UPPER LIMB

Brachial artery – major blood vessel of upper arm

Brachial plexus

Plexus :- network of nerve supplying to the upper brachial

Origin :-ventral rami of C5-T1

It consist of (Mn:-Reach To Drunk Cold Beer)

1) Roots
2) Trunk
3) Division
4) Cords
5) Branches

Roots:- ventral rami of C5-T1

Trunk

1) Upper Trunk:-formed by union of C5-C7

2) Middle Trunk:- Combination of C7
3) LowerTrunk:- formed by union of C8-T1

Brachail plexes

Ventral root Trunk Division cords

Suprascapular nerve lateral

C5 anterior
Upper trunk
C6 posterior
Nerver to subclavis
anterior meidal
C7 middle trunk cord
posterior
C8 anterior
Lower trunk post.
T1 posterior cord

Lateral cord Medial cord Posterior cord

 Lateral pectoral
Musculocutaneous nerve
lateral root of median
medial pectoral Upper subscapular ,
Medial cutaneous of Thoracodorsal ,
forearm Medial cutaneous Lower subscapular
of arm Medial root of Axillary nerve
Median nerve Ulnar Radial nerve
nerve

Divisions:- all the trunk divides into anterior and posterior divisions

Cords:-it is formed by union of posterior division of upper,middle and lower

1) Lateral cords
2) Posterior cords
3) Middle cords

Note :- roots and trunks are supraclavicular division /cords. branches are infraclavicular

The names of the cords are given upset to second part of axillary artery.

Root values

Lateral cord:- C5,C6,C7

Medial cord:- C8,T1 Except ulnar because ulnar gets additional value for C7

Posterior cord:-

1) Upper scapula
2) Lower scapula C5,C6
3) Axillary

Nerve to latismus dorsi C5,C6,C7

Radial nerve C5,C6,C7,C8,T1

Abnormalities in brachial plexus

ERB’s point
- Upper trunk
- 6 nerves will meet
Root of C5 Supra-scapular nerve Anterior division of upper trunk

Root of C6 Nerve to subclavius Posterior division of upper trunk

 - ERB-DUCHENE PARALYSIS- d/t external lateral flexion
-
ERB PARALYSIS
- Injury to upper part of brachial plexus
- Root involves C5,C6
- Nerve involve axillary , Musculocutaneous nerve,Suprascapular nerve
- Cause - Birth injury
- Sign
1) Arm - adducted + medial rotation
2) elbow joint – extended
3) forearm – pronated
4) wrist - flexed
5) police man / waiter tip

Klumpkes palsy
1) Injury to lower trunk of bracheal plexus
2) Root involves C8T1
3) Nerve involve ulnar nerve and median nerve
4) Cause –hyperabduction of arm
5) Deformity-claw hand
6) Hyperextension at metacarpal phalangeal joint
7) Flexion at interphalangeal joint

Winging scapula-injury of Long thoracic nerve C5,6,7( case of)

- Medial border of scapula become more prominent
- Serratus muscle affected
Major nerve

anterior compartment- musculocutaneous nerve

Arm
posterior compartment- radial nerve

Anterior compartment -Ulnar nerve , medial nerve

forearm
Posterior compartment - radial nerve

muscle of hand ulnar nerve , ,medial nerve

Axillary nerve deltoid muscle , teres minor

Minor Nerve Muscle supplies

1. Lateral pectoral nerve Pectoralis major
2. Medial pectoral nerve
3. Medial pectoral nerve Pectoralis minor
4. Seratus anterior Long thoracic nerve C5,6,7( case
of winging scapula)
Muscle joining the vertebral
column to upper limb 5 muscle
5. Trapezius Supplied by spinal XI
6. Rhomboidus major Dorsoscapular nerve
7. Rhomboidus minor
8. Levator scapulae
9. Lattismus dorsi climbing or Thorcodorsal nerve
swimming muscle
Muscle of scapular region
10. Supraspinatous Suprascapular nerve
11. Infrasoinatous
12. Teres minor Axillary nerve
13. Subscapularis Subscapular nerve
14. Teres major

Musculocutaneous nerve -C5,C6,C7

⚫ Origin -L.C of brachial plexus
⚫ Supplies -anterior compartment of arm
① Coracobrachialis
② Biceps brachi
③ Brachialis
Note
➢ Musculocutaneous nerve pierces corcabrachialis
➢ Brachialis nerve -medial 1/2 →musculocutaneous nerve and lateral 1/2 -
Radial nerve
➢ Composite muscle or hybrid Muscle -muscle supplied by 2 nerve
➢ It continues as lateral cutaneous nerve of forearm
Axillary nerve -C5 C6
⚫ Origin -posterior cord of brachial plexus
⚫ Supply to
① Deltoid muscle
② Teres minor

Anterior fiber lateral fibers Posterior fiber

Origin clavicle acromion spine of scapula
insertion Deltoid tuberosity of humerus
nerve supple Axillary nerve
action Flexion and abduction of arm extension and
medial rotation of 50°-90° lateral rotation of
arm arm

Abduction of arm
⚫ 0°-15°-supraspinatous muscle
⚫ 15°-90°- deltoid muscle
⚫ 90°-180°- Trapezius and serrutus anterior →over head abduction

Nerve related to humerus

① Axillary nerve -behind surgical neck
② Radial nerve - passing through spiral / radial groove profunda brachii
artery
③ Ulnar nerve- behind medial epicondyle

