Chapter 3: Autonomic Nervous System (p.

128-136)

Chapter 8: Digestive System

Lecture objectives:
1. Define the structural components of the digestive system
2. Explain the oral cavity and its subdivisions
3. Describe the anatomical features of a tooth
4. Discuss the structure of the tongue
5. Define the esophagus
6. Explain the peritoneum and its reflections
7. Describe the anatomical features of the stomach, small and large intestines and explain
their subdivisions

Divided into alimentary canal and accessory digestive organs

Alimentary canal: oral cavity, pharynx, esophagus, stomach, small intestine, large intestine
Accessory digestive organs
- Assist in ingestion and digestion of the food and include teeth, tongue, salivary glands,
liver, gall bladder, and pancreas

Comprised of two main components:

- Muscular tube
o Starts from oral cavity and ends at anus
o Called the alimentary canal
  Oral cavity, pharynx, esophagus, stomach, small and large intestine
- Accessory digestive organs
o Helps the alimentary canal in digestion
 Teeth, tongue, salivary glands, liver, gall bladder and pancreas

Oral cavity (boundaries and subdivisions)

- Opening of the oral cavity

o Lips anteriorly bounds the oral cavity
 Two muscular folds
 Core of the lips are made by skeletal muscles (Orbicularis Oris)
 Is connected to the gum by a midline mucosal fold – Frenulum
 If it’s too short, the lips won’t be able to move properly thus you
won’t be able to speak properly.

- The roof of the oral cavity is made by:

o Hard palate (anterior part of the roof of the oral cavity proper and floor of the
nasal cavities)
 Maxilla + palatine bone
o Soft palate (forms the posterior part of the roof of the oral cavity proper and
separates it from the nasopharynx superior to it)
 Muscles of the soft palate separates oral cavity from nasopharynx
 Cone shaped extension of soft palate – Uvula
 Epiglottis
 Covers the opening of the larynx so the food doesn’t enter larynx
 Food goes from oropharynx to laryngopharynx and then into
esophagus
- Floor of the oral cavity
o Formed by the suprahyoid muscles
- Lingual Frenulum
o Controls the movement of the tongue
- Dental arches are used to divide the mouth in two smaller areas:
o Vestibule
 Between the dental arches and the lips
 Horseshoe-shaped space
o Oral cavity Proper
 Anything behind the dental arches
 Tongue sits in this area

- Folds/Arches lateral to Uvula:

o Palatoglossal Fold
 Stretched between the soft palate and the root of the tongue
o Palatopharyngeal Fold
  Stretched between the soft palate and the pharynx
- Palatine Tonsils
o Housed in the shadow fossa formed between the palatoglossal and
palatopharyngeal layers

** when the food gets into the oropharynx, we don’t want that to come back into the
mouth, so these arches/folds move towards the midline and they shut down the
passage between the oral cavity and the oropharynx.

Teeth

Has three parts:

- Crown
o Is in the oral cavity
- Neck
o Immediately below the crown
o Connects the crown with the root
- Root
o Contained within the alveolar processes of the mandible and maxilla
o Attached to the bony socket by the periodontal ligament

Teeth are classified based on the shape of their crown

- 2 incisors, one canine, 2 premolars, and 3 molars in each half of the upper and lower
jaws
- The third molar is known as the wisdom tooth
 Different tissues of the tooth:

- Enamel
o Hardest substance in the body – white colored (can never be naturally yellow
colored)
o 9x stronger than the bone
o Protects the dentin in the oral cavity area

- Dentin
o Yellow colored soft tissue
o Encloses the pulp cavity that houses the blood vessels and nerves supplying the
tooth
o Also forms the core of the Root

- Cement (Cementum)
o Covers the surface of the Root
 o Is another calcified tissue
o Protects the dentin in the root area

- Root Canal
o Extension of the pulp cavity into the root
o This is where you get the branches of cranial nerves
 CN V – sensitizes the teeth both in upper and lower jaw

*** cells that make the enamel die before the tooth grow when we are children

- Periodontal ligament
o Winds the root of the tooth to the bone (Gomphosis Fibrous Solid Joint)

Tongue

Muscular organ; made by 19 skeletal muscles which are innervated by Cranial Nerve 12
Two surfaces which are separated by the V-shaped Terminal Sulcus

- Posterior 1/3rd / Root / Pharyngeal Part

o Predominantly made by Encapsulated Lymphoid Tissue
 Referred to as the Lingual Tonsil
 Both lingual tonsils join to form the posterior part of the tongue
- Anterior 2/3rd / Oral part / Body of the tongue
o Made by skeletal muscles

*** These two parts of the tongue develop from different sites as an embryo

- That’s why both the parts have different function, innervations and tissue
- Essentially the tongue is two different organs.
Epithelial structure of Anterior Tongue:

- Circumvallate papillae
o Sits in a row in front of the terminal sulcus
o Carry a lot of taste buds
- Foliate papillae
o Vertical grooves / taste buds on the sides of the tongue
o Only on the left and right
- Fungiform Papillae
o Under the microscope they look like mushrooms
o Also contain taste buds
- Filiform papillae
o Cover the entire dorsum of the tongue
o The only type of papilla that do not have taste buds
o They are just here to increase friction between tongue and food

 Trigeminal Nerve (CN V) - general sensory innervation of the anterior 2/3 rd of tongue

