Cardiac glands of stomach
Brunner’s glands
Compound alveolar – Mammary glands
Compound tubulo-alveolar – Salivary glands
Esophageal glands
JUNCTIONAL COMPLEXES – structures that provides for cell attachment
4 Types:
1. Macula adherens / Desmosomes – found in the stratified epithelia of mouth, esophagus, vagina and skin.
2. Zonula adherens / Intermediate junction / Fascia adherens – found in intercalated disc of cardiac muscles
3. Zonula occludens / Tight junction – found in epithelia of urinary bladder & GIT
4. Nexus or Gap junction – found in epithelial, muscular and nervous tissues
CONNECTIVE TISSUE:
I: Characteristics:
Cells are relatively few and far apart.
With abundant intercellular substance containing tissue fluid, ground matrix ( extracellular matrix ) and intercellular fibers.
Very vascular.
Derived from mesoderm.
II: Functions:
Connect, bind and support organs and tissues of the body
Protection
Fat storage and insulator
Hematopoetic functions
Immunity
Repair
III: Connective tissue cells: Categorized as:
Fixed cells – permanent
Fibroblasts – principal cells responsible for the synthesis of fibers and ground matrix ; stellate shaped with multiple processes
Mesenchymal cells – known as pluripotential cells
Fat / Adipose cells – characteristic “signet ring” appearance
Reticular cells
Wandering cells – transient
Plasma cells – ovoid cells with eccentric nucleus and intensely basophilic, “cartwheel or spokeswheel appearance of nucleus”
Mast cells – w/ cytoplasmic granules containing heparin & histamine
WBC’s
IV: Connective tissue fibers:
Collagen
Elastic
Reticular
Colorless to white
Yellow
Argyrophilic reacts with silver stains
Elastic and have greater strenght
Slender, refractile fibers
Very slender forming delicate net like patterns
Most abundant and widely distributed
Walls of blood vessels and organs capable of distention
Hematopoetic and lymphoid organs
Types of Collagen fibers and their distribution:
Type I: Most abundant and widely distributed
Dermis, bone, tendon, dentine, Fascia, Sclera of Eyeball, Capsules of
Organs, Fibrous cartilage
Type II: Hyaline and Elastic cartilages
Type III: Smooth muscles, Hematopoetic and Lymphoid organs ( liver & spleen)
Type IV: Basement membranes
Type V: Fetal membranes
V: Classification of Connective tissue:
Fibrous
Collagenous
Elastic
Reticular
Adipose
Mucous
Bone / Osseous
Cartilage
Myeloid
Blood
Lymphatics
A. Fibrous Connective Tissue – depending on the type of fiber that predominates, it is divided into:
Collagenous – collagen fiber predominates
Depending on the amount of collagen fiber – subdivided into:
Loose – also called as “Areolar tissue”- with numerous potential spaces which can be distended by fluid, blood or pus; found in the papillary layer of dermis, hypodermis, serosal linings of the peritoneal and pleural cavities, pia mater of spinal cord, endomysium of muscles, endoneurium of nerves
Dense – close packing of its fibers; occur in the form of bands, sheets, cords or bundles
b.1 – Dense, irregular – fibers are randomly oriented
ex. Reticular layer of dermis, submucosa of esophagus, capsules of organs, periosteum, perichondrium
b. 2 – Dense, regular – fibers are oriented in one direction only, giving it great tensile strength
ex. Tendons, ligaments, aponeurosis
Elastic – elastic fiber predominates
Ex. Walls of visceral organs and blood vessels, Yellow ligaments of the vertebral column, suspensory ligament of the penis
Reticular – reticular fiber predominates; forms the supporting framework of bone marrow and most of the lymphoid and hematopoietic organs
B. Adipose tissue – special type of connective tissue wherein adipose cell predominates. Characteristic “signet ring appearance”
Functions:
Storage of fat
Insulation against heat loss
Mechanical support
2 Types of Adipose Tissues:
Yellow / White / Unilocular – forms the main bulk of fats in the body. It is the adult or mature form; contains a single large fat droplet
Brown / Multilocular – fetal or immature form; with multiple lipid droplets
C. Mucous Connective tissue – abundance of ground matrix composed mainly of hyaluronic acid; jelly-like consistency containing collagen fibers and few elastic or reticular fibers; Wharton’s jelly of the umbilical cord.
