Intro To Gross Anatomy, [8.0] PDF

Anatomy 09/04/2023 MOD 2A: INTRO TO GROSS ANATOMY Name of Lecturer: Dr. Jay Mostajo Jr., MD...

Anatomy 09/04/2023 MOD 2A: INTRO TO GROSS ANATOMY Name of Lecturer: Dr. Jay Mostajo Jr., MD Trans Group/s: 16C & 17A CONTENT ADDITIONAL INFO TEXTBOOK ★ → GROSS ANATOMY OUTLINE DEFINITION Study of structures that can be seen by the naked eye or without the aid using a microscope. I. Gross Anatomy Origin: 14th century A. Definition Latin: anatomia - dissection B. Anatomical Position Greek: tem-nein - to cut 1. Importance of The Anatomical Position ANATOMICAL POSITION C. Anatomical Planes D. Anatomical Axes II. Terms of Movements A. Flexion and Extension B. Plantar and Dorsiflexion C. Abduction and Adduction D. Lateral Flexion E. Radial and Ulnar deviation F. Inversion and Eversion G. Circumduction H. Rotation (Medial and Lateral) I. Pronation and Supination J. Protraction and Retraction K. Opposition and Reposition III. Approaches in Anatomy A. Systemic Anatomy B. Anatomical Regions Figure 1. The Anatomical Position C. Clinical or Applied Anatomy IV. Terms of Laterality Based on the description of the correct anatomical position V. Terms of Depth below, the image above (Figure 1) shows the correct VI. Terms of Distance anatomical position VII. Terms of Relationship and Comparison VIII. Medico-legal body Diagram THE ANATOMICAL POSITION A. Types of Injuries or Lesion B. Sample Case Body Standing erect IX. References X. Online Consultation (Dr. Polido) A. Practice of Medicine Eyes and face Looking forward B. Practice of Medicine (R.A. 4224) C. Supreme Court Case Arms At the side with palms facing forward D. Application of Knowledge in Anatomy E. Application Feet Close together with toes pointing forward F. Wounds and Injuries G. Patient Case 1: Postmortem Report H. Patient Case 2: Wounds and Injuries LECTURE OBJECTIVES 1. Given a clinical image, create a precise anatomical description. Describe the Anatomical Position Illustrate cardinal planes, axis Define basic anatomical terms Break down the body into regions and systems 2. Given an anatomical description of a case, point out the ★ Image B demonstrates the correct anatomical position. correct location using a medico-legal diagram. ★ In image B, the figure is standing erect with the palms, face, and eyes facing forward. However, the upper extremities are fully abducted. Anatomy - Mod 2A Introduction to Gross Anatomy 1 of 12  ★ In image D, the arms are also abducted. to do movements like flexion and extension. ★ It is important to remember the correct anatomical position - Flexion: decrease in angle. because there are standard ways/terms in describing human - Extension: increase in angle. bodies. The terms/ways being universal helps to understand ★ In trying to identify the planes and axes based on the description of certain professionals. movements, the hand is usually used. ★ Question: If the arm is raised above the head, is it correct to - “Don’t break the glass” principle. describe it as superior to the head? - Put a pen in between your fingers, with the pen being Answer: No. It should be standardized. The arms are the axis and the hand as the plane. lateral to the trunk and inferior to the head. - Bring your hand on the opposite arm, with palm facing outward and the pen above the forearm. - Flex and extend the arm. IMPORTANCE OF THE ANATOMICAL POSITION - The elbow joint is rotating on the x axis (pen) All anatomical descriptions will be expressed in this position. - The sagittal plane (hand) allows movement without These terms are used globally and are consistent. breaking the glass. All practitioners in the medical field use this description as ★ Question: What plane and axis are involved if abduction reference. and adduction will occur? - Answer is the Coronal plane and z-axis. ANATOMICAL PLANES - Z-axis is also identified as the AP or anteroposterior These are four imaginary planes that intersect the body. axis. - Abduction and adduction will occur in the coronal plane and if abduction and adduction of the shoulder is done, the movement is allowed in the coronal plane paired by z-axis. ★ Question: A circular movement of the upper extremity that involves sequential Flexion, Abduction, Extension, and Adduction is called: a. Circumduction b. Opposition and Reposition c. Pronation and Supination d. Internal Rotation - Circumduction movement is a sequential or combination of flexion, abduction, extension, and Figure 2. Anatomical