Anatomy Theoretical 2024-2025 PDF

Mansoura National University Faculty of Nursing ANATOMY Theoretical FIRST LEVEL FIRST SEMSETER ACADEMIC YEAR 2024-2025 Mansoura University Faculty of Nursing First year / First Semester Anatomy Dr. Raouf Fekry Professo...

Mansoura National University Faculty of Nursing ANATOMY Theoretical FIRST LEVEL FIRST SEMSETER ACADEMIC YEAR 2024-2025 Mansoura University Faculty of Nursing First year / First Semester Anatomy Dr. Raouf Fekry Professor of Anatomy Faculty of Medicine, Mansoura University 2024 / 2025 1  Preface Human Anatomy forms the basis for the practice of medicine. Anatomy leads the physician towards an understanding of a patient's disease. Human Anatomy text was written to serve as a foundation and resource for students pursuing health-related careers in fields such as medicine, dentistry, nursing, physician assistant, medical technology, physical therapy, massage therapy, and other health related professions. The ability to interpret a clinical observation correctly is the endpoint of a sound anatomical understanding. The focus of Human Anatomy is to provide applicable knowledge of the structure of the human body. Practical information is presented in this text that will enable students to apply facts to the real- world situations they might encounter in theirprofession. The main objective of this course is to provide a text that is inviting and attractive and up-to-date information of practical concern. It aims to entice readers to study the material and thereby enhance their appreciation of life through a better understanding of the structure, function, and magnificence of their own bodies 2  ANATOMY Anatomy:The term anatomy is derived from a Greek word meaning “to cut up”. It is the study of the structure of the body and the relationship of its parts to eachother. 1- Anatomicalposition The anatomical position is the standard reference position of the body used to describe the location of structures The body is in erect posture with the feet close to each other and theface directedforwards. The upper limbs are straight by the sides with palms facing forward. Fig: Anatomical position 3 2- Anatomicalplanes 1) Sagittalplane: Is a vertical plane which divides the body into right and leftparts. Median sagittalplane: Is the plane passing through the centerof the body dividing it into right & lefthalves. Parasagittalplane: Plane lying to one or the other sideof median plane & parallel toit. It divides the body into unequalparts 2) Coronalplane: A vertical plane divides the body into anterior and posteriorparts. 3) Transverseplane: A horizontal plane divides the body into upper (cranial) and lowers (caudal)parts. Fig: the anatomical planes 4 3- Anatomicalterms I - Terms related toposition ▪ Superior: Toward thehead. ▪ Inferior: Toward thefeet. ▪ Anterior: Toward the front of thebody. ▪ Posterior: Toward the back of thebody. ▪ Median: At the middle line of thebody. ▪ Medial: Toward the midline of thebody. ▪ Lateral: Toward the side of thebody. ▪ Superficial: Toward the surface of thebody. ▪ Deep: Away from the surface of thebody. ▪ Proximal: Toward the root oflimb E.g. the arm is proximal to theforearm. ▪ Distal: Away from the root oflimb ▪ E.g. the hand is distal to theforearm. ▪ Internal: Inside an organ orcavity. ▪ External: Outside an organ orcavity. 5  Fig: Anatomical terms related to position II - Terms related tomovements 1. Flexion: a bending movement around a joint that decreases the angle between the two articulatingbones. 2. Extension: an unbending movement around a joint that increases the angle between the two articulatingbones. 3. Abduction: movement away from the midline of thebody. 4. Adduction: movement toward the midline of the bodyplane. 5. Rotation: Is the movement of a part of the body around its longitudinalaxis. 6  ▪ Medial rotation: rotation a part of the body around its longitudinal axis towards themidline ▪ Lateral rotation: rotation a part of the body around its longitudinal axis away frommidline. 6. Circumduction: movement of a limb or extremity so that the distal end describes a circle, it is successive movement of flexion, abduction, extension andadduction. 7.Protraction and retraction: Are mostly used to describe the forward and backward movement of the mandible at the tempro- mandibularjoint. ▪ Protraction: Is to moveforward. ▪ Retraction: Is to movebackward. 7 Fig : Anatomical terms related to movement 8 4- Bodyorganization ▪ The body of the living organism consists of manysystems. ▪ Each system is formed of manyorgans. ▪ Each organ is formed of manytissues. ▪ Each tissue is formed of layers or groups of similar cells that perform a commonfunction. ▪ The cell is the basic structural and functional component of the body. Each cell is composed of cytoplasm and nucleus and is surrounded by cellmembrane. Fig: Body organization 9 5- Bodyregions The human body is divided into several regions that can beidentified on the surface of the body. The major body regionsare the head, neck, trunk, upper extremity, and lower extremity. The trunk is frequently divided into the thorax, abdomen, and pelvis. 6- Bodysystems The main systems of the human body are as follows: 1- Cardiovascular / Circulatorysystem: It is responsible for delivering oxygen and nutrients to organs and cells and carrying their waste products away. 2- Digestivesystem: It is responsible for digestion and absorption of the nutrients and elimination of the waste from the body. 3- Endocrinesystem: It provides chemical communications within the body using hormones. 4- Integumentarysystem: It includes skin, and its appendages (hair, nail). 5- Lymphaticsystem: It defends the body against disease-causing agents. 6- Musculo-Skeletal (locomotor)system: It enables the body to move using muscles. It supports the body and itsorgans. 10 7- Nervoussystem: It collects information from the senses and tells themuscles to contract. 8- Urinarysystem: It is the system where the kidneys filter blood. 9- Reproductivesystem: It is responsible for the production of offspring. 10- Respiratorysystem: It brings air into the body to oxygenate the blood. 