Quadrangular space
⚫ Boundaries
① Superiorly -T. Minor
② Inferiorly - T. Major
③ Medially - Long head of triceps
④ Lateral - surgical neck of humerus
⚫ Structures passing
① Axillary nerve
② Posterior circumflex of humeral artery
Lower triangular space
⚫ Boundaries
① Superiorly - T. Major
② Medially - Long head of triceps
③ Lateral - shaft of humerus
⚫ structure passing
① Radial nerve
② Profunda branchial artery

Upper triangular space

⚫ Boundaries
① Superiorly -T. Minor
② Inferiorly - T. Major
③ Lateral - Long head of triceps
⚫ Structure Passing
① Circumflex scapular artery

Injury to axillary nerve lead to

① Atrophy Of deltoid muscle
② loss of round shape of scapula
③ Weakness of abduction of arm > 15°
④ Loss of sensation from upper lateral side of arm -Regimental sign

Ulnar nerve -C7,C8,T1

⚫ 15 muscle of hand + 2 muscle of arm
⚫ Musician Nerve
⚫ Supplies to
① Arm - no supply
② Forearm -medial 1/2 muscle of anterior compartment
a) Flexor carpi ulnaris
b) Flexor digitorum profunda
Note - Flexor digitorum profunda is hybrid or composite → medial 1/2 -ulnar
nerve and lateral 1/2 -medial nerve

Muscles of the Hand - 20 muscle

Thenar
1. flexor pollicis brevis
2. abductor pollicis brevis
3. opponens pollicis
4. adductor pollicis
Hypothenar
1. abductor digiti minimi
2. flexor digiti minimi
3. opponens digiti minimi
4. Palmaris brevis

4 lumbricals ( meddle part of hand )→ L1,L2,L3,L4

4 palmar intevossi ( below lumbricals )→ P1,P2,P3,P4
4 dorsal intevossi ( below PI) → D1,D2,D3,D4

Ulnar supplies to 15 muscle

① Hypothenar
② L3,L4
③ 4 palmar intevossi
④ 4 dorsal intevossi
⑤ adductor pollicis

Median nerve
⚫ Labourers muscle
⚫ Eye of hand
⚫ Origin lateral cord and medial cord of brachial plexus
⚫ Supplies to
 ① Arm - no supply
② Forearm -all muscle of anterior compartment except medial 1/2 muscle
⚫ muscles of hand - 5
① flexor pollicis brevis
② abductor pollicis brevis
③ opponens pollicis
④ L1,L2

Radial nerve
⚫ Origin -posterior cord of branchail plexus
⚫ Supplies to
① posterior compartment of arm
a) Long head
b) Lateral head
c) Medial head
② Posterior compartment of forearm - all extensor

✓ Partial claw hand -ulnar nerve

✓ Complete claw hand - ulnar nerve +median nerve
✓ Wrist drop -radial nerve
✓ Saturday night palsy -radial nerve

Sensory supply
Cubital fossa
⚫ it is a triangular depression in front of elbow joint
⚫ Lateral -brachioradialis
⚫ Medial -pronator teres
⚫ Floor- brachialis muscle and supinator muscle
⚫

Content of cubital fossa

• M: median nerve
• B: brachial artery
• T: tendon of biceps
• R: radial nerve
• P:posterior interosseous branch of radial nerve

Type of joint
Fibrous joint cartilaginous synovial
1. Suture 1. 1°Cartilaginous / 1. Ball and socket
 2. Gomphosis -between synchondrosis 2. Hinge
tooth and socket 2. 2°Cartilaginous 3. Condylar
3. Syndesmosis /symphysis 4. Bicondylar
5. Saddle
6. Ellipsoid
7. Plane
8. Pivot

Joint of upper limb

1. Sternoclavicular joint -saddle
2. Acromioclavicular joint -plane
3. Shoulder -ball and socket
4. Elbow joint -Hinge
5. Radiounlnar joint
a) Superior and inferior-pivot
b) Middle -syndesmosis
6. Wrist joint -ellipsoid

Carpal bone
(Lateral to medial )
1. Scaphoid
2. Lunate
3. Triquetrum
4. Pisiform
5. Trapezium
6. Trapezoid
7. Capitate
8. Hamate

Largest carpel bone -Capitate

Smallest carpal bone- Pisiform
Most common fracture - Scaphoid
Most common dislocated- Lunate
Carpal tunnel

Boundaries
• superficial border (roof): flexor retinaculum
• deep border (floor): carpal bones
Contents
• flexor digitorum superficialis tendons (four)
• median nerve (laterally)
• flexor pollicis longus tendon (laterally)
• flexordigitorum profundus tendons (four)

✓ Carpal tunnel syndrome-medial nerve

✓ Cubital tunnel syndrome-ulnar nerve
✓ Guyon’s canal syndrome-ulnar nerve

Anatomical snuff box

Boundaries
• floor
① scaphoid, trapezium bones
② base of 1st metacarpal
③ radial styloid process
• medial: tendons of the extensor pollicis longus
• lateral: tendons of the extensor pollicis brevis
Contents
• radial artery
 NeuroanAtomy

Nervous system
CNS PNS
⚫ Brain ⚫ cranial Nerve - 12 pairs
⚫ Spinal cord ⚫ Spinal nerve - 31 pairs
⚫ Cervical spinal nerve- 8 pair
⚫ Thoracic spinal nerve- 12 pairs
⚫ Lumber spinal nerve - 5 pairs
⚫ Sacral spinal nerve - 5 pairs
⚫ Cocygeal spinal nerve - 1 pairs
Ventricle of brain
Formation of CSF
➢ Formation- choroid plexus (network of capillaries)
➢ Volume- 150ml
➢ Formed per day - 500-600ml/day
Lateral ventricle
 foramen of monro
3rd ventricle
 Aqueduct of sylvius
4th ventricle
Formen of luschka/megenda
Subarachnoid space
 arachnoid villi
Dural venous sinus

Spinal cord
➢ extend - C1-L1 (lower border of L1 )-adult
C1-L3 (upper border of L3 ) - child
➢ length-45cm male and 42 male
➢ Shape -cylindrical
Transverse section of spinal cord

The gray matter is made up of neuroglia cells and neuron cell bodies. The white
matter is made up of neuron axons, mostly but not all myelinated.

