G E N E R A L

ANATOMYprinciples and applications

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G E N E R A L

ANATOMYprinciples and applications

NORMAN EIZENBERG

CHRISTOPHER BRIGGS

CRAIG ADAMS

GERARD AHERN

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NoticeMedicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment anddrug therapy are required. The editors and the publisher of this work have checked with sources believed to be reliable in theirefforts to provide information that is complete and generally in accord with the standards accepted at the time of publication.However, in view of the possibility of human error or changes in medical sciences, neither the editors, nor the publisher, nor anyother party who has been involved in the preparation or publication of this work warrants that the information contained herein isin every respect accurate or complete. Readers are encouraged to confirm the information contained herein with other sources. Forexample, and in particular, readers are advised to check the product information sheet included in the package of each drug theyplan to administer to be certain that the information contained in this book is accurate and that changes have not been made in therecommended dose or in the contraindications for administration. This recommendation is of particular importance in connectionwith new or infrequently used drugs.

First edition 2008

Text © 2008 Anatomedia Publishing Pty LimitedIllustrations and design © 2008 McGraw-Hill Australia Pty LtdAdditional owners of copyright are acknowledged on the acknowledgments page.

Every effort has been made to trace and acknowledge copyrighted material. The authors and publishers tender their apologiesshould any infringement have occurred.

Reproduction and communication for educational purposesThe Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10% of the pages of this work, whichever is thegreater, to be reproduced and/or communicated by any educational institution for its educational purposes provided that theinstitution (or the body that administers it) has sent a Statutory Educational notice to Copyright Agency Limited (CAL) and beengranted a licence. For details of statutory educational and other copyright licences contact: Copyright Agency Limited, Level 15,233 Castlereagh Street, Sydney NSW 2000. Telephone: (02) 9394 7600. Website: www.copyright.com.au

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National Library of Australia Cataloguing-in-Publication DataGeneral anatomy: principles and applications.

Bibliography.Includes index.ISBN 9780070134676 (pbk.).1. Human anatomy. I. Eizenberg, Norman. (Series: an@tomedia).

611

Published in Australia byMcGraw-Hill Australia Pty LtdLevel 2, 82 Waterloo Road, North Ryde NSW 2113Publisher: Nicole MeehanAssociate Editor: Hollie ZondanosManaging Editor: Kathryn FairfaxArt Director: Steve RandlesProduction Editor: Nicole McKenzieCopy Editor: Kathy KramarCover and internal design: Patricia McCallumIllustrator: Porcellato & CraigTypesetter: Midland TypesettersProofreader: Terry TownsendIndexer: Max McMasterPrinted in China on 80 gsm matt art by CTPS

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‘Anatomy is destiny.’Sigmund Freud (1856–1939)

During most of the history of medicine, anatomy wasnot only the destiny of those who ventured to practicemedicine but also the science of medicine. Even at theturn of the 20th century, when Sigmund Freud usedthe above quote to illustrate his claim that genderdetermined one’s main personality traits, anatomywas the major component of any medical curriculum.

With the development of technology and growth ofmedical knowledge, anatomy—the scientific empire and a foundation stone of medicine—has shrivelled to amarginal and unattractive discipline, and a small part ofa medical curriculum with less and less direct dissectionon cadavers. Unjustly so, because at the same timethere has been an enormous development of imagingmethods to show and analyse the anatomy of a livingbody, as well as microsurgical procedures whereanatomical details determine clinical practice.

As a student, you have to keep in mind that withoutcomprehensive morphological education and knowledge,you will not be able to interpret the images you willsee daily on ultrasound, CT or MRI scans. Don’t beoverconfident in the power of technology, because it isstill you, a human being with knowledge of morphology,who will have to interpret the morphology you see andmake the best clinical decision for your patient. To do thisyou need to have a sound knowledge of anatomy, so thatyou don’t see too much or too little.

With such new and ‘live’ anatomy in practice, teachinganatomy must also change, not by just restructuringthe old content, but by introducing a completely newconcept. an@tomedia is indeed a new approach tomedical education: a single tool to replace differentdidactic tools for transmission of three-dimensionalnotion, it is at the same time a photographic atlas,a gross anatomy dissector, a radiology overview, a setof coloured overlays and an anatomy textbook.

