N.B.

: Cover is leeched from: DR Matary PPT ツ

 Exam How To Study MCQ Book Missed

• •
•
• •
• •

•
•
• •
•
•
•
•
•
•
•
•
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Seeb el Thorax w el Embryology f el a5er •
You’ll need Only 2 hours ( 6 papers in 1h + 60 MCQs in another hour)
 Upper Limb
Important Notes
These 4 ms are called:
Rotator Calf muscles
Shoulder Girdle ‫عضالث انـ‬

Action: Adduction & Int. Rotation

Muscles Of Upper Limb

•
•
•
‫ألَٓا ياسكت فٗ انـ‬
‫ألَٓا عضهت كبيرة ْخرٔح نألبعذ‬


Upper Limb Initiates Abduction  Supre-spinatus
Continue Muscles Of Upper Limb Abduction 90o  Deltoid
Overhead Abduction  Trapezius &
Serratus Ant.

‫يٍ ٔرا‬ ‫كهٓى طانعيٍ يٍ انـ‬

Also Lesser trochanrter of
Femur has only one ms 
Ilio-psoas

These 4 ms are called:

 ‫ألَٓا بخخحط حبع انـ‬ Rotator Calf muscles
Shoulder Girdle ‫عضالث انـ‬

ٗ‫ٔاحذ بس عان‬ ‫عضهخيٍ نيٓى‬

‫بيذٖ عضهت كبيرة ٔعضهت صغيرة‬ ‫انـ‬

N.B.: Shoulder dislocation  ‫ يبيذيص‬.. ‫نكٍ ييذيص عضهخيٍ كبار‬

Spasm in Sub-scapularis ‫نيٓا‬ ‫انـ‬

• •
‫َص انـ‬
• .. ‫حــراٖ يٍ حــحج‬
ٌٔ‫حبذأ يٍ حيث اَخٓٗ األخر‬
•
.. ‫باٖ يٍ فٕق‬ •

• 
Musclo-cutaneous n. supply All ms of front of arm except:
(Lat. Part of brachialis = Radial n.)

i.e.: Brachialis  Double nerve supply  Musculo-cut. & Radial n.

 Upper Limb
Axilla :: Boundaries

Ant. Wall Post. Wall Med. Wall Lat. Wall

‫عضهتيه مٍميه َعضهة ٌفأ‬ ‫َرا‬

•
• • •
•
• • •
•
• • •

Axillary
a.

Lympha Contents Axillary   

tics Of Axilla v.    VIP
  

Brachial
plexus
 Really Tired
Upper Limb
Brachial Plexus Don’t Come Back

Roots Trunks Divisions Cords Branches

• •
• • 
• •
•
• •

* Med. Cut. N. of arm = Med. cord Root of

Phrenic
* Lat. Cut. n. of forearm = Musclo-cut. n.
* Lat. Cut. n. of arm = Upper & Lower cut. (1) C5
n. of arm (upper= axillary -Lower= Radial)

‫ٔرا يبمٗ انـ‬ ‫طانًا انـ‬ (3)

ٌ‫ٔكًا‬ ‫بخاعٓا يٍ انـ‬
C6
MCQ ًّ‫اس‬
(4)
C7

•  (2)
C8
• 

•
•  T1

• 

Fracture surgical neck humerus 

• •  Injury to  Axillary n.
•
• ‫عضهت ْفأ‬
 Upper Limb
Axillary Artery

Begining Pectoralis minor Relations End

• •
• •
• •

Coracoid
•   process
•

• Pectoralis
minor
• ‫انعريس‬

•
 N.B.: Deltoid br. Shares in: Anastomosis around humerusneck Teris major maska f el med. Lip of bicipital groove w dividing
el axillary a. 3 parts (above – behind – below)
 ‫‪Upper Limb‬‬
‫‪Brachial Artery‬‬

‫‪Begining‬‬ ‫‪Branches‬‬

‫•‬ ‫•‬ ‫•‬

‫•‬ ‫يعرٔفيٍ دٔل‬ ‫•‬ ‫‪‬‬

‫•‬
‫•‬
‫•‬

‫عايم زٖ انصهيبت جايهّ ‪ 4‬براَطاث يٍ أربع احجاْاث ‪‬‬

‫)‪1st part subclavian: (See H&N‬‬
‫‪ ‬قذاو َ َرا‬
‫ٔانـ‬ ‫ألَّ ٔاخذ جسء صغير يٍ انـ‬ ‫تحت‬ ‫‪‬‬
‫فُق‬ ‫‪‬‬

‫‪‬‬
‫انُحص(قُِ)‬
‫‪‬‬ ‫انعريس‬

‫‪Recurrent‬‬
‫َفسّ انًٕجٕد فٗ اسًّ‬ ‫طانع يٍ انـ‬
‫‪Collateral‬‬
‫طانع يٍ حاَٗ ٔبيًطٗ جُب انـ انًٕجٕد فٗ اسًّ‬
‫فااااكس‬ ‫‪‬‬
‫‪‬‬ ‫‪‬‬
 ‫‪Upper Limb‬‬ ‫‪Median Nerve :: Med. & Lat. Cords (C‬‬ ‫‪5,6,7,8‬‬ ‫)‪+ T1‬‬