White matter -bundle of axon in CNS

Association fibers commissure projection of fiber
connects different lobe in connect same lobe but in connect different
same hemisphere different hemisphere functional areas in brain
and spinal cord

Grey matter
⚫ Collection of cell bodies in CNS
① Cerebral cortex
② Basal ganglia

Association fiber
Short Association fiber
1. Arcute fasiculus
long Association fiber
1. Superior longitudinal fasiculus
2. Inferior longitudinal fasiculus
3. Uniciate fasiculus
4. Cingulum
Commissure fiber

Corpus callosum (largest)

1. Splenium
2. Trunk (body)
3. Genu
4. Rostrum
Projection fiber
① Corona radiate
② Internal capsule
③ Tracts
a) Descending tract-motor
b) Ascending tract -sensory

Descending tract

Pyramidal tract
⚫ Aka corticospinal tract
⚫ Origin -beginning from superiolateral surface
⚫
Dorsal column
⚫ Fine touch
⚫ Vibration
⚫ Stregnosis - ability to understand the things ,by touching without seeing
⚫ Proprioceptio- awareness of limb
Cerebral cortex
⚫ Brodman areas
1. Primary visual area: 17
2. Visual Association area: 18,19
3. Primary motor area: 4
4. Pre motor are -6
5. Primary somatosensory area-3,1,2
6. Somatosensory Association area- 5,7
7. Broca’s speech area -44,45 (motor)
8. Wernicke’s speech area -22,39,40 (sensory)
9. Primary auditory area-41,42
10. Auditory Association area -22
Basal ganglion
1. Corpus striatum - telencephalon
a) Caudate nucleus
b) Lentiform nucleus
i. Putamen
ii. Globus pallidum
2. Subthalamic nucleus - diencephalon
3. Substantia nigra - mesencephalon

Brain stem
① Mid brain
 ② Pons
③ Medulla

Ventral aspect of brain stem

Dorsal aspect pf brain
Transverse section of midbrain

Cranial nerve
Longest - X
Shortest -I Olfactory Nerve
Largest - V
Smallest - IV
Thickest - V
Thinnest - IV
Longest intracranial course -IV
Longest intradural course-VI
Longest intrapsseous course -VII
Dorsal origin -IV
M/c involved in increase ICP-VI
M/C involved in intracranial aneurysm- III
Largest distribution - X
Cerebellum- 6 lobes
➢ cerebral hemisphere

➢ Flocculonodular lobes- smallest

Cerebellar cortex
➢ 3 layer -5 type of cells
➢ Outer -stellate cells, basket cells
➢ Middle-purkinjie cells
➢ inner - golgi cells, granular cells

Deep nuclei
➢ dentrate nucleus-largest nucleus
➢ Emboliform nucleus
➢ Fastigial nucleus-medial most
➢ Globose nuclus
Circle of willis

Branches of vertebral artery

1. Anterior spinal artery -1
2. Posterior spinal artery-2
3. Posterior inferior cerebellar artery -PICA
4. Medullary branches
5. Meningeal branches

Branches of basilar artery

1. Anterior inferior cerebral artery
2. Superior cerebral artery
3. Posterior cerebral artery
4. Pondire atery

Branches of internal carotid artery

1. ACA
2. MCA
3. Posterior communicating
4. Ophalathamic artery- 1st branch
5. Anterior choroidal Artery
Head and neck
Cranial fossa

Cranial foramen structure passing

1. Cribriform plate cranial nerve - I
2. optic canal CN II,ophthalmic artery
3. superior orbital fissure CN III ,IV ,VI ,V1,ophthalmic vein
4. Foramen rotundum CNV2
5. foramen ovale CN V3
6. foramen spinosum ⚫ Mandibular nerve V3
⚫ Acc. Meningeal artery
⚫ Lesser petrosal nerve
⚫ Emissery vein
7. foramen lacerum intercartoid artery
8. internal acoustic meatus CN VII ,VIII
9. jugular foramen IX,X,XI
10. hypoglossal canal XII
11. foramen magnum medulla , vertebral artery , CNXI

Muscle of mastication
① Masster -elevation of mandible
② Temporalis -eleven of mandible
③ Lateral pterygoid -depression of mandible/opening jaw
④ Medial pterygoid -elevation of mandible
⚫ Nerve Supply-mandibular nerve
⚫ Accessory muscle mastication -buccinator

Accessory nerve XI
⚫ Accessory nerve pass through foramen magnum, jugular foramen
⚫ Supplies to SCM,trapezius

Hypoglossal nerve XII

⚫ All muscle of tongue supplied by Hypoglossal nerve XII except palatoglossus
muscle -VAC nerve

Tongue
Muscle of tongue
Intrinsic 4 pairs extrinsic 4 pair
⚫ superior longitudinal muscle ⚫ genioglossus (largest muscle)-
⚫ Inferior longitudinal muscle safety musccle
⚫ Transverse muscle ⚫ Styloglossus
⚫ Vertical muscle ⚫ Paletoglossus (not a true muscle
of tongue)
⚫ Hyoglossus