General Anatomy, the first book in a series to followthe nine an@tomedia interactive CD modules, is a mostvaluable introduction to modern anatomy. It will show youthe human body from four perspectives: systems andregions as the principles of body construction, anddissection and imaging as the principles of bodydeconstruction.

I’ll finish with another quote from a physician and a famous novelist, W. Somerset Maugham(1874–1965), who gave the following advice to first-yearmedical students: ‘You will have to learn many tediousthings which you will forget the moment you have passedyour final examination, but in anatomy it is better to havelearned and lost than never to have learned at all.’ Don’tbe afraid of learning anatomy—you really need to knowit. And by mastering the principles and applications ofgeneral anatomy, you will become not only a collector of important facts but their master, too.

ANA MARUSIÇ, MD, PHDProfessor of AnatomyPresident, Council of Science Editors (CSE)Past-President, World Association of Medical Editors (WAME)School of Medicine, Zagreb University Croatia

v

FOREWORD

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Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Design Features of this Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x

Objectives of this Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii

About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiv

Credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvi

About an@tomedia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii

Structure of an@tomedia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xviii

PART 1 THE HUMAN BODY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Introduction ‘Anatomy accommodates ancestry’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Chapter 1 Human Anatomical Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Chapter 2 Human Form and Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Chapter 3 Human Sexual Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

PART 2 BODY SYSTEMS AND ORGAN STRUCTURE . . . . . . . . 22

Introduction ‘Structure mirrors function’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Chapter 4 Skeletal System and Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Chapter 5 Articular System and Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Chapter 6 Muscular System and Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Chapter 7 Integumental System and Skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Chapter 8 Visceral Systems and Viscera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Chapter 9 Nervous System and Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Chapter 10 Arterial System and Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Chapter 11 Venous System and Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146

Chapter 12 Lymphatic System and Lymph Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

PART 3 BODY REGIONS AND ORGAN POSITION . . . . . . . . . . . 166

Introduction ‘Everything is somewhere’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Chapter 13 Regions of the Human Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Chapter 14 Arrangement of Body Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175

Chapter 15 Body Compartments and Fascial Planes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180

Chapter 16 Body Walls and Cavities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Chapter 17 Neurovascular Pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189

CONTENTS

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PART 4 HUMAN DEVELOPMENT AND VARIATION . . . . . . . . . . 194

Introduction ‘Derivation determines destiny’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Chapter 18 Growth and Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

Chapter 19 Normal Variation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203

Chapter 20 Anatomical Variation in Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

Chapter 21 Anatomical Variation in Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Chapter 22 Pathological Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

PART 5 PRACTICAL PERSPECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . 226

Introduction ‘Anatomy involves exploration’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227

Chapter 23 Surface and Functional Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

Chapter 24 Radiographic Anatomy and Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Chapter 25 Sectional Anatomy, CT and MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252

Chapter 26 Ultrasound Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260

Chapter 27 Endoscopic Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263

Chapter 28 Clinical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268

Chapter 29 Post-mortem Examination of Organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280

Chapter 30 Cadaver Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284

Appendix A Anatomical Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289

Appendix B Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

Glossary Derivation of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298

Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303

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General Anatomy

This book is about the human body. Anatomy (from theGreek: ‘apart + cut’ ) is the study of the structure ofthe (human) body. The subject known as gross ortopographic anatomy includes the study of normalstructures (that can be seen with the naked eye) andtheir arrangement into systems and regions. It is thefocus of this book. This is complemented by histology(microscopic anatomy), embryology (developmentalanatomy) and the study of evolution (incorporatingcomparative anatomy). Anatomy also interfaces withphysiology (through the correlation of structure withfunction) and pathology (by the recognition of abnormalstructure), together with many clinical disciplines (byapplying knowledge of normal and abnormal structure).

The new vista of general anatomy introduces thefoundations of organ structure (before launching intothe detailed study of a particular body system) and thegeneral rules governing arrangement of organs withinregions (before launching into detailed descriptions ofrelationships).

As well as being the foundation of systemic, regionaland practical perspectives, general anatomy is the gluethat holds the specifics together, as shown in Figure 1.

This book is primarily designed for medical, dental,physiotherapy and health science students. It is equallyapplicable for integrated (problem-based) courses or fortraditional (discipline-based) courses, as both require afoundation of anatomical literacy coupled with anunderstanding of the fundamentals.

Students will be equipped with the necessaryintellectual tools to then master specific subject mattermet in any sequence (see Figure 2).

