BD Chaurasia's Handbook of General Anatomy (2024) PDF

BD Chaurasia's Seventh Edition Handbook of GENERAL ANATOMY As per the latest CBME Guidelines | Competency Based Undergraduate Curriculum for the Indian Medical Graduate Free Access on CBS...

BD Chaurasia's Seventh Edition Handbook of GENERAL ANATOMY As per the latest CBME Guidelines | Competency Based Undergraduate Curriculum for the Indian Medical Graduate Free Access on CBSiCentral App 100+ Animated Models Related to the Anatomical Contents of the Book CBS Publishers & Distributors E Attention: Booksellers and Students Edited by Please do not purchase the book if it does not carry genuine Krishna Garg hologram on front and scratch code on inside front cover 50 Years in CBSPD Dedicated to Education Publishing CBS Publishers & Distributors Pvt Ltd DedicatedtoEducation  Seventh BD Chaurasia's Edition Handbook of General Anatomy As per the latest CBME Guidelines | Competency Based Undergraduate Curriculum for the Indian Medical Graduate Late Dr BD Chaurasia MBBS, MS, PhD, FAMS Department of Anatomy } GR Medical College Gwalior, India Revised and Edited by Krishna Garg MBBS, MS, PhD, FIMSA, FIAMS, FAMS, Chikitsa Ratan and FASI Ex-Professor and Head, Department of Anatomy Lady Hardinge Medical College, New Delhi CBSPD CBS Publishers & Distributors Pvt Ltd New Delhi Bengaluru Chennai Kochi. Kolkata Lucknow Mumbai.. · Hyderabad Jharkhand Nagpur Patna Pune Uttarakhand  Seventh Disclaimer BD Chaurasia's Edition Science and technologyare constantly changing Handbook of fields. New research and experience broaden the scope of information and knowledge. The General editor has tried her best in giving information available to her while preparing the material for this book. Although all efforts have been made Anatomy to ensure optimum accuracy of the material, yet it is quite possible some errors might have Asper thelatest CBMEGuidelines Co.pe Curriculumfor the Indian Medical Graduate Jste been left uncorrected. The publisher, the printer and the editor will not be held responsible for any inadvertent errors, omissions or inaccuracies. ISBN: 978-93-5466-569-1 Copyright Editor and Publisher Seventh Edition: 2024 First Edition: 1978 Reprint: 1980, 1981 Second Edition: 1983 Reprint: 1985, 1987, 1989, 1991, 1992, 1994, 1996 Third Edition: 1996 Reprint: 1998, 1999, 2000, 2001, 2002, 2003, 2004 Fourth Edition: 2000 Reprint: 2010, 2011, 2012, 2013, 2014 Fifth Edition: 2015 Reprint: 2016, 2017, 2018, 2019 Sixth Edition: 2020³ Reprint: 2021, 2022, 2023 All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the editor and the publisher. Published by Satish Kumar Jain and produced by Varun Jain for CBS Publishers & Distributors Pvt Ltd 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India Ph: 011-23289259, 23266861 Website: www.cbspd.com e-mail: [email protected] Corporate Office: 204 FIE, Industrial Area, Patparganj, Delhi 110 092, India Ph: 011-4934 4934 Fax: 011-4934 4935 e mail: [email protected]; [email protected] Branches Bengaluru: Seema House 2975, 17th Cross, KR Road, Banasankari 2nd Stage, Bengaluru 560 070, Karnataka, India Ph: +91-80-26771678/79 Fax: +91-80-26771680 e-mail: [email protected] Chennai: 7, Subbaraya Street, Shenoy Nagar, Chennai 600 030, Tamil Nadu, India Ph: +91-44-26680620, 26681266 Fax: +91-44-42032115 e-mail: [email protected] Kochi: 42/1325, 1326, Power House Road, Opp KSEB, Power House, Ernakulum Kochi 682 018, Kerala, India Ph: +91-484-4059061-65,67 Fax: +91-484-4059065 e-mail: [email protected] Kolkata: 147, Hind Ceramics Compound, 1st Floor, Nilgunj Road, Belghoria, Kolkata 700 056, West Bengal, India Ph: +91-33-25633055/56 e-mail: [email protected] Lucknow: Basement, Khushnuma Complex, 7 Meerabai Marg (behind Jawahar Bhawan), Lucknow 226 001, UP, India Ph: +91-522-4000032 e-mail: [email protected] Mumbai: PWD Shed, Gala no 25/26, Ramchandra Bhatt Marg, Next to JJ Hospital Gate no. 2, Opp. Union Bank of India, Noorbaug, Mumbai 400 009, Maharashtra, India Ph: +91-22-66661880/89 e-mail: [email protected] Representatives Hyderabad 0-9885175004. Jharkhand 0-9811541605 Nagpur 0-8692091830 Patna 0-9334159340 Pune 0-9664372571 Uttarakhand 0-9716462459 Printed at: Manipal Technologies Limited, Manipal, Karnataka, India | Preface to the eventh Edition [ost popular and student-friendly BD Chaurasia's Handbook MostpopularAntonyfor MBBS, BDS, physiotherapy and occupational therapy students has been upgraded by improving the diagrams and revising the text. However, the highlight of this edition is the addition of chapters of various systems of the body, including their gross and clinical anatomy, thus giving a bird's-eye view of these important areas. These seven newly added chapters are respiratory system, digestive system, sensory organs, endocrine system, urinary system, reproductive system (both male and female) and "Cadaver as our first teacher". This will make the study of gross anatomy and clinical anatomy holistic in nature. Thus the Handbook of General Anatomy now no longer remains the book for general anatomy only but it also includes brief study of all the systems. So it almost becomes a mini textbook for our dear students. This edition has been designed as per the latest CBME Guidelines| Competency Based Undergraduate Curriculum for the Indian Medical Graduate. Thanks to Mr Sanjay Chauhan, Mr Sushil Rawat and Mr Prasenjit Paul who have diligently done the graphic designing, formatting and proofreading of the book. My heartfelt thanks are to Mr SK Jain CMD, Mr Varun Jain Director, Mr YN Arjuna Senior Vice President-Publishing, Editorial and Publicity and Ms Ritu Chawla General Manager (Production) for encouraging and helping me all the time. Suggestions for rectification and improvement are welcome. These may be sent at [email protected] My first and last thanks are to Almighty for directing and guiding the intellect along the right path. Krishna Garg Editor  Index of Competencies Competency based Undergraduate Curriculum for the Indian Medical Graduate Code Competency Page no AN 1.1 Demonstrate normal anatomical position, various planes, relation, comparison, laterality and movement in our body 11 AN 1.2 Describe composition of bone and bone marrow 46 AN 2.3 Enumerate special features of a sesamoid bone 53 AN 2.1 Describe parts, blood and nerve supply of a long bone 62 AN 2.2 Enumerate laws of ossification 68 AN 2.4 Describe various types of cartilage with its structure and distribution in body 72 AN 2.5 Describe various joints with subtypes and examples 85 AN 2.6 Explain the concept of nerve supply of joints and Hilton's law 108 AN 3.2 Enumerate parts of skeletal muscle and differentiate between tendons and aponeuroses. Give examples. 