D. Bone / Osseous tissue - specialized type of connective tissue wherein the intercellular matrix is infiltrated with Calcium salts
Functions:
Mainly for support of fleshy structures
Performs protection of vital organs
Serves as attachment of muscles, tendons and ligaments
Contributes shape to the body
Acts as levers by which movement of the body is performed
Composition:
Organic – main component is Collagen ( type I ) 95%; responsible for elasticity of bones
Inorganic – in the form of salts, CaPO4 – responsible for the hardness of bones
Bone cells:
Osteocytes – mature bone cells
Osteoblasts – bone forming cells; responsible for the synthesis of the organic components of bone matrix
Osteoclasts – multinucleated giant cells involved in bone resorption
Parathyroid gland secretes PTH which stimulates Osteoclasts to release Ca from bone ( to increase Ca blood level )
IV. Bone development:
a. Intramembranous – derived from mesenchyme; bones referred
as membrane bones
ex. Flat bones of skull, maxilla, mandible
b. Intracartilagenous / Endochondral – derived from hyaline
cartilage
ex. Bones at the base of skull, vertebral column, pelvis,
extremities
V. BoneGrowth:
a. Appositional- increase in circumference of bones
b. Interstitial – increase in length of bones
VI. Bone Coverings
Periosteum-outer covering, dense irregular connective tissue,
Sharpey’s fibers – bind periosteum to bones
Endosteum-inner covering, lined by single layer of flat cells
VII. Classification as to Structure:
Spongy – made up of bony processes called trabeculae giving it a porous appearance; found in the epiphysis and metaphysic of long bones, diploe of flat bones and in the medullary cavities
Compact – more solid, found in the diaphysis of long bones and plates of flat bones; unit structure of a compact bone is called as Osteon or Haversian system.
Components of Haversian System:
Haversian canal
Concentric lamellae
Osteocytes
Canaliculi
Volkmann’s canal – communication between haversian canals or haversian system / osteon.
Cartilage:
I. Characteristics:
a. Chondrocyte / Cartilage cell is the characteristic cell
b. Firm, pliable type of connective tissue – the intercellular matrix
has a rigid consistency but less resistant to pressure than bone
c. Provided with fibers – collagen and elastin.
d. Avascular tissue.
e. Covered with Perichondrium – dense, irregular connective tissue
II. Functions:
a. Support to soft tissues.
b. Provide a sliding area for joints.
c. Essential for growth of bones.
III. Types: Based on the types of fibers present.
a. Hyaline – most common and widely distributed; with moderate
amount of collagen fibers; found in the costal cartilages of ribs,
thyroid and cricoid cartilages of larynx, cartilaginous rings of
trachea and bronchi, and articular cartilages.
b. Elastic – contains collagenous fibers plus large number of elastic
fibers; most flexible type; found in the auricles of the external ear,
in the walls of the external auditory canal, Eustachian tube,
epiglottic, corniculate and cuneiform cartilages of the larynx.
c. Fibrous – Also called as fibrocartilage, intermediate tissue
between dense connective tissue and cartilage; contains large
large amounts of collagen fibers; found in the intervertebral
discs and pubis symphysis
Myeloid – referred also as bone marrow, located in the medullary canals of long bones and medullary cavities of spongy bones.
I. Types:
a. Red bone marrow – also called as hematogenous or active bone
marrow. In newborns, all the bone marrow is red type. In adults,
it is found in flat bones ( sternum, ribs, clavicle ), bones of pelvis,
diploe of skull bones, in vertebrae and in proximal epiphysis of
femur and humerus. Main function is for production of blood
cells.
b.Yellow bone marrow – In adults, most of the bone marrow is
this type. This type contains great amounts of adipose cells. Main
function is for storage of fats.