‫‪In Arm‬‬ ‫‪Leaves Cubital fossa‬‬ ‫‪In Fore-arm‬‬ ‫‪Hand‬‬

‫‪To Enter Fore-arm‬‬
‫•‬ ‫•‬
‫•‬ ‫•‬
‫•‬ ‫•‬
‫•‬
‫•‬

‫‪Motor‬‬
‫اعخبرْى عضهت‬
‫‪‬‬ ‫‪‬‬ ‫اعخبرْى َص عضهت‬

‫‪Sensory‬‬
‫‪‬‬

‫ْٕٔ يعذٖ تحت انـ‬

‫‪‬‬

‫يبعج انبراَص دا يعذٖ يٍ فُق انـ‬

‫الزو حاخذ يٍ انـ‬ ‫عيب دٖ حخٗ اسًٓا‬

‫بيبعخهٓى براَص نخحج نحذ انعضى اسًّ‬ ‫انـ‬ ‫عطاٌ ًْا‬

‫‪‬‬ ‫‪‬‬ ‫‪‬‬

 Upper Limb
Medial :‫كهمة انسر‬
Ulnar Nerve :: Med. Cord (C + T ) 8 1

In Arm To Enter Fore-arm In Fore-arm Hand

•
•
• •
• ّ‫انعضهخيٍ بخٕع‬ •
‫جاٖ عهيّ رجع ٔرا‬ ‫نًا نمٗ انـ‬

Motor


* Adductor policis considered one of interossii

(Not thenar) & so supplied by  ULNAR N.
Axillary
(circumflex) n. Sensory
C5,6

•
Upper Lat. Cut.
Deltoid Teris minor
n. of arm
‫عضهت كبيرة‬ ‫عضهت صغيرة‬ Sensory
• 
•
• Lumbricles
•
•
Injury • •
•

‫ انهٗ ححج انسبااليط‬.. ‫• انًُطمت بخاعت ضاراث انعساكر‬ •

 Upper Limb
Radial Nerve :: Post. Cord (C 5,6,7,8 + T1 )

In Arm End Before Forearm Brs Of Radial n. Itself

•
• •

• •

•
•

•
.. ً‫عضالت‬
• •
َٗ‫حا‬ ‫عطاٌ يرجع‬
• •
5 dorsal digital brs.
‫انُحُش‬ • 4 ms of superficial group All 5 ms of deep group

• • •
• • •
Nerve Above CB At CB
• • •
Median Lat. Med.
• • •
Ulnar Med. Post.
• •
Radial Post. Ant.
•
‫ ٔانخايست احخريج‬... ‫ عضالث نهصٕابع بُحسٓى عهٗ َفسُا‬4 •
Upper Limb Brachial Plexus Injury

1) Whole Plexus Injury 2) Upper Trunk Injury 3) Lower Trunk Injury

ŵ
‫انعياٌ ساعخٓا ْيًٕث لبم يا يخطم‬

• •
Intact Sensation •

• 
Carpal Tunnel • 

F. Retinaculum is Attached: Structures Above Retinaculum Carpal Tunnel $

NAP
•
•  • •
• •
• 
•
Structures Below
•
•
• 
•
•
 Head
&
Neck Scalp

Layers Dangerous Area Muscles Lymph

Scalp
• Vss. 
• 
Emissary
• Vs.

•
• Dural S. LOOSE = DANGEROUS N.S. = FACIAL N.

‫ انذو بيىزل عانعيه‬.. ‫مه قذاو‬ ‫مص ماسكة فّ انـ‬ ‫عشان انـ‬

↔ ↔
• 
 ّ‫ألَٓا برِ خانص يغطيت كه‬
‫بخاع انـ‬ ‫الزليٍ فٗ بعض بانـ‬ •

•  

•   
• 

• 

•

 • 
 Head
&
Neck Triangles Of The Neck

Post. ∆ Ant. ∆
Boundaries Boundaries
•  • 
• 
•  • 
•  • 
•  • 
•  Divisions = 4 OR 3 ½
•
•  
 •
 •
•
 •
• •

•

• Carotid Boundaries

• 
N.B.: • 
• ‫انخٕأو انًهخصك‬ • 

• Thoracic outlet
Carotid Contents
• •
•
•
•
‫يهٕش أٖ عاللت بانـ‬ ‫• يعُٗ انـ‬
‫بس جِٕ انـ‬ ‫برِ انـ‬ ‫انـ‬
 