11  INTEGUMENTARY SYSTEM The integumentary system consists of the skin, hair, nails and related glands (sweat and sebaceous glands). It acts as a barrier to protect the body from the outside world. It also functions to retain body fluids, protect against disease, eliminate waste products, and regulate body temperature. 1- The Skin The skin consists of a- Outer epithelial layer calledepidermis. b- Inner connective tissue layer calleddermis. ▪ The epidermis: Formed of stratified squamous keratinized epithelium. ▪ Thedermis: o Formed of connective tissue having collagen & elasticfibers. o It contains blood vessels, lymphatics, nerves, hair follicles & sweatglands. 12 Skin appendages 1-Thenails: Are keratinized plates on the dorsal surface of the tips of fingers and toes. 2-Hairs ▪ Hairs are present over the whole surface of the body exceptlips, palms, soles, sides of fingers & toes, parts of external genital organs. 3-Sebaceousglands ▪ Open into the hair follicles and secrete oilymaterials. 4-Sweatglands ▪ They are long spiral glands which open on the surface of the skin. ▪ They are present over the surface of the body except lips, nail beds and parts of external genitalorgans. Functions of the skin 1-Protection Protection against mechanical, thermal and chemical damage, protection against water loss, ultraviolet rays andmicroorganisms. 2-Sensation It contains sense receptors & sensory nerves. 13 3-Temperatureregulation It aids in heat loss and heat retention through the fat, blood vessels and sweatsecretion. 4-Synthesis of vitaminD 5- Excretion of urea and uricacid 2-Fascia Fascia is a connective tissue that lies immediately deep to theskin. There are two types offascia: A. Superficialfascia. B. Deep fascia. A.S uperficialfascia Found immediately deep to theskin. It is a mixture of loose areolar & fatty tissue that unite the skin to the underlying deepfascia. Function 1. Facilitate the movement of theskin. 2. Gives passage to vessels & nerves of theskin 3. Control the temperature of the body as the fat is bad conductor of heat. 4. Gives the body its roundedappearance 14 B. Deepfascia It is a strong, dense, white fibrous layer that lies deep to the superficial fascia. Function 1. It is thickened in the palms & soles to provide protective function. 2. It invests the underlying muscles assisting theiraction. 3. It is thickened at the regions of the wrist and ankle forming retinaculaeholding the underlying tendons in position during action. 3-Body cavities and membranes A. Body Cavities: Body cavities are spaces within the body that contain and protectthe organs. There are two principal body cavities: the posterior bodycavity and the larger anterior body cavity. The posterior body cavity contains the brain and the spinalcord. The anterior cavity is formed of upper chest cavity contains the heart and lungsand a lowerabdominopelviccavitycontains abdominal and pelvicorgans. 15 B. Body Membranes Body membranes are composed of thin layers of tissue that cover, separate, and support visceral organsand line body cavities. They are 1- The Pleurae:covers thelungs. 2- The Pericardium:coverstheheart. 3- The Peritoneum: coversthe abdominalviscera. Fig: Body cavities 16  LOCOMOTOR SYSTEM The Locomotor system consists of bones, joints and muscles. A- TheBone The bone is a type of connective tissue formed of cells, fibers & matrix. Bone is hard due to calcification of its extracellular matrix, also it has a degree of elasticity due to presence of organic fibers. Functions of bones 1. Form the supporting framework of thebody. 2. Gives attachment to muscles and acts aslevers 3. Protection of underlying structures e.g. the skill protects the brain. 4. Storage of calcium &phosphorus. 5. Formation of blood cells by bonemarrow. Classification of bones (A) According to thestructure 1 -Compact bone: The bone appears as a solid mass. 2-Cancellous bone: The bone consists of a branching network oftrabeculae. (B) According to theshape 1- Long bones: as femur &humerus. 17  2- Short bones: as carpal & tarsalbones. 3- Flat bones: as scapula & bones of skullcap. 4- Irregular bones: as vertebrae & bones of the base ofskull 5- Sesamoid bones: they are small bones found in certain tendons as thepatella. 6- Pneumatic bones: it contains air cavities as some of skull bones (e.g.maxilla). Fig: Classification of the bone according to the shape 18 (C) Regionalclassification The human skeleton consists of two main parts a- Axial skeleton: which consistsof 1- Skull 2- Vertebralcolumn 3- Thoraciccage 4- Pelviccavity b- Appendicular skeleton: Which consists of 1- Bones of the upper limb. 2- Bones of the lower limb. Structure of long bones Each long bone has three parts, shaft and 2 ends: The shaft ▪ Is tubular in shape having a cavity called marrow cavity containing bonemarrow. The ends ▪ Is covered by articular cartilage. Epiphyseal plate: is a flat plate of hyaline cartilage liesbetween the ends and the shaft and is responsible for growth of the bone in length. 19 Fig: The human skeleton 20  Axial skeleton 1-Theskull ▪ It forms with the mandible the skeleton of thehead. ▪ It consists of 21 bones articulated with each other by fibrous joints namedsutures. It consists of the skull consists of two sets of bones: a- The cranial bones form the cranium that covers thebrain. b- The facial bones that support the eyes and nose and form the bony framework of the oralcavity. The skull articulates with the first cervical vertebra (Atlas). The skull of the newborn contains fontanels (membranous areas) that allow brain growth. 2-Vertebralcolumn 21  ▪ The vertebral column is formed of33 vertebrae separated byfibrocartilagenous discs called intervertebraldiscs. The vertebrae are classified into the following groups: A. In the neck: 7cervical vertebrae. B. In the chest: 12 thoracicvertebrae. C. In the abdomen: 5lumbarvertebrae. D. In the pelvis: 5 sacral vertebrae. (Fused to form sacrum) and 4 coccygeal vertebrae (fused to formcoccyx) The structure of the typical vertebra It consists of a body (anteriorly) and a vertebral arch(posteriorly). These two parts enclose a space called the vertebral canal through which run the spinal cord. The vertebral body: is the anteriorpart. It articulates with bodies above and below by intervertebraldiscs. The vertebral arch: consists of 2 pedicles and 2laminae. Processes. 