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    Anatomy Print

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    Reference lines of the back i Posterior trunk midline at Posterior midline the level of the spinous processes Paravertebral line eee _ transverse processes . Line through the inferior Scapular line angle of the scapula ‘spinous processes that provide useful posterior landmarks Vertebral spinous Posterior landmark process a Vereebra prominens . Pe (the projecting spinous process of C7is clearly visible and palpable) 3 The scapular spine 7 The inferio: angle of the scapula T12 Just below the 12th rib u The summt ofthe iliac crest The posteror superior iliac spine (recognized by small skin depressions 2 : a directly over the iliac spines) TERE | structural elements of vertebrae Vertebrae Body Vertebral foramen Transverse processes Artcular processes Spinous process Sirall maybe absent Inc7}anteiorané —__Superoposteriony and Cervalveterae Small Short (C2-C3): bi (C2-C0); 5 y Lage rargule) —_posteortuberces —_infroanteronhy oblique faces: oud (bitney shape ear eee a ee tong (7) foramen a Medium (heart Large and song;lenatn Pomeroy ahah er) Long, spina posteo- oes Shaped nels Smat(ckeven — denesesTITT3casal_ ttt GlaNY cg up extent ee costal aes facets 11-170) aaa of vertebral body below Rosteromedaly (or medial) Caled costal processes, and anterolateral orltrally: Lumber vertbrae large _— long and slender: feces neatly soital . us (Gidneyshapesy MESH (CERGUB Seessory rocesson plane: marily process | Shere and broad posterior surface ‘on posterior surface ofeach superior aticular process Saperoesterny (5) superior Sacral versbree (Sacrum) _ Decreases from Fused torudimentary ib 51-55 (ised) basetoapex —_ “wrelcanal (sos pp. 52-55) Se um | Medion socal aest Ci (ais) and C2 (os) ate considered atypical (see pp. 8-9) Joints of the vertebral column Craniovertebral joints @ __ Allanto-occipital joints @ Atlantoaxia joints Joints of the vertebral bodies © _ Uncovertetraljoints @ _ Intervertabyaljoints Joints of the vertebral arch ® __Zyaapophyseal joints Occiput-C1 a-2 ad Q-s1 aT Ped Vertebral ligaments Ligament Location Vertebral body ligaments an . Along antestor surface of ® ® Anterior longitudinal ligament Seal body ana Along posterior surface of © = Posterior longitudinal ligament bral body Vertebral arch ligaments @® | Ligaments flava @ | Interspinous ligaments © | Supraspinous ligaments @ __Intertransverse ligaments Nuchal ligament” Between laminae Between spinous process Along posterior ridge of spinous processes Between transverse processes Between external occipital protuberance and spinous process of C7 *Corresponds to a supraspinous ligament that is broadened superiorly. (QEDTEB ranches of a spinal nerve Branches Territory Meningeal ramus Spinal meninges; ligaments of spinal column ‘Atticular branch | Zygapophyseal joints Posterior Medial branches Muscular branch Intrinsic back muscles cc Ctzneots Pane. skin of posterior head, neck, back, and buttocks ee in of posterior head, neck, back, a femus Cutaneous branch Lateral branches Muscular branch Intrinsic back muscles ‘Anterior Lateral cutaneous branches ‘Skin of lateral chest wall (ventral) tomas Anterior cutaneous branches Skin of anterior chest wall “The white and gray rami communicantes carry pre- and postganglionic fibers between the sympathetic ‘trunk and spinal nerve. They are shown on p. 647. Transverse planes through the abdomen Transverse plane midway between the superior @Transpyloric plane _borders of the pubic symphysis and the manubrium Plane at the lowest level of Une costal matgiti (Ure: inferior margin of the tenth costal cartilage) Plane passing through the summits of the tlc crests, Piane at the level of the iliac tubercles (the iliac @ Transtubercular plane tubercle lies ~5 cm posterolateral to the anterior superior iliac spine) © Subcestal plane © Supracrestal plane ©interspinous plane Plane at the level of the anterior superior iliac spine Smmerettieinr ner Structures Formed by Anterior wall External oblique aponeurosis Internal oblique muscle Roof ‘Transversus abdominis. Transversalis fascia wall Posterior wall Parietal peritoneum Inguinal ligament (densely interwoven fibers of the lower external oblique aponeurosis and adjacent fascia lata of thigh) © e006 © Floor Opening in external oblique Superficial ~aponeurosis; bounded by medial and inguinal ring lateral crus, intercrural fibers, and Oper _teflected inguinal igament ‘Outpouching of the transversal Deep inguinalring fascia lateral to the lateral umbilical fold (inferior epigastric vessels) bared Boundaries of the omental foramen ‘The communication between the greater sac and lesser sac (omental bursa) Is ‘the omental (epiploic) foramen (see arrow in Fig. 12.6) Direction Boundary Anterior a.,and bile duct Inferior Duodenum (superior part) Posterior —_inferior vena cava, diaphragm (right crus), Superior Liver (caudate lobe) ryan Coverings of the testis Covering layer Devided from ® Scrotal skin Abdominal skin i Dartos ‘ascia and @ | Tunica dartos a External spermatic - oS External oblique ‘Cremaster muscle @ | andcemasteric | Intemaloblique fascia* @ internal spermatic; Transversalis fascia fascia e Tunica vaginalis, rietal layer parietal layer itoneum @ _ Tunica vacinalis, visceral layer * The trensversus abdominis has no contribution to the spermatic cord or covering of the testis. Table 12. Boundaries of the omental bursa Direction Boundary Recess Anterior Lesser omentum, gastrocolic ligament — Inferior Transverse mesocolon Inferior recess Superior Liver (with caudate lobe) Superior recess Pancreas, aorta (abdominal part), celiac trunk, splenic a. and v., gastrosplenic Posterior fold, left suprarenal gland, left kidney (superior pole) Right Liver, duodenal bulb = Left Spleen, gastrosplenic ligament Splenic recess (ies) | Structures of the retroperitoneum, ‘See pp. 186, 194, 207 for neurovascular structures of the revopetitoneum. Classification Organs Vessels Nerves Primary retroperitoneal + Kidreys + Aorta (abdominal part) + Lumbar plesus branches (wo mesentery: + Supratena lands + nferior ver cava and lohypogasticn. retroperitoneal when | = Ureters tributaries, © tlioinguinal n. eal + Ascending lumbar w. » Genitofemoral n, + Pancreas + Portland tributaries | Lateral femoral cutaneous, secondarly + Duodenum (descending and horizontal pars; some of ascend + Lumbar sacral. andilae » Femorain. retroperitoneal par ‘ = ss ymph nodes © Obturatorn. (evesenerylost during = Ascending and descending colon + Lumbartrunis and | + Sympathetic trunk development) + Cecum (portions vaioble) disterna cy + Autonomic ganga and pluses + Rectum (upper2/3) vi — Round ligament ofliver au Fibrous appendix 1 vil A Diaphragmatic Ns surface, ante- rior view. Inferior vena cava B Visceral sur- Rightlicament face, inferior nbver I i \V_ Leftmedial V Right anteromedial ae VI_ Right anterolateral Right lateral divsion Pugh posterolateral Vill Right posteromedial (08) | Branches of the abdominal aorta