 ‫‪Head‬‬
‫&‬
‫‪Neck‬‬
‫‪Muscles Of Head & Neck‬‬

‫‪‬‬
‫‪‬‬

‫اخٕاث بيساعذٔا بعض ‪‬‬

‫‪‬‬
‫‪‬‬
‫‪‬‬ ‫•‬
‫‪‬‬ ‫•‬
‫‪‬‬
‫احلاجات اللى بيتضغط عليها‬
‫فى الـ ‪Thoracic outlet $‬‬ ‫‪N.B‬‬
‫•‬ ‫‪‬‬ ‫‪‬‬
‫•‬
‫•‬ ‫‪MCQ‬‬ ‫•‬ ‫‪‬‬

‫صغيرة جذا‬

‫‪‬‬
‫‪‬‬ ‫عطاٌ كذا يص حبعٓى‬
Head
&
Neck
Very Important Notes

•
•  
•  

•
•
Ansa Cervicalis • Descendens Hypoglossi = C1
•  = C1,2,3 • Descendens Cervicalis = C2,3

•  Muscles Supplied • Omohyoid – Sternothyroid – Sternohyoid

• N.B.: • Thyrohyoid Supplied by C1 Only & Directly

•

•

•
To Supply: Thyro & genio hyoid Hypoglossal n. ‫ دخم جُي انـ‬C1 ‫انـ‬
•
• To Supply Palatoglossus X ِٕ‫ دخم ج‬XI ٔ

Structures Passing Through Jugular Foramen To Carry taste (Ant. 2/3 tongue) Lingual ‫ دخم جِٕ انـ‬Ch.tympani ‫ٔانـ‬

IJV + Inf. Petrosal Sinus + C.Ns 9, 10, 11 C1 & 12 11 & 10 7&5

 ‫‪Head‬‬
‫&‬
‫‪Neck‬‬ ‫‪Tongue‬‬

‫‪Sulcus Terminalis‬‬ ‫‪Muscles‬‬ ‫‪Bl. Supply‬‬ ‫‪N.S.‬‬

‫•‬ ‫انهسان وفسً‬ ‫‪Sensory‬‬ ‫‪Motor‬‬

‫•‬
‫•‬

‫•‬
‫‪‬‬
‫‪‬‬
‫•‬ ‫‪N.B.: General Sensation = Temperature, Pain, etc,‬‬
‫دخم جُا‬ ‫انـ‬
‫دخم جُا‬ ‫َانـ‬
‫دخم جٕا انـ‬ ‫ٔانـ‬

‫•‬
‫‪‬‬

‫•‬
‫جايت يٍ ححج عطاٌ حُسنّ ححج‬ ‫جايت يٍ ٔرا حرجعّ نٕرا‬ ‫جايت يٍ لذاو حجيبّ لذاو‬ ‫جايت يٍ فٕق عطاٌ حجيبّ نفٕق‬
 Head
& •
Neck Parotid Gland :: - Largest Salivary Gland
- Secretes Serous Fluid

Parts Surfaces Bl. Supply

Antromedial 
•  
3M
• 
•  N.S.
Postromedial
•
Sensory Symp
• 
•   
• 3P
•
NVA
•  Parasymp.
Lateral surface
• •
•
•
Facial n. brs
Relations

MCQ
ُٗ‫عيب عهيّ يع‬
• 

• 

Relations Of Parotid Gland Parasympathetic Supply

Upper Part

ŵ




Lower Part
Otic Medulla
Ganglion Oblangata
Auriculotemporal n.

Inferior
Lesser Salivary
Nucleus
Petrosal n.
Tympanic
Plexus
Ant. Border Tympainc br.
Sends Glossopharyngeal n.
Gives

‫عضهة مخرَمة فّ انـ‬

‫عضهة مخرَمة فّ انـ‬

 Head
& Site: Digastric triangle, partly below &
Neck Submandibular (Submaxillary) Gland partly deep to the mandible

Parts N.S

• 
•   
•  VIP
• 
Relations
:ّ‫مه األخر يعى‬
.. ً‫َتحتي‬ .. ً‫فُقي‬ ‫) يٕجٕد انـ‬ ‫ٔرا انهيهت دٖ كهٓا (ٔرا انـ‬

 ٗ‫انطرياٌ انهساَٗ انخهف‬

Inferior Med. Lat.

• •
• 
• • 1- Triple relations of LINGUAL N. to DUCT
• 
• • 2- Plain betw. 2 Ms containing 4 7agat

Lingual n.