The book is also designed for medical and allied healthpractitioners to fill gaps left by a lack of emphasis onprinciples in their own training (including associatedbooks), creating a bridge for new concepts and advancesin anatomy.

General Anatomy: Principles and Applications iscomplemented by the (A New Approach TO Medical Education Developments In Anatomy):General Anatomy CD-ROM. However, either may beused independently. This book has a linear (sequential)organisation and provides a road map for the CD-ROM.In contrast, the CD-ROM has a non-linear (hierarchical)organisation with freedom for the user to choose theorder, rate and depth of study. It is also interactive, withinstant feedback to questions requiring identification ofobjects on images and explanations of events (particularlytheir associated clinical phenomena).

Principles and applicationsThis book is conceptual, a concept being the idea of anobject or an event. A principle is a recurring pattern oflinked concepts. Principles provide general rules relating

viii

PREFACE

Figure 1 ‘General anatomy’ and ‘specific anatomy’

Ultrasoundimaging

Sectionalanatomy,CT & MRI

Radiographicanatomy &

imaging

Endoscopicanatomy

Dissection

Surfaceanatomy

Physicalexamination

Clinicalprocedures

PRACTICAL

Upperlimb

Pelvis Abdomen

Lowerlimb

Thorax

Head Neck Back

REGIONAL

Lymphatic&

haemopoetic

Cardio-vascular

Nervous

Integumental Urogenital& endocrine

Musculo-skeletal

Respiratory Digestive

SYSTEMIC

SPECIFIC

ANATOMY

GENERAL

ANATOMY

Figure 2 Components of general anatomy

Theoreticalperspectives

Practicalperspectives

GeneralAnatomy

Principles (recurring patterns linking concepts) and their clinical applications

Anatomical terms, concepts (ideas of objects & events) and their functional correlation

Body systems & organ structure

Body regions &organ position Imaging modalities Clinical procedures

Systemic Regional Visual Manual

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ix

objects and events to each other. This enables deductive(from the Latin: ‘from + lead’ ) reasoning where thespecifics are examples derived from a generalisation.In contrast, inductive (Latin: ‘to + lead’ ) reasoning allowspatterns to emerge after gathering all the detailedinformation and reflecting on them, the specifics leadto generalisations. Versatile learners require both formsof reasoning.

Essential (core) factual information is trapped betweenthe pincers of a principle and its application. Thechallenge for any curriculum is to extract this fromextraneous descriptive detail (see Figure 3). Theapplication of anatomical principles is primarily to clinicalcontexts. The prime goal of this book is to help thelearner competently (and confidently) meet new situationsin future practice, armed with the capacity to reasonfrom first principles.

Understanding anatomical principles is the basisfor recognising clinical manifestations of diseaseprocesses.

Anatomical principles are comprehensivelyconstructed, organised and explained in this book.They are missing or receive only scant reference inintroductory sections of most anatomy textbooks.

A goal of this book is neither to replace nor to attemptto cover the entire scope of large descriptive books, butto complement these books, helping to make them moremeaningful and easier to learn from.

New directions

This book incorporates both theoretical and practicalperspectives. The former enables the body to beconstructed from its components, systemically andregionally, while the latter enables an intact body tobe deconstructed, with the hands, e.g. dissection orclinical procedures, or with the eyes, e.g. imaging,endoscopy.

Looking forwardEven if the human body may not seem to change, waysof viewing it, conceptualising it and intervening on itcertainly do.

New developments in viewing the body are occurringthrough special imaging techniques, e.g. three-dimensional reconstructions.

New concepts are being developed, e.g. angiosomes,venosomes and neurosomes, and new terms will berequired to replace outmoded terms.

New advances are continually evolving in surgicaltechniques, such as endoscopic or reconstructivesurgery, and in interventional radiology, such as balloonangioplasty.

Looking backWith new discoveries, there is also a need to be awareof anatomical variants that may impact on them. Thisrequires accessing past documentation of such variants,which have been described in great detail although notin the context of surgical interventions previouslyunimaginable. Furthermore, it is increasingly importantthat investigators of anatomy obtain access to cadaversto verify surgical techniques (ideally) prior to them beingperformed on living patients.

Complications resulting from a new procedure can bedue to the presence of an unexpected anatomical variant.The dissecting room may be used to refine the techniqueto take this possibility into account rather than abandonan otherwise valid surgical advance.