126 AN 3.1 Classify muscle tissue according to structure and action 130 AN 3.3 Explain shunt and spurt muscles 142 AN 7.5 Describe principles of sensory and motor innervation of muscles 142 AN 7.6 Describe concept of loss of innervation of a muscle with its 146 applied anatomy AN AN 5.2 Differentiate between pulmonary and systemic circulation 155 5.4 Explain functional differences between elastic, muscular arteries and arterioles 158 AN 5.3 List general differences between arteries and veins 161 AN 5.5 Describe portal system giving examples 162 AN 5.6 Describe the concept of anastomoses and collateral circulation with significance of end-arteries 168 AN 5.7 Explain function of meta-arterioles, precapillary sphincters, arteriovenous anastomoses 168 AN 5.8 Define thrombosis, infarction and aneurysm 173 AN 6.1 List the components and functions of the lymphatic system 183 AN 6.2 Describe structure of lymph capillaries and mechanism of lymph circulation 183 AN 6.3 Explain the concept of lymphoedema and spread of tumors via lymphatics and venous system 196 AN 7.1 Describe general plan of nervous system with components of central, peripheral and autonomic nervous systems 203 AN 7.2 List components of nervous tissue and their functions 205 AN 7.3 Describe parts of a neuron and classify them based on number of neurites, size and function 205 208 AN 7.7 Describe various types of synapses viii Handbook of General Anatomy Code Competency Page no 213 AN 4.1 Describe dermatomes in body 213 AN 7.4 Describe structure of a typical spinal nerve AN 4.2 Describe structure and function of skin with its appendages 240 251 AN 4.5 Explain principles of skin incisions AN 4.3 Describe superficial fascia along with fat distribution in body 252 AN 4.4 Describe modifications of deep fascia with its functions 254 AN 24.1 Mention the blood supply, lymphatic drainage and nerve supply of pleura, extent of pleura and describe the pleural recesses and their applied anatomy 275 AN 24.2 Identify side, external features and relations of structures which form root of lung & bronchial tree and their clinical correlate 277 AN 24.3 Describe a bronchopulmonary segment 277 AN 47.5 Describe & demonstrate major viscera of abdomen under following headings (anatomical position, external and internal features, important peritoneal and other relations, blood supply, nerve supply, lymphatic drainage and 286, applied aspects) 335 AN 39.1 Describe and demonstrate the morphology, nerve supply, embryological basis of nerve supply, blood supply, lymphatic drainage and actions of extrinsic and intrinsic muscles of tongue 308 AN 37.1 Describe and demonstrate features of nasal septum, lateral wall of nose, their blood supply and nerve supply 311 AN 40.1 Describe and identify the parts, blood supply and nerve supply of external ear 312 AN 40.2 Describe and demonstrate the boundaries, contents, relations and functional anatomy of middle ear and auditory tube 312 AN 40.3 Describe the features of internal ear 313 AN 41.1 Describe and demonstrate parts and layers of eyeball 316 AN 35.2 Describe and demonstrate location, parts, borders, surfaces, relations and blood supply of thyroid gland 327 AN 48.2 Describe and demonstrate the (position, features, important peritoneal and other relations, blood supply, nerve supply, lymphatic drainage and clinical aspects of) important male 348 and female pelvic viscera AN 46.1 Describe and demonstrate coverings, internal structure, side determination, blood supply, nerve supply, lymphatic drainage 357 and descent of testis with its applied anatomy 360 AN 46.2 Describe parts of epididymis AN 46.3 Describe penis under the following headings: Parts, 361 components, blood supply and lymphatic drainage  Contents Preface to the Seventh Edition < Preface to the First Edition vi Index of Competencies vii M. Introduction 1-45 Subdivisions of Anatomy 1 History of Anatomy Anatomical Nomenclature 10 Anatomical Terminology 11 Terms Related to Body Movements 17 Clinical Anatomy 41 Arrangement of Structures in the Body from within outwards 43 Points to Remember 43 Multiple Choice Questions 44 2. Skeleton 46-83 Bones 46 Classification of Bones 48 Gross Structure of an Adult Long Bone 59 62 Parts of a Young Growing Bone Blood Supply of Bones 65 Nerve Supply of Bones 68 Development and Ossification of Bones 68 Growth of a Long Bone 69 Medicolegal and Anthropological Aspects 70 Cartilage 72 Clinical Anatomy of Skeleton 75 Points to Remember 81 Multiple Choice Questions 82 3. Joints 84-123 Classification of Joints 85 Fibrous Joints 89  Handbook of General Anatomy Cartilaginous Joints 92 Synovial Joints 94 Clinical Anatomy of Joints 116 Points to Remember 121 Multiple Choice Questions 121 4. Muscles 124-152 Derivation of Name 124 Skeletal Muscles 126 Parts of a Muscle 126 Structure of Striated Muscle 128 Naming the Muscles 133 Nerve Supply of Skeletal Muscle 142 Actions of Muscles 144 Clinical Anatomy of Muscles 147 Points to Remember 150 Multiple Choice Questions 151 5. Circulatory System 153-181 Components 153 Arteries 158 Veins 161 Capillaries 166 Sinusoids 167 Angiosome 168 Nerve Supply 168 Anastomoses 168 End Arteries 172 Clinical Anatomy of Circulatory System 174 Points to Remember 179 Multiple Choice Questions 179 6. Lymphatic System 182-201 Components 183 Lymph Nodes 188 Clinical Anatomy of Lymphatic System 196 Points to Remember 200 Multiple Choice Questions 200  xi Contents 7. Nervous System 202-237 Parts of Nervous System 203 Cell Types of Nervous System 205 Blood-Brain Barrier 211 Reflex Arc 211 Peripheral Nerves 212 Spinal Nerves 213 Nerve Fibres 217 Autonomic Nervous System 222 Sympathetic Nervous System 223 Parasympathetic Nervous System 224 Clinical Anatomy of Nervous System 228 Points to Remember 235 Multiple Choice Questions 236 8. Skin and Fasciae 238-262 Surface Area 238 Pigmentation of Skin 240 Structure of Skin 240 Surface Irregularities of the Skin 242 Appendages of Skin 244 Clinical Anatomy of Skin 250 Superficial Fascia 252 Deep Fascia 254 Modifications of Deep Fascia 255 Clinical Anatomy of Skin 257 Points to Remember 260 Multiple Choice Questions 261 9. Connective Tissue, Ligaments and Raphe 263-271 Introduction 263 Constituent Elements 263 Types of Connective Tissue 264 Definition 266 269 Clinical Anatomy of Connective Tissue Points to Remember 270 Multiple Choice Questions 271 xii Handbook of General Anatomy 10. Respiratory System 272-282 272 Organs Of Respiration 280 Clinical Anatomy of Respiratory System Points to Remember 281 Multiple Choice Questions 282 11. Digestive System 283-307 Layers of the Alimentary Canal 284 Digestive Tract/Alimentary Canal 286 Liver 297 Extrahepatic Biliary Apparatus 299 Pancreas 301 Spleen 301 Clinical Anatomy of Digestive System 302 Points to Remember 306 Multiple Choice Questions 306 12. Sensory Organs 308-322 Tongue 308 Nose 311 Ear 312 Eye 316 Clinical Anatomy of Sensory Organs 319 Points to Remember 321 Multiple Choice Questions 322 13. Endocrine System 323-334 Hypothalamus and Pituitary Gland 325 Thyroid Gland 327 Parathyroid Glands 328 Suprarenal/Adrenal Glands 329 Pancreas-Islets of Langerhans 330 Pineal Gland 331 Ovaries, Testes 331 Juxtaglomerular Apparatus in Kidneys 331 Clinical Anatomy of Endocrines 331 Multiple Choice Questions 334  xiii Contents 14. Urinary System 335-347 Components of Urinary System 335 Gross Structure of Kidney 337 Blood Supply of the Kidney 338 Nephron 338 Clinical Anatomy of Urinary System 345 Points to Remember 346 Multiple Choice Questions 346 15. Reproductive System 348-367 Female Reproductive System 348 Breast/Mammary Gland 355 Male Reproductive System 357 Clinical Anatomy of Reproductive System 362 Points to Remember 366 Multiple Choice Questions 366 16. Principles of Radiography 368-384 History of X-Rays 368 Properties of X-Rays 369 Radiographic Procedures 372 Special Procedures 376 Magnetic Resonance Imaging (MRI) 378 Positron Emission Tomography (PET) 379 Interventional Radiology 380 Points to Remember 381 Multiple Choice Questions 382 17. Genetics 385-409 The Genes 386 Some Important Terms 388 The Chromosomes 389 Mitochondrial DNA 394 Chromosomal Aberrations 395 Prenatal Diagnosis 400 Methods of Diagnosis 401 Fetal Therapy 403 404 Molecular Regulation of Development xiv Handbook of General Anatomy Points to Remember 408 Multiple Choice Questions 409 18. Cadaver as Our First Teacher 410-414 Cadaver as a First Teacher 410 How to Obtain a Cadaver 410 Preservation of the Cadavers 410 Embalming and Ethics 411 Dissection Instruments 413 Points to Remember 413 Multiple Choice Questions 414 Anatomical Terms and Historical Names 415-440 Additional Reading 441-446 Index 447-450  Chapter 1 Introduction Life is a book with three chapters. Two are already written by God-birth and death. The chapter in the middle is empty; fill