Revision I 11 12 2024 Human Anatomy PDF

REVISIONS Professor Dr Panagiotis Karanis Professor and Director of Anatomy Centre UNic Medical School Introduction to Anatomy The anatomical position Description of position and movement done with anatomical position as reference point Head, gaze (eyes), and toes directed ante...

REVISIONS Professor Dr Panagiotis Karanis Professor and Director of Anatomy Centre UNic Medical School Introduction to Anatomy The anatomical position Description of position and movement done with anatomical position as reference point Head, gaze (eyes), and toes directed anteriorly (forward) Arms adjacent to the sides with the palms facing anteriorly Lower limbs close together with the feet parallel Img : human anatomy Anatomical planes Median – Vertical, front to back in midline Frontal (coronal) – vertical, perpendicular to median Horizontal (transverse) – parallel to floor, perpendicular to median, coronal Sagittal – vertical, parallel to median Img : There are nine abdominal regions and four abdominal quadrants in the peritoneal cavity Subcostal plane Transversal plane (transumbilical) Intertubercular plane Why are these sub-divisions useful? Differential diagnosis of abdominal pain by area Q: A patient complains of pain in the abdominal area indicated by the number 2 in Figure below. What area is indicated by the number 8 in Figure below Cardiovascular System An aortic angiogram is performed in a patient with suspected aortic dissection. What vessel is indicated by the arrow in this patient’s aortic angiogram as shown in Figure below (Aortic angiogram). A. Brachiocephalic trunk. B. Left common carotid artery. C. Left subclavian artery. D. Pulmonary artery. E. Right common carotid artery. An aortic angiogram is performed in a patient with suspected aortic dissection. What vessel is indicated by the arrow in this patient’s aortic angiogram as shown in Figure 1? (Aortic angiogram) Figure 1. Aortic angiogram. A. Brachiocephalic trunk. B. Left common carotid artery. C. Left subclavian artery. D. Pulmonary artery. E. Right common carotid artery. Coverings of the heart: Pericardium The middle mediastinum includes pericardium the pericardium, heart, and roots of its great vessels —ascending aorta, Three layered: pulmonary trunk, and SVC—passing to and from the heart. Fibrous pericardium Serous pericardium of layers (x2) Parietal layer of serous pericardium Visceral layer of serous pericardium = epicardium: on heart and is part of its wall (Between the layers is the pericardial The pericardium is a fibro-serous membrane that covers the heart and the cavity) beginning of its great vessels. The pericardium is a closed sac composed of two layers (fibrous and serous pericardium). Layers of pericardium and heart wall Pericardium ATLAS OF HUMAN ANATOMY / MARK NIELSEN & SHAWN MILLER, p. 264 Pericardiocentesis from infrasternal angle by passing the needle superoposteriorly in 5 or th 6th intercostal space on left next to the sternum to avoid the lungs under ultrasound guidance (subxiphoid approach) - Needle avoids the lung and pleurae - Beware and avoid the internal thoracic artery and its branches Cardiac tamponade Pericardiocentesis - made possible from cardiac notch of left lung Hansen, J. T. (2011). Netter's Clinical Anatomy. Elsevier Health Sciences.  Pericardial Sinuses The pericardial sinuses are not the same as ‘anatomical sinuses’ (such as the paranasal sinuses). They are passageways formed the unique way in which the pericardium folds around the great vessels. The oblique pericardial sinus is a blind ending passageway located on the posterior surface of the heart. The transverse pericardial sinus is found superiorly on the heart. It can be used in coronary artery bypass grafting. Clinical Relevance: Transverse Pericardial Sinus The location of the transverse pericardial sinus is: Posterior to the ascending aorta and pulmonary trunk. Anterior to the superior vena cava. Superior to the left atrium. In this position, the transverse pericardial sinus separates the arterial vessels (aorta, pulmonary trunk) and the venous vessels (superior vena cava, pulmonary veins) of the heart. This can be used to identify and