Facial Nerve (CN VII) - supplies taste fibers

 Glossopharyngeal Nerve (CN IX) – general and sensory senses for posterior 1/3 rd of the
tongue

Pharynx

- Muscular tube that connects the nasal cavities to the larynx and the oral cavity to the
esophagus

Esophagus
 o Muscular tube that carries the food from pharynx down to the stomach
o Beginning of the esophagus is at the level of C6 vertebra
o Passes the diaphragm at T10
o Attaches to the stomach at T11
o Passes through the superior and posterior mediastinum
o Sits behind the Trachea
 “esophagus is anteriorly related to trachea”
  related mean touch and not that they are connected or anything else
o Is also related to the left atrium and the Aortic arch

Peritoneum

o -  serous membrane like pericardium and pleura

o -  Parietal and visceral peritoneum
o Peritoneal ligaments connect the abdominal viscera to the abdominal walls or
other organs
 Falciform ligament that connects the liver to the anterior abdominal wall
and diaphragm
 o Lesser omentum or gastrohepatic ligament
 Connects stomach to liver
o Greater omentum connects the greater curvature of stomach to the transverse
mesocolon and like an apron covers the intestinal loops anteriorly
o Mesenteries – connect the small intestine, transverse colon, sigmoid colon and
appendix to the posterior abdominal wall
 Named as mesentery, transverse mesocolon, sigmoid mesocolon and
mesoappendix respectively
o -  Sigmoid colon
o -  Blood vessels and lymphatic vessels travel to digestive system through the
mesentery preventing entanglement of vessels
o -  If surround by peritoneum the organ is referred to as intraperitoneal
o -  Partially covered organs are referred to as retroperitoneal
o -  Be able to classify each organ as intra or retro peritoneal

Stomach

o -  found in left hypochondriac region

o -  Cardiac: joining point between esophagus and stomach
o -  Lower esophageal sphincter
o -  Fundus
o -  Body
o -  Pyloric antrum, pyloric canal, and pyloric sphincter
o -  Lesser and greater curvatures
o -  Rugae: folds of stomach that allow expansion

- Cardiac and pyloric openings connect the stomach to the esophagus and duodenum
respectively
o The pyloric sphincter guards the pyloric opening
- The mucosal membrane lining the interior of stomach is throwing into longitudinal folds,
the gastric rugae that disappear when the stomach is full

Small intestine
 Duodenum

- duodenum is the first part of small intestine and has 4 parts itself
- starts from the pyloric opening of stomach and merges with jejunum at the
duodenojejunal flexure

 superior, descending (receives secretion from gallbladder and pancreas),

horizontal, ascending parts
o -  Jejunum mostly occupies the umbilical region of the abdomen
o -  Ileum mostly occupies the hypogastric region of stomach

Large intestine

o -  Cecum
o -  Ileocecal valve
o -  Vermiform appendix
 The surface marking for the appendix is lateral 1/3 of line between ASIS
and umbilicus
 Clinically referred to as McBurney’s point
 - Ascending colon -> Right colic flexure (aka hepatic flexure) -> Transverse colon -> Left
colic flexure (aka splenic flexure) -> Descending colon -> sigmoid colon -> rectum -> anal
canal (surrounded by external anal sphincter)

o -  Teniae coli
o -  Haustrum

Rectum

o -  Hemorrhoidal veins

Liver:

o -  Sits mainly in the right hypochondria

o -  Anterior, superior and right surface are in touch with the diaphragm
 Diaphragmatic surface
o -  Inferior surface
 Impressions produced by the abdominal viscera that are in touch with the
liver
 Called the visceral surface

- Completely surrounded by peritoneum

o At the anterior joining point forms a ligament called the Flaciform ligament?
 Attaches liver to posterior surface of anterior abdominal wall
o At the superior joining point forms another ligament called coronary ligament?
 Attaches the liver to the under surface of the diaphragm

** these ligaments stabilize the liver in its place

- Round ligament
- Left and right lobe
- Caudate lobe
o Only visible from the inferior view
- Quadrate lobe
o On the left side of gallbladder
o Visible only in the inferior view of the liver

** physiologically these two are part of the left lobe, but visually part of the right lobe

** physiologically four lobes, anatomically two lobes???

 -  Porta Hepatis
 -  Common bile duct
 -  Hepatic portal vein
  -  Hepatic artery proper

Gallbladder

o -  Attached to the inferior (visceral) surface of the liver

o -  Fundus
 The parts that sticks out from the liver
o -  Body
o -  Neck
o -  Bile ducts
 Left and right hepatic ducts join together to form the common hepatic
ducts
 CGD joins to cystic duct and forms the common bile duct

Chapter 9: Urinary System

Lecture objectives:
1. Name the components of the urinary system
2. Describe the external and internal features of the kidney
3. Define the coverings of the kidney
4. Explain the characteristics of the ureter
5. Describe the external and internal features of the urinary bladder
6. Discuss the characteristic differences between the male and female urethra

MAIN FUNCTION: to filter the blood and dispose some of the waste byproducts of metabolic
reactions in human body
 system also plays a major role in fluid and electrolyte balance
Components of the urinary system
- Kidneys
- Ureters
- Urinary bladder
- Urethra