N.B.:

•
•
 Head
& Carotid Artery
Neck

CCA ICA Styloid Pr. Separates ICA & ICA ECA

S
PRINCIPAL A. OF BRAIN T
Y
L
•  O
I
•  D

Course Course
• Some Supereior thyroid a.
• 
• American Ascending pharyngeal

•  Ladies Lingual a.
•
Find Facial a.
Branches Our Occipital a.
Pyramids Post. Auricular
•
SoOoOoOo Superficial temporal
OCP Magnificant Maxillary

•
•
• • ‫انخٕأو انًهخصك‬
• • 

• • 
•
• • 

•
‫نٕ يطهعص يٍ ُْا ْيطهع يٍ انـ‬
 Head
& Cranial Nerves
Neck

III, IV, VI
• •
• •
o
•  • 
•
• 

• Nervus Spinosus •
• 
Mandibular
•  
= Mixed
  •
•
VAGUS
• NERVE
•
• Greater Superficial Pertrosal n. •
In Facial Canal
• Chorda Tympani (Taste from Tip)
Galasco Coma Scale •
• Stapedius ( nerve to stapedius)
After leaving Stylo- • Stylohyoid ( n. to stylohyoid)   
mastoid Foramen • Post. Belly Of Digastric   
Terminal Branches • To Zoo By Motor Cycle (See Parotid) • 
Cycle = Cx. Br Of Facial • 

• •
• 

 
• 
Head
& Extras
Neck

ECA
Inside Parotid

Superf.
Maxillary
Temporal
Anasthestist’s a. Gives MMA

•

•
• 
• 

•  
 Abdomen Anterior Abdominal Wall Skin  Camper’s Fascia (Superficial
fatty)  Scarpa’s fascia (Deep
fibrous)  E.O.  I.O.  Tr. Abd.
Ms E.O ms I.O ms Tr.Abd.ms Rectus Abd.
 Fascia transversalis  Extra-
 Ribs → lower 6
 Ing. Lig. (upper peritoneal fat  Parietal Peritonium
 Fleshy digitations from lower Costal Cartilage
surface ) → lat. ⅔  Lat. Head
8 ribs .  Lumbar fascia .
 Iliac crest → pubic crest .
Origin  Inner lip of iliac
(intermediate line)  Med. Head
 Upper 5 slips interdigitate crest → Ant ⅔ .
→ Ant. ⅔ → SP
with serratus ant.  Ing. Lig. (upper
 Lumbar fascia .
surf. ) → lat. ⅓
- Fleshy fibers
 Outer lip of iliac crest
 From Ant. Boundary of inf.  Lower 6 CC.
Lumbar ∆  Xiphoid and linea  Xiphoid
Inserti - Aponeurosis: alba . Same as I.O process .
on  Med → lines alba from  Pubic crest &  5.6.7 CC.
xiphoid to SP pectineal line .
 Lat → folded up and ӗ
backward → inguinal lig.
Direct. DFM UFM Horizontal Flexion Of trunk
 I.C. T₇ ₋ T₁₁ • As E.O + ilio hypogast.
N.S Same as I.O Same as E.O
 Subcostal T₁₂ n. + ilio-ing. n.
→



I.O → Form Ant. & Post. Rectus sheaths & it has triple relation to ing. Canal → Ant. & Post. & Sup
Abdomen
Rectus Sheath :: Envelope-like sheath of rectus ms

Site Formation Contents




•
•
•
• 

•
•

•
•
Abdomen
Oesophagus :: 25 cm

Parts Constrictions Parts

Sites Of F.B.
• 15 cm  Cricoph.
Impaction
• 25cm  Aortic arch
• 27 cm  Lt. main bronchus
• 40 cm  Opening in Diaphragm

Supply


Abdomen * J shape: (M/C)
= vertical
Stomach * steer horn: less
= transverse

Parts Peritoneal Coverings

‫ بالعرض‬

‫ عالشمال‬

All separated by lesser sac except SPLEEN by greater

 
 





All to sub & retro pyloric  ceolic LN

Abdomen
Duodenum :: Shortest, Widest, Most fixed, 12 fingers
S.I. = Surgical Importance

Peritoneal Coverings Blood Supply Obst. 3rd

BA meal
part

Lig. teris
• CA head Pre-ampul
SMA Pr. contractio DU
panc. CA
n

• Widened C
Trifoliate
curve of Inverted 3
deformity
DU

1st part =2” 2nd part =3” 3rd part =4” 4th part =1”


Abdomen
Intestine
A- Small Intestine B- Large Intestine

•
•

   

Mesentry = Fan shaped free border = 6cm

 Abdomen
Appendix

Site Position Bl. supply N.S & L.N

• • •
• •
• •
•
• 
• 

Surgical Importance

MC-Burny Gvidiron Incision During Surgery

• 
•
• 
•
• 
• 
Abdomen Liver
Lobes ‫بيلمع‬ ‫الـ‬ Peritoneal Covers
Anatomy

•
•
•
Peritoneal Folds

Recently • (F)

Far from mid-liver Near to mid-liver •

• (CL)
• •
•
• •

• ‫ورا‬ N.B.
• ‫فوق‬
• ‫عالجىبيه‬

Groove for IVC Cantlie’s line = Middle hepatic v.

CL = Diaphragm
R L Rt. hepatic v. Lt. hepatic v.

