Lee_Overview of Human Structure.pptx

PHU: The Patient’s Body Visualization and Organization i.e Overview of Human Structure Vaughan Lee  Learning Resources for Anatomy: Subject Guides: Medicine Resources 5th Edition also avail...

PHU: The Patient’s Body Visualization and Organization i.e Overview of Human Structure Vaughan Lee  Learning Resources for Anatomy: Subject Guides: Medicine Resources 5th Edition also available  OBJECTIVES Recommended but Non-required reading: Grays Anatomy for Students, 4th edition Chapter 1: pages 1-48. Selections from Chapters; After this session students will: Recall how anatomy relates to clinical observation and diagnosis. Identify the anatomical positions of the patient. Contrast systemic vs regional approaches to anatomy. Compare the skeletal and muscular systems. Recall key features of the circulatory, respiratory, and, gastrointestinal systems. Recall modalities of imaging used in clinical medicine. Correlate anatomy with clinical cases. Recall how anatomy relates to clinical observation and diagnosis (Macroscopic vs Microscopic). Human Clinical Anatomy Lead’s physician to understanding of the healthy patient and to the patient with disease. Visual observation in the physical exam Medical Imaging: Radiograph, CT, MRI, Ultrasound, and etc. Language is key to communication Gross Anatomy – observation and dissection Dr. Lee’s first law of clinical diagnosis: When all else fails, exam the patient.  Identify the anatomical positions of the patient. Anatomical Position: Standing facing forward Planes: Palms forward Legs together Coronal Toes pointed forward Transverse, horizontal, or axial Orientation: Sagittal Anterior/Posterior (Ventral/Dorsal) *Imaging Medial/Lateral Superior/Inferior Cranial/Caudal Rostral Superficial/Deep Bilateral Symmetry Is this patient Bilateral Symmetrical? The Onion  Contrast systemic vs regional approaches to anatomy. Systemic Approach Regional Approach 1. Individual Systems, i.e. cardiovascular, nervous, etc. 1. Regions of the body 2. Physical exam – system specific components 2. Physical exam – structures in a region 3. USACOM Preclerkship Curriculum. 3. Anatomy Dissection  Systems-based Organization USMLE topic list for Step 1 (examples). USACOM Systems-based Modules. Immune PII = Immune System Musculoskeletal: MSK = Musculoskeletal Skin & Subcutaneous Tissue o Includes skin Cardiovascular CVR = Cardiovascular Lymphatic URN = Renal Renal DIG = Gastrointestinal Gastrointestinal RES = Respiratory Respiratory NBS = Nervous System Nervous System ENR = Endocrine & Reproductive Endocrine Hematopoeitic (HemOnc) Reproductive Blood and Lymphoreticular Bold = components in PHU Bold = components in PHU Skeletal & articular systems Head & Neck Thorax Axial Skeleton Abdomen Compact - dense Bones Spongy Bone – trabecular or Cartilage cancellous Joints Long bones – epiphyseal plate Ligaments Periosteum – growth & repair, pain fibers  Articular systems Joints Synovial 1. Synovial 1. Joint cavity 2. Fibrous 2. Free movement 3. Cartilaginous 3. Articular cartilage Thorax Ribs (costovertebral & Sternocostal, 2-7) Sternoclavicular joint Acromioclavicular joint Glenohumeral Osteoarthritis  PHU: Joints Cartilaginous Fibrous Neck, Thorax, and Abdomen Head Intervertebral disc Sutures Costochondral (8-10) Teeth & alveolar Sternocostal, 1st rib processes Manubriosternal Xiphisternal  Describe the Skin, fascia and muscle Skin: Muscles (skeletal): Dissection Attachments Innervation: Dermatomes Actions Surface landmarks Innervation Fascia: Superficial Deep Skin: Details later in MSK Muscle: Details later in MSK Define the Cardiovascular system; arteries, veins and lymphatics.  Cardiovascular system Systemic Circulation Venous compartment: Arterial compartment: Less oxygen Higher oxygen Lower pressure Higher pressure Thinner walls Thicker walls Capillary beds Cardiovascular system : PHU Arterial compartment: Aorta Ascending Arch Descending Brachiocephalic Subclavian (R&L) Carotid (R&L) Abdominal aorta Common iliac (R&L)  Cardiovascular system : PHU Venous compartment: Superior vena cava Brachiocephalic (R&L) Internal jugular (R&L) Subclavian (R&L) Azygous Inferior vena cava Hepatic veins (R&L) Clinical Application: Common iliac (R&L) Superior Vena Cava Syndrome, DVT  Lymphatic system Function: Return interstitial fluid (CVR) Protect against infection (PII) Absorb fat (DIG) t en er Lymph Node Eff “filter” Immune response Sequence Afferent Lymph vessels Thin walled Valves  Lymphatic system : Drainage Regions Right lymphatic duct Thoracic duct Thoracic duct Lumbar nodes Iliac nodes Deep inguinal nodes Superficial inguinal nodes Lower limb lymph Infection, Cancer  Lymphatic system : Lymph Nodes Head & Neck Thorax Abdomen  Enlarged axillary lymph nodes Breast (most) Breast parasternal abdominal Upper limb Clinical Application: Carcinoma of the breast  Respiratory system Head & Neck Thorax Gastrointestinal system Head & Neck Thorax Abdomen  Medical (diagnostic) Imaging PHU Radiograph, aka x-ray or plain film. PACS system (DICOM) With or without contrast CT or Computed tomography MRI Radiology ILAs by Dr. Fields Radiographs in Laboratory Imaging review sessions US - Ultrasound  Thorax, Radiograph Right Left Cross-sectional Anatomy & CT or MRI (Transverse Sections) Conventional Orientation: Standing at foot of patient in bed Looking up at inferior surface of sections Anterior Right Insides Left Posterior Ultrasound (US) Reflective BONE, CALCIFICATIONS Gallstone Heart and Lung Sounds Flail chest Pleural effusion, Pneumothorax: thoracostomy Thorocostomy: Needle Tube Thorocotomy: Incision along intercostal space THE END