Nerve supply to tongue

① Motor- all muscle Of tongue -XII excepts paletoglossus
② Sensory
a) anterior 2/3rd of tongue →Taste -special →corda tympani branch of facial
nerve
b) anterior 2/3rd of tongue →General →lingual branch of mandibular nerve
→trigeminal nerve
1. All muscle of larynx supplied by RLN ,Except cricothyroid muscle which
supplied by ELN
2. All muscle of pharynx supplied by VAC ,Except Cricoparyngeous muscle which
supplied by RLN and stylopharyngeaous muscle which supplied by IX
3. All muscle of palate supplied by -XII except Tensor veli palatine which supplied
by VAC
4. All muscle of mastication supplied by

Head and neck embryology

Ectoderm cleft Derivation

1 external acoustic meatus
2,3,4 closed

Ectoderm cleft Derivation

1 ⚫ Middle ear cavity
⚫ Eustachian tube
2 ⚫ Palatine tonsil
3 ⚫ thymus
⚫ Inferior parathyroid gland
4 ⚫ superior parathyroid gland
⚫ Ultimobranchial body
⚫ Remanent of 5 arch
➢ Tympanic membrane -derive from all 3 germ layer

Pharyngeal arches
Pharyngeal arches Nerve Derivation
1 V3 ⚫ Malleus
⚫ Incus
⚫ Anterior ligament of malleus
⚫ Sphenomandibular ligament
⚫ Mandible
⚫ Maxilla
Muscle
① Muscle of mastication
② TVP
③ Tensor tympani
④ Anterior belly of
digastric
⑤ Mylohyoid
2 VIII ⚫ stapes
⚫ Styloid process
⚫ Lesser horn and upper part of
body pf hyoid bone
Muscle
1. Muscle of facial expressions
a) Buccinator
b) Platysma
c) Auricular
d) Occipitalis
2. Posterior belly of digastric
3. Stylohyoid muscle
4. Stapedius muscle
3 IX ⚫ Greter horn and lower part of
body of hyoid bone
 Muscle- stylopharyngeous
muscle
4 SLN ⚫ All catilagenous of larynx
Muscle
5 RLN
⚫ Muscle of larynx ,pharynx ,
plate

Facial artery
⚫ Branch of external carotid artery
⚫ In face
① angular
② Lateral nasal
③ Superior labial artery
④ Inferior labial artery

⚫ In neck
① Submental artery
② Tonsilar artery
③ Ascending paltine
④ Grandular

Veins of face
Nerve supply of face
Motor sensory
⚫ all muscle of facial expressions- VII ⚫ Trigeminal nerve 3 branches
Expect LPS-III ⚫ Except skin over angle of mandible
great auricle nerve

Transverse section of neck

Carotid sheath
⚫ Contents
① CCA
② ICA
③ ECA
④ IJV
⑤ Vagus nerve

External carotid artery

⚫ Branch of common carotid artery
⚫ Branch
① Super thyroid artery -1st branch /ventral
② Lingual artery -ventral
③ Facial artery-ventral
④ Ascending pharyngeal artery- medial branch
⑤ Posterior auricular artery -dorsal
⑥ Occipital artery -dorsal
⑦ Maxillary artery -largest beaches
⑧ Superficial temporal artery -terminal

Maxillary artery
⚫ Branch of external carotid artery
⚫ Divided into 3 parts by lateral pterygoid muscle
Branches
1st part
① accessory meningeal artery- fossa ovale
 ② Anterior tympanic artery
③ Deep auricular artery
④ Middle meningeal artery
⑤ Inferior alveolar artery- fossa spinosum
2nd part
① 2 deep temporal artery
② Artery to masseter
③ Artery to medial pterygoid
④ Artery to lateral pterygoid
3rd part
① Posterior superior alveolar artery
② Inferior orbital artery
③ Greater palatine artery
④ Pharyngeal artery
⑤ Artery to pterygoid canal
⑥ Sphemopalatine artery- largest

Cavernous sinus
⚫ Paired
⚫ Either side of body of sphenoid bone
⚫ Passing through lateral wall of cavernous sinus-CN III ,IV ,V1 ,V2
⚫ Passing inside the cavernous sinus -ICA and VI
 General embryology

Spermatogenesis
⚫ Site of spermatogenesis -semiferous tubules
⚫ Duration of spermatogenesis- 72-74 days
Spermatogonium
 mitosis
Primary spermatocyte(2n)
 meiosis-1
Secondary spermatocyte(n)
 meiosis-2
Spermatid
spermeogenesis
Spermatozoa
spermiation
Release pf spermatozoa from sertoli cells into lumen pf seminiferous tubules
migrate
Epididymis(storage,maturation,motility)

Oogenesis
Oogonium
 mitosis
Primary oocyte (2n)
 meiosis-1
Arrested in prophase -1

Ovaries are inactive
 complete meiosis 1
Secondary oocyte
 meiosis-2
 Arrested in metaphase 2

It complete meiosis 2, only if fertilization occur

1st week - fertilization and implantation

Day 1

Zygote

Morula (16 cells)

Late/advanced morula(32 cells)
 day 4
Blastocyst
⚫ Stage of implantation
⚫ Implantation begin -D6
⚫ Implantation complete -D10
⚫ Site of implantation -J of funds and body of uterus on posterior wall

2nd week
⚫ Formation of bilaminar germ disc
3rd week-gastrulation
⚫ Primitive streak forms all 3 germ layers
⚫ The first germ layer to be formed is endoderm
⚫ Sequence of formation = endoderm→mesoderm→ectoderm
⚫ Perimitive knot forma notochord