it with smile, love and faith. uman anatomy is the science which deals with the structure of Hthehumanbody.Theterm, 'anatomy', is derived from a Greek word, anatome”, meaning cutting up. The term 'dissection' is a Latin equivalent of the Greek anatome. However, the two words, anatomy and dissection, are not synonymous. Dissection is a mere technique, whereas anatomy is a wide field of study. Anatomy forms firm foundation of the whole art of medicine and introduces the student to the greater part of medical terminology. "Anatomy is to physiology as geography is to history, i.e. it describes the theatre in which the action takes place." SUBDIVISIONS OF ANATOMY Initially, anatomy was studied mainly by dissection. But the scope of modern anatomy has become very wide because it is now studied by all possible techniques which can enlarge the boundaries ofthe anatomical knowledge. The main subdivisions of anatomy are: 1. Cadaveric anatomy is studied on dead embalmed (preserved) bodies usually with the naked eye (macroscopic or gross anatomy). This can be done by one of the two approaches: a. In regional anatomy the body is studied in parts, like the upper limb, lower limb, thorax, abdomen, head and neck, and brain (Fig. 1.1). 1  2 Handbook of General Anatomy___ Brain Head and neck Thorax Abdomen Upper limb Lower limb Fig. 1.1: Various regions of the body b. In systemic anatomy the body is studied in systems, like the skeletal system (osteology), muscular system (myology), articulatory system (arthrology or syndesmology), vascular system (angiology), nervous system (neurology), and respiratory, digestive, urogenital and endocrine systems (splanchnology). The locomotor system includes osteology, arthrology and myology. These systems are briefly mentioned close to the end of this chapter. 2. Living anatomy is studied by inspection (Fig. 1.2a), palpation (Fig. 1.2b), percussion (Fig. 1.2c), auscultation (Fig. 1.2d), endoscopy (bronchoscopy, gastroscopy), radiography, electromyography, etc. 3. Embryology (developmental anatomy) is the study of the prenatal developmental changes in an individual (Fig. 1.3). The developmental history is called ontogeny'. The evolutionary 1 history, on the other hand, is called 'phylogeny'.  3 Introduction Fig. 1.2a: Inspection of the chest Fig. 1.2b: Palpation Fig. 1.2c: Percussion Fig. 1.2d: Auscultation Ventral mesogastrium Dorsal body wall Dorsal Ventral body mesogastrium wall Spleen Liver Coeliac artery Foregut Superior mesenteric artery Dorsal mesentery Midgut Inferior mesenteric artery Hindgut Aorta Fig. 1.3: Development of various parts of the gut  4 Handbook of General Anatomy 4. Histology (microscopic anatomy) is the study of structures with the aid of a microscope (Fig. 1.4). 5. Surface anatomy (topographic anatomy) is the study ofdeeper parts of the body in relation to the skin surface, e.g. palpating the artery. It is most important in clinical practice, physical therapy and surgical operations, e.g. palpating the artery (Fig. 1.5). Simple columnar epithelium. Short duct and long. secretory portion ASMO Oxyntic cells Chief cells Lamina propria with glands Muscularis mucosae All epithelial cells are simple columnar in type ⚫ Parietal cells are large and pink, chief cells are small and blue Duct is 1/3rd, secretory part is 2/3rd Fig. 1.4: Histology of the fundus of stomach Dorsalis pedis artery 1 Fig. 1.5: Palpating the dorsalis pedis artery  5 Introduction 6. Radiographic and imaging anatomy is the study of the bones and deeper organs by plain and contrast radiography, by ultrasound and computerised tomographic (CT) scans (Fig. 1.6). 7. Comparative anatomy is the study of anatomy of the other animals to explain the changes in form, structure and function (morphology) of different parts of the human body. 8. Physical anthropology deals with the external features and measurements of different races and groups of people, and with the study of the prehistoric remains (Fig. 1.7). 9. Applied anatomy (clinical anatomy) deals with application of the anatomical knowledge to the medical and surgical practice (Fig. 1.8). Fig. 1.6: X-ray Chest: Posteroanterior view 1 Fig. 1.7: Physical anthropology 6 Handbook of General Anatomy Axillary nerve Radial nerve Ulnar nerve Fig. 1.8: The relation of nerves to the posterior aspect of humerus 10. Experimental anatomy is the study of the factors which influence and determine the form, structure and function of different parts of the body. 11. Genetics deals with the study of information present in the chromosomes (see Chapter 17). HISTORY OF ANATOMY 1. Greek Period (~ Hippocrates of Cos (circa 400 BC), the 'father of medicine', is regarded as one of the founders of anatomy. Parts of hippocratic collection are the earliest anatomical descriptions. Herophilus of Chalcedon (circa 300 BC) is called the "father of anatomy". He was a Greek physician, and was one of the first to dissect the human body. 2. Roman Period (A Galen of Pergamum, Asia Minor (circa 130-200 AD), the "prince of physicians". practised medicine at Rome. He was the foremost practitioner of his days and the first experimental physiologist.  7 Introduction 3. Fourteenth Century Mundinus or Mondino d'Luzzi (1276-1326), the 'restorer of anatomy', was an Italian anatomist and professor of anatomy at Bologna. 4. Fifteenth Century Leonardo da Vinci of Italy (1452-1519), the originator of cross sectional anatomy, was one of the greatest geniuses the world has known. He was the founder of modern anatomy. 5. Sixteenth Century Vesalius (1514-1564), the 'reformer of anatomy', was German in origin, Belgian (Brussels) by birth, and found an Italian (Padua) university favourable for his work. He was professor of anatomy at Padua. Hippocrates Herophilus Galen Leonardo da Vinci Vesalius 1  Handbook of General Anatomy 6. Seventeenth Century William Harvey (1578-1657) was an English physician who discovered the circulation of blood, and published it as Anatomical Exercise on the Motion of the Heart and Blood in Animals. He also published a book on embryology. 7. Eighteenth Century William Hunter (1718-1783) was a London anatomist and obstetrician. He introduced the present day embalming with the help of Harvey's discovery, and founded with his younger brother (John Hunter) the famous Hunterian museum. 8. Nineteenth Century. Dissection by medical students was made compulsory in Edinburgh (1826) and Maryland (1833). Burke and Hare scandal of 16 murders took place in Edinburgh in 1828. Warburton Anatomy Act (1832) was passed in England under which the unclaimed bodies were made available for dissection. The 'Act' was passed in America (Massachusetts) in 1831. Formalin was used as a fixative in 1890s. X-rays were discovered by Roentgen in 1895. The noted anatomists of this century include Ashley Cooper (1768–1841; British surgeon), Cuvier (1769-1832; French naturalist), Meckel (1724-1774; German anatomist), and Henry Gray (1827-1861; the author of Gray's Anatomy). 9. Twentieth Century The electron microscope was invented in 20th century. It was applied in clinical practice, which made startling changes in the study of normal and diseased conditions. Besides plain X-rays, in this century, ultrasonography and echocardiography were discovered. These were the non-invasive safe procedure. Also computer-axial tomography or CT scan, a non-invasive procedure and magnetic resonance imaging were devised. 10. Twenty-first Century Foetal medicine is emerging as a newer subject. Even treatment in utero is being practised in some cases. 1 Human genome has been prepared.  