Kidneys
- Two brownish red, bean-shaped organs that are 12 cm long, 6 cm wide, and 3 cm thick
- Located behind the peritoneum at either side of the vertebral column at the level of
vertebrae TXII to LIII
- The right kidney is slightly lower than the left kidney due to the presence of liver
- Each kidney has two surfaces (anterior and posterior), two borders (medial and lateral),
and two poles (superior and inferior)

The anterior surface of the right kidney is mainly related to the liver, right colic flexure
(hepatic flexure), and duodenum
WHEREAS
The anterior surface of the left kidney is mostly related to the spleen, pancreas, left colic
flexure (splenic flexure), and stomach

The posterior surface of both kidneys is related to the diaphragm, psoas major,
quadratus lumborum, and transversus abdominis muscles

The lateral border is convex but the medial border is concave and houses the renal
hilum
1. The renal hilum is the entrance to the renal sinus, a space that contains the renal
vein, renal artery, renal pelvis, lymphatics, nerve fibers, and fat

The superior pole of the kidney is capped by the suprarenal (adrenal) gland and is
inclined towards the vertebral column whereas the inferior pole is farther from the
vertebral column
Coverings of the kidney
 these coverings provide mechanical protection or thermal insulation for kidneys or anchor
them in place

Kidneys are enclosed and associated with 4 distinct layers of fascia and fat:

1. The fibrous capsule is intimately attached to the kidney and partially extends to the
interior of the renal hilum to line the renal sinus
2. The perineal (perinephric) fat invests the kidney outside the fibrous capsule
3. The renal fascia separately surrounds the kidney and the suprarenal (adrenal) gland and
associated perineal ft
a. This fascia continuous inferiorly and blends with the fascia surrounding the
ureter
b. It is also continuous medially with the connective tissue surrounding the renal
vessels
4. The pararenal (paranephric) fat is located behind the kidney and cushions it

Internal features of the kidney

coronal section of kidney, internal features

- Inner region, medulla, outer region, cortex can be identified

 The medulla consists of 8 to 10 conical or triangular structures, the renal pyramids

o The base of each pyramid faces the cortex and its apex, the renal papilla, points
towards the renal hilum
 The cortex is bounded between the renal capsule and renal pyramids
o Extends between the renal pyramids to form the renal columns
o A renal lobe consists of a renal pyramid, the overlying are of renal cortex, and
half of the adjacent renal columns
 The production of urine occurs within the renal lobes
  Microscopic ducts within each renal papilla drain urine into a cup-shaped
space, the minor calyx
 Every 3-4 minor calyces coalesce to form a major calyx
 All major calyces join to form a large, funnel-shaped structure, the
renal pelvis that occupies most of the renal sinus and continues
as the ureter after the hilum of the kidney

Characteristics of the ureter

- 25 cm muscular tube that starts from the renal pelvis and ends at the urinary bladder
- Pelvic part of the ureter is crossed by the ductus deference in male and uterine artery in
female

The ureter has 3 constrictions in its course that are potential sites for obstruction by kidney
stones:
1. First narrowing is at the junction of ureter and renal pelvis
2. Second narrowing is where the ureter passes over the common iliac artery
3. Third narrowing is at the entrance to urinary bladder

- The ureters pass through the bladder wall at an oblique angle thus as the urinary
bladder fills with urine, the pressure within it compresses the opening of the ureters and
prevents the back flow of urine

External and internal features of the urinary bladder

- A hollow muscular organ, situated in true pelvis (when empty) behind pubic symphysis
- Located in front of rectum (in males) // in front of uterus and vagina (in females)
- When empty the urinary bladder is a 3-sided pyramidal structure with 3 surfaces
(superior, right inferolateral, and left inferolateral), a base, an apex, and a neck
- Superior surface is covered by peritoneum and is related to the sigmoid colon (in
males), uterus (in females), and coils of small intestine in both genders

In males:
- Peritoneum covering the superior surface of urinary bladder reflects on the anterior
surface of rectum and forms a peritoneal pouch, the rectovesical pouch

In females:
- Peritoneal layer reflects to cover the body of the uterus and then reflects on the
anterior surface of rectum to form the uterovesical and rectouterine pouches
respectively

- Inferolateral surfaces are related to the muscles of the pelvic wall and pelvic diaphragm

- The base (fundus), triangular in shape, receives the ureters at its superolateral angles
and gives rise to the urethra at its inferior angle
1. Related to the ductus deference, seminal vesicles, and rectum in males and to
the uterus and vagina in females

- The apex is located behind the pubic symphysis and is connected to the umbilicus by the
median umbilical ligament

- The neck is the most inferior part of the urinary bladder and is related to prostate gland
in males and external urethral sphincter in females

- The mucosal membrane lining the interior of the urinary bladder is thrown into folds
except on the base (fundus) of urinary bladder that forms a smooth inverted triangular
area known as the trigone

- The ureters open at the superior angles of trigon and the internal urethral sphincter
surrounding the internal urethra orifice is located at the inferior angle of trigone
The characteristic differences between the male and female urethra

Urethra – muscular tube that starts from the neck of the urinary bladder and opens to the
exterior at the external urethra orifice