Blood
I. Characteristics:
a. Specialized connective tissue consisting of formed elements and a fluid
intercellular plasma.
b. Total quantity constitutes about 8 % of total body weight.
II. Components:
Plasma: 55% of the total quantity
Formed primarily by water; contains plasma proteins like albumin, globulin and fibrinogen.
Slightly alkaline fluid.
Formed elements: 45 % of the total quantity
Red blood cells / Erythrocytes
non nucleated
biconcave disc, average diameter 7.5 um
White blood cells / Leucocytes
2.1 Granular
- Neutrophils / Polymorphonuclears
55 to 65 % of the total count
Nucleus consists of 3 to 5 sausage masses
of chromatin
Granules contain lyzosomal enzymes which
has anti-bacterial activity
First line of defense against infection
- Eosinophils
1 to 3 %
Nucleus is usually bilobed and its cytoplasm
contains coarse acidophilic granules
Increase in parasitic and allergic infections
- Basophils
0.5 to 1 %
Nucleus may assume a S, U or J shaped and
its cytoplasm contains larger basophilic
granules with histamine and heparin.
2.2 Agranular
- Lymphocytes
25 to 35 %
With large spherical nucleus slightly indented
on one side and thin cytoplasm
Increase in viral infections
- Monocytes
2 to 8 %
Largest WBC
Nucleus is kidney shaped and cytoplasm has
a grayish blue tint
Source of Monocyte formation
Platelets / Thrombocytes
Non – nucleated, biconvex discs avemeter diameter
of 2 to 3 um
Liberates thromboplastin which is important in
blood coagulation
Lymphatics


anatomy made easy

MEDIASTINUM:
space between 2 pleural sacs
Boundaries:
Superior – Root of the neck, Thoracic inlet
Inferior – Diaphragm
Anterior – Sternum and Costal cartilages
Posterior – Bodies of the 12 Thoracic vertebra
Divisible into:
Superior:
-------------- imaginary plane passing from Sternal angle of Louie anteriorly to the lower border of the body of 4th Thoracic vertebra
Inferior:
Subdivided into:
Anterior
Middle
Posterior

CONTENTS:
Superior mediastinum:
remains of Thymus gland, SVC, Brachiocephalic art/vein, Left CCA, Left Subclavian art, Arch of Aorta, Phrenic and Vagus N, Left Recurrent Laryngeal N, Trachea, Esophagus, Thoracic duct, Lymph nodes, Sympathetic trunk
Anterior mediastinum: remains of Thymus gland, Sternopericardial ligament, LN

Middle mediastinum: Heart, Pericardium, Roots of great blood vessels, LN, Phrenic N, Bifurcation of Trachea

Posterior mediastinum: Descending thoracic aorta, Esophagus, Thoracic duct, Azygous and Hemiazygous veins, Vagus N, Splanchnic N, LN, Sympathetic trunk

PERICARDIUM:
double walled fibro-serous sac that encloses the heart and the roots of great blood vessels; located Posteriorly to the body of sternum and 2nd to 6th costal cartilages and Anteriorly to T5 – T8 vertebrae
Fibrous Pericardium: tough fibrous tissue, limits unnecessary movements of the heart
Serous Pericardium:
Parietal layer – closely adherent to fibrous pericardium
Visceral layer – closely adherent to heart; equivalent to Epicardium in Histology