Introduction New research in drugs for many diseases, especially AIDS, is being done very enthusiastically. There is also a strong possibility of gene therapy. Indian Anatomists Dr Inderjit Dewan worked chiefly on osteology and anthropology. Dr DS Choudhry did notable work on carotid body. Dr H Chaterjee and Dr H Verma researched on embryology. Dr SS Dayal did good work in cancer biology. Dr Shamer Singh and his team did pioneering work on teratology. Dr Chaturvedi's and Dr CD Gupta's prominent work was on corrosion cast. Dr LV Chako, Dr HN Keswani, Dr Veena Bijlani, Dr Gopinath, Dr Shashi Wadhwa of All India Institute of Medical Sciences, New Delhi, researched on neuroanatomy. Dr Keswani and his team established museum of history of medicine. Dr AK Susheela of AIIMS, New Delhi, has done profound work on fluorosis. Dr MC Vaidya and Dr NK Mehra are well known for their work on leprosy, HLA and immunology. Dr IB Singh of Rohtak did enlightening studies on histology. He has been author of several books in anatomy. Dr AK Dutta of West Bengal had authored many books on anatomy. Dr Yogesh Sontakke has been writing many books on anatomy. Pandit Madhusudan Gupta was the first man who dissected a cadaver in 1836 in Calcutta and created a sensation in orthodox Hindu society. He was honored by a 7 cannon salute. Dr A Halim is a great teacher of many teachers. He retired from KGMC, Lucknow, UP. His book Surface and Radiological Anatomy is most popular. Dr Chandrama Anand retired as Director of Lady Hardinge Medical College and associated hospitals. She was Director Professor and Head, Department of Anatomy, a very passionate, all-rounder lovable teacher. Amongst the medical educationists are Dr Sita Achaya, Dr Ved Prakash. Dr Basu, Dr M Kaul, Dr Chandrama Anand. Dr Indira Bahl, Dr Swarna Bhardwaj, Dr Rewa Choudhary, Dr Smita Kakar, Dr Anita Tuli, Dr Shashi Raheja, Dr Ram Prakash, Dr Veena 10 Handbook of General Anatomy Dr Madhusudan Gupta Dr A Halim Dr Chandrama Anand Bharihoke, Dr Madhur Gupta, Dr Neelam Vasudeva, Dr Sabita Mishra, Dr Raj Mehra, Dr Rani Kumar, Dr Satyam Khare, Dr JM Kaul, Dr Shipra Paul, Dr Dharamnarayan, Dr AC Das, Dr A Halim, Dr DR Singh and many others. Dr Harish Agarwal, an anatomist, worked in jurisprudence for a number of years. Dr Cooper of Chennai, Dr M Thomas and Dr Kiran Kucheria did commendable work on genetics. Dr Mehdi Hasan and Dr Nafis Ahmad Faruqi did pioneering research in neuroanatomy. Dr Balasubramanyam is a computer anatomist. ANATOMICAL NOMENCLATURE Galen (2nd century) wrote his book in Greek and Vesalius (16th century) did it in Latin. Most of the anatomical terms, therefore, are either in Greek or Latin. By 19th century about 30,000 anatomical terms were in use in the books and journals. In 1895, the German Anatomical Society held a meeting in Basle, and approved a list of about 5000 terms known as Basle Nomina Anatomica (BNA). The following six rules were laid down to be followed strictly: (1) Each part shall have only one name; (2) each term shall be in Latiņ; (3) each term shall be as short and simple as possible; (4) the terms shall be merely memory signs; (5) the related terms shall be similar, e.g. femoral artery, femoral vein, and femoral nerve; and (6) the adjectives shall be arranged as opposites, e.g. major and minor, superior and inferior.  Introduction 11 BNA was revised in 1933 by a committee of the Anatomical Society of Great Britain and Ireland in a meeting held at Birmingham. The revised BNA was named Birmingham Revision (BR). An independent revision of the BNA was also done by German anatomists in 1935, and was known as Jena Nomina Anatomica (JNA or INA). However, the BR and INA found only local and restricted acceptance. In 1950, it was agreed at an International Congress ofAnatomists held at Oxford that a further attempt should be made to establish a generally acceptable international nomenclature. In the Sixth International Congress of Anatomists held at Paris (1955), a somewhat conservative revision of BNA with many terms from BR and INA was approved. Minor revisions and corrections were made at the International Congresses held in New York (1960), and Wiesbaden, Germany (1965), and the 3rd edition of Nomina Anatomica (Ed. GAG Mitchell, 1968) was published by the Excerpta Medica Foundation. The drafts on Nomina Histologica and Nomina Embryologica prepared by the subcommittee of the International Anatomical Nomenclature Committee (IANC) were approved in a plenary session of the Eleventh International Congress of Anatomists held in Leningrad in 1970. After a critical revision, the 4th edition of Nomina Anatomica (Ed. Roger Warwick, 1977) containing Nomina Histologica and Nomina Embryologica was published by the same publisher. Competency achievement: The student should be able to: AN 1.1 Demonstrate normal anatomical position, various planes, relation, comparison, laterality and movement in our body ANATOMICAL TERMINOLOGY Various positions, planes, terms in relation to various regions and movements are described. Positions Anatomical position: When a person is standing straight with eyes looking forwards, both arms by the side of body, palms facing forwards, both feet together, the position is anatomical position (Fig. 1.9). 1 12 Handbook of General Anatomy Fig. 1.9: Anatomical position St position: When a person is lying on his/her back, arms by the side, palms facing upwards and feet put together, the position is supine position (Fig. 1.10). Prone position: Person lying on his/her face, chest and abdomen is said to be in prone position (Fig. 1.11). Lithotomy position: Person lying on her back with legs up and feet supported in straps. This position is mostly used during delivery of the baby (Fig. 1.12). Fig. 1.10: Supine position 1 Fig. 1.11: Prone position  Introduction 13 Fig. 1.12: Lithotomy position Planes A plane passing through the centre of the body dividing it into two equal right and left halves, is the median or midsagittal plane (Fig.1.13). Plane parallel to median or midsagittal plane is the sagittal plane. A plane at right angles to sagittal or median plane which divides the body into anterior and posterior halves is called a coronal plane (Figs 1.14 and 1.15). Median or midsagittal plane -Sagittal plane Coronal plane Median plane Horizontal planes Fig. 1.13: Median and sagittal planes Fig. 1.14: Median, sagittal, coronal and horizontal planes 1 14 Handbook of General Anatomy A plane at right angles to both sagittal and coronal planes which divides the body into upper and lower parts is called a transverse horizontal plane (Fig. 1.15). Oblique plane: Any other plane other than coronal, transverse and midsagittal is called oblique plane. Cardinal plane: If any plane traverses the centre of the body, it is called cardinal plane. Some other terms: Fundamental position: It is same as anatomical position except that palms are facing the body. It is a comfortable position and is not important from anatomy point of view. Centre ofgravity: The point where three cardinal planes intersect in the body is called "centre of gravity". Terms used in Relation to Trunk, Neck and Face Ventral or anterior is the front of trunk, neck and face. Dorsal or posterior is the back of trunk, neck and face (Fig. 1.17). Medial is a plane close to the median plane (Fig. 1.16). Lateral is plane away from the median plane. Proximal/cranial/superior is close to the head end of body. Coronal plane D -Horizontal plane 1 Fig. 1.15: Coronal and horizontal planes  15 Introduction Ventral/anterior Flexor aspect Lateral border Medial border Median plane Medial Lateral Medial border Palmar aspect Ipsilateral- Contralateral- Medial border Lateral border Dorsum of foot Fig. 1.16: Language of anatomy Distallcaudal/inferior is close to the lower end of the trunk. Superficial is close to skin/towards the surface of body (Fig. 1.18). Deep is away from skin/away from the surface of body. Ipsilateral is on the same side of the body as another structure. Contralateral is on opposite side of body from another structure. Invagination is projection inside. Evagination is projection outside (Fig. 1.19). Terms Used in Relation to Upper Limb Ventral or anterior is the front aspect (Fig. 1.17). Dorsal or posterior is the back aspect. Medial border lies along the little finger, medial border of forearm and arm. Lateral border follows the thumb, lateral border of forearm and arm (Fig. 1.16). 