Transverse section of embryo

Paraxial mesoderm
⚫ Skeletal muscle
⚫ Axial skeleton

Intermediate mesoderm
⚫ Urogenital system

Lateral plate mesoderm

⚫ Smooth muscle
⚫ Cardiac muscle
⚫ Appendicular skeletons

Thorax

Thoracic wall
⚫ Anteriorly -sternum
⚫ Posteriorly -thoracic vertebrae(12)
⚫ Lateral -Ribs (12 pairs)

Sternum
⚫ Flat bone
⚫ 3 parts -manubrium,body, xiphoid process

Ribs
1. True (1-7)
2. False (8-12)
a) Vertebrovhondral - 8,9,10
b) Floating ribs- 11,12

Inter-coastal space
1. Intercostal muscle
a) External intercostal muscle
b) Internal intercostal muscle
c) Inner most intercostal muscle
i. Sternocostalis muscle
ii. Subcostalis muscle
iii. Intercostalis intimis muscle
2. Neuro vascular bundle is between internal and inner most intercostal muscle
3. Arrangements
a) Vein ,artery,nerve (above downwards) Except 1st intercostal space
Nerve,artery, vein

➢ Applied aspect - pleural Tap,the needle has to be inserted just above the
lower rib

Intercostal artery
Posterior intercostal artery Anterior intercostal artery
 total 11 total 9
⚫ Superior intercostal artery -upper 2 ⚫ Internal thoracis artery- upper 6
⚫ Aorta -lower 9 ⚫ Superior epigastric artery -rectus
sheath
⚫ Musculophrenic artery -7,8,9
anterior intercostal artery

Intercostal vein

Intercostal
nerve

⚫ T3,T4,T5,T6 - typical intercostal nerve→supply only intercostal space

LUNG

⚫ Pleura
① Inner -visceral pleura
② Outer -parietal pleura
Right lung - 2 fissure and 3 lobes
Left lungs - 1 fissure and 2 lobes

Tracheo bronchial tree

⚫ Length- 10-15 cm
⚫ Diameter-1.5-2 cm
⚫ Trachea bifurcate at T6
⚫ Trachea bifurcate at T4 in cadaver

Root of lungs

Root of right lung (above downward) Root of left lung (above downward)

⚫ EB (epiaterial bronchus ⚫ PA(pulmonary artery)

⚫ PA(pulmonary artery) ⚫ B (bronchus)
⚫ HB(hypoaterial bronchus) ⚫ PV(pulmonary vein)
⚫ PV(pulmonary vein)

Bronchopulmonary segments(BPS)
⚫ A segment aevated by tertiary bronchus
⚫ Shapes -pyramidal
⚫ Number -10 BPS /each lung
Organ No. of. Segments
lungs 10
liver 8
kidney 5
 CVS embryology
Development of heart
⚫ Heart formation begins on 16th day
⚫ Heart beats begin by 4th week
⚫ 1st system to because functional CVS

⚫ Pulmonary veins derived form LA

⚫ Smooth past of LA is derived from absorbed past of pulmonary veins
⚫ Derived from neural crest cells→aortic -pulmonary septum/sprial
septum(formation by 5 week)

Development of venous system

1. Cardinal vein
⚫ Source -collect blood from body wall lf embryo
⚫ Derivative -SVC and IVC

2. Vitelline veins
⚫ Yolk sac - derivative portal vein

3. Umbilical vein
Before birth
⚫ Right umbilical vein -regress
⚫ Left umbilical-carries oxygenated blood from mother to foetus

After birth
⚫ Left umbilical vein-ligamentum teres

Development of arterial system

⚫ Arch of arota -left 4th arch artery
⚫ Carotid artery -3rd arch artery
⚫ Pulmonary artery -6th arch artery

Development of inreratrial septum

Foramen ovale→fossa ovalis→fossa ovalis→(floor )septum primum and septum
secundum (margin/limbus)

Development of inter ventricle septum

 Heart

Pericardium
1. Fibrous
2. Serous
a) Parietal
b) Visceral

⚫ Pericardial cavity→pericardial fluid-50ml

Coronary circulation
⚫ Coronary arteries
① RCA
② LCA
⚫ Origin -aortic sinuses
① Anterior aortic sinus
a) RCA
② Posterior aortic sinuses
a) Right
b) Left -LCA
⚫ RCA begin form anterior aortic sinus
⚫ LCA begins form left posterior aortic sinus

Course and branches

RCA LCA
 
PIVA AIVA/LAD artery
 Circumflex branch
Posterior interventricular artery 
Left anterior descending artery

Blood supply
RCA LCA

1. RA 1. LA
2. RV 2. LV
3. Posterior part of LV 3. Anterior part of RV
4. posterior part of i/v septum 4. Anterior part of I/V septum
5. SA node and AV node 5. LBB
6. LBB (left bundle branch) 6. RBB

Cardiac dominance
⚫ Right cardiacs dominance 65%
⚫ Left cardiac dominance-10%
⚫ 25% combined cardiac dominance

Venous drainage of heart

1. Coronary sinus
⚫ Location-posterior atrio ventriclular groove
⚫ Length-3cm

2. Cardiac vein→coronary sinus→RA

⚫ Great cardiac vein
⚫ Small cardiac vein
⚫ Middle cardiac vein

3. Anterior cardiac vein→RA

⚫ Right border -SVC+RA+IVC

⚫ left order - Left ventricle +left auricle
⚫ Inferior border- RA+RV+LV
⚫ Apex- LV
⚫ Left 5 intercostal space
⚫ 9cm away from sternum
⚫ Base=RA(1/3)+LA(2/3)