planes adduction. - These movements will occur in the shoulder joint and THE ANATOMICAL PLANES other joints such as hip joints. Commonly seen in ball and socket type of joint like shoulder and hip but it Vertical plane that is passing may also be seen in the thumb. Median Sagittal through the center of the body. ★ Question: How about opposition and reposition? Where Plane Divides the body in equal left can we see this movement? and right sides. - Answer: Thumb - Opposition is when you try to approximate the pulp of Divides the body into left and your fingers. And if you go back to the position, it is a Parasagittal Plane reposition. right halves but not necessarily or Paramedian ★ Question: How about pronation and supination? Where do equal. Sagittal we observe these movements? Situated parallel and to the side Plane - Answer: Forearm of the median plane. - When we do pronation and supination, it is actually Divides the body front and back the radius rolling over the ulna. Coronal or Frontal or anterior and posterior. - Pronation: Palms facing downward Plane Situated at a right angle with the - Supination: Palms facing upward. median plane. ANATOMICAL AXES Divides the body into superior Axial or Horizontal and inferior (head and tail) or parts. Transverse Plane Situated at a right angle to both the median and coronal plane. ★ Question: The elbow joint is a hinge type of joint that allows movement like flexion and extension. In what plane and axis do these movements occur? a. sagittal plane and x axis. b. sagittal plane and z axis. c. coronal plane and z axis. d. coronal plane and x axis. Figure 3. Anatomical axes ★ It is in the sagittal plane and x axis. Since the elbow joint is a hinge joint, it is placed in such a plane and axis for it to be able The different anatomical planes are always paired up with anatomical axes. Anatomy - Mod 2A Introduction to Gross Anatomy 2 of 12  The forearm in the images is moving along the sagittal plane ANATOMICAL AXES WITH THEIR PAIRED ANATOMICAL and the elbow joint serves as the axis. PLANES Hyperextension – term used if it goes beyond the neutral position as seen in the shoulder, hip, wrist, and neck. X (Horizontal/Transverse) Sagittal Plane ★ In the thumb, the flexion and extension occurs at the coronal plane. Y (Vertical) Horizontal Plane ★ The thumb is unique; it is rotated 90 degrees in reference to the other joints of the fingers. Z (Antero-posterior) Coronal Plane PLANTARFLEXION/DORSIFLEXION Movements pertaining to the ankle joint that occur in the NOTE: sagittal plane or the x-axis (similar to the elbow joint). MNEMONIC FOR ANATOMICAL AXES I asked my X (↔; x-axis) Y ( ↕ ; y-axis) we broke up because we were going in Zig-zag ( ↘ ; z-axis) Figure 5. Plantarflexion and Dorsiflexion PLANTARFLEXION VS DORSIFLEXION Source: Introduction to Gross Anatomy, Lecture Video Part 1 TERMS OF MOVEMENTS Terms used to describe movements in the body, occurring in a particular plane and axis in reference to the correct anatomical position. FLEXION/EXTENSION These movements generally occur in the sagittal plane around Bends the foot or toes Bends the foot or toes a transverse or x-axis. towards the ground. off the ground. Flexion – indicates decrease in angle of the joint. Increasing the angle of Decreasing the angle Extension – indicates increase in angle of the joint. the ankle joint. of the ankle joint. Source: Introduction to Gross Anatomy, Lecture Video Part 1 ABDUCTION/ADDUCTION Movements that generally occur in the coronal plane or z-axis. Figure 4. Flexion and Extension Source: Introduction to Gross Anatomy, Lecture Video Part 1 Source: Introduction to Gross Anatomy, Lecture Video Part 1 Anatomy - Mod 2A Introduction to Gross Anatomy 3 of 12  ABDUCTION VS ADDUCTION Abduction Adduction Used to describe the Used to describe the segment or extremity segment or extremity moving away from moving towards the the median plane. median plane. LATERAL FLEXION (TRUNK & NECK) Used to describe side-to-side movements of the trunk and neck. Special form of abduction only for the trunk and neck. Figure 8. Inversion and Eversion Face and trunk are directed anteriorly as the head and shoulders tilt to the right or left. INVERSION VS EVERSION Inversion Eversion Sole of the foot Sole of the foot moves or faces moves or faces away towards the median from the median plane. plane. Ankle sprains are most likely to occur in this type of movement. ★ The movement of the subtalar joint will