1 16 Handbook of General Anatomy Superior Cranial end Root of the limb Proximal Dorsal/ extensor/ posterior surface Ventral/ flexor/ anterior surface Caudal end Distal Flexor aspect Extensor aspect Inferior Fig. 1.17: Language of anatomy Superficial Deep Invagination Evagination Fig. 1.18: Language of anatomy Fig. 1.19: Language of anatomy Proximal is close to root of limb, while distal is away from the root (Fig. 1.17). Palmar aspect is the front of the palm (Fig. 1.16). Dorsal aspect of hand is on the back of palm. Flexor aspect is front of upper limb. Extensor aspect is back of upper limb.  17 Introduction Terms used in Relation to Lower Limb Posterior aspect is the back of lower limb. Anterior aspect is front of lower limb. Medial border lies along the big toe or hallux, medial border of leg and thigh (Fig. 1.16). Lateral border lies along the little toe, lateral border of leg and thigh. Flexor aspect is back of lower limb. Extensor aspect is front of lower limb (Fig. 1.17). Proximal is close to the root of limb, while distal is away from it. Terms of Relation Commonly used in Embryology and Comparative Anatomy, but Sometimes in Gross Anatomy a. Ventral towards the belly (like anterior). b. Dorsal towards the back (like posterior). F.c. Cranial or rostral—towards the head (like superior) (Fig. 1.17). d. Caudal towards the tail (Fig. 1.17). TERMS RELATED TO BODY MOVEMENTS Movements in general at synovial joints are divided into four main categories. 1. Gliding movement: Relatively flat surfaces move back-and-forth and from side-to-side with respect to one another. The angle between articulating bones does not change significantly. 2. Angular movements: Angle between articulating bones decreases or increases. In flexion there is decrease in angle between articulating bones and in extension there is increase in angle between articulating bones (Fig. 1.20). Lateral flexion is movement of trunk sideways to the right or left at the waist. Adduction is movement of bone toward midline, whereas abduction is movement of bone away from midline. 3. Special ovements: These occur only at certain joints, e.g. pronation, supination at radioulnar joints, protraction and retraction at temporomandibular joint, inversion and eversion at subtalar joint. 4. Rotation: A bone revolves around its own longitudinal axis. In medial rotation anterior surface of a bone of limb is turned towards the midline. In lateral rotation anterior surface of a bone of limb is turned away from midline. 1 18 Handbook of General Anatomy In Upper limb Shoulder Joint e Abduction of shoulder: When limb is taken away from the body (Fig. 1.21). Adduction of shoulder: When limb is brought close to the body.. Flexion of shoulder: If arm is taken towards the front of the chest wall. Extension: Arm is taken backwards and laterally (Fig. 1.22). Cinction: It is movement of distal end of a part of the body in a circle. A combination of extension, abduction, flexion and adduction in a sequence is called circumduction as in bowling. Medial rotation of shoulder: When the arm rotates medially bringing the flexed forearm across the chest (elbow in contact with trunk)., ds the Flexion Adduction Extension Abduction 1 Fig. 1.20: Angular movements Fig. 1.21: Abduction and adduction of shoulder joint  19 Introduction Lateral rotation Flexion Extension Medial rotation Fig. 1.22: Flexion and extension of Fig. 1.23: Medial rotation and shoulder joint lateral rotation of shoulder joint Lateral rotation of shoulder: When arm rotates laterally taking the flexed forearm away from the body (Fig. 1.23) (elbow in contact with trunk). Elbow Joint Flexion: When two flexor surfaces are brought close to each other, e.g. in elbow joint when front of arm and forearm move close to each other (Fig. 1.20). Extension: When extensor or dorsal surfaces are brought in as much approximation as possible, e.g. straighten the forearm at the elbow joint (Fig. 1.20). Forearm Supination: When the palm is facing forwards or upwards, as in putting food in the mouth (Fig. 1.24). 1 20 Handbook of General Anatomy Pronation: When the palm faces backwards or downwards, as in picking food with fingers from the plate. Wrist Joint Flexion of wrist: When palm comes closer to front of forearm. Extension ofwrist: When dorsum of hand comes closer to back of forearm (Fig. 1.25). Adduction of wrist: When medial border of palm is turned medially. Abduction of wrist: When lateral border of palm is turned laterally. Thumb Opposition ofthumb: When tip of thumb touches the tips of any of the fingers (Fig. 1.26). Circumduction of thumb: Movement of extension, abduction, flexion and adduction in sequence. Flexion ofthumb: When thumb is taken across the palm (Fig. 1.27). Extension of thumb: When thumb is taken backwards in the plane of the palm (Fig. 1.28). Abduction ofthumb: When thumb is put vertically at right angles to plane of the palm (Fig. 1.29). Adduction ofthumb: When thumb is in close contact with lateral side of index finger (Fig. 1.30). Humerus Ulna Radius Extension Flexion (a) (b) 1 Fig. 1.24: Supinated forearm (a) and Fig. 1.25: Flexion and extension of wrist joint pronated forearm (b)  21 Introduction Flexion Opposition Fig. 1.26: Opposition of thumb Fig. 1.27: Flexion of thumb Extension Fig. 1.28: Extension ofthumb Adduction Abduction Fig. 1.29: Abduction of thumb Fig. 1.30: Adduction ofthumb 1 22 22 Handbook of General Anatomy Movement of Fingers The axis of movement of fingers is the line passing through the centre of the middle finger (Fig. 1.31). Adduction of digits/fingers: When all the fingers get together. Abduction: When all fingers separate (Fig. 1.31). Flexion of metacarpophalangeal and interphalangeal joints: When attempting to make a fist. Extension of metacarpophalangeal and interphalangeal joints: When opening the fist (Fig. 1.32). In Lower Limb Flexion of thigh: When front of thigh comes close to or in contact with front of abdomen (Fig. 1.33). Extension of thigh: When person stands erect. : When thigh is taken away from the median plane. Adduction: When thigh is brought close to median plane. Medial rotation: When thigh is turned medially. It is done by pointing the big toe medially. Lateral rotation: When thigh is turned laterally. It is done by pointing the big toe laterally. Circumduction: When flexion, adduction, extension and abduction are done in sequence (Fig. 1.35) Abductor digiti minimi 1 4 2 1 Fig. 1.31: Abduction of 2nd-5th digits  23 Introduction Flexion Flexion Extension Extension Fig. 1.32: Flexion and extension of metacarpophalangeal and inter- Fig. 1.33: Flexion and extension phalangeal joints of thigh Medial rotation Lateral rotation Flexion of knee: When back of right hip joint of left hip joint of thigh and back of leg come close to or are in opposition (Fig. 1.36a and b). Extension of knee: When thigh and leg are in straight line as in standing (Fig. 1.36). Dorsiflexion of foot: When dorsum of foot is brought close to front of leg and sole faces forwards (Fig. 1.37). Plantarflexion offoot:When sole of foot or plantar aspect of foot faces backwards. Inversion of foot: When Normal Normal medial border of foot is position position raised from the ground Fig. 1.34: Medial rotation and (Fig. 1.38). lateral rotation ofthigh 1 24 Handbook of General Anatomy Flexion Extension Fig. 1.36: Flexion and extension Fig. 1.35: Circumduction of lower limb of knee joint Dorsiflexion Eversion Inversion fal to Plantar flexion Fig. 1.37: Dorsiflexion and plantar flexion of foot Fig. 1.38: Inversion and eversion of foot Eversion offoot: When lateral border of foot is raised from the ground.  