Lower limb
Lumbo sacral plexus

Major nerve
anterior compartment femoral nerve
Thigh
medial compartment obturator nerve
 posterior compartments tibial nerve

anterior compartments DPN

Leg Medial compartments SPN
Posterior compartments Tibial nerve

medial and lateral planter

Foot
nerve

Common peroneal nerve

⚫ Aka fibular nerve
⚫ Origin-posterior of L4-S2 And it’s a part of sciatic nerve(TN+CPN)
Supplies CPN
DPN(anterior compartment of leg) SPN(lateral compartment of leg)
⚫ Peroner tertius ⚫ Peroneus longus
⚫ Tibialis anterior ⚫ Peroneus brevis
⚫ Extensors hallusis longus
⚫ Extensors digitorum longus
Cutaneous supply -Skin in cleft of 1st Cutaneous supply -skin in the dorsum
and 2nd toe or 1st web space of foot
⚫ Foot drop -DPN

Tibial nerve
⚫ origin- anterior division of L4-L5
⚫ It is a part of sciatic nerve (TN+CPN)
⚫ Supply -posterior compartment of thigh
1. Semitendinosus
2. Semi membranosus
3. Biceps femoris
a) Long head- tibial nerve
b) Short head -common peroneal nerve
4. Adductor magnum-hybrid
a) Adductor part supplied by Obuturator nerve
b) Hamstring part -tibial nerve
Supply
⚫ Posterior compartment of leg
① Medoal and lateral head of gastronemis
② Soleus
③ Tibialis posterior
④ FHL
⑤ FDL
⑥ Plantaris
⑦ Popliteal
note
➢ peripheral heart -soleus muscle
➢ Longest tendon -plantaris muscle

Muscle of foot
⚫ Supplied by medial and lateral plantar nerve

Cutaneous supply
1. Planter nerve
a) Lateral 1½
b) Medial 3½
2. Sural nerve
a) Skin on lateral side of leg and foot
b) Branch of tibial nerve

Femoral nerve
⚫ Origin -posterior division of L2L3L4
⚫ Supply-all muscle in anterior compartment of thigh
1. Sartorius /tailor’s muscle/honeymoon muscle - longest muscle
2. Quadriceps femoris
a) Vastus lateralis
b) Vastus intermediated
c) Rectus femoris
 d) Vastus medialis
3. Pectineus muscle - lateral half

Cutaneous supply
1. Medial cutaneous nerve of thigh
2. Intermediate cutaneous nerve of thigh
3. Saphenous nerve- skin on medial side of leg and foot

Obturator nerve
⚫ Origin - anterior division of L2L3L4
⚫ Supplies -medial compartment of thigh
① Adductor longus
② Adductor brevis
③ Adductor magnum
④ Pectineus (medial half)
⑤ Gracilis muscle -anti rape muscle

Minor branches
⚫ L1 - iliohypogastric ,ilioinguinal nerve
⚫ L1,L2 - genitofemoral nerve
⚫ L2,L3 - lateral cutaneous of thigh

Femoral triangle
⚫ It is a triangle depression in upper 1\3 of anterior aspect of thigh
Content
① FA
② FV
③ FN
④ Lymph nodes
⚫ Medial to lateral - vein →artery→nerve(VAN)

Femoral sheath
⚫ funnel shaped
 Femoral sheath
lateral intermediate medial
⚫ femoral artery ⚫ femoral vein aka femoral canal
⚫ Femoral branch of ⚫ Consists of lymph
genitofemoral muscle node of
cloquet/Rosenmuller

⚫ Note- femoral nerve is outside the femoral sheath

Femoral ring
Boundaries
① Posterior-pectinealliz
② Medially- lacunar ligament
③ Anterior-inguinal ligament

Gluteal region
Muscle Nerve supply Action
1. Gluteus maximum inferior gluteal nerve extension at hip joint
2. Gluteus medius Superior gluteal nerve Abduction at hip joint
3. Gluteus minimus and stabilize the pelvis
4. Gamellus superior Nerve to obturator
5. Obturator internus internus Lateral at rotation at hip
6. Gamelluus inferior Nerve to Quadrates joint
7. Quadratus femoris femoris

Iliotibial tract
⚫ condensation of facia latum
⚫ Tensor fasia latae is supplied by superior gluteal nerve

Gluteal nerve
superior gluteal nerve L4L5S1 Inferior gluteal nerve L5S1S2
⚫ Gluteal medius ⚫ Gluteus maximus
⚫ Gluteus minimus
⚫ Tensor fascia lata

Structures passing through greater sciatic foramen

Above piriformis
⚫ Superior gluteal NAV

Below piriformis
⚫ inferior gluteal
⚫ Nerve to obturator internus
⚫ Nerve to quadratus femoris
⚫ Sciatic nerve
⚫ Pudendal nerve
⚫ Internal pudendal artery and vein

Structures passing through lesser sciatic foramen

⚫ pudendal nerve
⚫ Internal pudendal artery and vein
⚫ Obturator internus muscle

Hip joint
⚫ type - synovial joint
⚫ Subtype - ball and socket joint
⚫ bones -head of femur,acetabulum of hip bones

Ligament
① Acetabular labrum
② Ileofemoral ligament - aka ligament of biglow
③ Ischio femora ligament - y shaped
④ Pubofemoral ligament- strongest ligament