Male urethra Female urethra

Male urethra:
- About 20cm long
- Consists of 4 parts:
1. The preprostatic (intramural) urethra starts from the internal urethral orifice
and passes through the neck of the urinary bladder
 The involuntary internal urethral sphincter surrounds this part of urethra
2. The prostatic urethra passes through the prostate gland and is the widest part of
the urethra
 The prostatic and the ejaculatory ducts open to this part of urethra
3. The membranous urethra is the narrowest and shortest part of urethra that
passes through the anterior part of pelvic floor and is surrounded by the
voluntary external urethral sphincter
4. The spongy (penile) urethra is the longest part of urethra that passes through
the bulb and corpus spongiosum of penis and ends as the external urethral
orifice
 The bulbourethral glands – part of the male reproductive system – open
into the spongy urethra

Female urethra:
- About 4 cm long
- Starts from the internal orifice at the neck of the urinary bladder  ends as the external
urethral orifice to the exterior below the clitoris as the vestibule
- The female urethra descends in front of the vagina and passes through the anterior part
of pelvic floor where it is surrounded by the voluntary external urethral sphincter
 Kidney and upper part of the ureter are
supplied by the renal artery
- Branches of the internal iliac artery
supply the lower part of ureter,
urinary bladder, and urethra
Vagus  CN X nerve

Chapter 10: Reproductive System

Lecture objectives:
1. Discuss the main differences between male and female reproductive systems
2. Name the different components of male and female reproductive systems
3. Explain the characteristics of testes
4. Describe the position and characteristics of epididymis and ductus (vas) deferens
5. Discuss the location and features of seminal vesicles, prostate gland, and bulbourethral
glands
6. Describe the structure of penis
7. Explain the characteristics of ovaries
8. Describe the position and characteristics of uterine tubes, uterus, and vagina
9. Discuss the supportive ligaments of uterus
10. Explain the female external genitalia
11. Describe the mammary glands

Main differences between male and female reproductive systems

1. Relation with urinary system
2. Location
3. Relation with peritoneal cavity

Male
- Not only related but also shares parts
of its ducts with the urinary system
- Most parts of the male reproductive
system are located outside the pelvis
- Male RS has no connection with the
peritoneal cavity
Female
- Anatomically related to the urinary
system
- Most of the female reproductive
system is located within the true
pelvic cavity
- Female RS connects the peritoneal
 cavity with the exterior as a conduit

Different components of male and female reproductive systems

Male Reproductive System

- Testes
- Series of ducts (epididymis, ductus (vas) deferens, and ejaculatory duct)
- Accessory sex glands (seminal vesicles, prostate, bulbourethral glands)
- Associated structures (penis and scrotum)

Testes
- Two flattened egg-shaped organs, 5 cm long, contained in scrotum
- Produces sperms and secrete male sex hormone  testosterone
- Each testis has two surfaces (lateral and medial), two borders (anterior and posterior),
and two poles (superior and inferior)
o Posterior border carries the hilum through which the testicular blood vessels,
lymphatics, and nerves enter or leave the testis
- Fibrous capsule, the tunica albuginea, covers the testis and invaginates into its posterior
border to form the mediastinum of the testis
- Testis is divided into about 250 lobules by the septa arising from the tunica albuginea
- Each lobule contains one to three tortuous seminiferous tubules
o These tubules produce sperms and eventually deliver them to the epididymis
- Testes develop in the abdominal cavity behind the peritoneum near the kidneys
- They descend via the inguinal canal and enter the scrotum before birth
- Spermatic cord that attaches to the superior pole of the testis

- Duct system stores and conveys sperms and contributes in their maturation
- Accessory sex glands produce the fluid part of the semen that nourishes, supports and
protects the sperms
- Penis transfers sperms into the female reproductive tract and the scrotum – a pouch of
skin suspended inferior to the perineum – supports and protects the testes
Epididymis
- Convoluted muscular tube, 6m long when uncoiled
- Composed of head, body, and tail parts
- Attached to the superior pole, posterior border, and inferior pole of testis respectively
- Head of epididymis indirectly receives sperms from seminiferous tubules and its tail is
continuous with ductus deferens
- The epididymis stores sperms (up to several months) and their maturation

Ductus (vas) Deferens

- 45 cm long muscular tube that starts from the tail of epididymis, ascends through the
spermatic cord and ends at the posterior surface (base) of urinary bladder
- Ascends through the spermatic cord and inguinal canal to enter the pelvic cavity
- Inside the pelvis, it passes over the ureter towards the base or posterior surface of the
urinary bladder
o Lies medial to the seminal vesicle and slightly dilates to form the ampulla of vas
deferens
- Ductus (vas) deferens narrows and joins to the duct of seminal vesicle to form the
ejaculatory duct

Seminal vesicles
- Two coiled tubular glands on either side of the midline, lateral to the ampula of the
ductus deferens, and are sandwiched between the anterior wall of the rectum and base
of urinary bladder
- Seminal vesicles produce about 60% of the volume of semen
- The duct of each seminal vesicle joins to the ductus deferens to form the ejaculatory
duct that pierces the posterior surface of the prostate and opens into the prostatic
urethra

Prostate
- Located behind the pubic symphysis and in front of the rectal ampulla
 - The base of the gland is related to the neck of the urinary bladder and its apex lies on
the external urethral sphincter
- The prostate surrounds the prostatic urethra and releases its secretions into it via
several short ducts

Bulbourethral Glands
- Two small pea-sized glands on either side of the membranous urethra
- Secretions of these glands, during sexual arousal, empty into the spongy urethra to
lubricate its lumen