allow the inversion Figure 6. Lateral Flexion and eversion of the ankle. RADIAL AND ULNAR DEVIATION CIRCUMDUCTION Describe movements occurring in the wrist along the Circular movement that involves sequential flexion, coronal plane abduction, extension, and adduction of the extremities Source: Introduction to Gross Anatomy, Lecture Video Part 1 Figure 7. Radial and Ulnar deviation ROTATION (MEDIAL & LATERAL) Involves turning or revolving of part of the body around its RADIAL DEVIATION VS ULNAR DEVIATION axis Internal/Medial Rotation - brings the anterior surface of the Radial deviation Ulnar Deviation limb closer to the medial plane External/Lateral Rotation - brings the anterior surface of Hand and fingers Hand and fingers the limb away from the medial plane move toward the move toward the ulnar radial side or the side or the pinky side. thumb side. INVERSION AND EVERSION Movements occurring at the subtalar and transverse tarsal joints (different from the ankle joint that would allow plantar and dorsiflexion). Figure 9. Rotation (Medial & Lateral) Anatomy - Mod 2A Introduction to Gross Anatomy 4 of 12  Internal and External Rotation of the Hip Joint Scapular protraction and retraction are gliding movements that will occur between the scapula and the thoracic cage protraction is anteriorly and protraction is posteriorly Shows internal rotation of Shows external rotation of the hip, even though it seems the hip joint, this is because that we are bringing the the patient is sitting and not extremity outward. in the correct anatomical position. Source: Introduction to Gross Anatomy, Lecture Video Part 1 Even though the patient is in a sitting position, all movements and structures are being described in reference to the normal OPPOSITION AND REPOSITION anatomical position. Opposition and reposition is the movement of the pad of the first digit of the thumb to the pad of the other digits. Internal and External Rotation of the Shoulder Joint When making an “OK” sign with your thumb and index finger or holding a cup of tea or coffee The image above shows how internal and external rotation Source: Introduction to Gross Anatomy, Lecture Video Part 1 may also occur in the shoulder joint. PRONATION AND SUPINATION Pronation and Supination are the rotational movements of the forearm and hand. The radius rolling over the ulna. Figure 10. Pronation and Supination Pronation rotates the radius medially. Supination rotates the radius laterally. The thumb or 1st carpometacarpal (1st CMC Joint) is ○ Mnemonics: When holding soup you supinate, when rotated 90 degrees relative to other structures, it occurs you pronate you are prone to spilling it. opposite to the other joints. ★ Pronation and supination of the foot is a combination of The flexion and extension movements occur on the movements from the different joints of the foot. sagittal plane. ○ In the ankle: subtalar joint will produce inversion and ○ For the thumb, it moves on the coronal plane. eversion (sole of the foot will face the midline) Normal abduction and adduction of the fingers happen in ○ Forefoot: allow pronation and supination movements the coronal plane. ○ For the thumb, it happens in the sagittal plane PROTRACTION AND RETRACTION Protraction and retraction are movements used in the APPROACHES IN ANATOMY Temporomandibular Joint (TMJ) and the Scapula on the Different styles and strategies are used in teaching and thoracic wall. studying the anatomy of the human body. ○ Protraction is the movement of the joint or the jaw The three main approaches in studying anatomy are: forward or anteriorly. ○ Systemic ○ Retraction moves the jaw backwards or posteriorly ○ Regional ○ Applied/ Clinical Anatomy - Mod 2A Introduction to Gross Anatomy 5 of 12  SYSTEMIC ANATOMY Systemic anatomy is the study of the body's organ systems that work together to carry out complex functions. These basic systems would include: ○ Integumentary System Consists of the skin and its appendages Hair, nails, and different glands ○ Skeletal System Source: Introduction to Gross Anatomy, Lecture Video Part 2 Consists of the bones and joints of the body that would provide structural framework and support 2. THORAX (CHEST) for the body as well as protection to vital organs Part of the body between the between the neck and such as the heart abdomen ○ Articular System The heart and lungs are studied together in this region Consists of the bones and joints of the body that would provide structural