The abdominal aorta gives rise to three major unpaired trunks (bold) and the unpaired median sacral artery, as well as six paired branches. Branch from abdominal aorta Branches @ © @ | Inferior phrenic aa. (paired) | Superior suprarenal aa. Left gastric a Splenic a. ® — Celactrunk Proper hepatic a. et Right gastric a. Gastroduodensl a. @ | @ _ Micdle suprarenal aa. (paired) ® ‘Superior mesenteric a. @ @ _ Reralaa, (paired) Inferior suprarenal aa. @ —& _ tumbaraa. (Ist through 4th, paired) @ — @ _ Tesicularjovarian za. (paired) ® Inferior mesenteric a. @ — @ Commonilacas. (paired) Peel lac. intemal tiaca. @ Median sacral a. Tributaries of the inferior vena cava @ | @ = inferior phrenicw.. (paired) @ Hepatic wv. (3) Suprarenal w.. (the right vein is a direct tributery) Renal w.. (paired) Testicularjovarian wy. (the right vein is a direct tributary) Ascending lumbar w. (paired), not direct tributaries Lumbarw. @®@oOO®D ©@©2808@®8 ‘Common iliac w. (paired) © Median sacral v. Intestinal trunk Right lumbar —| ‘trunk ® Right common tac Ln. Left common iliac Ln, Z—® @ Inferior phrenic Ln. — oe @ Caliacl.n. Cistema_ oa tuna pemnic | sne mse La. a tumor @ Inferior mesenteric In. | © Left lateral aortic Ln. @ Right lateral aortic (caval) Ln. @ Retroaortic Ln. ® Commoniliac Ln. Leftumbar tun t 4 + eft antrymph nodes ‘tateralzort moh nose + Petri mph odes Superior mesenteicymph nodes + a resin mph nodes $F + Precca mph nodes + reoteavgh nodes * Hecac nph noes + Papen bre ces Mesa ymph odes Hhcle p> “naib Meech Imesuneltrnts Splenic mph nodes = Spleen Hepatclymph nodes 2 oticimph node - *fogmialnmen ms htt gate lymph nodes Porc lymph nodes + Sup ub and reo. ple lmphedes » / hye gato: ‘omental mph nodes Superorfnterie Icnurd pancreatclymph nodes team _ 3 Sepesiorinerie parcertcodvodend bro noses pao Meocchmoh a Teoh ‘aon = L_ nfeormeserterchmnph nodes Sigrid clon Pen + Sigmod oh noes ——__. + Superorrectdhmph nodes << enees Rectan Fig. 14.23 Principal lymphatic pathways draining the digestive organs and spleen {Lymph from the spleen and most digestive organs dans drecty fom ‘ecionaliyph nodes or through intervening cllecting nodes to the intestinal trunks, except forthe descending and sigmoid colon andthe "upper part of the return, which ate drained by the let amar trunk “The there large collecting nodes ae: + Cevebmph nodes collect mph from the stomach, duodenum, pancreas, spleen, andliver.Topographicaly and at dssecon they {a often instnguishable from the regional iymph noes of the neatby upper abdominal organs. «+ superior mesenteric ymph nodes collect mph from the jejunum, ileum, ascending and transverse colon, “Inferior mesenteric mph nodes collect Iymph from the descending and sigmoid colon and rectum. “These nodes drain princlpally through the Intestinal trunks tothe cisterna chy, but there san accessory drainage route by way ofthe lefclumnba lymph nodes. Lymph from the pelvis also drains up into the inferior mesenteric and lateral aortic lymph nodes. & complete drain ‘age pathway fr ph fom the pels can be found on p. 259. Fig. 14.26 Lymphatic drainage of the kidneys (with pelvic organs) Gv t bw} fo Right lumbar trunk = —> Cisterna chyli — Left lumbar trunk eee Thoracic duct Ce Ea ren t ree rea mana re a ; ae dit —P Stein Soman mil == main t Lateral edi and Promontory Sutra her an ae fae sem isl : = = t Lower limb, uterus, ‘and vagina Fig. 14.30 Lymphatic drainage of the stomach, liver, spleen, pancreas, and duodenum — wn 4 Fig. 14.32 Lymphatic drainage of the intestines