Knee joint
⚫ Type -synovial joint
⚫ Subtype
① femur and tibia -bicondylar joint
② Femur and patella - saddle joint
⚫ locking -Quadriceps femoris
⚫ unlocking- popliteus muscle
Popliteal fossa
⚫ diamond shaped depression behind the knee joint
⚫ Boundaries

⚫ Contents
① Politesl artery
② Politeal vein
③ Tibial nerve
④ Common peroneal nerve

Tarsel bones
⚫ 7 bones in each foot
① talus
② calcaneus – largest trasal bone
③ navicular
④ medial cuneiform
⑤ intermediate cuneiform
⑥ lateral cuneiform
⑦ cuboid -lateral side
⚫ Calcaneonavicular ligament -aka spring ligament

Eversion of foot Inversion of foot

⚫ elevation of lateral border of foot Elevation of medial border of foot
⚫ Muscle Muscle and nerve
① Perpneus longus ① Tibialis anterior-DPN
② Peroneus brevis ② Tibialis posterior - Tibial
⚫ Nerve -SPN nerve
 Gut embryology

⚫ Umbilical cord
① Vitellointestinal duct
② Allantois
③ Wastons jelly
④ Right and left umbilical artery
⑤ Left umbilical vein

Foregut
Development of liver

⚫ Liver develop in ventral mesentery

⚫ Liver is endodermal in origin
⚫ Faciform ligament and lesser omentum derived - ventral mesentery

Development of pancreas
⚫ dorsal pancreatic bud - head,neck,body,tail
⚫ Ventral pancreatic bud -uncinate process

Development of stomach
⚫ Gastrosplenic ligament- derived dorsal mesentery
⚫ Splenorenal ligament - derived from dorsal mesentery
⚫ Spleen develop form dorsal mesentry
⚫ Spleen is mesodermal in origin

Rotation of gut
⚫ foregut -90°(clockwise)
⚫ Midgut-270°(anti-clockwise)
⚫ Hind gut- No

Midgut
⚫ physiological hernia occurs- 6th week
⚫ Reduction of physiological hernia - 10th week
⚫ Failure of reduction of physiological hernia -Omphalocele

Hindgut -urogenital system

⚫ Intermediate mesoderm
① Nephrogenic cord
② Genital Ridge(gonads)
Development of urinary bladder
⚫ urinary bladder-urogenital sinus (endoderm ) except trigone
⚫ Trigone derived form- absorbed part of mesonephric (Mesoderm)

Development of kidney
⚫ Metanephric blastoma→secretary part
⚫ Bowman’s capsule
⚫ PCT
⚫ Loop of Henle
⚫ DCT
Mesonephric duct
⚫ Collecting duct
⚫ Renal papillae
⚫ Calyces
⚫ Pelvis
⚫ Ureter
Development of urethra

Male urethra- 20 cm
⚫ Prostatic urethra- endoderm,except posterior wall
⚫ Membranous urethra- endoderm
⚫ Penile urethra- endoderm

Female urethra- 4 cm
⚫ derived from - endoderm,except posterior wall

Wolffian duct
⚫ Aka mesonephric duct
Male Female
1. Ureteric bud and it’s derived 1. Ureteric bud and it’s derived
2. Trigone of urinary bladder 2. Trigone of urinary bladder
3. Posterior wall of prostatic urethra 3. Posterior wall of prostatic urethra
4. Spermatic pathway 4. Gartner’s duct
 a) Epididymis
b) Vas deference
c) Seminal vesicle
d) Ejaculatory duct
5. Prostate gland

Mullerian duct
⚫ aka paramesonephric duct
Male Female
1. Appendicular of Testis 1. Fallopian tubes
2. Prostatic urtricle 2. Uterus
3. Upper part of vagina

⚫ Genital ridge- testis or ovary

⚫ Genital tubercle- glans penis or clitoris
⚫ Genital swelling- scrotum /Labia majora
⚫ Genital fold- ventral aspect of penis/labia minora
Abdomen
Anterior abdominal wall
1. Skin
2. Superficial fascia

Camper (fatty) Scarpa (fibrous)

Muscles
3. External Oblique-
4. Internal Oblique- Conjoint liament
5. Transversus Abdominus
6. Transversalis Fascia
(fibrous)
7. Extraperitoneal Fat
8. Parietal Peritoneum

Inguinal canal
⚫ It extend between deep inguinal ring and superficial inguinal ring
⚫ Location- above and medial to inguinal ligament
⚫ Length-4 cm
Boundaries

⚫ Anterior boundaries - external oblique and internal oblique

⚫ Posterior boundaries-transversalis fascia and conjoint tendon
⚫ Superior-internal oblique and transverse abdiminus
⚫ Inferior-inguinal ligament
Contents
1. Male
- Spermatic cord
-Ilioinguinal nerve

2. Female
-round ligament of uterus
-Ilioinguinal nerve

Applied aspect
Inguinal hernia
direct inguinal hernia indirect inguinal hernia
⚫ Via anterior abdominal wall ⚫ Via deep inguinal ring

Hesselbachs triangle
⚫ aka inguinal triangle
Rectus sheath
⚫ it is formed by aponeurosis of EO,ID and TA
⚫ arcuate line- between umbilicus and pubic symphysis
Boundaries
Above arcuate line

Below arcuate line

⚫
Contents
1. 2 nerve
a) Rectus abdominis nerve
b) Pyramidalis nerve
2. 2 arteries
a) Superior epigastric artery
b) Inferior epigastric artery
3. 2 vein
 a) Superior epigastric vein
b) Inferior epigastric vein
4. Nerve - lower 6 thoracic nerve