subsequently ligate (to tie  Right atrium (Forms part of the right border of the heart) Right auricle Superior vena cava SA node AV node Interatrial septum Fossa ovalis Coronary sinus Inferior vena cava Crista terminalis Sulcus terminalis Pectinate muscle *Fossa ovalis vs foramen ovale Hansen, J. T. (2011). Netter's Clinical Anatomy. Elsevier Health Sciences. Coronary Sinus The coronary sinus serves as the primary collector of cardiac venous blood and is located in the atrioventricular groove on the diaphragmatic surface of the heart. The coronary sinus is the most prominent cardiac vein in terms of diameter. Various landmarks have been described as the location of the coronary sinus origin, including where the oblique vein of the left atrium meets the great cardiac vein and at the valve of Vieussens. The coronary sinus empties directly into the right atrium near the conjunction of the interventricular and coronary grooves (also known as the crux cordis area), located on the inferior region of the right atrial septum between the inferior vena cava and tricuspid valve. The atrial orifice can be partially covered by a Thebesian valve, although the anatomy of this valve is highly  Right ventricle (Forms part of the right border of the heart) Atrioventricular groove Tricuspid valve Chordae tendineae Papillary muscles Interventricular septum Trabeculae carneae Trabecula septomarginalis (moderator band) Pulmonary valve Pulmonary trunk Hansen, J. T. (2011). Netter's Clinical Anatomy. Elsevier Health Sciences.  Chordae tendinae “Heart strings” Cord like tendons that connect papillary muscles to the tricuspid & mitral valves During atrial systole, chordae tendineae are relaxed because the atrioventricular valves are forced open. When the ventricles contract in ventricular systole, the increased blood pressures in both chambers push the AV valves to close simultaneously, preventing backflow of blood into the atria. Since the blood pressure in atria is much lower than that in the ventricles, the flaps attempt to evert to the low pressure regions. The chordae tendinae prevent the eversion (prolapse) by becoming tense thus pulling the flaps, holding them in closed position A patient is taken to the A&E with acute chest pain. Cardiac enzymes are elevated. The patient died and an autopsy is performed. The cause of death is rupture of the papillary muscles. What structure is indicated by the arrow in Figure 2 of this patient’s heart? A. Chordae tendineae. B. Coronary artery. C. Musculi pectinate. D. Papillary muscle. E. Trabeculae carneae. A. Chordae tendineae. B. Coronary artery. C. Musculi pectinate. D. Papillary muscle. E. Trabeculae carneae. Figure 2. Heart specimen. A. Chordae tendineae. B. Coronary artery. C. Musculi pectinate. D. Papillary muscle. E. Trabeculae carneae.  Left atrium (Forms the base of the heart) Left auricle Interatrial septum 4 pulmonary veins Hansen, J. T. (2011). Netter's Clinical Anatomy. Elsevier Health Sciences.  Left ventricle (Forms the posterior part of the heart, on the left) Bicuspid (mitral) valve Chordae tendineae Papillary muscles Trabeculae carneae Interventricular septum Aortic valve Aorta *Ligamentum arteriosus Hansen, J. T. (2011). Netter's Clinical Anatomy. Elsevier Health Sciences.  There are 2 types of heart valves Atrioventricular valves have flat Arterial Valves have 3 cup-shaped “semi- leaflets and a tension apparatus lunar” cusps Diastole Systole  Nodule When the opening is closed by the valve flaps, the nodules of the semilunar valve come together and reinforce to obstruct a potential triangular opening. The arterial supply to the heart is provided by the right and left coronary arteries, which arise from the ascending aorta just above the aortic valve. They supply the myocardium, including the papillary muscles and conducting tissue. The principal venous return is via the coronary sinus and the cardiac veins. Coronary arteries - origin - blood circulation *Coronary blood flow at rest is ~ 225 ml/minute ~ 5% of cardiac output (adult: 5 L blood pump through heart/minute). Moore, K. L., Dalley, A. F., & Agur, A. M. (2013). Clinically oriented anatomy. Lippincott Williams & Wilkins.  