framework and support for the body ○ Muscular System Consist of muscles that are attached to the skeletal system or the bones to produce movements together with articulation or the joints. ○ Nervous System or Neurology Consists of the central nervous system, or the brain or spinal cord, and the peripheral nervous Source: Introduction to Gross Anatomy, Lecture Video Part 2 system Functions as the main control center that would coordinate the different functions of the body 3. ABDOMEN ○ Circulatory System Part of the trunk between the thorax and the pelvis Cardiovascular System Contains the gastrointestinal organs and part of urogenital Lymphatic System system Include the heart and its blood vessels, as well as the lymphatic vessels ○ Digestive System Include the digestive tract from the mouth up to the anus and its associated glands ○ Respiratory System/ Pulmonology Consist of the airways and the lungs that would Source: Introduction to Gross Anatomy, Lecture Video Part 2 supply oxygen to the blood and elimination of carbon dioxide ○ Urinary System 4. PELVIC REGION Include structures, such as your kidneys, that would filter the blood to form urine The urethra, urinary bladder, and urethra ○ Reproductive System Consists of the male and female gonads and the genitalia ○ Endocrine System or Endocrinology Source: Introduction to Gross Anatomy, Lecture Video Part 2 Specialized structures that secretes hormones that would influence the human body in different Part of the trunk that is inferoposterior to the ways abdomen Area of transition between the trunk and the lower ANATOMICAL REGIONS limbs Aside from the systemic approach, one way to describe the Houses the urinary and reproductive organs different structures of the body is by using the different anatomical regions 5. BACK AND SPINE This considers the organization of human body as major parts or segments This approach is followed in human anatomy courses that involves laboratory dissections ○ A lecture will always be followed by a scheduled dissection of a particular region 1. HEAD AND NECK The part of the body that is attached to the trunk by the neck Consist of the brain and its protective coverings, cranial vault and meninges, the ears and the face Source: Introduction to Gross Anatomy, Lecture Video Part 2 Back comprises the posterior aspect of the trunk, inferior to the neck, and to the buttocks Region of the body to which the head, neck, and limbs are attached Anatomy - Mod 2A Introduction to Gross Anatomy 6 of 12 6. UPPER AND LOWER LIMBS TERMS OF DEPTH Describes the position, structures, relative to the surface of the body Keep in mind that when trying to describe the structure using the terms of depth, don’t forget to emphasize the point of reference Source: Introduction to Gross Anatomy, Lecture Video Part 2 Also called “Upper and Lower Extremities” Part of appendicular skeletal system, attached to the trunk and the pelvic regions Main function: Upper extremities are for reaching and grasping Lower extremities are for locomotion and movement CLINICAL/ APPLIED ANATOMY Emphasizes the aspects of bodily structure and function important in the practice of medicine Source: Introduction to Gross Anatomy, Lecture Video Part 2 This approach in studying anatomy incorporates both the regional and systemic approach ○ Example (refer to the picture above): In this picture, the Considered exciting since students will be able to learn how to bones, muscles, nerves, blood vessels, muscle fascia, correlate their newly acquired knowledge in solving clinical subcutaneous fats, and skin is appreciated problems Skeletal muscle will be used as the reference point We can say that the skin is more superficial TERMS OF LATERALITY than the muscle As healthcare practitioners, these terms are used to describe The fascia is intermediately located between locations of organs or structures the muscle and the subcutaneous fat The bone is deeper than the muscle ○ Using these terms, the students must always have a mental picture of the arrangement of structures in the body TERMS OF DISTANCE Use when contrasting positions that are nearer or farther from the center or attachment of the limb. Terms Definition Proximal Used to describe structures near the center or attachment of the limb. Source: Introduction to Gross Anatomy, Lecture Video Part 2 Distal Used to describe structures farther from the ○ Ipsilateral center or attachment of the limb. If the structures are occurring in the