Penis
Structure:
- Cylindrical organ that consists of an attached root and a free body
- The root of the penis is fixed and is formed by 3 masses of erectile tissue, a bulb in the
middle, and two crura one on each side
- The bulb of penis anchors to the membrane covering the inferior surface of the external
urethral sphincter and carries the spongy urethra
- Each crus attaches to the ischiopubic ramus
- The bulb and crura of penis are covered by the bulbospongiosus and ischiocavernosus
muscles respectively

- The bulb and crura continue anteriorly as the corpus spongiosum and the corpora
cavernosa respectively to form the body of the penis
- These columns of erectile tissue are completely invested by a thick layer of dense
connective tissue, the tunica albuginea
- The two corpora cavernosa are positioned on the dorsal aspect whereas the corpus
spongiosum is on the ventral aspect of the penis
- Anterior end of the corpus spongiosum enlarges to form the glans of penis that reflects
on the anterior ends of the corpora cavernosa
- The spongy urethra passes through the corpus spongiosum and opens to the exterior at
the glans
 - A loosely fitting fold of skin, the prepuce covers the glans of the penis

Female Reproductive System

- Pair of ovaries
- Pair of uterine tubes
- Uterus
- Vagina
- External genital organs
- Mammary glands or breasts may also be considered as parts of the female reproductive
system

Characteristics of ovaries
- Two almond-shaped organs
- 3 cm long, 1.5 cm wide, and 1 cm thick, located on the lateral wall of the true pelvic
cavity
- Ovaries produce the female gametes (ovum) and female hormones (estrogen and
progesterone)
- Each ovary has two surfaces (lateral and medial), two borders (anterior and posterior),
and two poles (superior and inferior)
- The anterior border of the ovary attaches to mesovarium, whereas the posterior border
is free. The ovarian hilum is located on its anterior border where the ovarian blood
vessels, nerves, and lymphatics enter or exit the ovary
- The ovarium hilum is located on its anterior border where the ovarian blood vessels,
nerves, and lymphatics enter or exit the ovary
- The ovarian surfaces are smooth before puberty and become rough afterward due to
ovulation

Each ovary is held in place by the following ligaments:

1. The ligament of the ovary attaches the inferior pole of the ovary to the lateral wall of
the uterus, near the entrance of the uterine tube
 2. The suspensory ligament is a double-layer fold of peritoneum that attaches the superior
pole of the ovary to the posterior abdominal wall
a. This ligament carries the ovarian vessels and nerves from the posterior
abdominal wall to and between the two layers of the broad ligament
3. The mesovarium is a double-layer fold of peritoneum stretched between the anterior
border of the ovary and the posterior layer of the broad ligament
a. It carries the ovarian vessels, nerves and lymphatics from the broad ligament
into the ovary via ovarian hilum.

Position and characteristics of uterine tubes, uterus, and vagina

Uterine (Fallopian) tubes or Oviduct
- Uterine tubes are 10-cm muscular tubes located on the superior border of the broad
ligament
- Uterine tube connects the uterine cavity to the peritoneal cavity and carries sperms
towards the ovaries or the fertilized egg towards the uterine cavity
- This tube is divided into infundibulum, ampulla, isthmus, and uterine parts

1. The infundibulum is the funnel-shaped lateral end of the tube that hangs over the ovary
a. The free margin of the infundibulum carries some finger-like projections, the
fimbriae, one of which, the ovarian fimbria, is longer and attaches to the ovary
b. The infundibulum collects the released ovum from the surface of the ovary
2. The ampulla is the most dilated part of the uterine tube forming the lateral 2/3 of
uterine tube
3. The isthmus is the narrowest part of the uterine tube that forms the medial 1/3 of it
4. The uterine part (intramural) passes through the thickness of the uterine wall and
opens into the uterine cavity

Uterus
- Inverted pear-shaped hollow organ with thick muscular walls that accommodates and
nourishes the fertilized ovum
- Part of the passageway for the sperms’ journey toward the ovaries, and also the source
of menstrual flow
- Has two surfaces (superior and inferior) and two lateral borders
- Both surfaces are covered by peritoneum and related to the sigmoid colon and small
intestine loops (superior surface) and urinary bladder (inferior surface)

Divisible into the following parts:

1. The fundus is that part of the uterus located superior to the entrance of the uterine
tubes
2. The body is the middle part of the uterus located between fundus and cervix (neck)
a. The distal third of the body is known as the isthmus
3. The cervix (body) extends between the isthmus and vagina

- The uterine cavity is a triangular in a coronal section and connects with the cervical
canal via an opening, the internal os.
- The cervical canal in turn opens into the vagina through the external os
- The uterus arches anteriorly over the empty urinary bladder and forms the following
angles:

o The angle between the axis of the cervix and the axis of the vagina opens
anteriorly and is known as the anteversion angle
o The angle between the axis of the uterine body and the axis of the cervix is
known as the anteflexion angle
Supportive ligaments of uterus

 the weight and position of the uterus is supported and maintained by the following
ligaments on either side