2- transverse processes (directed laterally). 3-One spine (directed posteriorly) 4- articular processes (directed vertically; 2 superior&2 inferior). 22  Fig: Structure of typical vertebra 3- Thoraciccage: It is formed of sternum, ribs and 12 thoracic vertebrae Sternum ▪ It is a flat hone in the anterior aspect of thethorax. ▪ It articulates with the upper 7ribs. Ribs ▪ There are 12 pairs ofribs. ▪ Each rib is attached posteriorly to the vertebral column and is continued anteriorly with a costalcartilage. ▪ Ribs can be classifiedinto A- Trueribs The upper 7 ribs, attached anteriorly to thesternum. 23  B- Falseribs: the8th , 9th , &10th areattached to each otherbytheir costalcartilages. the 11th& 12th ribs are free &are called the floating ribs. 4- Bonypelvis: Is composed of 2 hip bones and sacrum. Male pelvis is narrower than female pelvis. 24  Appendicular skeleton It is formed of the bones of the upper & lower limbs. Bones of theupperlimb Bones of the lowerlimb Region Bone Region Bone Shoulder Scapula & Pelvic girdle Hip bone girdle Clavicle Arm Humerus Thigh Femur Forearm Ulna (medially) Leg Tibia (medially) Radius (laterally) Fibula (laterally) Hand Carpal bones (8) Foot Tarsal bones (7) Metacarpal bones Metatarsal bones (5) (5) Phalanges(14) Phalanges(14) 25  B- Joints Definition: Joint is the meeting of two or more bones. Classification Joints are classified according to the tissues that lie between the bones into 1. Fibrousjoints: The articular surfaces of bones are joined by fibrous tissues. 2. Cartilaginousjoints: The articular surfaces of bones are joined together by cartilage. 3. SynovialJoints: The articular surfaces of bones are separated by a fluid -filled cavity. 1- Fibrousjoints Contain fibrous tissue between the articulating bones. Movement: No movement Examples: Sutures of the skull and joints between teeth and mandible Fig: Fibrous joint 26 2- Cartilaginousjoints ContainsCartilage (hyaline or fibrocartilage) between the two articulatingbones. Movement: limitedor No movement. Types: a- Primarycartilaginous ▪ The bones are connected by hyaline cartilage which becomes ossified byage. ▪ No movement ispossible. ▪ Example: Theepiphyseal plate in the longbones. (2) Secondarycartilaginous ▪ The bones are connected by fibrocartilage which is not ossified by age. ▪ A small amount of movement ispossible. ▪ Example: Joints between the vertebral bodies and Symphysis pubis. 27  Anatomy 3-Synovialjoints Characteristic features of the synovial joints The articulating surfaces are covered by hyaline cartilage. The articulating bones are separated by a joint cavity. The joint cavity contains a lubricating synovialfluid. The joint cavity is lined by a synovial membrane. The synovial membrane is protected from outside by a capsule supported by ligaments. The synovial joints allow a wide range ofmovement. Fig: Synovial joint 28  Anatomy Types of synovial joints The synovial joints may be classified according to the shape of the articular surfaces and the types of movement that are possible into the following 1- Synovial planejoints ▪ The articular surfaces areflat ▪ Allow gliding movements in anydirection. ▪ Example: intercarpal & intertarsaljoints. 2- Synovial hingejoints ▪ Resemble thehinge ▪ Allows flexion &extension ▪ Example: Elbow& Anklejoints. 3- Synovial pivotjoints ▪ Have a central bony axis rotate in a ring formed of bone &ligaments. ▪ Example: superior radio-ulnarjoint 4- Synovial ellipsoidjoints ▪Allow flexion -extension and abduction-adduction. ▪Example: wrist joint. 5- Synovial condyloidjoints ▪Allow flexion -extension and abduction-adduction with small amounts of rotation. ▪ Example:Tempromandibularjoint. 6- Synovial ball and socketjoints ▪ Allow movements in manyplanes. 29  Anatomy ▪ Example:hip joint & shoulderjoint. 30  Anatomy C- Muscles Types There are three types of muscles 1. Skeletalmuscles 2. Smoothmuscles 3. Cardiacmuscles Skeletal muscles ▪ They are the muscles that are attached to and produce movement of theskeleton. ▪ They are called voluntary muscles because they act by the will of man. ▪ They are called striated because they appear striated under the microscope. Characters 1- A skeletal muscle has two or moreattachments. ▪ Theorigin: The attachment of the muscle that moves theleast. ▪ The insertion: The attachment of the muscle that moves the most. 2-Theendsofamuscleareattachedtobonesbyfibroustissuecalled tendon. 4-The fleshy part of the muscleis called thebelly. 5- They are supplied by motor nerves. 31  Anatomy Comparison of the different types of muscles Skeletalmuscle Cardiacmuscle Smooth muscle Site Attached Heart Wall of viscera Toskeleton &blood vessels Action Voluntary Involuntary Involuntary Shape of cells Cylindrical Cylindrical Spindle shaped Striation Striated Striated Non- striated Branching No Branch &join No 32  Anatomy CARDIOVASCULAR SYSTEM The cardiovascular system transports blood to and from capillary beds in the tissues for the exchange of respiratorygases, nutrients and metabolites. The cardiovascular system consists of the heart & blood vessels. 1- Heart The heart is a conical hollow muscular organ which is enclosed by the pericardium in the thoraciccavity. The heart wall is formed mainly by muscle layer called myocardium and lined from inside by endothelial layer called endocardium. It is formed of 4 chambers 2 atria (right and left) and 2 ventricles (right andleft). Position: ▪ It lies obliquely behind the body of the sternum and the adjoining parts of the costal cartilages and is surrounded on each side by the lung andpleura. Shape & external features: ▪ The heart is pyramidal (or conical) in shape. It has a- Anapex b- Abase c- Four surfaces 1-Anterior(sternscostal) 2- Inferior(diaphragmatic) 33  Anatomy 3- Rightsurface 4- Leftsurface a)Apex of theheart: ▪ Directed downwards, forwards and to theleft. ▪ Formed by the leftventricle. ▪ Lies in the left5thintercostal space, 3.5 inchesfromthe midlineplane. b)Base ofheart: ▪ Forms the posterior surface of theheart ▪ Formed mainly by the left atrium and a small part by the right atrium. c)Surfaces of theheart: 1 - Anterior (sternocostal) surface: ▪ Directedanteriorly. ▪ Formed by the 2 atria and 2 ventricles 2- Inferior (diaphragmatic)surface: ▪ It rests on thediaphragm. o Its right 1/3 is formed by therightventricle o Its left 2/3 is formed by the leftventricle 3- Left surface: ▪ Formed mainly by the left ventricle and small part by the left atrium. 