Thirty years ago, who would have thought that cardiacsurgeons would now be contemplating variance of radialand ulnar arterial supply to the hand when graftingcoronary arteries?

Figure 3 Selecting appropriate content

PRINCIPLE

APPLICAT

ION

Essentialfactual

material

Identifications (lowest level)

Explanations (highest level)

Descriptions (intermediate level)

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■ New terms and their Latin (L), Greek (G)or French (F) derivations

■ Parts (with an Introduction)

DESIGN FEATURES OF THIS BOOK

Evolutionary history of the human body

All animals evolved from a common ancestor. Humans (Homo sapiens) sharemany features with other animals on our family tree but may be categorised viaa hierarchy of progressively more specific characteristics.

THE HUMAN ‘IDENTITY CARD’ IS:

Kingdom: Animal

Superphylum: Coelomate

Phylum: Chordate

Subphylum: Vertebrate

Class: Mammal

Order: Primate

Family: Hominid

Genus: Homo

Species: Homo sapiens

Developmental history of the human body

During development from a single cell (itself the product of fertilisation of anovum by a sperm) to an adult human (male or female), features from each of theabove categories appear, at least transiently. For example, all developing verte-brates acquire precursors of gills and a tail, even though they may subsequentlydisappear or become modified beyond recognition.

It is also no accident that this reflects the evolution from unicellular organismto Homo sapiens, as at the earliest stages of their development embryos of differ-ent animals tend to resemble each other (a human embryo even up to six weeksis almost indistinguishable from one of other mammals). However, from thenon they progressively diverge, both in form (external appearance) and in struc-ture (internal construction). The respective genetic blueprint (modified bymutations) predetermines this. According to Haeckel’s Biogenetic Law:Ontogeny recapitulates phylogeny.

PART 1

THE HUMANBODY

1 Human Anatomical Terms 5

2 Human Form and Structure 9

3 Human Sexual Characteristics 19

2 3

INTRODUCTION

‘ANATOMY ACCOMMODATES ANCESTRY’

Visceral systemsViscera (L. ‘sticky’ ) have a variety of structures and func-tions. Collectively they are responsible for regulating theinternal environment of the body. Viscera occupy cavitieswithin the body framework and are involved with secre-tion, excretion, digestion and absorption.

Viscera are either hollow or solid. They are typicallyorganised into systems composed of a tract of hollowtubes and associated solid glands.

Respiratory systemThe respiratory system consists of the respiratory tractand lungs (Fig. 8.1). The tract is made up of the nasalcavity, pharynx (nasal and oral parts), larynx, trachea and

bronchial tree. It is shared with the digestive tract wherethe pathways for air and for food intersect.

Digestive systemThe digestive system consists of hollow tubes—the diges-tive (alimentary) tract—together with solid viscera (theassociated glands). The tract extends from the mouth tothe anus. It is made up of the pharynx (oral and laryngealparts), oesophagus, stomach, small intestine and largeintestine. The associated glands are the (paired) salivaryglands and the (unpaired) pancreas. The digestive systemalso includes the biliary system, made up of the liver, gallbladder and biliary tree (Fig. 8.2).

82 PART 2 Body Systems and Organ Structure

� Visceral systems 82� Hollow viscera 83� Exocrine glands and ducts 85� Endocrine glands 86� Paired and unpaired viscera 87

� Serous membrane and mesenteries 88� Muscle coats and sphincters 91� Mucous membrane and junction zone 94� Hilum and vascular segments 99� Neurovascular supply of a viscus 99

CHAPTER 8

VISCERAL SYSTEMS

AND VISCERA

Figure 8.2 Digestive system

HEAD

NECK

PELVIS

THORAX

ABDOMEN

Rectum

Anal canal

Gall bladder

Liver

Bile duct

Pancreas

Stomach

Duodenum

Small intestine

Large intestine

Oropharynx

Oral cavity

Laryngopharynx

Oesophagus

Figure 8.1 Respiratory system

HEAD

NECK

THORAX

Bronchi

Lungs

Trachea Larynx

Oropharynx

Paranasal air sinuses

Nasopharynx

Nasal cavity

■ Chapter breakdown on each chapteropener

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■ Photographs (of objects)

84 PART 2 Body Systems and Organ Structure

numerous folds to increase their surface area for absorp-tion, e.g. in the small intestine (Fig. 8.6).