Left coronary artery and branches – anterior oblique view Netter, F. H. (2011). Atlas of Human Anatomy, 5th ed., Elsevier Health Sciences. Coronary Arteries – anterior view Moore, K. L., Dalley, A. F., & Agur, A. M. (2013). Clinically oriented anatomy. Lippincott Williams & Wilkins. Coronary Arteries - posterior view Moore, K. L., Dalley, A. F., & Agur, A. M. (2013). Clinically oriented anatomy. Lippincott Williams & Wilkins.  DISTRIBUTION Right Coronary Artery (dominant in 67%) Walls of right atrium and inter-atrial septum Inferior wall of left atrium SA node in 60% of people AV node in 80% of people Walls of right ventricle 1 /3 of inter-ventricular septum Left Coronary Artery Posterior wall of left atrium The rest See anatomy book for further details. Hansen, J. T. (2011). Netter's Clinical Anatomy. Elsevier Health Sciences. Moore, K. L., Dalley, A. F., & Agur, A. M. (2013). Clinically oriented anatomy. Lippincott Williams & Wilkins. Coronary Artery Occlusion Moore, K. L., Dalley, A. F., & Agur, A. M. (2013). Clinically oriented anatomy. Lippincott Williams & Wilkins. Sites 1-3 account for at least 85% of all occlusions. Most common sites of coronary artery occlusion: Blood supply to conducting system Moore, K. L., Dalley, A. F., & Agur, A. M. (2013). Clinically oriented anatomy. Lippincott Williams & Wilkins.  Cardiac Veins Remember: Great, middle, small cardiac veins, oblique vein of LA, left posterior ventricular vein - drain into the coronary sinus (RA) Anterior cardiac veins and venae cordis minimae (thebesian veins) - drain into the anterior wall of right atrium Moore, K. L., Dalley, A. F., & Agur, A. M. (2013). Clinically oriented anatomy. Lippincott Williams & Wilkins. Q: A patient undergoes emergency surgery for tamponade. Which vein is indicated by the pin? e azygos system of veins, on each site of the Azygos rtebral column, drains the back and thoraco- dominal walls and mediastinal viscera. Accessor between the SVC and IVC and drains blood from the y Azygos The azygos vein forms a collateral pathway (=unpaired) azygos vein is the main tributary, posterior walls of the thorax and abdomen the hemi- Thoraci azygos vein usually arise c duct from ‚roots‘ arising from the posterior aspect of the IVC and or renal vein, resp., which merge with Hemiazygo the ascending s lumbar vein. Notice the anastomoses between the inferior vena cava – azygos – superior vena cava AUSCULTATION Auscultation was first practised by Hippocrates (BC 460 – 370), who applied his ear directly to the chest. Stethoscope Greek: stethos, chest; skopein, to view or to see. Auscultation of the heart requires an understanding of normal and abnormal heart sounds and knowledge of the optimal location to detect the sounds. Sounds are best heard by auscultating the area where turbulent blood flow radiates (i.e., distal to the valve through which the blood has just passed). You can hear at the 4 listening points mentioned by no means isolate one of the valves. It deals the total noise in each case which, however, is particularly the valve in question is strongly represented. Fetal Circulation Fetal Circulation In the fetus, the RA received oxygenated blood from the mother through the umbilical cord, so blood travels Rt to Lt through the foramen ovale: fossa ovalis is left after it closes. The pulmonary trunk had high resistance (because the lungs did not function yet) => ductus arteriosus shunted blood to aorta; it becomes ligamentum arteriosum after birth.  Thank you Literature: - illustrations and slides for this presentation were taken from:  Hansen, J. T. (2011). Netter's Clinical Anatomy. Elsevier Health Sciences.  Marieb, E.N., Wilhelm, P.B., and Mallatt, J. (2012), Human Anatomy, Media Update, 6th edition, Boston: Benjamin Cummings.  Moore, K. L., Dalley, A. F., & Agur, A. M. (2013). Clinically oriented anatomy. Lippincott Williams & Wilkins.  Netter, F. H. (2014). Atlas of Human Anatomy, Professional Edition E-Book: including Netter Reference. com Access with Full Downloadable Image Bank. Elsevier Health Sciences.  Netter, F. H. (2011). Atlas of Human Anatomy, 5 th ed., Elsevier Health Sciences.  Mark Nielsen Shawn Miller (2011). Atlas of Human Anatomy. Willey.