25 Introduction In the Neck Flexion: When face comes closer to chest. Extension: When face is taken away from the chest (Fig. 1.39). Lateralflexion: When ear is brought close to shoulder (Fig. 1.40). Rotation: When neck rotates so that chin goes to opposite side. Opening the mouth: When lower jaw is lowered to open the mouth (Fig. 1.41). Closure of the mouth: When lower jaw is opposed to the upper jaw, closing the mouth (Fig. 1.42). Protraction: When lower jaw slides forwards in its socket in the temporal bone of skull (Fig. 1.43). Retraction: When lower jaw slides backwards in its socket in the temporal bone of skull (Fig. 1.44). In the Trunk Backward bending is called extension (Fig. 1.39). Forward bending is flexion. Sideward movement is lateral flexion (Fig. 1.40) Sideward rotation is lateral rotation. Terms used for Describing Muscles a. Origin: The end of a muscle which is relatively fixed during its contraction (Fig. 1.45). Extension Lateral flexion Fig. 1.39: Extension of neck Fig. 1.40: Lateral flexion of neck 1 and trunk and trunk 26 Handbook of General Anatomy Mandibular depression ↑ Mandibular elevation Fig. 1.41: Opening the mouth Fig. 1.42: Closing the mouth Mandibular protrusion Mandibular retraction Fig. 1.43: Protraction of lower jaw Fig. 1.44: Retraction of lower jaw b. Insertion: The end of a muscle which moves during its contraction. The two terms, origin and insertion, are sometimes interchan- geable, when the origin moves and the insertion is fixed. c. Belly: The fleshy and contractile part of a muscle (Fig. 1.45). d. Tendon: The fibrous noncontractile and cord-like part of a muscle. e. Aponeurosis: The flattened tendon. f. Raphe: A fibrous band made up of interdigitating fibres of the tendons or aponeuroses. Unlike a ligament, it is stretchable. g. Ligaments: Fibrous, inelastic bands which connect two segments of a joint. Terms used for Describing Vessels a. Arteries carry oxygenated blood away from the heart. The only exception to this remark are the pulmonary and umbilical arteries which carry deoxygenated blood. Arteries resemble trees 1 because they have branches (arterioles) (Fig. 1.46).  27 Introduction Origin of short head of biceps brachii from coracoid process Origin of long head of biceps brachii from supraglenoid tubercle Glenoid cavity Muscle belly Biceps tendon inserted into radial tuberosity Bicipital aponeurosis Fig. 1.45: Terms for describing muscles Capillaries Arteriole Venule Artery Vein Fig. 1.46: Terms used for describing vessels b. Veins carry deoxygenated blood towards the heart. The exception to this remark are the pulmonary and umbilical veins which carry oxygenated blood. Veins resemble rivers because 28 Handbook of General Anatomy they have tributaries (venules). Veins have valves to allow unidirectional flow of blood (see Fig. 5.8). c. Venae comitantes are two veins, one on each side of a medium- sized artery of a limb joined to each other across the artery (see Fig. 5.11). d. Capillaries are networks of microscopic vessels connecting arterioles to venules (Fig. 1.46). e. Sinusoids are large, irregular, vascular spaces which are closely surrounded by the parenchyma of the organ. These are seen in liver, spleen, bone marrow, suprarenal glands, parathyroid glands. f. Anastomoses are precapillary or postcapillary communications between the neighbouring vessels (Fig. 1.47). Flexor retinaculum Radial artery Ulnar artery Superficial Pisiform bone palmar branch Deep branch of Deep palmar ulnar artery arch Hamate Princeps pollicis artery Superficial palmar arch Anastomosis Digital arteries Palmar metacarpal arteries Radialis indicis artery Fig. 1.47: Anastomoses of the arteries Terms used for Describing Bone Features Bone marking Example Linear elevation Line Superior nuchal line and inferior nuchal line of the occipital bone (Fig. 1.48) 1 (Contd.)  29 Introduction Bone marking Example (Contd.) Crest The illac crest ofthe hip bone, of spine of scapula (Fig. 1.49) Ridge Themedial and lateral supracondylar ridges ofthe humerus (Fig. 1.50) Rounded elevation Kubercle Pubic tubercle, lesser and greater tubercles of humerus Protuberance External occipital protuberance (Fig. 1.48) ✓Tuberosity Ischial tuberosity of the hip bone, deltoid tuberosity (Fig. 1.50) Malleolus Medial malleolus of the tibia, lateral malleolus of the fibula ✓Trochanter Greater and lesser trochanters of the femur (Fig. 1.51) Sharp elevation Spineor spinous Ischial spine, spine of vertebra, anterior superior iliac spine process Styloid process Styloid process of temporal bone (Fig. 1.48) Expanded ends for articulation Head Head of humerus, head of femur, head of radius Condyle Medial and lateral condyles of femur (knuckle-like process Fig. 1.51) ✓Epicondyle Medial and lateral epicondyles of femur (Fig. 1.52), medial (a prominence and lateral epicondyles of humerus (Fig. 1.50) situated just above condyle) Small flat area for articulation ✓ acet Facet on head of rib for articulation with vertebral body Depressions ✓Notch Greater sciatic notch and lesser sciatic notch of hip bone Groove or sulcus Bicipital groove of humerus (Fig. 1.50) ✓Fossa Radial and coronoid fossae (Fig. 1.50) of humerus, acetabular fossa of hip bone Openings ✓Fissure Superior orbital and inferior orbital fissures (Fig. 1.53) Foramen Infraorbitalforamen of the maxilla Canal Carotid canal of temporal bone Meatus External acoustic meatus and internal acoustic meatus of temporal bone 1 30 Handbook of General Anatomy Styloid process Mastoid process Foramen magnum External occipital protuberance Superior nuchal line Fig. 1.48: Terms used for describing bone features Acromial process (acromion): Coracoid process Suprascapular notch- Spinous process. Lateral Supraspinous fossa border Crest of spine of - Infraglenoid scapula tubercle Infraspinous fossa Medial border Lateral border 1 Fig. 1.49: Terms used for describing bone features  Introduction 31 Greater tubercle Bicipital groove Deltoid tuberosity Lateral supra- condylar ridge Coronoid fossa Radial fossa Medial epicondyle Capitulum Trochlea Fig. 1.50: Terms used for describing bone features Head ✓Greate Greater trochanter Neck Intertrochanteric line Lesser trochanter Anterior surface (shaft) Lateral epicondyle- Adductor tubercle Medial epicondyle Lateral condyle- Medial condyle Articular surface for patella Fig. 1.51: Terms used for describing bone features 1 32 32 Handbook of General Anatomy Fovea. Tip of greater trochanter - Head Greater trochanter Neck Lesser trochanter Quadrate tubercle Intertrochanteric crest Gluteal tuberosity Spiral line- Linea aspera- with two lips Medial supracondylar Lateral supracondylar line line Adductor tubercle Popliteal surface Medial epicondyle Lateral epicondyle Medial condyle Lateral condyle Intercondylar fossa Fig. 1.52: Terms used for describing bone features Frontal bone Frontal eminence Part of coronal suture Nasal bone Superior orbital fissure Zygomatic bone Maxilla Infraorbital foramen Anterior nasal spine Intermaxillary suture Ramus of mandible Angle of mandible Mental foramen Symphysis menti 1 Fig. 1.53: Terms used for describing bone features  33 Introduction Systems of the Body The study of anatomy can be divided into the following twelve major body systems. These body systems influence one another and work interdependently and independently to maintain health. These are as follows: 1. Respiratory system (pulmonology) consists of nose, nasopharynx, larynx, trachea, bronchi, bronchioles, alveoli and the main muscle is the diaphragm. These structures receive oxygen to oxygenate the venous blood and help in elimination of carbon dioxide (Fig. 1.54). 