Sites of normal constrictionsThe lumen of a tubular viscus may have a dilatation termedan ampulla (L. ‘flask’) or constrictions at particular sites.

Normal constrictions of the lumen tend to occur atthe beginning and end of a tubular viscus.

These are often associated with orifices, mucosal foldsor thickenings of the muscle wall to control passagethrough the lumen.

The beginnings and ends of the ureters and the urethrahave normal constrictions of the lumen (Fig. 8.7).

Normal constrictions may also occur where adjacentstructures compress a tubular viscus at particular sitesalong its course. Such normal constrictions occur wherethe ureter crosses the pelvic brim and where the urethra(in the male) passes through the urogenital diaphragm.

Figure 8.7 Normal constrictions of urinary tract

At the beginningof the ureter

At the end of the ureter At the beginning

of the urethra

At the site ofmuscular thickening

At the endof the urethra

Figure 8.6 A typical hollow viscus (small intestine)

Serosal surface

Mesentery

Mucosal surface(lumen opened)

OBSTRUCTION OF A TUBULAR VISCUS

Impairment of propulsion through a tubular viscus is termedvisceral obstruction. This may occur directly by mechanicalfactors or indirectly by interference with its neurovascular supply(affecting wall function and/or vitality). Obstruction of a tubularviscus may be classified anatomically into three types (accordingto its relationship with the wall) (Fig. 8.8).

Extramural (external) obstruction comes from outsidecompression of a tubular viscus, e.g. by a tight hernial orifice orfibrous adhesions.

Intramural obstruction arises from within the wall, e.g. by amucosal tumour, spasm of smooth muscle or occlusion of arteriessupplying the wall.

Intraluminal (internal) obstruction is from a blockage withinthe lumen, e.g. by a foreign body.

Obstruction of a tubular viscus causes impaired passage ofluminal contents.This, in turn, tends to produce distension (prox-imal to the obstruction), pain (due to stretching of the distendedviscus) and, initially, increased peristalsis (to overcome theobstruction). As an example, intestinal obstruction typicallyproduces the triad of constipation (reduced passage of faecesand flatus), abdominal distension and pain. These symptomsmay be accompanied by altered bowel sounds (from peristalsis),detected on auscultation.

Figure 8.8 Types of visceral obstruction

External

Intramural

Internal

■ Anatomical principles highlighted (also collated in a review section for easy access)

The photographs show concrete reality;some reveal the body in all its complexity.

Certain photographs display the nakedexterior of the body, others the exposed interior,which by their very nature is graphic (particularlythose at autopsy). Images of embalmed anddissected human remains are provided to be educational, rather than sensational. Inparticular, they provide access to anatomicalmaterial that is not readily available, e.g. fetaldissections.

■ Diagrams (of events)

The complementary diagrams are abstractconceptualisations either showing what cannotbe made visible or helping provide a way to seewhat is otherwise obscured by complexity. All ofthe images (both photographs and diagrams)have been made as simple as possible but notsimpler.

■ Clinical applications in boxes atstrategic points

Except where otherwise specified, thecolours chosen for each figure representtypes of anatomical structures accordingto the following convention:

bone

cartilage

fibrous tissue

membrane

skeletal muscle

smooth muscle

fat

gland

nerve

artery

vein

skin

■ Specially selected colours within images

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THIS BOOK AIMS TO ENABLE UNDERSTANDING PRINCIPLES AND APPLICATIONS OF:1 Anatomical terms (and how to use them correctly)2 Organ structure (correlating with function) and arrangement into systems3 Organ position and subdivision of the body into regions4 Human variation, appreciating range of normality of the living body5 Surface anatomy and functional testing (for physical examination of a living body)6 Imaging modalities and how a living body can be viewed (including endoscopically)7 The anatomical basis for general clinical procedures8 Manipulating anatomical structures (with instruments) using dissection skills.