Pericardial cavity – potential space between Parietal and Visceral layers of Serous Pericardium containing a small amount of fluid (30 ml) to prevent friction
PERICARDITIS – inflammation of the pericardium; causes severe Substernal pain and produces Pericardial effusion – if the effusion is extensive, excess fluid may interfere with the action of the heart by compression – results to Cardiac tamponade; inflammation causes the surfaces to become rough and the resulting friction between the 2 layers maybe detected during auscultation – Friction Rub

HEART:
Normal weight – Males – 280 – 340 gms
Females – 230 – 280 gms
Base – formed by Left Atrium
Apex – Left Ventricle; Apex beat – 5th ICS LMCL (7 to 9cm from median plane)
Surfaces- Sternocostal / Anterior – Right Ventricle
Diaphragmatic / Inferior – Both Ventricles, mainly Left
Pulmonary / Left – Left Ventricle
Borders – Right border – Right Atrium
Inferior border – Both ventricles, mainly Right
Left border – Left Ventricle
Superior border – Right / Left Auricles
RIGHT ATRIUM:
Receives blood from: SVC
IVC
Coronary sinus
Anterior Cardiac vein
Vena cordis minimae
Internal wall – Musculi pectinati – rough anterior portion
Sinus venarum – posterior part; presence of oval
Depression – Fossa ovalis (site of Foramen
Ovale); if persists after birth – leads to ASD
RIGHT VENTRICLE:
- Thicker wall than the R atrium
- Internal surface with irregular muscular ridges called Trabeculae Carnae
where Papillary muscle originates; apices are connected to the valve by
fibrous strands called as Chordae tendinae
Moderator Band – modified Trabeculae carnae that crosses the
Interventricular septum
LEFT ATRIUM:
- Receives the Pulmonary veins
- Thicker wall compared with Right Atrium
LEFT VENTRICLE:
Thicker wall than R ventricle
Conical cavity longer than Right
Trabeculae carnae finer and more numerous than Right
Papillary muscles are larger than Right
AUSCULTATORY AREAS FOR HEART VALVES:
TRICUSPID – Lower end of the sternum
PULMONARY – 2nd Left ICS
MITRAL – 5th ICS Left MCL
AORTIC – 2nd Right ICS
HEART SOUNDS:
1st – produced by closure of Tricuspid and Mitral valves
2nd – produced by closure of Aortic and Pulmonary valves
BLOOD SUPPLY OF THE HEART:
from ascending aorta
Right Coronary
Marginal
Posterior interventricular
Left Coronary
Anterior interventricular
Circumplex
VENOUS DRAINAGE OF THE HEART:
mainly by Coronary Sinus which opens into the Right Atrium
Receives the: Great Cardiac vein
Small Cardiac vein
Middle Cardiac vein
Anterior cardiac vein and Vena cordis minimae – partly drains blood and directly into the Right atrium
Branches of Coronary arteries are END arteries – if there is sudden occlusion of a major branch, the region supplied by the occluded branched becomes INFARCTED and soon will undergo NECROSIS – leads to MYOCARDIAL INFARCTION
3 MOST COMMON SITES OF CORONARY OCCLUSION
Anterion Interventricular artery
Right Coronary
Circumplex artery
Most common cause of Ischemic heart disease is Coronary Insufficiency resulting from ATHEROSCLEROSIS of Coronary arteries.