Bare II
area IV G.B.
VIII
(F) Lig. Venosum III
fissure VII VI IV
Lig. teris
IV
Teris lig. III
V
Fissure for L. teris Porta VII
VI II
Hepatis G.B.
IVC
Abdomen Liver Cont.
Relations C & Q Lobes Supply

Superior Surface

 

Anterior Surface

C
LV IVC

Porta hepatis
Rt. Lat. Surface

LT
Q GB

Inf. (Vent) Surface N.B.

•
•

N.B. about Peritoneal Folds

Ventral ‫ بـ‬Ant. Abd. Wall ‫ طلعت ومسكت فً الـ‬stomach ‫ الـ‬Embryology ‫*أثىاء الـ‬
Dorsal mesogastrium ‫ بـ‬Post. Abd. Wall ‫ وفً الـ‬mesogastrium
:‫ وقسمه وصيه‬Ventral mesogastrium ‫ زي الخسوء فً الـ‬Liver ‫ بعديه طلع الـ‬-
:‫ وقسمه وصيه‬.. Dorsal mesogastrium ‫ وسل بالبراشىت فً الـ‬Spleen ‫وراح الـ‬-
Abdomen Gall Bladder

Parts Supply

Arterial Venous Lymphatics

Extra hepatic biliary passages

* 3-4“ & length inversly
proportionate to length of
hepatic duct
* Diameter: 6mm by US &
Cystic Duct CHD CBD 8mm by cholangiography
Parts

Supraduodenal Retroduodenal Infraduodenal Intraduodenal

É Pancreatic Duct Separate

 posteromedial part of Open in
Duodenal papilla allows passage 2nd part of duodenum and AOV OR No
of dilator of 3 mm in diameter 10cm beyond the pylorus ampulla
 Opening in lesser sac
Abdomen Foramen of Winslow Communicates it with
greater sac

Boundaries Surgical Improtance

Superior Inferior Anterior Posterior

Caudate
process of
liver  

ln hypochondrium
Spleen opposite 9th ,10th,11th ribs
with its longaxis against
10th rib

Embryology Ligaments Supply

Gastro-Splenic

Lieno-Renal

Gastro-Splenic
Abdomen Pancreas
Embryology Parts

• Neck
Head Body Tail

Blood supply -ė




Lymph drainage

Supra-Renal Glands = SR
Shape Arterial Supply Venous Drainage

3 Arteries Not entering through hilum 

• 
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Abdomen
Kidney

Embryology Anatomy Relations

Anterior Relations

Left Kidney Right Kidney

Posterior Relations
Renal Artery

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Arise from AA Can cause ureteric obstruction
Renal Vein

Position in paravert. gutter.

Kideny Fascial & fatty capsules
1. Zuker-Kandle = Gerota = Perirenal capsule: encloses Kd. but not suprarenal.
Stability
Renal vss to aorta & IVC
Intra abdominal pressure
Capsules
Abdomen
Ureter

1) Abdominal part 12,5 cm 2) Pelvic part 12,5 cm 3) Intramural part 2 cm

Blood supply

During operation
 Abdomen
Blood Supply Of Gut

Celiac Trunk SMA IMA

N.B: SMA lies on left side of SMV

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• :D L2 ‫*مشيها‬ •
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N.B.:
• ė
ė
• ė
Betw. Panc. Head &
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2nd part duodenum

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• ‫وعامليه جسء مه الـ‬ ‫كان ماشً مع الـ‬
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Abdomen
Portal Vein

About Course Tributaries

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 See p5 L.L.
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Kareem
Kamel
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 Abdomen
Blood Vessels Of Abdomen

Abd. Aorta CIA EIA IVC

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Brs
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N.B.:

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Abdomen
Psoas Major | N.B.: Psoas fascia thickened upward → Med. Arcuate lig.

Origin Insertion Action

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• → N.B.: If fracture neck Femur →
→
Lateral Rotation

Diaphragm

Origin Insertion Action Nerve Supply

•   Phrenic n. “C4” Lower 6-7 IC ns.

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•  (refered pain to Rt shoulder)

Rt: Front of upper 3 lumbar verteb

2Crura
Lt: Front of upper 2 lumbar vereb.

2 lat Bridges over Q. lumborum
5 arcuate 
ligaments 2med Bridges over Psoas major

1median  
 Pelvis
Muscles of pelvic wall :: Levator Ani

Origin Insertion Action N.S.

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Pelvic Organs :: Urinary Bladder

Site Angles Periton. Coverings Supply

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1.Symp. 2.Parasymp.
 Pelvis Pelvic Organs :: Prostate

CCC. Position Structures éin PR (S)

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Suply   Prostatic v. plexus of santorini bet. true&false capsules ( thin wall|valveless ) 

Epididymis VS. Vas Deferens Pelvic Organs :: Urethra

EP
Embryology Parts




VAS
Pelvis Pelvic Organs :: Rectum
Relations
Peritoneum
Bl.Supply

Fascia around

Ischio Rectal fossa boundaries:

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 - Origin: at level of sacro iliac joint.
Pelvis Int. Iliac a. :: - End: in pelvis (near upper part of greater sciatic foramen).