same side of Example: The head is more distal than the elbow. the body Example: right arm is ipsilateral with the right leg, or the right hand and the right foot are ipsilateral to each other ○ Contralateral If the structures are occurring on the opposite sides of the body Example: the left arm is contralateral to the right leg ○ Bilateral Paired structures occurring on both sides of the body Example: kidneys since they occur on both the left and right side ○ Unilateral Structures occurring on one side of the body Figure 11. Terms of distance, Lecture Video Part 2 Example: spleen since it only occur on the left side of the peritoneum Anatomy - Mod 2A Introduction to Gross Anatomy 7 of 12  TERMS OF RELATIONSHIPS AND COMPARISON Terms Definition Superior (Cephalic) Used to describe structures that are near the vertex or the top most portion of the cranium. Inferior (Caudal) Refers to the structure that is situated near the foot or tail region. Example: The brain is more superiorly located than the heart. NOTE: Cephalic and caudal are useful directional terms which means towards the head and towards the feet. Anterior Describe structures located in the (Front/Ventral) front or ventral surface of the body. ○ Example: The breast is located Figure 12. Terms of relationship and comparison, Lecture Video anterior to the lungs. Part 2 Rostral - instead of anterior, the term rostral is used when describing MEDICO-LEGAL BODY DIAGRAM parts of the brain or towards the anterior part of the head. Posterior Describe structure located in the (Back/Dorsal) back or dorsal surface of the body. Medial Describe structures near the median plane or center Example: The breast is more medial than the shoulder. Lateral Describe structures that are farther away from the median plane ○ Example: The thumb is more lateral than the middle finger. Dorsum aspect of any part that protrudes anteriorly from the body Also used to describe the posterior surface of the hand. Can also be used for the part of the male penis (origin of the name of the nerves in the penis: dorsal nerve of Source: Introduction to Gross Anatomy, Lecture Video Part 2 the penis and deep dorsal vein of the penis.) Note for: ○ Size (cm.) Plantar surface/ Plantar: sole of the foot ○ Type of Injury or Lesion Palmar surface Palmar: sole of the hand ○ Laterality ○ Location Internal Inside or closer to the center. ○ Example: The stomach is more TYPES OF INJURIES OR LESION internally located than the abdominal muscles. Types of Injury Image Definition ○ Example: The branch that of Lesion enters the cranium is called the internal carotid artery 1. Stab A wound made by a Wounds pointed weapon External Outside from the center of an organ such as a knife. In cavity. Tagalog, “saksak”. Example: The branch that is located outside the cranium is called the external carotid artery Anatomy - Mod 2A Introduction to Gross Anatomy 8 of 12  Medico-legal diagram 2. Gunshot Wounds that are wounds made by bullet. 3. Contusion Rupture of small blood vessels and discoloration without a break on the skin. Commonly known as “pasa”. 4. Hematoma A mass of usually clotted blood. We call it hematoma if Source: Introduction to Gross Anatomy, Lecture Video Part 2 there is a mass under the skin. In Lesions are usually drawn on the said location plus the type actual practice, and size. “contusion hematoma” is used since most of the ★ Question: Can you describe this Injury? time we encounter severe injuries in the ER. 5. Abrasion Injury caused by something that rubs the skin. Commonly known as “gasgas”. 6. Lacerations Deep cut or tear in the flesh with irregular borders. Size, type, laterality, location: ○ 5-6 cm stab wound on the anterior chest wall, Inferomedial to the right nipple Use a combination of terms to more accurately Source: Introduction to Gross Anatomy, Lecture Video Part 2 describe the location. SAMPLE CASE 1. A 5-cm abrasion was noted on the anterior aspect of the patient’s right knee. Source: Introduction to Gross Anatomy, Lecture Video Part 2 Size 5 cm Type of Injury Abrasion Source: Introduction to Gross Anatomy, Lecture Video Part 2 Laterality Right Location Anterior Knee Anatomy - Mod 2A Introduction to Gross Anatomy 9 of 12 ★ Question: Create a correct anatomical description of Plane: the injury. ○ Coronal plane (flexion/ extension) ○ Sagittal plane (abduction/ adduction) Axis: Z and X axis Condyloi Movement: d Flexion/ Size, type, laterality, location: Extension/ ○ 5 cm abrasion