NERVE SUPPLY OF THE HEART:
innervated by sympathetic and parasympathetic fibers of the autonomic nervous system via the cardiac plexuses
SKELETAL SYSTEM:
Total number of Bones: 206 AXIAL = 80
APPENDICULAR = 126 (64 upper; 62 lower)
AXIAL SKELETON:
SKULL – 22
PAIRED UNPAIRED
CRANIAL - Parietal Frontal
Temporal Occipital
Sphenoid
Ethmoid
FACIAL Palatine Vomer
Lacrimal Mandible
Maxilla
Nasal
Inferior Nasal Concha
Zygomatic
OSSICLES – 6
Malleus = Hammer
Incus = Anvil
Stapes = Stirrups
HYOID – 1
VERTEBRAL COLUMN – 26
Cervical = 7
Thoracic = 12
Lumbar = 5
Sacrum = 1
Coccyx = 1
Primary Curvature – CONCAVE VENTRALLY; Thoracic and Sacral
Secondary Curvature – CONVEX VENTRALLY; Cervical and Lumbar
STERNUM – 1
Manubrium , Body and Xiphoid process
Sternal angle of Louie = at level T4
= costal cartilage of 2nd rib is attached
RIBS – 24
TRUE / VERTEBROSTERNAL – 1st to 7th
FALSE / VERTEBROCHONDRAL – 8th to 12th
False rib proper – 8th to 10th
Floating rib – 11th and 12th
APPENDICULAR SKELETON:
Upper extremity – 64
Shoulder girdle – Clavicle -2
Scapula -2
Humerus -2
Radius -2
Ulna -2
Carpals – 16
PROXIMAL row – Scaphoid / Navicular
Lunate
Triquetral
Pisiform
DISTAL row - Trapezium
Trapezoid
Capitate
Hamate
Metacarpals – 10
Phalanges – 28
Lower extremity – 62
Hip bone – 2 (Ilium, Ischium, Pubis)
Femur – 2
Patella -2
Tibia – 2
Fibula – 2
Tarsals – 14
Calcaneus
Talus
Navicular / Scaphoid
Cuboid
Cuneiform - 3
Metatarsals – 10
Phalanges – 28
JOINTS:
Basis of classification:
Mobility
Medium that connects it
Types of Joints:
SYNARTHROSIS – united by a Fibrous tissue
Suture – Coronal and Sagittal sutures in skull
Syndesmosis – Interosseous membranes
Gomphosis – articulation between a tooth and alveolar socket of maxilla or mandible
AMPHIARTHROSIS – united by a Cartilage
Synchondrosis / Primary Cartilagenous joint – Hyaline cartilage
Symphysis / Secondary Cartilagenous joint – Fibrocartilage
DIARTHROSIS – Synovial
characterized by the presence of a joint cavity covered with an articular capsule; synovial membranes lining the capsule secrete fluid to lubricate the joint
TYPES
Plane – flat for gliding / sliding movements ex. Sternoclavicular and Acromioclavicular joints
Ball and Socket / Enarthrosis – Multiaxial joint ex. Shoulder and Hip joints
Hinge / Ginglymus – for Flexion and Extension movements ex. Knee, Elbow and Ankle joints
Pivot / Trochoid – for Rotation ex. Atlantoaxial joint
Condyloid – for Flexion / Extension; Adduction / Abduction ex. Metacarpophalangeal / Knuckle joint
Saddle – for Flexion / Extension; Adduction / Abduction ex. Carpometacarpal joint
MUSCLES OF THE GLUTEAL REGION
ACTION
NERVE SUPPLY
Gluteus Maximus
Extension of Thigh
Inferior Gluteal
Gluteus Medius *
Gluteus Minimus
Abduction of Thigh
Medial Rotation
Superior Gluteal
Piriformis
Obturator internus
Sup / Inf Gemellus
Quadratus femoris
Lateral Rotation
Waddling gait – as a result of Superior Gluteal nerve injury; weakened abduction of the thigh by Gluteus medius muscle – (+) Trendelenberg sign
MUSCLES OF THE THIGH
ACTION
NERVE SUPPLY
ANTERIOR GROUP
Iliopsoas
Tensor Fascia Lata
Sartorius
Quadriceps femoris *
Flexion of Thigh
Extension of Leg
Femoral
MEDIAL GROUP
Pectineus *
Adductor Longus
Adductor Brevis
Adductor Magnus *
Gracilis
Adduction of Thigh
Obturator
POSTERIOR GROUP
( Hamstring muscles)
Semitendinosus
Semimembranosus
Biceps femoris
Flexion of Leg
Extension of Thigh
Sciatic
Quadriceps femoris – Rectus femoris, Vastus lateralis, Vastus intermedius and Vastus medialis
Pectineus – Adducts and Flexes Thigh, supplied by Femoral nerve
Adductor magnus – 2 parts : Adductor and Hamstring
FEMORAL TRIANGLE:
- Boundaries: Superiorly – Inguinal ligament