2. Articular system (arthrology) comprises various joints with their ligaments. Various types of movements take place at the synovial joints. Cartilaginous and fibrous joints are for growth of the bones. The joints provide integrity and stability to the adjoining bones (Fig. 1.55) and some form cavities for protection of organs. Nose with nasopharynx larynx Trachea with two bronchi Left lung Right lung The diaphragm Fig. 1.54: Respiratory system 11 34 Handbook of General Anatomy __ Fibrous joint (suture)· Frontal bone Cranial cavity Orbit Skull Maxilla Mandible Sternoclavicular Clavicle joint Scapula Shoulder joint Rib Xiphoid process Humerus Thoracic cavity Elbow joint Vertebral Intervertebral column joint (cartilaginous) Radius Ulna Hip joint Carpal bones Wrist joint Metacarpal bones Hand Phalanges Pelvic cavity. Femur Knee joint Tibia Fibula Ankle joint Calcaneus Metatarsals Foot 1 Fig. 1.55: Articular system  35 Introduction Frontalis ©Orbicularis oculi Orbicularis oris Fig. 1.56: Part of muscular system 3. Muscular system is the system which moves the various joints ofthe body and is responsible for activity, locomotion and facial expressions (Fig. 1.56). 4. Circulatory system (angiology) comprises cardiovascular system which consists of heart and blood vessels, i.e. arteries, veins and capillaries. Blood supplies nutrients and oxygen to cells and takes away carbon dioxide and wastes from cells and helps to regulate acid-base balance, temperature and water content of body fluids. Blood components help to defend against diseases and disease causing organisms (Fig. 1.57). 5. Lymphatic system comprises of various lymph vessels which withdraw excess tissue fluid with macromolecules, filters it through lymph nodes and returns it to the venous system (see Fig. 6.3). 6. Skeletal system (osteology) consists of numerous cartilages and bones, providing support and symmetry to the body. Cartilage 1 36 _ Handbook of General Anatomy Common carotid Brachial Abdominal aorta Radial Femoral Popliteal Posterior tibial Dorsalis pedis Fig. 1.57: Arterial system keeps the respiratory pathway patent. Bones being the largest storehouse of calcium provide attachment to numerous skeletal muscles for locomotion. Bones also make cavities or cages for protection of organs like brain, spinal cord, heart, lungs, and reproductive organs (Fig. 1.55). 7. Integumentary system (dermatology) consists of the skin with its various appendages, f.e. hair, sweat gland, sebaceous gland and nail. Skin is the outermost protective and sensitive covering of the body (see Fig. 8.1). 8. Digestive system (gastroenterology) comprises various organs associated with ingestion, mastication, deglutition, digestion and absorption of food components. This system also eliminates the solid waste from the body through the anal canal. It is made up 1 of a long tube from mouth to the anus and various associated  37 Introduction Mouth with pharynx Oesophagus Liver Stomach - Kidney Small Ureter intestine Urinary bladder with urethra Large intestine Fig. 1.58: Digestive system Fig. 1.59: Urinary system glands like salivary glands, liver, gallbladder, pancreas, gastric and intestinal glands (Fig. 1.58). 9. Urinary system (urology) helps in excretion of liquid waste from the body. This system comprises kidneys, ureters, urinary bladder and urethra. The kidneys filter the blood and produce, transport, store and expel the urine at frequent intervals (Fig. 1.59). Details can be learnt from 9th edition of BD Chaurasia's Human Anatomy, Volume 2, Chapter 24. 10. Reproductive system (andrology in males and gynaecology in females) consists of different organs in males and females. In males these are testes, epididymes, vas deferens, ejaculatory ducts, urethra, prostate, seminal vesicles and penis (Fig. 1.60). In females the organs are ovaries, fallopian tubes, uterus and vagina (Fig. 1.61). These two sets of organs are responsible for the production of ova and spermatozoa which on fertilization, implantation and proper nourishment in the uterus develops 1 38 Handbook of General Anatomy Pineal -Hypophysis gland cerebri Thyroid and parathyroids Remains of thymus on the heart Suprarenal Pancreas Ductus deferens Urinary bladder Prostate Testis Fig. 1.60: Reproductive and endocrine systems in male into a foetus. The foetus delivers out after nine months of pregnancy. Details can be seen from 9th edition of BD Chaurasia's Human Anatomy, Volume 2, Chapters 31 and 32. 11 Endocrine system (endocrinology) consists of ductless glands like hypothalamus, hypophysis cerebri, thyroid, parathyroid, suprarenal glands and islets of Langerhans in pancreas which produce hormones, that are carried to various target organs via blood. In male additional endocrine gland is testis, whereas in female it is replaced by ovary (Figs 1.60 and 1.61). These hormones influence metabolism and other processes like production of spermatozoa and the menstrual cycle. 12. Special senses include senses of taste, sight, smell, hearing, balance and touch. Taste is appreciated by the papillae present in the tongue, epiglottis and soft palate. Sense of sight is  39 Introduction Pineal Hypophysis gland cerebri - Thyroid with parathyroid Remains of thymus on the heart Suprarenal Pancreas Ovary Fallopian tube Uterus Fig. 1.61: Reproductive and endocrine systems in female appreciated in the nervous layer, the retina, of the eyeball. Receptors of smell are only present in the mucous membrane of the upper part of the nasal cavity. Hearing and balance are compactly organised in the internal ear. Touch is perceived through the skin (Fig. 1.62). 13. Nervous system (neurology) consists of billions of neurons included in the central nervous system (brain and spinal cord) and peripheral nervous system (cranial and spinal nerves). This is the system which controls the whole body including its muscles, glands and organs. The nervous system controls both our voluntary and involuntary activities. The personality of the person is dependent on the integrity of the nervous system (Fig. 1.63). The details of the system can be available in 9th edition of BD Chaurasia's Human Anatomy, Volume 4. 1 40 40 Handbook of General Anatomy For sense of For sense of vision hearing and balance For sense of smell Tongue in mouth for sense of taste Skin for sense of touch Brain -Spinal cord 1-8 Cervical segments Cervical ro ts Fig. 1.62: Special senses Thoraci segments 1-12 Thoraci ro ts Lumbar segm nts 1-5 Lumbar ro ts Sacral segments Coccygeal segments Cauda 1-5 equina Sacral ro ts Coccygeal roots 1 Fig. 1.63: Central nervous system  41 Introduction Clinical Anatomy 1. The suffix, '-itis', means inflammation, e.g. appendicitis, tonsillitis, arthritis, neuritis, dermatitis, etc. 2. The suffix, '-ectomy', means removal from the body, e.g. appendicectomy, tonsillectomy, gastrectomy, nephrectomy, etc. 3. The suffix, '-otomy', means to open and then close a hollow organ, e.g. Taparotomy, hysterotomy, cystotomy, cysto- lithotomy, etc. 4. The suffix, '-ostomy', means to open hollow organ and leave it open, e.g. cystostomy, colostomy, tracheostomy, etc. 5. The suffix, '-oma', means a tumour, e.g. lipoma, osteoma, neurofibroma, haemangioma, carcinoma, etc. 6. Puberty: The age at which the secondary sexual characters develop, being 12-15 years in girls and 13-16 years in boys. 7. Symptoms are subjective complaints of the patient about his disease. 8. Signs (physical signs) are objective findings of the doctor on the patient. 