1. The broad ligament is a double-layer membrane made by the peritoneum that extends
from the lateral border of the uterus to the lateral pelvic wall and pelvic floor
a. Contains the uterine tube on its superior border and the ligament of ovary and
round ligament of uterus inferior to the uterine tube
b. The part of the broad ligament, between the uterine tube and is known as the
mesosalpinx
c. Major part of the broad ligament, inferior to the mesosalpinx and mesovarium,
serves as a mesentery for the uterus and is referred to as the mesometrium
2. The round ligament of uterus starts from the superolateral angle of the uterus, passes
through the inguinal canal, and blends with the connective tissue of the labium major
3. The transverse cervical (cardinal) ligament connects the uterine cervix and the superior
part of the vagina to the lateral pelvic wall
4. The pubocervical ligament anchors the cervix of the uterus to the posterior surface of
the pubis
5. The uterosacral ligament extends from the inferior part of the anterior surface of the
sacrum to the cervix and superior part of the vagina

Vagina
- 10 cm fibromuscular tube that starts at the vestibule, runs posterosuperiorly, between
the rectum and urinary bladder, to end to the cervix of the uterus
- The hymen, a thin mucus membrane, partially closes the entrance of the vagina
- Vagina is usually collapsed; therefore, its anterior and posterior walls are in contact,
except the proximal end where it surrounds the cervix of the uterus to form a circular
recess, the fornix
o  the fornix is subdivided into the anterior, posterior, and two lateral parts
Female external genitalia

- The female external genitalia, the vulva or pudendum, include the mons pubis, labia
majora, labia minora, vestibule, clitoris and greater vestibular glands

 Mons pubis is a skin prominence in front of the symphysis pubis that contains fat

 Labia majora are two skin folds that contain fat and are covered by coarse hairs after
puberty

 Labia minora are two hairless skin folds partially concealed by the labia majora on the
outside

 Vestibule is the cleft between the two labia minora. It receives the openings of the
urethra anteriorly and vagina posteriorly

 Clitoris is homologous to the penis located at the anterior end of the vestibule.
o has a root and a body
o the root is formed by the left and right crura and right and left bulbs of the
vestibule
 o the crura and bulbs of vestibule continue anteriorly to form the corpora
cavernosa and glans of clitoris respectively in the body of the clitoris
o an extension of the labia minora encircles the body of the clitoris on either side
to form the prepuce of the clitoris

 Greater vestibular glands are a pair of glands deep to the skin and posterolateral to the
vestibule and are homologous to the bulbourethral glands in males
o they release their secretion by means of small ducts into the vestibule
posterolateral to the vaginal orifice to lubricate the vagina during sexual arousal

Mammary glands (breasts)

- modified sweat glands located within the hypodermis (superficial fascia) of the pectoral
region
- relatively round base of each breast is extended vertically between the rib II to VI and
transversely between the sternum and midaxillary line
- each breast has a conical projection, the nipple, which is surrounded by a circular
pigmented skin, the areola

Each mammary gland consists of a number of lobes that are drained by individual ducts which
open into the nipple
- the bands of connective tissue between the mammary gland lobes, the suspensory
ligaments of the breast, arise from the skin and attach to the deep fascia covering the
pectoralis major muscle
o these ligaments support the weight of the breast

Blood supply of the Female and Male reproductive organs

- Branches of internal thoracic artery, anterior and posterior intercostal arteries, and
axillary artery supply blood for the breast
- The fourth to sixth intercostal nerves provide general sensory innervation of the skin of
breast
 o These nerves also carry the sympathetic fibers to supply the smooth muscle
fibers in the wall of the blood vessels, areola, and nipple

Chapter 11: Endocrine System

Lecture Objectives:
1. Compare the nervous and endocrine systems from functional point of view
2. Name the major components of the endocrine system
3. Explain the main features of the pituitary gland
4. Describe the pineal gland
5. Discuss the thyroid and parathyroid glands
6. Explain the suprarenal glands

Comparison of nervous and endocrine system

- EC and NS cooperate together to regulate different functions of other organ systems

- Effects of NS activation are usually brief and fast compared to the endocrine system that
generates slower and long-lasting responses
- The NS generally targets specific organ systems whereas the influence of the endocrine
system is much broader and targets virtually all organ systems
- The secretions of the endocrine glands, the hormones, are directly released into the
bloodstream and circulate throughout the body

Nervous System Endocrine System

- Effects of NS activation are usually - Generates slower and long-lasting

brief and fast responses
- Targets specific organ systems - Influence of the endocrine system is
much broader and targets virtually all
organ systems
 - Secretions of the endocrine glands,
the hormones, are directly released
into the bloodstream and circulate
throughout the body

Major components of endocrine system

Major endocrine glands: Organs that are not considered as glands

but contain cells that produce hormones:
- Pituitary
- Thyroid - Heart, Liver, Pancreas, Stomach,
- Parathyroid Intestine, thymus, ovaries, testes,
- Pineal glands skin, hypothalamus, skin, and
- Adrenal glands placenta
 they all produce a wide variety of hormones

Main features of the pituitary gland, or hypophysis

- Oval-shaped structure (~1.5cm)

- Located in the hypophyseal fossa of sphenoid bone in the middle cranial fossa
- Pituitary gland regulates the secretion of most of the other glands and in turn is
controlled by the hormones of the hypothalamus
- The arterial circle of Willis (blood supply) supplies pituitary gland
o Function of this gland is primarily regulated by the hormonal feedbacks through
the hypothalamus

- Sits in the pituitary fossa of sphenoid bone

- Hypothalamus sits above the pituitary gland and physically connected by infundibulum
- Optic chiasm
- Divisions of the pituitary gland:
o Posterior pituitary (neurohypophysis)
 o Anterior pituitary (adenohypophysis)
 Pars tuberalis
 Pars distalis
 Pars intermedia