Medially – Adductor longus
Laterally – Sartorius
Base – Inguinal ligament
Apex – Sartorius and Adductor longus
Floor – Adductor longus, Pectineus, Iliopsoas
Roof – Fascia Lata
- Contents: 1. Femoral vein
2. Femoral artery
3. Femoral nerve – L2,L3,L4
4. Femoral sheath
5. Lymph nodes
MUSCLES OF THE LEG
ACTION
NERVE SUPPLY
ANTERIOR GROUP
Tibialis anterior *
Extensor hallucis longus
Ext. digitorum longus
Peroneus tertius *
Dorsiflexion of Foot
Deep Peroneal *
LATERAL GROUP
Peroneus longus
Peroneus brevis
Plantarflexion and
Eversion of Foot
Superficial Peroneal *
POSTERIOR GROUP
Gastrocnemius
Soleus
Plantaris
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior *
Plantarflexion of Foot
Tibial *
SCIATIC NERVE – L4 to S3 ; 2 terminal branches – TIBIAL
COMMON PERONEAL
FOOT DROP – due to injury to Common Peroneal nerve
Peroneus muscles ( tertius, longus & brevis ) – Eversion of Foot
Tibialis anterior and posterior – Inversion of Foot
INTRINSIC MUSCLES OF THE SHOULDER
ACTION
NERVE SUPPLY
Supraspinatus*
Abduction of arm
Suprascapular
Infraspinatus*
Lateral rotation of arm
Suprascapular
Teres minor*
Lateral rotation of arm
Axillary
Subscapularis*
Medial rotation of arm
Upper Subscapular
Deltoid
Abduction
Axillary
ROTATOR CUFF MUSCLES – stabilizes the shoulder joint on it’s anterior, posterior and superior parts. WEAKEST on the inferior portion – common dislocation of shoulder joint
MUSCLES OF THE ARM
ACTION
NERVE SUPPLY
Biceps Brachii
Flexor of Elbow joint
Supinator of Forearm
Musculocutaneous
Coracobrachialis
Flexion and Adduction of arm
Musculocutaneous
Brachialis
Main Flexor of Elbow joint
Musculocutaneous
Triceps Brachii
Main Extensor of Elbow joint
Radial
MUSCLES OF THE FOREARM
ACTION
NERVE SUPPLY
ANTERIOR GROUP *
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris *
Flexor digitorum superficialis
Flexor digitorum profundus *
Flexor pollicis longus
Pronator quadratus
FLEXION
Median
POSTERIOR GROUP *
Brachioradialis *
Ext. carpi radialis longus
Ext. carpi radialis brevis
Ext. digitorum
Ext. digiti minimi
Ext. carpi ulnaris
Anconeus
Supinator
Abductor pollicis longus
Ext. pollicis brevis
Ext. pollicis longus
Ext. indicis
EXTENSION
Radial
All muscles of Anterior aspect of Forearm supplied by Median nerve EXCEPT Flexor carpi ulnaris and medial half of Flexor digitorum profundus – supplied by Ulnar nerve
All muscles of Posterior aspect of Forearm are Extensors EXCEPT Brachioradialis which is a Flexor
LATERAL EPICONDYLITIS / ELBOW TENDONITIS – inflammation of the lateral epicondyle ( common origin of extensor muscles ); repetitive forceful Pronation - Supination of the forearm leads to “TENNIS ELBOW”
ANATOMICAL SNUFF BOX:
Boundaries – Anteriorly: tendons of APL and EPB
Posteriorly: tendon of EPL
Floor: Scaphoid and Trapezium
BRACHIAL PLEXUS – formed by union of ventral rami of C5 to T1
Branches from roots
Dorsal scapular – Rhomboids
Long thoracic – Serratus anterior
Branches from upper trunk
Suprascapular – Supraspinatus and Infraspinatus
Nerve to Subclavius
Branches from lateral cord
Lateral pectoral – Pectoralis major
Musculocutaneous – Coracobrachialis, Brachialis, Biceps brachii
Lateral half of Median – Flexor muscles of forearm
Branches from medial cord
Medial pectoral – Pectoralis minor
Medial brachial cutaneous nerve
Medial antebrachial cutaneous nerve
Ulnar – Intrinsic muscles of hand
Medial half of Median – Flexor muscles of forearm
Branches from posterior cord
Upper subscapular – Subscapularis
Thoracodorsal – Latissimus dorsi
Lower subscapular – Teres major
Axillary – Deltoid and Teres minor
Radial – Extensor muscles of upper limb
UPPER BRACHIAL PLEXUS INJURY:
due to excessive separation of neck and shoulder or may result from violent stretching of an infant’s neck during a difficult delivery
ERB – DUCHENES PARALYSIS
Characteristic position – WAITER”S TIP ; limb hangs by the side in medial position and forearm is pronated
LOWER BRACHIAL PLEXUS INJURY:
due to traction injury as in excessive abduction of arm; ex. Forceful pull of the infants upper limb during delivery
ULNAR NERVE INJURY
Impairment of wrist flexion and movements of intrinsic muscles of the hand – CLAW HAND DEFORMITY
LONG THORACIC NERVE INJURY:
caused by blows or surgical injury to the nerve in axilla; ex. Weight lifting or carrying a heavy object on the shoulder for a long time
paralysis of Serratus anterior muscle
medial border and inferior angle of scapula to become unusually prominent – WINGED SCAPULA
AXILLARY NERVE INJURY:
due to inferior dislocation of the shoulder joint or fracture of the surgical neck of the humerus
wasting and atrophy of Deltoid muscle; results to weakened abduction of the shoulder
RADIAL NERVE INJURY:
due to fracture of the midshaft of the humerus
inability to extend wrist and fingers
WRIST – DROP
MEDIAN NERVE INJURY:
due to supracondylar fracture of the humerus
compression of median nerve at Carpal tunnel
Muscles of the Thenar eminence are paralyzed and wasted; thumb is laterally rotated
APE – LIKE HAND
ULNAR NERVE INJURY:
due to fracture of the medial epicondyle of the humerus
inability to adduct and abduct the fingers
CLAW – HAND
LATERAL EPICONDYLITIS / TENNIS ELBOW:
inflammation of the common extensor tendon – lateral epicondyle
MEDIAL EPICONDYLITIS / GOLFER’S ELBOW:
inflammation of the common flexor tendon – medial epicondyle
PLEURA: 2 parts:
PARIETAL LAYER – lines the thoracic wall
VISCERAL LAYER – covers the outer surfaces of the lungs
2 layers are separated from one another by a slit-like space called as Pleural cavity which normally contains a small amount of fluid
Nerve supply:
Parietal layer is sensitive to Pain, Temperature, Pressure and Touch
Costal part – Intercostal nerve
Mediastinal part – Phrenic nerve
Diaphragmatic part – Phrenic and Lower intercostals nerve
Visceral layer is sensitive to Stretch; from pulmonary plexus
COSTAL LINE of Pleural reflection passes obliquely across the:
8th rib in MCL
10th rib in MAL
12th rib in sides of vertebral column
LOWER MARGIN of Lungs cross the:
6th rib in MCL
8th rib in MAL
10th rib in sides of vertebral column
PLEURISY /PLEURITIS:
inflammation of pleura secondary to inflammation of lung ex. Pneumonia
results in the pleural surfaces becoming coated with exudates causing the surface to be rough – produces friction – PLEURAL RUB
LUNGS:
RIGHT
LEFT
Larger,heavier,shorter,wider
Smaller,lightier,longer,narrower
Lobes
Superior,Middle & Inferior
Superior & Inferior
Fissures
Horizontal and Oblique
Oblique
BRONCHOPULMONARY SEGMENTS:
anatomical, functional and surgical unit of lung
subdivision of lung lobe
pyramidal in shaped; apex directed towards the lung root
surrounded by connective tissue
supplied by it’s own bronchus, receives an artery, vein, lymph vessels
RIGHT LUNG
LEFT LUNG
Superior lobe
Apical
Posterior
Anterior
Apical
Posterior
Anterior
Superior Lingular
Inferior Lingular
Middle lobe
Lateral
Medial
Inferior lobe
Superior / Apical
Anterior Basal
Medial Basal
Lateral Basal
Posterior Basal
Superior / Apical
Anterior Basal
Medial Basal
Lateral Basal
Posterior Basal
Blood supply of Lungs:
Bronchial artery – from descending aorta
Pulmonary artery
Venous drainage:
Bronchial vein – drains into Azygous and Hemiazygous veins
Pulmonary vein
Nerve Supply:
From pulmonary plexus which is formed from branches of the sympathetic trunk and receives parasympathetic fibers from Vagus nerve.