near the base of the thumb on the Adduction/ palmar surface of the left hand Abduction/ Based on the terms discussed in Introduction to Circumduction Condyloid Wrist/ MCP Gross Anatomy, Lecture Video Part 2 Plane: joint & MTP joints Plantar: sole of the foot ○ Sagittal Palmar: sole of the hand plane use medical terms and we may use superior or (Flexion/Ext inferior ension) ○ Coronal Plane (Adduction/ ANNEX A: TYPES OF SYNOVIAL JOINTS & MOVEMENTS Abduction) Axis: Z and X Joint Movement at Joint Examples Structure axis Type Gliding Movement: Hinge Movement: Gliding Flexion/ movements Extension Usually uniaxial; Gliding joint Plane: Sagittal permits sliding Axis: X axis Hinge Joint Intercarpal Elbow/Knee joints Pivot Movement: NOTE: Rotation of one In some books, the knee joint is considered as a modified bone around hinge type of joint since it also allows some degree of another. rotational movement to help lock or unlock the joint. Plane: Pivot Joint Remember that the thumb is rotated 90 deg. to other Horizontal plane structures of joints of the hand. Top of the Axis: Y axis neck (atlas and axis REFERENCES bones) Lecture Video by Dr. Jay Mostajo Jr., MD: Introduction to Gross Anatomy Part 1 and 2 Ball and Movement: Moore’s Clinical Oriented Anatomy 7th Ed. Socket Flexion/ Past transes Extension/ Adduction/ ONLINE CONSULTATION (DR. POLIDO) Abduction/ Ball and Internal and Shoulder/ Socket Joint PRACTICE OF MEDICINE External Hip Rotation/ Described by two laws: Circumduction. ○ "The Medical Act of 1959" R.A. No. 2382 MULTIPLE axes ○ R.A. No. 4224 and planes Amended The Medical Act of 1959 Saddle Movement: PRACTICE OF MEDICINE (R.A. 4224) Flexion/ Extension/ DIAGNOSE, TREAT, AND PRESCRIBE Adduction/ Abduction/ With or without Compensation Saddle joint Circumduction Paid directly or indirectly CMC joint of Dx, Tx, Px the thumb Anatomy - Mod 2A Introduction to Gross Anatomy 10 of 12  Who shall, for compensation, fee, salary of reward in any He asked the patient to go to the backroom and provided form paid to him directly or through another, or even an enema without the same, physically examine any person, and ○ Enema: Cleansing of the large intestine diagnose, treat, operate, or prescribe any remedy for After the enema, the patient’s back was exposed to a big human disease, injury, deformity, physical, mental, bulb for 15 minutes (could be Ventura’s substitute for a psychological condition or any ailment, real or imaginary, warm compress) regardless of the nature of the remedy or treatment Then, the patient was exposed to another bulb which was administered, prescribed or recommended; x x x red in color for a few minutes. Do not diagnose, do not treat, do not prescribe. Before the patient left, Ventura advised him to come back for 6 consecutive days ★ So will you just dismiss your neighbor? Ventura was notorious to the NBI and the patient was just a ○ Tell the patient that if the pain is intolerable cover-up go to the hospital. After knowing that Ventura was prescribing, diagnosing, ○ Don’t suggest medications. and treating patients without a license, they raided his clinic and arrested him. ADVERTISE AND UNDERTAKE Ventura’s defense: Offer Medical Services and Actually Undertake ○ He claimed that his act of stimulating the affected x x x who shall by means of signs, cards, advertisements, nerve of the patient without the use of any drugs or written or printed matter, or through the radio, television or medicine is not a practice of medicine. any other means of communication, either offer or ○ His defense inspired the amendment of the 1959 undertake by any means or method to diagnose, treat, Medical Act operate or prescribe any remedy for any human disease, injury, deformity, physical, mental or psychological The Supreme Court said that the fact that Ventura was condition; x x x providing treatment, diagnosed a patient, and applied a It means you commit yourself and promise this person remedy, which contradicted his allegations of not that you are a doctor and will do this. practicing medicine, is considered an illegal practice of ○ We should prevent doing or saying the example medicine. mentioned above. Instead, you can say this: Do not forget: Always follow a standard of care. ○ “I am a first-year student and we only tackled this in our subjects, so I cannot give you advice or prescribe APPLICATION OF KNOWLEDGE IN ANATOMY anything for this situation.