Describe the pineal gland

The pineal gland or epiphysis cerebri is a small,

red, cone-shaped structure that attaches to the
posterior wall of the third cerebral ventricle

- Its secretions control the circadian rhythm

and distribution of the melanin pigments in
the skin
- This gland may be calcified in elderly people
- Posterior cerebral artery supplies this gland
and its function is controlled by hormonal
feedbacks

Discuss the thyroid and parathyroid glands

Thyroid gland:
- Butterfly-shaped thyroid gland is situated in the neck, anterior to the trachea and
inferior to the larynx
- Consists of two lateral lobes connected together by isthmus, a slender connection
anterior to the trachea at the level of the 2nd or 3rd cartilage rings of trachea
- Thyroid hormones regulate either the metabolic rate of the body or the blood calcium
level
- 2 sources of blood to the thyroid
 o Superior thyroid artery from the external carotid
o Inferior thyroid artery from subclavian

 Parathyroid gland

Parathyroid glands:
- Usually four pea-sized reddish-brown mass of glandular tissue partially embedded
within the posterior surface of the lateral lobes of the thyroid gland
- Parathyroid hormone cooperates with the thyroid hormone (calcitonin) in blood calcium
level regulation
- The superior and inferior thyroid arteries branches of the external carotid and
subclavian arteries supply both thyroid and parathyroid glands
- The activities of these glands are regulated by the hormonal feedbacks or the level of
blood calcium

Explain the suprarenal glands

- Suprarenal or adrenal glands are located on the superior pole of the kidneys while
surrounded by a separate capsule
- Right gland is pyramidal-shaped
 - Left gland is crescent-shaped
- Coronal section of the gland:
o Superficial cortex and a deep medullary part can be identified
- Hormones of the cortex contribute in balancing the level of sodium and glucose or
regulation of sexual activities WHEREAS the hormones of the medullary part mimic the
function of the sympathetic nervous system

- Suprarenal glands are supplied by several branches mainly arising from abdominal aorta
and renal arteries
- Function of the cortex of the gland is regulated by the hormonal feedbacks WHEREAS
the activity of the medullary part of the gland is controlled by the preganglionic
sympathetic fibers carried by greater, lesser, and least splanchnic nerves
- The cells of the medullary part of the suprarenal gland (chromaffin cells) are modified
neurons that act as postganglionic sympathetic neurons

Chapter 12: Special Senses

Lecture objectives:
1. Describe the different layers of the eyeball
2. Explain the inner space of the eyeball and its subdivisions
3. Discuss the structure of the eyelid
4. Define the lacrimal apparatus and its components
5. Describe the main features of the middle ear
6. Identify the major characteristics of the inner ear

Eyeball is supported and protected by the accessory structures – eyelids, extraocular muscles,
and lacrimal apparatus

Layers of eyeball:
- Surrounded by a layer of loose connective tissue that allows its relatively free
movement within the orbital cavity
Structure of eyeball:
 Sclera: dense irregular connective tissue
o Anteriorly continuous as cornea
 Choroid: vascular layer
o Anteriorly gives rise to ciliary body and iris
 Retina: neural layer
o Axons come together to make optic nerve
o Ora serrata end of neural aspect of retina

3 layers:
1) Fibrous layer (tunic) is the outermost layer and its posterior five sixths, the sclera, is
made up of whitish dense connective tissue
a. the sclera protects the inner parts of the eyeball, serves as the attachment site
for extraocular muscles and maintains the shape of the eyeball
b. optic nerve and blood vessels penetrate the posterior aspect of the sclera
c. anterior one sixth of the fibrous layer, the cornea, is transparent, lacks blood
vessels, and is covered by the conjunctiva
d. it is convex anteriorly thus contributing in focusing the light onto the retina
2) vascular layer is then middle layer of the eyeball and consists of 3 parts
a. the choroid forms the posterior five sixth of the vascular layer and lines the inner
surface of the sclera, it is highly vascularised and nourishes the retina. The
choroid carries melanin pigments that absorbs the light rays and prevents the
reflection of light within the eyeball.
b. The ciliary body is the anterior continuation of the choroid that secretes the
aqueous humour and modifies the convexity of the lens. The core of the ciliary
body is formed by the circular smooth muscle fibres, the ciliary muscle.
c. The suspensory ligaments are delicate fibres stretched between the inner
surface of the ciliary body and the circumference of the lens. The contraction or
relaxation of the ciliary muscle alters the convexity of the lens to adapt for near
and far visions respectively.
d. The iris is the anterior one sixth of the vascular layer and forms a vertical disc in
front of the lens and behind the cornea. The parasympathetic activation
contracts the circular muscle fibers that entails constriction of the pupil. The
sympathetic activation contracts the radial muscle fibers that leads to dilation of
then pupil.
3) The nervous layer is composed of two parts: the posterior ¾, the retina, carries
photoreceptors that are sensitive to light. The anterior ¼ doesn’t have any
photoreceptor but carries pigments and lines the ciliary body and the posterior surface
of the iris.
a. The optic nerve leaves the retina at the optic disc which lacks the
photoreceptors. The macula lutea is situated lateral to the optic disc and is very
sensitive to the light due to abundance of colour detecting photoreceptors. The
 highest concentration of these photoreceptors is at the center of the macula
lutea, the fovea centralis.