4 – Right surface: ▪ Formed by the rightatrium 34  Anatomy Difference between atria and ventricles Atrium Ventricle Wall thin thick Site occupy upper part occupy lower part Function receive blood from veins push blood into arteries Vessels right atrium: superior vena Right-ventricle: connected cava and inferior vena cava pulmonary trunk left atrium: 4 pulmonary to them left ventricle: aorta veins Valves of the heart The heart is provided by four valves to allow blood flow in one direction. 1- Atrioventricularvalves They are located between atria and ventricles. The tricuspid valve: lies between right atrium and right ventricle. 35  Anatomy The mitral valve: lies between left atrium and left ventricle. 2- Semilunar valves They are located between ventricles and the vessels connected to them. Pulmonary valve: lies between right ventricle and pulmonary trunk. Aortic valve: lies between left ventricle and aorta. Fig: Internal features of the heart Blood supply of the heart ▪ The heart is supplied by two coronary arteries (Rt. One & Lt. One) ▪ Coronaries originate from the ascending aorta. Nerve supply of theheart It is supplied by sympathetic & parasympathetic autonomic nerves. 36  Anatomy Conducting system of the heart The conducting system of the heart consists of cardiac muscle cells and conducting fibers that are specialized for initiating impulses and conducting them rapidly through the heart. It includes 1- Sino-atrial (SA) node:it initiates the heart beat (pace maker), lies at rightatrium. Fig: Conducting system of the heart 37  Anatomy Clinical notes In certain pathological conditions (rheumatic fever) the valves may be damaged (stenosis or incompetence) and need to be replaced by synthetic valves. 2- Blood vessels Blood vessels are of three types 1- Arteries 2-Veins 3-capillaries Difference between arteries and veins Artery Vein Carry oxygenated blood (with the carry deoxygenated blood (with exception of the pulmonary the exception of pulmonary artery) veins). Carry blood from the heart to Carry blood from various parts various parts of the body. of the body to the heart. Locate deeper in the body Locate closer to the skin (superficial) Give branches, the smallest Has tributaries, the smallest one branch is calledarteriole is called venule Doesnot have valves Have valves especially in limb veins Has thick wall Has thin wall Usually accompanied by veins Can be present without accompanyingarteries Used for counting pulse, Used for injections and blood measuring bloodpressure sampling 38  Anatomy Fig: Artery and vein Capillaries Capillaries are microscopic vessels forming a network connecting the arterioles to thevenules. Capillaries wall consist of endothelium only to allow exchange materials between tissue cells and theblood. Sinusoids Thin-walled blood vessels like capillaries but they have irregular cross diameter and they are wider thancapillaries. They are found in liver, spleen & bonemarrow. Fig: Structure of sinusoid 39  Anatomy Important arteries in the body 1- Aorta The aorta is the largest artery in thebody. It arises from the leftventricles It has threeparts a- The ascending aorta: gives rise to the right and left coronary arteries, which supply theheart. b- The aortic arch: gives rise to 3branches The brachiocephalic artery that divides into right common carotid artery and right subclavianartery The left common carotidartery The left subclavianartery (The subclavian arteries supply the upper limb, while the common carotid arteries supply the head and neck and the brain) c- Descending aorta: which has 2parts Descending thoracic aorta: gives branches tothorax. Descending abdominal aorta: gives branches toabdomen. The abdominal aorta divides into 2 terminal branches called common iliac arteries that divide into External iliac artery: supply the lower limb Internal iliac artery: supply the pelvic organs (urinary bladder, rectum, sex organs) 2- Pulmonarytrunk = It originates from the right ventricle. 40  Anatomy = It divides into right and left pulmonary arteries that enter the lung. = They carry nonoxygenated blood to the lungs. Fig: Arterial system 41  Anatomy Important veins in the body 1- Superior venacava Drain the upper part of the body (head and neck, upper limb andchest). Is formed by union of right and left brachiocephalicveins. It ends the right atrium. 2- Brachiocephalicveins Are formed by the union of internal jugular vein (drain the head and neck and brain) and subclavian vein (drain the upper limb). 3- Inferior venacava Drain the lower part of the body (lower limb, abdomen and pelvis). Is formed by union of 2 common iliacveins. It ends in the right atrium. 4- Portalvein Drain the GIT (stomach, intestine) andspleen. Divide into right and left branches that enter theliver. 42  Anatomy Fig: Venous system Clinical notes: Taking the Carotid Pulse: The bifurcation of the common carotid artery into the internal and external carotid arteries can be easily palpated just beneath the anterior border of the sternocleidomastoid muscle. 43  Anatomy 3- Circulation 1- Systemic circulation Aim: The systemic circulation provides the blood supply to all body tissue. It carries oxygen and nutrients to the cells and picks up carbon dioxide and waste products. Steps: ▪ The oxygenated blood in the left ventricle passes into the aorta through the aorta valve during ventricularcontraction. ▪ The aorta and its branches distribute the oxygenated blood to all parts of the body through arteries, arterioles then tocapillaries. ▪ The oxygen and nutrients pass to cells and the carbon dioxide and the waste products enter the blood through the capillary wall. ▪ The deoxygenated blood is collected and passed throughvenules, veins, large veins then to superior and inferior vena cavea. ▪ The deoxygenated blood passes from superior and inferior vena cavea to the rightatrium. ▪ The deoxygenated blood passes from the right atrium to the right ventricle through tricuspidopening. 