“ At the end of the day, even though you are a 4th year Anatomy is the most essential for clinical practice. student already, but you do not have a license, you are still Inadequate knowledge of anatomy among medical under the supervision and control of your superiors. students leads to poor comprehension of clinical practice. ○ So you are not allowed to Sound knowledge of Human Anatomy is most essential Prescribe during medical practice for Physicians. Diagnose Source: Singh et al., (2022). Is inadequate anatomical Treat patients knowledge on the part of physicians hazardous for Suggest directly to the patient successful clinical practice? Inform your senior about it first This will serve as a learning experience APPLICATION between you and your senior, not you and the patient Paolo Anthony C. De Jesus, Petitioner vs. Dr. Romero F. Uyloan Substituted by his wife Salvacion Uyloan Asian FALSELY USING M.D. Hospital and Medical Center and Dr. John Francois Ojeda Respondents. G.R.234851 (February 15, 2022) "Falsely use" Definition: An individual is holding himself out to the public Surgery: 2010 that he is a doctor Gallstones were identified via ultrasound. ○ You can use it as a “manifesting” word for yourself or Given two options: laparoscopic cholecystectomy or open for your friends but not for patients cholecystectomy. ○ It will also inspire you to study and reach that goal Patient opted for laparoscopic cholecystectomy for shorter hospitalization since recovery is faster for a smaller SUPREME COURT CASE EXAMPLE incision. G.R. No. L-15079 January 31, 1962 Post-op THE PEOPLE OF THE PHILIPPINES, plaintiff-appellee, vs. Patient found out that an open cholecystectomy was GUILLERMO I. VENTURA, defendant-appellant performed. ○ Ventura is the accused It was revealed that during the procedure, a cystic artery ○ People of the Philippines: means it is a criminal case was accidentally cut, requiring open cholecystectomy instead of laparoscopic cholecystectomy. What happened in this case? Loss of significant amounts of blood also occurred, A patient consulted Ventura for back pain requiring blood transfusion. First consultation diagnosis: Sciatica (Lumbago) After the patient's discharge, the patient reported ○ It is an illness concerning the sciatic nerve abdominal pain, vomiting, and green discharge in surgical Ventura asked for a payment (5 pesos – at that time it had drain1. a big value) Anatomy - Mod 2A Introduction to Gross Anatomy 11 of 12  Patient opted for a second opinion as to why there’s a green discharge in the surgical drain. It was revealed that the doctor who operated cut the common bile duct itself (mortal sin). 1 Surgical drain - tubes placed near surgical incisions in the post-operative patient, to remove pus, blood or other fluid, preventing it from accumulating in the body. WOUNDS AND INJURIES PATIENT CASE 1: POSTMORTEM REPORT Hacking wound, 21cms. long horizontally oriented 10 cm. deep, starting at the center in the posterior portion of the neck just below the skull, going forward towards the right anterior portion of the neck, lacerating the underlying muscle, major blood vessels, spinal column and fracture of 2nd cervical vertebrae Hacking wound, 15cms. long, horizontally oriented, 10 cm. deep, starting at the center in the posterior portion of the head going forward towards the right anterior portion of the head, just above the right ear fracturing the underlying skull, and spillage out of brain tissues. Hacking wound, 15cms. long horizontally oriented, 10 cm. deep, starting at the center in the posterior portion of thA head going forward towards the right anterior portion of the head, 10 cm just below wound # 2. fracturing the underlying skull, and spillage out of brain tissues. Hacking wound, 15cms. long, horizontally oriented. 10 am. derp, starting at the center in the posterior portion of the head going forward towards the right anterior portion of the head. 1.0 cm just below wound # 3, fracturing the underlying skull, and spitage out of brain tissues CAUSE OF DEATH: Hacking wounds, neck and head PATIENT CASE 2: WOUNDS AND INJURIES (Titanium) Metal Implant from Intra-op X-ray. Dr. Polido’s PPT Slide: Intro to Gross Anatomy Pt. 2. FL - Fracture Line, R - Radius, U - Ulna, TH - Thumb, PH - Phalanges, M - Metacarpals Scenario: The patient was wearing a long skirt (up to the ground), accidentally tripped, and fell badly especially the wrist (natukod). FRACTURE: Occurred in the distal radius Anatomy - Mod 2A Introduction to Gross Anatomy 12 of 12