Ant. Division Post. Division

(ILS)

Brs. In Both ♂ & ♀ ♂ BRs ♀ BRs 2 Terminal BRs

* Iliolumbar A.
* Lat. Sacral A.
UMO * Sup. Gluteal A.

Middle
Rectal A.

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 Sternum
Thorax
Boundaries
Mediastinum Vertebral Column

Lung & pleural both sides

Superior Anterior Middle Posterior

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Don’t Miss: Phrenic Nerves + Relations Of trachea & Esophagus

Thorax
IMPORTANT NOTES IN THORAX
1) SUPRA-PLEURAL MEMBRANE
2) STERNAL ANGLE OF LEWIS (LOWER BORDER OF T4)

3) UPPER BORDER OF STERNUM = LOWER BORDER OF T2

4) IN THE COSTAL GROOVE:
5) LUNGS
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6) PLEURA
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7) PULMONARY ARTERY
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8) POST. INTERVENTRICULAR A.:

9) INTERNAL THORACIC A.: 1st part subclavian + used for coronary bypass.
 Thorax
IMPORTANT NOTES IN THORAX
10) BRACHEO-CEPHALIC ARTERY:
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11) BRACHEO-CEPHALIC VEINS:

• Begin:
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• End:
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12) TRACHEA: Bifurcates @ T4

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13) THORACIC DUCT:
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Embryology
IMPORTANT NOTES IN EMBRYOLOGY

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Embryology
IMPORTANT NOTES IN EMBRYOLOGY
1) MAIN PANCREATIC DUCT IS FORMED FROM:

2) ILEUM DEVELOPS FROM THE REGION OF ATTACHMENT OF VITELLO INTESTINAL DUCT.

3) MIDGUT


4) KIDNEY
→
→
→
5) TESTES
→
→
→
6) UMBILICAL FOLD
→
→
→
→
 STRUCTURES PASSING THROUGH

Greater sciatic foramen Lesser Sciatic foramen

PYRIFORMIS Tendon of Oburator Internus
+ (3, 4 & 5 from GSF)
ABOVE BELOW
¯ ¯
SGN & vs. 1) IGN & vs.
2) Sciatic n. + Post. Cut. n. of thigh.
3) Pudendal n. ® Perineal ms.
4) Internal pudendal vs. 1
5) Nerve to Oburator Internus.
A) MS. OF THE ANT. COMPARTMENT:
ORIGIN INSERTION NERVE SUPPLY ACTION
1) SARTORIUS ASIS SGS T Femoral Nerve CROSS-LEG POSITION:
(Upper part of med. 1) Thigh ® flexion + abd. + lat. rotation.
surface of tibia) 2) Leg ® flexion & medial rotation
2) QUADRICEPS FEMORIS 4 HEADS: Patella, then into Femoral Nerve Main extensor of the knee
1) RECTUS FEMORIS. tibial tuberosity
2) VASTUS INTERMEDIUS.
3) VASTUS LATERALIS.
4) VASTUS MEDIALIS.

B) MS. OF THE GLUTEAL REGION

ORIGIN INSERTION NERVE SUPPLY ACTION
G. MAXIMUS 1) Ilium 1) Gluteal tuberosity. IGN Main extensor of hip
2) Sacrum 2) Ilio-tibial tract.
3) Sacro-tuberous ligament
G. MEDIUS & Ileum Greater trochanter SGN Abduction & Support during
MINIMUS walking preventing waddling gait
® tested by TRENDLENBERG'S TEST!
PIRIFORMIS Front of sacrum + greater sciatic notch GREATER TROCHANTER Sacral plexus Ext. rotation

QUADRATUS FEMORIS Ischial tuberosity Inter-trochanteric crest Sacral plexus Ext. rotation

MS. ATTACHED TO GREATER TR. : 7 = 1 + 6 (3 X2)

1) PYRIFORMIS.
2) 2 = GLUTEUS MEDIUS & MINIMUS. “Ilio-psoas is the only ms.
3) 2 = SUP. & INF. GEMILLUS. attached to lesser trochanter”
4) 2 = OBTURATOR INTERNUS & EXTERNUS. 2
 C) MS. OF THE MEDIAL COMPARTMENT

(GRACILIS - PECTINEUS – ADDUCTORS: AL - AB - AM) PECTINEUS

Hamstrings
· ORIGIN: Pubic bone except Ischeal part of AM from ischeal tuberosity. Ischial part of AM.
· INSERTION: Linea aspra except Gracilis. (SGSt) ® Medial surface of tibia Quadratus femoris
ADDUCTOR
BREVIS
· NS: ON except Pictineus by FN & Ischeal part of AM by Sciatic N.
· ACTION: Adduction except AM is extension of hip ADDUCTOR
LONGUS
Ø OPENING IN AM BET. THE PUBIC & ISCHIAL PART ® FA continues as popliteal!
OPENING
ADDUCTOR
MAGNUS