Posterior abdominal wall

⚫ made of 4 muscle
① Psoas major
② Psoas minor
③ Quadratus lumbarum
④ Iliacus

Stomach
⚫ Related to lesser curvature of stomach-lesser omentum
⚫ Related to greater curvature of stomach
① Greter omentum
② Gastrosplenic ligament
③ Gastrophrenic ligament

Posterior surface relation

⚫ aka stomach bed relation
① Diaphragm
② Splrnic artery
③ Splenic flexure of colon
④ Left supra renal gland
⑤ left kidney
⑥ Pancreas
⑦ Transverse mesocolon
Artery supply
1. Along lesser curvature
⚫ Right and left gastric artery

2. Along greater curvature

⚫ right and left gastroepiploic artery
⚫ Short gastric artery

Diaphragm
⚫ muscle structures
⚫ Nerve -phrenic nerve (C3,C4,C5)
⚫ Major openings
1. Venacanal opening
⚫ Inferior vena cava
⚫ Right phrenic nerve

2. Esophageal opening
⚫ Oesophageal
⚫ Vagus nerve

3. Aortic opening
⚫ aorta
⚫ Thoracic duct
⚫ Azggous vein

Abdominal aorta
⚫ extend T12-T4
Branches of abdominal aorta
1. Ventral branches
⚫ Coeliac trunk (T12)
⚫ Superior mesenteric artery
⚫ Inferior mesenteric artery

2. Lateral branches
⚫ inferior phrenic artery
⚫ Middle suprarenal artery
⚫ Renal artery
⚫ Gonadal artery

3. Dorsal branches
⚫ 4 pairs of lumber arteries
⚫ 4 median sacral artery

Coeliac trunk branches

⚫ left gastric artery
⚫ Splenic artery
⚫ Common hepatic
Superior mesenteric artery
⚫ ileocolic artery
⚫ Right colic artery
⚫ Middle colic artery
⚫ Jejunal artery

Inferior mesenteric artery

⚫ Left colic artery
⚫ Sigmoidal artery
⚫ Superior rectal artery

Duodenum
⚫ C shaped
⚫ Extend L1-L3
⚫ Length
① D1 - 2 Inches =5 cm
② D2 - 3 Inch =7.5 cm
③ D3 - 4 inch = 10 cm
④ D4 - 1 inch = 2.5 cm

Liver
⚫ shape wedge
⚫ Weight-1.5 kg
⚫ Anatomical/Division
⚫ Anterior surface

⚫ Posterior surface

Surgical division
⚫ caunard’s classification
⚫ 2 lobes→4 sections →8 segment →based on hepatic vein and portal vein

Arterial supply
① Proper hepatic artery- 20-30%
② Portal vein - 70-80%
Gall bladder
⚫ shape -pear
⚫ Capacity 30-50 ml
⚫ Parts
① Fundus
② Body
③ Neck - hartmann’s pouch
④ Cystic duct - valve of heister
⚫ artery supply- cystic artery
⚫ Vein - cystic vein →portal vein

Pancreas
⚫ both endocrine and exocrine glands
⚫ Extend L1-L2
⚫ Parts
① Head
② Neck
③ Body
④ Tail
⑤ Uncinate process
⚫ Ducts of pancreases
Main pancreatic duct accessory pancreatic duct
⚫ aka wirsung’s duct ⚫ Aka ducts of santorani
⚫ Open in major duodenal papillae ⚫ Opens in minor duodenal papilla

Kidney
⚫ Extend-T12-L3
⚫ Right kidney is lower compare to left kidney Since because of presnce of liver

Venous drainage of abdomen

Portal vein
⚫ Its formed by -splenic vein and superior mesenteric vein

Tributaries of portal vein

1. Cystic vein
2. Superior pancreatico duodenal
3. Right & left gatric vein
4. Paraumblical

Inferior vena cava

⚫ it’s formed by - common iliac veins at L5
1. Inf phrenic vein
2. Hepatic vein
3. Right suprarenal vein
4. Renal vein
5. Right testicular/overian
6. 4 Lumbur vein
7. Common Iliac vein

Note- left suprarenal ,left testis and overian vein drain into left real vein
Pelvic diaphragm
1. Levator ani muscle
a) Iliococcygeus muscle
b) Puboccygeus muscle
2. Ischiococcygeus muscle or coccygeal muscle

Urogenital diaphragm
⚫ Ext. urethral sphincter muscle
⚫ Deep transverse perineal muscle
⚫ Superior fascia
⚫ Inferior fascia /perineal membranes

Perineal body
⚫ 10 muscle
4 paired
① Superficial transverse muscle
② Deep transverse perineal muscle
③ Bulbospongiosus
④ Levator ani
2 unpaired
① External anal sphincter
② Longitudinal muscle anal canal
Perineum
Boundaries
⚫ Perineum is divided into urogenital triangle and and anal triangle
⚫ Urogenital triangle consists of superficial perineal pouch and deep perineal
pouch

Deep perineal pouch

⚫ between superior fascia of urogenital diaphragm and inferior fascia of
urogenital diaphragm /perineum membranes
Contents
① External urethral sphincter muscle
② Deep transverse perineal muscle
③ Membranous urethra (male)
④ Bulbourethrak gland of cowper’s

Superficial perineal pouch

⚫ Between inferior fascia of urogenital diaphragm/perineal membranes and
superficial fascia
Contents
① Superficial transverse perineal muscle
② Bulb (male ) bulbospongiosus muscle
③ Crus (male)
④ Greater vertebral gland /bartholin’s gland

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