2- Pulmonarycirculation Aim: The pulmonary circulation carries the deoxygenated blood to the lung to be oxygenated. 44 steps: Anatomy ▪ The deoxygenated blood passes from the right ventricle to the pulmonary trunk through pulmonaryvalve. ▪ The deoxygenated blood passes from the pulmonary trunk to pulmonary arteries to the lung to beoxygenated. ▪ The oxygenated blood returns back to the left atrium through the four pulmonaryveins. ▪ The oxygenated blood passes from the left atrium to the left ventricle through the mitralvalve. 3- Hepatic portalcirculation The venous blood of the gastrointestinal tract is delivered to the liver through the portal vein and its right and leftbranches. Inside the liver the nutrients areprocessed. The blood is drained from the liver by hepatic veins that terminate in the inferior venacava. 45  Anatomy LYMPHATIC SYSTEM Lymph: is the name given to tissue fluid after it enters a lymphatic vessel. It contains lymphocytes, fats and proteins. Function of lymphatic system Filtering out the organisms that cause thediseases Formation oflymphocytes. Formation ofantibodies. The lymphatic system consists of lymphatic tissues and lymphatic vessels. Fig: Components of the Lymphatic system 46  Anatomy Lymphatic tissues They are a type of connective tissue that contains a large number of lymphocytes. They are present in many organs & structures as: Lymphnodes Spleen Thymusgland Tonsils 1- Lymphnodes ▪ They are smalloval bodies that are present along the course of lymphvessels. ▪ They are present mainly in axilla, groin, neck and along blood vessels. 2- Spleen Lies in the abdomen behind thestomach. It has a role in filtering the blood and destroying the oldRBCs. It acts as a reservoir for the blood as in emergency it contracts to push blood into thecirculation. 3- Thymusgland It lies in the upper part of the chest behind the sternum. It has a role in formation of T lymphocytes. 4- Thetonsils The tonsils form a protectivering of lymphatic tissue around the openings between the nasaland oral cavities and the pharynx. They are mainly 2 tonsils the palatine tonsil that lies in the oropharynx, and the pharyngeal tonsil that lies in the nasopharynx. 47  Anatomy Clinical notes: Swelling of the lymph nodes is a sign of immune system functioning to fight off the invaders of the body as bacteria and viruses. Lymphatic vessels provide a pathway for the spread of certain types of malignant tumors from their site of origin. Fig: Components of the Lymphatic system 48  Anatomy THE DIGESTIVE SYSTEM It is consisted of the alimentary canal and the accessory organs of digestion: Fig: The digestive system A) Alimentarycanal: This is a long tube trough which foodpasses. It starts at the mouth and ends at theanus. It consists of the followingparts: 1-Mouth 2-Pharynx 3-Oesophagus 4-Stomach, 5-Smallintestine 6-Largeintestine. 49  Anatomy B) Accessory organs ofdigestion: They are glands outside the alimentary tract and their secretion pass through ducts to enter the tract. 1- Salivaryglands 2- Pancreas 3- Liver and the biliarytracts The main functions of digestive system: 1- Ingestion: taking food into the alimentarytract 2- Digestion: mechanical and chemical breakdown offood 3-Absorption: passage of digested food from the alimentary canal to blood and lymphcapillaries 4- Elimination: excretion of undigested food asfaeces. - It is concerned with gridding, swallowing, digestion and absorption of the digestedfood. A-THE ALIMENTARY CANAL 1- MOUTH CAVITY The mouth (oral cavity) is divided into two parts: 1- The vestibule of the mouth: is the narrow space between lips and cheek "externally" and the teeth and gums"internally" 2- Mouth cavity proper: is the part enclosed by theteeth. 50  Anatomy The Palate Definition: It is the partition between oral and nasal cavities. Parts: = Hard palate: {bony part}. -Anterior 2/3 -formed of bone. = Soft palate: {muscular part} - Posterior 1 /3 of the palate. - Movable fibro muscular fold. - Its posterior border is free and shows the uvula hanging down from its middle. The Tongue It is a voluntary muscular structure at the floor of the mouth. Site: 1- Partly in the mouth {oral.part} 2- Partly in the pharynx {pharyngealpart}. External feature: The tongue has: 1- Apex: the anterior freeend. 2- Base: the posterior part; attached to the mandible and hyoidbone. 3- body: it has upper surface and inferiorsurface. Blood supply: Lingual artery (mainly) Nerve supply: = Motor: by hypoglossal nerve (12th cranial nerve) 51  Anatomy = Sensory: a) Anterior 2/3 o General sensation "pain, temperature and touch" by lingual nerve. o Taste sensation by chorda tympani (7th nerve). b) Posterior 113: o General and taste sensations by glossopharyngeal nerve (9th nerve). Function: = Mastication = Swallowing = Speech = Taste Fig: the tongue (superior view) The Teeth Each individual has two sets of teeth a- Temporary ordeciduousteeth b- Permanent teeth Temporary teeth Number: 20, {10 in eachjaw} They begin to erupt at 6 months and complete at 24month 52  Anatomy They include: 4 incisors, 2 canines, 4 molars in each jaw. Permanent teeth Number: 32 {16 in eachjaw} They start to erupt at 6 years and complete at 21years. They include: 4 incisors, 2 canines, 4 premolars, 6 molars in eachjaw. Fig: Permanent teeth Structure of a tooth It consists of: 1- The crown: the part above thegums. 2- The root: the part embedded in thebone. 3- Theneck:the Eachtooth has the following: 1- Pulp cavity: in the center; containing blood vessels andnerves. 53  Anatomy 2- Dentine: hard substance surrounding the pulpcavity. 