Schematic view of sagittal section of eye:

- To see an object close to eye, you need to contract ciliary body (parasympathetic)
o This results in loosening of the suspensory ligaments
- When looking at an object 60m or more, the ciliary body relaxes and stretches
suspensory ligaments (sympathetic)

Iris
- Sphincter pupillae (parasympathetic)
o Contraction reduces diameter of pupil
- Dilator pupillae (sympathetic)
o Contraction dilates the pupils

Inner space of the eyeball and its subdivisions

3 spaces inside the eyeball – anterior chamber & posterior chamber (continuous through pupil),
and the vitreous chamber

- Anterior chamber and posterior chamber

 o Filled with aqueous humour produced by ciliary body
o Drainage of aqueous humour through scleral venous sinus at junction of cornea
and sclera
- Vitreous chamber

1) Anterior chamber – lies between cornea and the iris

a. Filled with the aqueous humour, a clear fluid that cushions the lens and cornea
and provides a transport system for nutrients and waste materials
2) Posterior chamber – lies behind the iris and in front of the lens
a. this space is continuous with the anterior chamber through the pupil and is
similarly filled with the aqueous humour
b. aqueous humour is secreted by the ciliary body and after filling the posterior
chamber, flows through the pupil and fills the anterior chamber
i. eventually drains into the scleral venous sinus, the canal of Schlemm, at
the junction of the sclera and cornea
ii. the aqueous humor undergoes constant turnover

3) Vitreous chamber – lies between the lens and the retina and is occupied by a clear jelly-
like substance, the vitreous body (vitreous humor)
a. It helps maintain the shape of the eyeball, cushions the lens, and holds the retina
against the choroid
b. The vitreous body is formed during the embryonic life and unlike the aqueous
humor does not undergo constant turnover

Structure of the eyelid

Eyelid (aka palpebrae) are thin skin folds in front of the eyeball that protect the eye against
excessive light and foreign objects
 - Core of eyelids formed by a fibroelastic plate, the tarsal plate, and skeletal muscles
- Inner surface of the eyelids is lined by the conjunctiva, a mucous membrane that
reflects on the eyeball to cover the cornea
- Eyelashes, sweat glands, and sebaceous glands are found at the free margin of the
eyelids

Lacrimal Apparatus and its components:

Lacrimal Apparatus – comprised of a group of structures that produce and drain tears.
- Innervated by CN VII
- Lacrimal canaliculi
o Ducts that collect tears
o Lacrimal sac – nasolacrimal duct  inferior nasal meatus

These structures include:

a) Lacrimal gland, (~size and shape of an almond), occupies the superolateral part of the
orbital cavity. It releases the tears on the surface of the eye. The tears are swept across
the ocular surface by blinking movements of the eyelids and are collected at the medial
corner of the eye
 b) Lacrimal canaliculi are a pair of small tubes on the medial corner of the eye that drain
the tears into the lacrimal sac. The opening of the lacrimal canaliculi is known as the
lacrimal punctum
c) Lacrimal sac is a membranous sac that fills the lacrimal groove of the lacrimal bone and
receives the tears from the lacrimal canaliculi
d) Nasolacrimal duct is the distal continuation of the lacrimal sac which empties into the
lateral wall of the nasal cavity at the inferior nasal meatus

EAR
External ear:
- Auricle
- External acoustic meatus
- Ends to tympanic membrane

Describe the main features of the middle ear

- Middle ear, tympanic cavity, is an irregular cubic space contained within the petrous
part of the temporal bone
o 3 ossicles: Malleus, incus, and stapes bones, that amplify and convey the sound
from the tympanic membrane to the inner ear
 Synovial joints between bones
o Oval window and round window
o Two small skeletal muscles: tensor tympani and stapedius are also contained in
the middle ear and their function is to dampen the sound
 Tensor tympani attaches to malleus (CN V)
 Stapedius (CNVII)
o Auditory tube

Middle ear
 Inner ear

Identify the major characteristics of the inner ear, labyrinth

- The sound waves are converted to the electrical impulses and conveyed to the brain
- Contains the organ of balance
- Includes the osseous and membranous divisions
- Bony labyrinth – a series of boney cavities
o 3 main regions
 Semicircular canals (3) – three tubes that open into the vestibule
 Vestibule – connected to the middle ear (via the ovale window)
 Cochlea – shell-shaped part of the bony labyrinth
 Lumen of this tube is partially divided into two sections by a bony
septum (lamina)
o The scala vestibuli is located in the upper section of the
lumen that ends to the fenestra vestibuli (ovale window)
- The bony labyrinth contains the perilymph  a fluid similar to CSF. This fluid surrounds
the enclosed membranous labyrinth
-
o Membranous labyrinth: inside the bony labyrinth, filled with endolymph and
surrounded by perilymph
 Membranous semicircular ducts occupy semicircular canals
 Ampula containing sensory organ crista
  Crista carries the equilibrium receptors
 Utricle and saccule occupy the vestibule
 Maculae are sensory organs of utricle and saccule
 Cochlear duct
 Carries the organ of hearing, known as the organ of corti that
gives rise to the cochlear nerve
 Sensory organ called spiral organ
 Filled with endolymph
 Scala vestibuli and tympani filled with perilymph