OBJECTIVES OF THIS BOOK

1. TERMS

Terms of position, relationship, comparison and movement Communicating about anatomy

2. BODY SYSTEMS AND ORGAN STRUCTURE

(a) Somatic systems

Skeletal systemBone structure and bone marrow Bony features and cartilageParts of a developing long bone Epiphysial plate and epiphysial line

Roles (mechanical and haemopoietic)Growth of bonesBlood supply of a long boneFractures and epiphysial injuries

Articular systemJoint types (fibrous, cartilaginous and synovial)Articular surfaces and articular cartilageSynovial cavity and synovial membrane, Fibrous capsule, ligaments and special structures

Trade-off between mobility and stability Joint degenerationRoles of synovial membrane and synovial fluid Dislocations and ligament injuries

Muscular systemMuscle structure and attachmentsTendons and aponeurosesFascial septa, sheets and sheathsNeurovascular hilumMyotomes

Types of muscle contraction and actionsMuscle and tendon injuries Roles and regional adaptations of fascia Motor pointMotor units and muscle tone

Integumental systemSkin structure, appendages and specialisationsCutaneous nerve supply, axial borders and axial lines Neurosomes and dermatomesAngiosomes Lymphotomes

Roles of skin and relaxed skin tension linesNerve overlap and internervous linesReferred pain and sites of referralVascular supply territoriesWatershed areas of lymph drainage

(b) Visceral systems

Respiratory, digestive, urogenital, endocrine systems Viscus (hollow tube or solid gland) structure Exocrine glands (with ducts) and endocrine glandsSerous membrane and mesenteriesMuscular wall and sphincters Mucous membrane and junction zones

Motility of tubular visceraExocrine secretion and endocrine secretionMobility and fixationRole (and mechanisms) of sphincters Visceral obstruction and strangulation

LEARNING OBJECTIVES

CONCEPTS AND ASSOCIATED PRINCIPLES FUNCTIONAL AND CLINICAL APPLICATIONS

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CONCEPTS AND ASSOCIATED PRINCIPLES FUNCTIONAL AND CLINICAL APPLICATIONS

(c) Supply systems

3. BODY REGIONS AND ORGAN POSITION

4. HUMAN VARIATION

5. SURFACE ANATOMY

6. IMAGING

7. CLINICAL PROCEDURES

Incisions and wound closure Joint and body cavity taps Injections and nerve blocks Vascular access

Selecting appropriate sitesLayers traversed or piercedStructures endangeredImplications of anatomical variants

Plain radiographs and contrast studiesCT and MRIUltrasoundEndoscopy

Assessing bony and joint integrity on imagesDistinguishing soft tissues on imagesInterpreting properties of images Interior of hollow viscera and body or joint cavities

Surface markings (features and projections)Sites where structures are palpable or accessible

Mapping supply territoriesFunctional testing of actions and reflexes

Normal variation Anatomical variationPathological changes (congenital and acquired)

Constitutional and functional factorsRange of normalitySurgical and radiological implications

Head, neck, trunk and limbsPaired and unpaired regionsFlexor and extensor regionsCompartments and layersMobile and fixed fascial planesBody walls and parietal structuresSerous sacs with body cavitiesNeurovascular bundles and pathways

Midline and bilateral symmetryCoronal morphological planeCompartment syndromePotential paths of direct spreadHerniaProlapseNeurovascular endangerment

Nervous (central and peripheral) systemsNerve structureBrain and spinal cord structureSpinal nerve roots and rami Nerve ganglia and plexuses Nerve branches and distribution

Sensory and motor functional fibre typesSomatic and visceral functional fibre typesReflexes and components of a reflex arcSegmental and peripheral nerve supplyReflex muscle spasm and nerve injuries

Arterial (pulmonary and systemic) systems Artery structure Arterial branches and anastomoses End arteries

Arterial flow and arterial supplyHaemorrhage, thrombosis and embolism Arterial occlusion

Venous (pulmonary, systemic and portal) systemsVein structureValves Venous tributaries and communications

Venous flow and venous drainage Varicose veins Venous spread

Lymphatic and haemopoietic system Lymph vessel and lymph node structureSites of entry and communications to venous systemLymphoid organs and tissue aggregates

Lymph return and defense rolesLymph flow and lymph drainage Lymphatic spread

8. DISSECTION SKILLS

Manipulating structures (incising, reflecting and separating) Exposure utilising instruments safely and correctly

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Principal AuthorsNorman EizenbergProject Leader of Anatomedia, ACB (U of M)

Coordinator, Postgraduate Surgical Anatomy

Member, Anatomy Committee RACS

Contributor, RACS and RACDS Fellowship Courses

Contributor, International Graduates MCQ Exam (AMC)