3- Enamel: hard substance outside the dentine in thecrown 4- Cement: a substance fixes the root to thebone. Fig: Structure of the tooth Nerve supply: Upper teeth: by maxillary nerve. Lower teeth: by mandibular nerve. Blood supply: Arterial supply by maxillary artery. Venous drainage by internal jugular vein. 54  Anatomy 2- PHARYNX behind the nose, mouth and larynx. Extent: vertebra where it becomes continuous with the esophagus. The wall of the pharynx: It is composed of the following layers: 1- Inner layer of lining mucous membrane 2- Middle layer of the fibrous tissue. 3- Outer layer consisting of a number of voluntary muscle. Parts of the pharynx 1- Nasopharynx: ---- behind the nasal cavity. 2- Oropharynx: ---- behind the oral cavity. 3- Laryngopharynx: behind thelarynx. N.B.- Only the oral "oropharynx" and the laryngeal "laryngopharynx" parts of the pharynx are associated with the alimentary canal. 3-ESOPHAGUS Definition: It is a narrow muscular tube forming the food passage between pharynx& stomach. Dimensions Diameter: 2 cm. Course and Relation: It begins in theneck. 55  Anatomy It passes in the median plane in thethorax. It pierces the diaphragm and becomes continuous with the stomach. 4- STOMACH Site: lies obliquely in the upper and left part of the abdomen. Shape: variable; may be J-shape. External features: it has the following two orifices: cardiac and pyloric two curvatures: lesser and greater It is the most dilated part of the alimentary tract which connects the lower end of the esophagus to the duodenum. Surfaces A- Anterior surface: is related to = Left lobe of liver and anterior abdominal wall B - Posterior surface: is related to pancreas and left kidney 56  Anatomy Parts of stomach Fundus:is Body:is the main part below the fundus Pyloric portion: is the lower narrow part, the pyloric sphincter is at its lowerend. 5- SMALLINTESTINE Extent: from the pylorus to the ileocaecal. Length: about 6 meters long. Parts (a) Duodenum = The shortest & widest part of small intestine. = Form a C-shaped curve around the head of pancreas. = Length: 10 inches =25 cm. (b) Jejunum = The middle part of small intestine, Its length: about 2 meters. (c) Ileum = The terminal part of small intestine, Its length: about 3 meters. = Ends at the ileocaecal opening. 6- LARGEINTESTINE Extent: from ileocaecal junction to the anus. Length: about 1.5 meters. Parts : it is divided into Caecum Appendix 57  Anatomy Ascendingcolon Transversecolon Descendingcolon Sigmoidcolon Rectum Analcanal. B- ACCESSORY ORGANS OF DIGESTIVE SYSTEM 1) SALIVARYGLANDS They are 3 pairs, which pour their secretion into the mouth. They include: 2 parotid glands, 2 submandibular glands, 2 sublingual glands. a) ParotidGlands They lie on each side of the face just below the external auditory meatus. b) SubmandibularGlands They lie on each side of the face under the angle of the jaw. c) Sublingualglands They lie under the mucous membrane of the mouth. 58  Anatomy 2) PANCREAS It consists of: head, body & a tail. A- The head: lies in the concavity of the duodenum. B- The body: lies behind the stomach. C- The tail lies in front of left kidney and just reaches the spleen. Fig: Anatomy of pancreas 3) LIVER It is the largest gland of the body. Weight: about 1.5 k gm. Site: upper part of abdominal cavity mainly on the right side. Shape: wedge-shape. Lobes of liver: it has two lobes A- Largerightlobe. B- Small leftlobe. C- The right lobe has two smalllobes 1- Caudate lobe: on the posteriorsurface. 59  Anatomy 2- Quadrate lobe: on the inferiorsurface. The portal fissure "the hilum": It is the part where structures enter and leave the liver. Fig: Anatomy of the liver 60  Anatomy THE RESPIRATORY SYSTEM The respiratory system consists of Nose Pharynx Larynx BronchiandBronchioles Twolungs 1- The Nose Is formed of 2 parts: 1- External nose: covered byskin. 2- Internal part (nasalcavity): - Is divided into two equal parts by aseptum. - Connected to the pharynx through the posterior nasalopenings - Is lined by mucous membrane rich in bloodvessels. - Has olfactory receptors in its upperpart. 61  Anatomy - Receives the opening of paranasalsinuses. Function 1. Warm, humedify and purify the inspiredair. 2. Organ ofsmell. 3. Respiratory airpassage Clinical notes: Epistaxis: or bleeding from the nose. The most common cause is nose picking. Deviated septum: Deflection of the nasal septum is common. It is believed to occur most commonly in males because of trauma in childhood. 2- The Pharynx It is a muscular tube extending from the base of skull to the level of the 6th cervicalvertebra. Acts as passage for air andfood. Is divided into 3parts 1- Thenasopharynx Lies behind thenose. Receive the opening of the auditorytubes. Contains the pharyngeal tonsil "Adenoids'". 62  Anatomy 2- Theoropharynx Lies behind themouth. Contains the palatine tonsils. 3- Thelaryngopharnyx Lies behind the larynx. Clinical notes: Tongue and Airway Obstruction: In an unconscious patient, there is a tendency for the tongue to fall backward and obstruct the laryngeal opening. Tonsillitis: The palatine tonsils are a common site of infection, producing the characteristic sore throat and pyrexia. Adenoids: are enlarged nasopharyngeal tonsils usually associated with infection. 63  Anatomy 3- The Larynx It extends from the root of tongue to thetrachea. The junction between the larynx and the pharynx is guarded by the epiglottis which prevents entry of the food or fluid into the respiratory system duringswallowing. It is formed of a group of cartilages; the most prominent one isthe thyroid cartilage or Adams apple. It contains the vocal folds, so it has a role inphonation. Fig: Components of the Larynx 64  Anatomy 4- The Trachea (The WindPipe) It starts from the larynx to the primarybronchi. It is 10 cm inlength. Its wall contains 15-20 incomplete C shaped cartilaginous rings that are deficient posteriorly to help the act ofswallowing. It ends by dividing into right & leftbronchus. 