D) MS. OF THE POST. COMPARTMENT: “HAMSTRING’S”

· ORIGIN: Ischial tuberosity except Short head of Biceps f. from linea aspra

BICEPS FEMORIS ® HEAD OF FIBULA

· INSERTION: SEMITENDINOSUS ® SGS SEMI-
MEMBRANOSUS
SEMI-MEMBRANOSUS ® MEDIAL CONDYLE OF TIBIA
· NS: Sciatic nerve.
BICEPS SEMI-
· ACTION: Main flexors of knee + Weak extensors of hip.
FEMORIS TENDINOSUS

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 FEMORAL ARTERY
SUPERFICIAL BRANCHES
1) Superf. Epigastric*
2) Superf. Ext. Pudendal.
3) Superf. Circumflex iliac.
(* supplies lower
abd. wall not LL only)
POPLITEAL ARTERY
Continuation of FA at the opening in AM.
DEEP BRANCHES
1) PROFUNDA FEMORIS
2) Deep Ext. pudendal
3) Desc. genicular
(shares in collat. circ.
around the knee)
LNS: SUPERFICIAL INGUINAL LNS:
Medial & lat. circumflex · Receive from lower part of abd. Wall.
femoral ® to head of femur · Send efferent to Ext. iliac LNs mainly.
4 perforators. · Form a chain // to & 1 cm below the
inguinal ligament.
· Area drained by SSV ® popliteal LNs.
THE ONLY BRANCHES OF EIA
· Deep circumflex iliac.
· inf. Epigastric.

ACCESSORY OBTURATOR ARTERY:

ANT. TIBIAL TIBIO-PERONEAL
Ant. leg compart. Peroneal artery Post. Tibial · Pubic branch of inf. Epigastric ® very
¯ ¯ ¯ large in 30 % of the people.
DORSALIS PEDIS lateral compart. post. · May stick to FV ® safe position.
¯ “main arterial compart. · Or medial to lacunar ligament ® dang.
Pulse felt on dorsum of supply of the calf position ® injury & massive hge during
foot lat. to tendon of EHL surgery!
· Best felt when the leg is semi-flexed.

GREATER SAPHENOUS VEIN LESSER SAPHENOUS VEIN

1) Receive Superf. Epigastric & Superf. Circumflex iliac vein. 1) Enters the leg behind the lat. Mallelolus.
2) Ends in the FV. 2) Passes lat. to Tendon Achilles.
3) Longest vein in the body. 3) Ascends over the middle of the calf.
4) Connected to deep veins by perforators. 4) Perforates the deep (crural) fascia.
5) M/C site for venesection is ANT. to Medial mallelus. (Stripping op.) 5) Ends in the Popliteal vein. 4
 Nerves
LUMBAR PLEXUS SACRAL PLEXUS
1) FN ® from the dorsal divisions of L2,3,4 passes between Psoas & 1) SCIATIC ® Hamstrings + Ischial part of AM (see below)
iliacus & behind to the inguinal ligament
2) PUDENDAL
MOTOR SENSORY
3) POST. CUTANEOUS NERVE OF THIGH
‫ﺳﻤﻴﺤﺔ‬ · SAPHENOUS N. ® to medial side Pass through
SARTORIUS
of leg & dorsum of foot till the 4) SGN ® Gluteus medius & minimus the GSF
‫ﻛﺮﻫﺖ‬ QUADRICEPS + T. FASCIA LATA
ball of the big toe.
‫ﻟﻌﺒﺔ‬ ILIACUS · DIVIDED INTO SUPERF. & DEEP brs. 5) IGN ® Gluteus Maximus
‫ﺑﻮﻛﺮ‬ PECTINEUS by "Lateral circumflex FA"
6) N. to pyriformis – Quadratus femoris – Obturator internus.
2) ON ® Obturator externus + All medial compartment except
Ischeal part of AM
3) Lumbo-sacral branch (to the sacral plexus)
4) Ilio-hypo-gastric & ilio-inguinal.
5) lateral cutaneous nerve of thigh.
6) Genito-femoral

MISCELLANEOUS: NELATON'S LINE:

1) COXA VARA ® ¯ neck-shaft angle of femur. · From ischial tuberosity to ASIS.
2) HOUSE-MAID'S KNEE ® Pre-patellar bursa. · Touching the tip of the greater trochanter.
3) TALIPES- EQUINOVARUS ® plantar flexion + adduction + inversion. · But in true supra-trochanteric shortening ® the head is
shifted upwards & the greater trochanter lies above the line.
BRYANT'S TRIANGLE:
1) A line from ASIS perpendicular to bed.
2) Another line from the greater trochanter perp. To the 1st
3) Compare to the other site. 5
4) it's narrower in trochanteric displacement
 SCIATIC NERVE
MEDIAL POLITEAL LATERAL POPLITEAL
"TIBIAL" "COMMON PERONEAL" FIBULAR

· Sural communicating +
SENSORY MOTOR lat. cutaneous n. of Calf.
· 3 genicular brs. to knee.
· No muscular branches

SURAL N. SUPERF. GROUP DEEP GROUP

SUPERF. PERONEAL DEEP PERONEAL
BESIDE SV
"MUSCULO-CUT." "ANT. TIBIAL N."