Examiner in Anatomy RANZCR

General Medical Practitioner

Research: Medical education, anatomical variations

Universitas 21 Award (2000) for ‘outstanding achievement’

Meritorious Service Award RACDS (2006)

Christopher BriggsDeputy Head and A/Professor, ACB (U of M)

Coordinator, Undergraduate Anatomy

Contributor, Postgraduate Surgical Anatomy

Contributor, Postgraduate Physiotherapy Anatomy

Examiner in Anatomy RANZCR

Consultant Forensic Anthropologist, VIFM

Research: Applied Anatomy, Forensic Anthropology

Craig AdamsHead of Anatomy (University of Notre Dame, Sydney)

Visiting A/Professor (Fiji School of Medicine)

Coordinator, RACS Surgical Skills for GPs

Contributor, International Graduates MCQ Exam (AMC)

Excellence in Teaching Awards (1999, 2002)

Gerard AhernCoordinator, Postgraduate Anatomy (Monash University)

Honorary A/Professor (Oceania University)

Honorary Senior Fellow, ACB (U of M)

Contributor, Postgraduate Surgical Anatomy

Contributor, RACS Surgical Skills for GPs

Contributor, International Graduates MCQ Exam (AMC)

Medical journalist (Orthopaedics Today)

ABOUT THE AUTHORS

The authors are all current or former members of the Department of Anatomy and Cell Biology (ACB) at The University of Melbourne (U of M). They also contributeto the Royal Australasian Colleges of Surgery (RACS), Radiology (RANZCR), DentalSurgery (RACDS) and Physicians in Nuclear Medicine (ANZAPNM), the VictorianInstitute of Forensic Medicine (VIFM) and the Australian Medical Council (AMC).

Contributing AuthorsPriscilla BarkerPrincipal Prosector ACB (U of M)

Contributor, Physiotherapy and Science Anatomy

Physiotherapist

Research: Lumbar spine anatomy andbiomechanics

Spine, Young Investigator of the Year Award(2005)

Ivica GrkovicHead of Anatomy (University of Split, Croatia)

Coordinator and Professor, UndergraduateAnatomy

Contributor, Postgraduate Anatomy PhD Courses

Research: Neurobiology of autonomic nervoussystem

Alexander PitmanProfessor of Medical Imaging (U of M)

Honorary Senior Fellow, ACB (U of M)

General Radiologist and Specialist in NuclearMedicine

Author, Radiology Core Review

Anatomy Coordinator RANZCR

Councillor, ANZAPNM

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Editorial consultantsHenoh Dolezal (MBBS)

Zdenek Dubrava (MBBS)

Marius Fahrer (FRACS)

John Furness (PhD)

Jenny Hayes (MBBS)

D.G. Macleish (FRACS)

Robert Marshall (FRACS)

Vernon Marshall (FRACS)

Michael Murphy (FRACS)

Priti Pandey (MD)

Educational consultantCyril Driver (MEd)

Educational evaluationDavid Kennedy (PhD)

Gregor Kennedy (PhD)

Clinical consultantsKarl Alexander (FANZCA)

Christen Barras (MBBS)

Tina Bryant (BVSc)

Maurice Brygel (FRACS)

Claude Fahrer (MBBS)

Erica Fletcher (PhD)

Jeremy Grummet (FRACS)

Robert Heng (FRANZCR)

Justin Kelly (FRACS)

Elizabeth Penington (FRACS)

Martin Richardson (FRACS)

Andrew Rotstein (FRANZCR)

Ramin Shayan (MBBS)

G. Ian Taylor (FRACS)

Jeff Wassertheil (FACEM)

PhotographyStuart Thyer (BAppSc)

DissectionsPriscilla Barker (PhD)

Matt Jackson (BSc)

Illustration and imagesPriscilla Barker (PhD)

Diana Keshtiar (BSc)

Graphic designGavin Leys

Chris Hanger (Supervision)

CD developmentDaniel Robertson (BABSc)

Website developmentGordon Yau (MSc)

Video digitisingRussell Evans

CD quality assuranceDaniel Jones (BPhysio)

Prototype illustrationsQuang Minh Phan (MBBS)

Yun Fan Lu (MBBS)

Photographic assistanceMichelle Gough (BAppSc)

CREDITS

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