65  Anatomy 5- The PrimaryBronchi The two bronchi right and left arise from the lower end of trachea. Each bronchus passes obliquely downward to the hilum of the correspondinglung. Right bronchi left bronchi Shorter (about one inch) Longer (about 2 inch) Wider Narrower More vertical nearly in line with More oblique (not in line with trachea trachea) It divides into 3 bronchi. One for It divides into two bronchi. one each lobe of lung for each lobe of lung Clinical notes: Endotracheal Intubation: is inserting a tube inside the trachea to introduce oxygen in cases of anesthesia and obstruction. Aspiration of Foreign Bodies: In adults, foreign bodies tend to be aspirated into the right principal bronchus, since this is more in line with the trachea than the leftbronchus. 66  Anatomy 6- TheLungs There are two lungs, covered by the pleural, separated by mediastinum. The lung is covered by the pleura. Shape: Each lung is Cone-Shaped, and has An apex: the upperend A base: directed downward and resting on thediaphragm Twosurfaces: Lateral surface: convex and related to the ribs Medial surface: concavo-convex and related to the heart. It contains the hilum which is the area through which structures enter and leave the lung. Fissures and lobes of the lung The right lung: is divided into three lobes (superior, middle and inferior) by two fissures oblique and horizontalfissures. The left lung: is divided into two lobes (superior and inferior) by the obliquefissure. Each lobe is divided intosegments. The alveoli are where gaseous exchange occurs between the air and theblood. 67  Anatomy Differences between right and left lungs Right lung left lung Shorter Longer Wider Narrower 3 lobes 2 lobes 2 fissures 1 fissure 10 bronchopulmonary segments 8 bronchopulmonary segments 68  Anatomy THE URINARY SYSTEM It consists of the following organs: 1-Kidneys 2-Ureters 3- Urinarybladder 4-Urethra Fig: Components of the Urinary system 1- Kidneys They are paired organs (right and left), brown reddish in color. Site: They lie on the posterior abdominal wall. One on each side of the vertebral column, behind the peritoneum and below the diaphragm. The right kidney is lower than the left due to the presence of the liver. Shape: Bean-shaped. Surfaces: it has 2 surfaces 69  Anatomy Anterior surface: convex and is related to the abdominal viscera. Posterior surface: flat and is related to the muscles of the posterior abdominal wall. Hilum of the kidney: gives passage to the renal artery, renal vein and the pelvis of the ureter. Blood supply of the kidney: The renal artery: arises from the aorta. The renal veins: terminate into IVC. 2- Ureters The ureters are a Pair of muscular tubes which transport urine from the kidney to the urinary bladder. Length : 25 cm Course: They pass downwards from the hilum of the kidney to enter the posterior wall of the urinary bladder. Fig: Components of the Urinary system 70  Anatomy 3- Urinarybladder ▪ It is a muscular sac collecting theurine. ▪ Site: It lies in the anterior part of the pelvic cavity behind the symphysispubis. o Shape: An empty bladder pyramidal inshape. o A full bladder: ovoid inshape. ▪ Openings: It has 2 openings for the ureters on each side of the base, one urethral opening at the lower end(neck). 4- Urethra It is a thin wall tube extending from the neck of the urinary bladder to the exterior. 71  Anatomy THE REPRODUCTIVE SYSTEM It is the system of sex organs which work together for the purpose of sexual reproduction. It is comprised of the following organs: Male Female Primary sex organ testis ovary Duct system epididymis uterinetubes ductusdeferens uterus ejaculatoryduct vagina urethra accessory glands prostate greater vestibular seminalvesicle gland bulbourethral gland 72  Anatomy THE NERVOUS SYSTEM It is concerned with receiving stimuli from outside and inside the body "These stimuli are analyzed and integrated and the suitable response produced which may stimulate or depress activity in muscular, glandular and other tissues. It is assisted by the endocrine system. The nervous system is divided into two main parts: 1- Central nervous system{C.N.S.} 2- Peripheral nervous system{P.N.S.} The nervous system can be divided, according to the function into: A) Somatic nervous system: Which control voluntaryactivities B) Autonomic nervous system which controls involuntaryactivities 1- Central Nervous System {C.N.S.} The central nervous system consists of: A-brain B-spinalcord The central nervous system is composed of large number of neurons embedded in a special type of connective tissue called neuroglia. The neuron is the structural & functional unit of the nervous system. It is formed of a nerve cell with its processes which are the axon anddendrites 73  Anatomy The interior of C.N.S. is organized into 1- Gray matter: consist of nerve cells embedded inneuralgia. 2- White matter: consists of nerve fibers embedded inneuralgia. A- BRAIN Parts of the brain 1- Cerebrum: Formed of` two cerebral hemispheres connected by the corpus callosum. Each hemisphere has a lateralventricle. 2- Cerebellum: Formed of two cerebella hemisphere connected by thevermis. 3- Brain stem: Is formedof: Midbrain:{above}. Pons:{middle} Medullaoblongata :{ below}. It is continuous below with the spinal cord al the foramen magnum. 74  Anatomy 2- Peripheral nervoussystem Consists of cranial & spinal nerves with their associated ganglia. The nerves are formed of bundles of nerves A- Cranialnerves 12 pair of nerves that leave the brain and pass through foramina in the skull. All cranial nerves are distributed in the head & neck except the 10th (vagus nerve) which also supply structures in thorax and abdomen B- Spinalnerves 31 pairs of nerves that leave the spinal cord and pass through intervertebral foramen in the vertebral column. Consists of 7 cervical, 12 thoracic 5 lumbar 5 sacral & 1 coccygeal Fig: Spinal nerves 75  Anatomy 3-Autonomic nervoussystem Part of nervous system concerned with innervation of involuntary structures as heart, smooth muscles & glands. It is distributed through central & peripheral nervous system. It is divided into 2 parts: Sympathetic system: Prepare the body for an emergency. It increases the heart rate, raises the blood pressure, inhibits peristalsis and closes the sphincters Parasympathetic system: Responsible for conserving and restoring energy. It decreases the heart rate, increases the peristalsis & glandular activity and open sphincters. 