· GASTRO-CONEMIUS Popliteus thats

· PLANTARIS
· SOLEUS
forms the TENDON ACHILES
ATTACHED TO POST. SURFACE
OF CALCENEUM
Continues as "POST-TIBIAL N."
supplying the deep group
· Tom ® Tibialis post.
· Does ® flexor Digitorum.
· Hats ® flexor Hallucis longus.
+ 1 Superf. = Soleus.
“SOLEUS HAS A DOUBLE N. SUPPLY FROM
BOTH. & CALLED THE PERIPH. HEART”
forms the floor of ANT. COMPARTMENT
popleteal fossa Latral compart.
"DORSI-FLEXION" foot drop if
"EVERSION"
injured also if Sciatic n. inj.
· pEroneous longus. · Tom ® Tibilais ant. (from
lat. surface of tibia)
· pEroneous Brevis.
· Has ® EHL.
NB: SCIATIC NERVE · 2 Dogs ® EDL & (EDB "not
a part of the ant. compart.")
· Roots: L4 to S3 .
· Leaves the pelvis by passing through · 1 Pig ® Peroneous tertius.
the GSF below piriformis.
· Injured with post. HD ® foot drop
· Hamstrings escape the injury if the
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lesion occurs in the mid-thigh.
 FEMORAL TRIANGLE
a) SITE:. Upper 1/3 of front of thigh.
b) BOUNDARIES:
· Lateral: Medial border of Sartorius.
· Medially: Medial border AL.
· Base: Inguinal lig. (Pouparts's)
· Apex: Sartorius overlapping AL.
c) FLOOR (FROM MEDIAL TO LATERAL):
· A = Adductor Longus.
· P = Pectineus.
· P = Psoas major.
· I = Iliacus.
d) ROOF: Skin, Superf. Fascia, deep fascia
® containing the saphenous opening.
f) CONTENT: FROM LATERAL TO MEDIAL
FEMORAL NERVE FEMORAL SHEATH (FROM LAT. NEDIAL)
& OTHERS FA ® FV ® FEMORAL CANAL
1. Saphenous N. (from FN) “& femoral br. of Allows expansion of FV during ex.
2. lat. cutaneous n. of thigh genitor- femoral n · SITE OF FEMORAL HERNIA ± Enlarges to relive
(from lumbar plexus) (in front of FA)” strangulation ± serious he dt rupture of
FA bisects the Accessory Obturator a.
NB: AT THE APEX, STRUCTURES ARE ARRANGED
AS FOLLOWS (FROM ANT. T O POST .):
triangle vertically. · CONTAINS: fat, lymphatics + LN OF CLOQUET
· FEMORAL RING FORMS ITS BASE! BOUNDARIES:
· FA ü Ant: Inguinal lig. (Poupart's lig.)
· FV ü Post: Pectineal lig. (Cooper's lig.)
· Profunda femoris Vein. ü Lat.: FV. (separated from the
· Profunda femoris Artery femoral canal by the lacunar part of ing. Lig) 7
ie: arteries enclose the veins ü Med.: Lacunar ligament.
 ADDUCTOR CANAL
(SUB-SARTORIAL OR HUNTER'S CANAL

1) SITE: middle 1/3 of medial side of the ant. Surface of thigh

2) BOUNDARIES:
· AM wall: Sartorius.
· AL wall: Vastus Medialis.
· Floor: AM + AL.
3) CONTENTS: IT'S CONSIDERED AS A CONTINUATION TO THE FEMORAL CANAL
· FA & FV + it's Descending genicular branch (to knee)
· Saphenous nerve. (not the FN!) crosses the vs. from lat. to medial.
· N. to vastus medialis.

POPLITEAL FOSSA
1) SITE: diamond shaped space at the back of knee
2) BOUNDARIES:
· Antero-lat.: Biceps femoris.
· Antero-medial: 2 Semis. (Semi-tendinosus & membranosus)
· Below: 2 heads of Gastrocnemeus.
3) FLOOR: -
· Above: popliteal surface of femur.
· Middle: Joint capsule..
· Below: fascia covering popliteus
4) ROOF: skin & superf. Fascia (containing short saphenous vein ) & deep fascia
5) CONTENTS:
· FROM DEEP TO SUPERF.(POPLITEAL AVN)
ü Middle of fossa ® Medial popliteal n.
ü Lat. part of fossa ® Lat. popliteal n.
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· MEDIALLY ® LNs + semimembranosus bursa!