Thoracic duct t Lefelumbar Ln. > eftlumbartrunke => Gisterna chy Intestinal trunks Lateral aorticLn. Preaortic T_T le t -_— a Drececl > Inferior mesenteric. \ ee Siri on. Leftcolc In UeocolcLn eee ide cobc ln hear Right colin, Table 17.1 Divisions of the pelvis and perineum ‘The levels of the pelvis are determined by bony landmarks (iliac alae and pelvic inlet/brim). The contents of the perineum are separated from the true pelvis, by the pelvic diaphragm and two fascial layers. + lleum (coils) = Cecum and appendix False pelvis ‘+ Sigmoid colon + Common and external iliac aa. and w. + Lumbar plexus (branches) Pelvic inlet += Distal ureters Betis + Urinary bladder = Rectum g: Vagina, uterus, uterine tubes, and ovaries True pelvis ¢: Ductus deferens, seminal gland, and prostate '* Internal iliac a. and v. and branches + Sacral plexus + Inferior hypogastric plexus Pelvic diaphragm (levator ani with superior and inferior fascia of pelvic diaphragm) \cter urethrae and deep transverse perineal mm. * Urethra (membranous) = Vagina Deep pouch + Rectum + Bulbourethral gland * Ischioanal fossa * Internal pudendal a. and v., pudendal n. and branches Perineum | Peri membrane Ischiocaverosus, bulbocavernosus, and superficial transverse perineal mm. ‘Superficial + Urethra (penile) pouch + Clitoris and penis + Internal pudendal a. and v., pudendal n. and branches Superficial perineal (Colles’) fascia Subcutaneous = perineal space (;2iEs) | Regions of the rectum and anal canal Region Colon-ike with crypts; simple Ee columnar with goblet cals, ® Columnar zone Stratified, nonkeratinized © Anal pecten squamous Stratified, keratinized ® Cutaneous zone squamous with sebaceous lands Stratified, keratinized squamous with sebaceous glands, hairs, and siveat glands Anal canal © Perianal skin (pigmented) Branches of the internal iliac artery The intemal iliac artery gives off five parietal (pelvic wall) and four visceral (pelvic organs) branches.* Parietal branches are shown in italics. Branches © | liolumbar a. ® Superior gluteal a. ® Lateral sacral a. a rn A. of ductus deferens Superior vesical a. ® Obturator a. ® Inferior vesical a. @ Middle rectal a. ® __ Internal pudendal. Inferior rectal a. ® _ Inferior gluteol o. * Inthe female pelvis, the uterine and vagi anterior division of the internal iliac artery. trench noracinftor sh ‘Tributaries Superior gluteal v. | arteries arise directly from the ° Lateral sacral v. Obturator w. ‘Vesical wv. Vesical venous plexus Middle rectal w. (rectal venous plexus) (also superior and in‘erior rectal w., not shown) Internal pudendal v. Inferior gluteal wv. Prostatic venous plexus @ ©0898: © G8: 0:0 Urerine and vaginal venous plexus ‘The male pehis also contains veins draining the penis and scrotum. Fig. 19.11 Lymphatic drainage of the pelvic organs Thora duct € FS t os 9 Aig ier rk —e Cherny af ber rk fiontunbaris, SY tattambartn, eaaa i riers pees Sa Preoricn Retrocwaln + peat. lacunar Ln. (lateral, —> External. ‘medial, and intermediate) obturator. + common tac Ln. S— imeemel lac. Subporicln. seca ' tte eal an reese Sipe ond sr oe eet sea ay feel ECs ' tet me ' “Visceral pelvic, Sie Pararectal Ln w/ ain ae My Lateral vesical Ln. Pre- and retrvesicalL, ¢—— —@ The skull is subdivided into the neurocranium (gray) and viscerocranium (orange). The neurocranium protects the brain, while the viscerocranium houses and protects the facial regions. Neurocranium + Ethmoid bone (cribriform plate)” + Frontal bone + Occipital bone + Pariatal bone + sphenoid bone + Temporal bone (petrous and squemous parts) Viscerocranium ‘+ Ethmoid bone * Mandible + Hyoid bone * Maxilla + Inferior nasal concha + Nasal bone + Lacrimal bone + Palatine bone * Sphenoid bone (pterygoid process) + Temporal bone = Vomer “Most of the ethmoid bone is in the viscerocranium; most of the sphencid bone is in the neurocranium. The temporal bone is, divided between the two. CERETEY] cranial nerves of the extraocular muscles Course’ Fibers Nuclei Funetion Effects of nerve injury ‘Oculomotor nerve (CN I) Inervates: Somatic Oculomotor + Levatorpalpebra superiors eee eee ee pees Perec efferent nudeus Be eee eened er poe + Inferior oblique + Prosis (drooping of eyelid) uns anteroily from mesencephalon Synapse with neurons in ciary + Downward and lateral gaze deviation en Ge ‘angi += Diplopia (double vision) ee + Myisis(pupil dation) ret (EdogeWetohl | ee + Accommodation difcities (ciary paralysis) a + Gllary muscle Trochlear nerve (CNV) Emerges from posterior surface of . + Diplopia Braserear mine cousesSametc Nudeusofthe Imenates: 1 ected eels Nghe and devted medially anteriorly around the cerebral peduncle a (dominance of inferior obique) ‘Abducent nerve (CN Vt) + Diplopia Somatic Nudaus ofthe Innervates: Follows long extradural path** a + Medal strabismas (due to unopposed action efforent_abducentn. Lateral rect ee * Allcree nerves enter the orbit through the superior orbital fissure; CN Ill and CN VI pass through the common tendinous ring ofthe extraocular muscles. ** The abducent nerve follows an extradural course; abducent nerve palsy may therefore develop in association with meningitis and subarachnoid hemotrhage. "gern nerve (CNV) course Fibers ‘Nuelet Funetion Effects of nerve injury Baits fiom the middle canal fossa, Somatic atfocent ‘ophthalmic division {CNV}: Enters bic though supesior conta fissure el visceral Maxilary division ferent (cWV,sEnters prerygopalatine fossa through foramen rotundum Visco andibular di ae Mandibular division . [cNV,}:Passes Lata through foramen ovale visceral ino infratemporal SS afferent athway* + Principal (pontine) sensory nuceus ofthe | Innervates tuigeminaln. + Fal skin (A) + Mesencephalicnudeus ofthe tigeminal_, » Nasopharyngeal mucosa 8) + Spinal nucleus ofthe trigeminal ‘Motor nucleus ofthe tigeminal + Tongue (anterior two this) (€) Involved inthe comeal reflex (reflex closure of eyelid) lnnervates (via CN V,) * Muscles of mastication (terporalis, masseter, ‘medial and lateral ptergoids (D)) + Sensory loss (traumatic + Oral floor muscles (mylohyoid anterior digastric) _nevelesions) + Tensor tympani + Hetpeszoster + Tensor vel palatin cophthalmicus (arcella- zoster virus); herpes + Lacimaln (CN V,) conveys parasympathetic bes ion CN Vilalong the zygomaticn (CNV) seater the face tothe lacinal gland + Lingua. (CN V,) conveys parasympathetic fibers from CN Il (va the chords tympani to the submandibular and subingualglands + Auriculotemporal n. (CNV, conveys parasympathetic fibers rom CN DX tothe parotid gland Gustatory (taste) ides from CN VI (via chorda tympani travel with the lingual n. (CN V,) tothe anterior two thirds ofthe tongue * Fibers of certain cranial nerves adhere to divisions or branches ofthe trigeminal nerve, by which they travel to thelr destination. \Vestibulocochlear nerve (CN Vill) =o es eae ERTS TSE Spaapoaas saree Vestibular Pass from the inner ear ‘Superior, lateral, medial, and saceule, at le pass lar lion ines Pear Pasom einer ay inital |

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