76  Anatomy ENDOCRINE GLANDS These are ductless glands that secrete hormones directly into the blood. 1- Pituitary gland It is a small endocrinegland. It lies in a special fossa in the cranial cavity and connected with the base of thebrain. It has two lobes; anterior and posteriorlobes. Anterior lobe of the pituitary gland secretes growth hormone, prolactin and different hormones which control the secretions of other endocrineglands. Posterior lobe of the pituitary gland secretes antidiuretic hormone andoxytocin. 77  Anatomy 2-Thyroid gland It lies in the lower part of the front of the neck clasping the larynx and upper part of thetrachea. It has two lobes joined across the median plane by an isthmus. It secretes thyroxinehormone. Its enlargement calledgoitre. 3-Parathyroid glands They are four in number, two in each side behind the thyroid gland. They secrete parathrmone hormone which controls the level of Calcium and phosphorus inblood. 78  Anatomy 4-Supra-renal glands They are a pair of important endocrine glands situated over the upper poles of thekidneys. Each gland consists of two parts: cortex andmedulla. The cortex secrets mineralocorticoids, glucocorticoids and sex hormones. The medulla secretes adrenaline andnoradrenaline. 5-Thymus gland It lies in the thoracic cavity behind thesternum. It reaches the height of its development at puberty. Then it undergoes gradualinvolution. It is an important source oflymphocytes. 79  Anatomy General Anatomy (final exam) 1- Select the single best answer: (1 mark each) A- Which one of the following endocrine glands lies in the cranial cavity? A. Thymus B. Pituitary C. Thyroid D. Parathyroid B- The apex of the heart is formed by: A. Right ventricle B. Left ventricle C. Right atrium D. Left atrium C- The length of the ureter is: A. 10 cm B. 15 cm C. 20 cm D. 25 cm D- The scapula is an example of: A. Long bones B. Short bones C. Flat bones D. Irregular bones 80  Anatomy E-The endocrine gland that secretes adrenaline hormone is: A. Thymus B. Supra-renal C. Thyroid D. Pitutary F- One of the following bones presents in the axial skeleton: A. Femur B. Radius C. Sternum D. Ulna G- The pulmonary trunk is connected to: A. Right atrium B. Right ventricle C. Left atrium D. Left ventricle H- The structure which acts as a passage for both air and food is: A. Pharynx B. Larynx C. Trachea D. Bronchi I- The carpal bones are example of: A. Flat bone B. Irregular bone C. Long bone D. Short bone J- The intervertebral disc is an example of A. Fibrous joint B. Primary cartilaginous joint C. Secondary cartilaginous joint D. Synovial joint 81  Anatomy 2- Put true (T) or false (F) for each of the following statements: (1 mark each) A-The term proximal means near to the root of limb. ( ) B- Abduction means movement toward the midline of the body. ( ) C- The membrane covering the heart is called pericardium. ( ) D- The kidney lies on the anterior abdominal wall. ( ) E- The pulmonary veins carry oxygenated blood ( ) F- The cranial nerves are 10 in number ( ) G- The oesophagus is a part of the alimentary tract ( ) H- The smooth muscles of the human body are involuntary muscles ( ) I- The lumbar vertebrae are 7 in number. ( ) J- The diaphragmatic surface of the heart is formed by the 2 atria. ( ) 82  Anatomy 3- Mention each of the followings: (2 marks each) A- Bones forming the shoulder girdle: ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… …………………………… B-Parts of the brainstem: ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… …………………………………………………… C- Types of joints: ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… D- Two valves in the heart : ………………………………………………………………………… ………………………………………………………………………… …………………………………………………………………………. E- Bones forming the skeleton of the leg : ………………………………………………………………………… ………………………………………………………………………… ………………………………………………………………………… ……………………………… 83  Anatomy 4-Compare between each of the followings: (10marks) Right Lung Left Lung Length Fissures Segments Atrium Ventricle Wall thickness Function Vessels connected to them 1ry cartilaginous joints 2ry cartilaginous joints 84  Anatomy Model final exam: I- Select the single best answer: (0.5 mark each) 1- The vertebra is an example of: A. flat bones B. irregular bones C. short bones D. long bones E. pneumatic bones 2- The type of tempromandibular jointis: A. synovial pivot B. synovial codyloid C. synovial ellepsoid D. synovial plane E. synovial hinge 3-One of the following bones is present in axial skeleton: A. sternum B. radius C. femur D. humerus E. ulna 4-One of the following bones present in the skeleton of upper limb: A. tibia B. fibula C. sternum D. humerus E. rib 85  Anatomy 5- The number of vertebra in the cervical region is: A. five B. six C. seven D. eight E. nine 6- The intervertebral disc is an example of: A. fibrous joint B. primary cartilaginous joint C. secondary cartilaginous joint D. synovial joint E. none of the above 7- The smooth muscle is present in: A. heart B. wall of viscra C. attached to skeleton D. none of the above E. all of the above 8- The motor nerve supply the tongue is: A. lingual nerve B. glossopharyngeal nerve C. hypoglossal nerve D. chorda tympani nerve E. facial nerve 9- The most dilated part of the alimentary tract is: A. the pharynx B. the esophagus C. the stomach D. the small intestine E. the large intestine 86  Anatomy 10- The pylorus is a part of: A. small intestine B. large intestine C. pharynx D. stomach E. esophagus 87  Anatomy References : 1- Gray's Anatomy for Students. 2nd Edition. Richard L. Drake, Wayne Vogl, and Adam W.M. Mitchell. Elsevier Churchill Livingstone. 2- Snell RS. Clinical Anatomy by regions. 9th ed.Philadelphia: Lippincott Williams & Wilkins. 3- Atlas of Human Anatomy. 4th ed. Philadelphia: Saunders WB. NetterFH. 88  Anatomy CONTENTS Chapter Page N. 1 Anatomical terminology 3 2 Integumentary system 12 3 Locomotor system 17 4 Cardiovascular system 33 5 Lymphatic system 46 6 Digestive system 49 7 Respiratory system 61 8 Urinary system 69 9 Reproductive system 72 10 Nervous system 73 11 Endocrine system 77 12 Model Exams 80 13 References 88 89