9. Diagnosis: Identification of a disease, or determination of the nature of a disease. 10. Prognosis: Forecasting the probable course and ultimate outcome of a disease. 11. Pyrexia: Fever. 12. Lesion: Injury, or a circumscribed pathologic change in the tissues. 13. Inflammation is the local reaction of the tissues to an injury or an abnormal stimulation caused by a physical, chemical, or biologic agent. It is characterized by: a. Swelling b. Pain c. Redness d. Warmth or heat e. Loss of function. 14. Oedema: Swelling due to accumulation of fluid in the extra- cellular space. 15. Thrombosis: Intravascular coagulation (solidification) of blood. 16. Embolism: Occlusion of a vessel by a detached and circulating thrombus (embolus). 17. Haemorrhage: Bleeding which may be external or internal. 18. Ulcer: A localized breach (gap, erosion) in the surface continuity of the skin or mucous membrane. 19. Sinus: A blind track (open at one end) lined by epithelium. 1 42 Handbook of General Anatomy 20. Fistula: An abnormal passage usually between two internal organs or organ to surface of the body and lined by epithelium. 21. Necrosis: Local death of a tissue or organ due to irreversible damage to the nucleus. 22. Degeneration: A retrogressive change causing deterioration in the structural and functional qualities. It is a reversible process, but may end in necrosis. 23. Gangrene: A form of necrosis (death) combined with putrefaction. 24. Infarction: Death (necrosis) of a tissue due to sudden obstruction of its artery of supply (often an end-artery). 25. Atrophy: Diminution in the size of cells, tissue, organ, or a part due to loss of its nutrition. 26. Dystrophy: Diminution in the size due to defective nutrition. 27. Hypertrophy: Increase in the size without any increase in the number of cells. 28. Hyperplasia: Increase in the size due to increase in the number of cells. 29. Hypoplasia: Incomplete development. 30. Aplasia: Failure of development. 31. Syndrome:A group of diverse symptoms and signs constituting together the picture of a disease. 32. Paralysis: Loss of motor power (movement) of a part of body due to denervation or primary disease of the muscles. 33. Hemiplegia: Paralysis of one-half of the body. 34. Paraplegia: Paralysis of both the lower limbs. 35. Monoplegia: Paralysis of any one limb. 36. Quadriplegia: Paralysis of all the four limbs. 37. Anaesthesia: Loss of sensation. 38. Analgesia: Loss of the pain sensibility. 39. Thermanaesthesia: Loss of the temperature sensibility. 40. Hyperaesthesia: Abnormally increased sensibility. 41. Paraesthesia: Perverted feeling of sensations. 42. Coma: Deep unconsciousness. 43. Tumour (neoplasm): A circumscribed, noninflammatory, abnormal growth arising from the body tissues. 44. Benign: Mild illness or growth which does not endanger life. 45. Malignant: Severe form of illness or growth, which is resistant to treatment.  43 Introduction 46. Carcinoma: Malignant growth arising from the epithelium (ectoderm or endoderm). 47. Sarcoma: Malignant growth arising from connective tissue (mesoderm). 48. Cancer: A general term used to indicate any malignant neoplasm which shows invasiveness and results in death of the patient, if not properly treated. 49. Metastasis: Spread of a local disease (like the cancer cells) to distant parts of the body. 50. Convalescence: The recovery period between the end of a disease and restoration to complete health. 51. Therapy: The treatment of disease. ARRANGEMENT OF STRUCTURES IN THE BODY FROM WITHIN OUTWARDS 1. Bones form the supporting framework of the body. 2. Muscles are attached to bones. 3. Blood vessels, nerves and lymphatics form neurovascular bundles which course in between the muscles, along the fascial planes. 4. The thoracic and abdominal cavities contain several internal organs called viscera. 5. The whole body has three general coverings, namely (a) skin; (b) superficial fascia; and (c) deep fascia. Points to Remember Hippocrates is the father of medicine. Leonardo da Vinci is the founder of modern anatomy. Dr Inderjit Dewan researched on osteology and anthropology. Anatomical position is the most important position for understanding anatomy. Median plane is only one plane in the trunk. Pronation and supination of forearm are special movements which permit "picking up of food (pronation)" and "putting it in the mouth (supination)". Big toe being in the same plane as rest of the toes is unique to human. 1  44 Handbook of General Anatomy Inversion and eversion of the foot help in its adjustment to the rough ground. There are 12 systems in the body. Medical students learn anatomy as regional anatomy, whereas nursing students learn it as systemic anatomy. Median/midsagittal plane divides the body into right and left halves. Coronal plane divides the body/any part into anterior and posterior parts. Transverse/horizontal plane divides the body/part into upper and lower portions. Multiple Choice Questions 1. Name the founder of modern anatomy: a. Vesalius b. Herophilus c. Galen d. Leonardo da Vinci 2. Name the father of medicine: a. Herophilus b. Galen c. Hippocrates d. Vesalius 3. Name the father of anatomy: a. Henry Gray b. Hippocrates c. Galen d. Herophilus 4. Phylogeny is the developmental history of a human: a. Through evolution b. Through life c. Before birth d. From birth to death 5. Ontogeny is the developmental/history of a human: b. Before birth a. Through evolution c. From fertilization till death d. After birth 6. Anatomical position has following features except: a. Person standing erect b. Forearms are pronated c. Feet together d. Eyes looking forwards 7. Which statement about the coronal plane is incorrect: a. Divides the body into anterior half and posterior half b. Lies at right angle to sagittal plane c. Lies at right angle to transverse plane 1 d. Divides the body into right half and left half  Introduction 45 8. Define abduction: a. Movement away from central axis b. Movement towards central axis c. Approximation of the ventral surfaces d. Approximation of the dorsal surfaces 9. What is the position of forearms in the anatomical position? a. Pronated b. Supinated c. Midprone d. None of the above 10. Plane at right angle to the long axis of body/body part is called: a. Sagittal b. Coronal c. Transverse/horizontal d. Oblique 11. The term cranial means: a. Towards the head b. Towards the back c. Towards the tail d. Towards the front 12. Preaxial border of upper limb is: a. Its inner border b. Its outer border c. Its anterior median line d. Its posterior median line ✓ Answers 1. d 3. d 4. a 5. C 6. b 7. d 8. a 2. C 9. b 10. C 11. a 12. b 1 Chapter 2 Skeleton One quarter of what you eat keeps you alive; the three quarters keep doctors alive. keleton includes bones and cartilages. It forms the main Skelet supporting framework of the body, and is primarily designed for a more effective production of movements by the attached muscles. BONES Synonyms 1. Os (L) 2. Osteon (G). Compare with the terms, osteology, ossification, osteomyelitis, osteomalacia, osteoma, osteotomy, etc. Competency achievement: The student should be able to: AN 1.2 Describe composition of bone and bone marrow 1/3rdconnectiy Definition and Composition Bone ismadeupofLy21gral casalt tissue Bone is one-third connective tissue. It is impregnated with calcium salts which constitute the remaining two-thirds part. The inorganic calcium salts (mainly calcium phosphate, partly calcium carbonate, and traces of other salts) make it hard and rigid, which can afford resistance to compressive forces of weight- bearing and impact forces ofjumping. The organic connective tissue (collagen fibres) makes it tough and resilient (flexible), which can afford resistance to tensile forces. In strength, bone is comparable to iron and steel. 46  47 Ske