Sympathetic efferent fibers produce Bronchodilatation and Vasoconstriction
Parasympathetic efferent fibers produce Bronchoconstriction and Vasodilatation; and increase glandular secretion.
AORTA:
Ascending Aorta
R / L Coronary
Arch of Aorta
Brachiocephalic
Left CommonCarotid
Left Subclavian
Descending / Thoracic Aorta
Posterior intercostals
Subcostal
Pericardial
Esophageal
Bronchial
Mediastinal
Abdominal Aorta
Descending / Thoracic Aorta enters the Aortic Hiatus at level T-12 to become Abdominal aorta
COMMON CAROTID: Right from Brachiocephalic; Left from Arch of Aorta
External Carotid
Superior Thyroid
Ascending Pharyngeal
Lingual
Facial
Occipital
Posterior Auricular
Superficial Temporal
Maxillary
Internal Carotid
Opthalmic
Posterior communicating
Anterior cerebral
Middle cerebral
SUBCLAVIAN ARTERY: Right from Brachiocephalic; Left from Arch of Aorta
divided into three / 3 parts by Scalenous anterior muscle
1. First part – Vertebral
Thyrocervical
Internal thoracic
2. Second part – Costocervical trunk
3. Third part
AXILLARY ARTERY:
begins at the lateral border of 1st rib as a continuation of the subclavian artery; and at the lower border of Teres major muscle it becomes the Brachial artery
divided into three / 3 parts by Pectoralis Minor muscle
1. First part – Highest Thoracic
2. Second part – Thoraco-acromial
Lateral thoracic
3. Third part – Subscapular
Anterior Circumplex humeral
Posterior Circumplex humeral
ABDOMINAL AORTA:
Branches:
1. Anterior Visceral ( Unpaired) – Celiac
Superior mesenteric
Inferior mesenteric
2. Lateral Visceral ( Paired) – Suprarenal
Renal
Testicular / Ovarian
3. Lateral Parietal ( Paired) – Inferior Phrenic
Lumbar
4. Terminal branches – R / L Common Iliac
Median Sacral
INTERNAL JUGULAR VEIN:
drains blood from brain, face and neck regions
continuation of Sigmoid sinus
Receives the – Facial
Pharyngeal
Lingual
Superior Thyroid
Middle Thyroid
BRACHIOCEPHALIC / INNOMINATE VEIN:
union of Internal jugular and Subclavian veins
at the level of the inferior border of the 1st Right costal cartilage, the 2 Brachiocephalic veins unite to form the Superior vena cava
Receives the – Internal thoracic
Vertebral
Inferior thyroid
Superior intercostals
SUPERIOR VENA CAVA:
union of R and L Brachiocephalic veins
ends at the level of the 3rd costal cartilage to enter the Right Atrium
AZYGOUS VEIN:
connects SVC from IVC
Receives the – Lower intercostals veins
Mediastinal
Esophageal
Bronchial
Hemiazygous
Accessory Hemiazygous
Azygous, Hemiazygous and Accessory Hemiazygous system offers an alternate means of venous drainage from the thoracic, abdominal and back regions when there is obstruction to IVC