G E N E R A L
ANATOMYprinciples and applications
00 Eizenberg-Anatomy 27/9/07 11:02 AM Page i
00 Eizenberg-Anatomy 27/9/07 11:02 AM Page ii
G E N E R A L
ANATOMYprinciples and applications
NORMAN EIZENBERG
CHRISTOPHER BRIGGS
CRAIG ADAMS
GERARD AHERN
ww
w.a
nato
media
.com
00 Eizenberg-Anatomy 27/9/07 11:02 AM Page iii
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
Reproduction and communication for other purposesApart from any fair dealing for the purposes of study, research, criticism or review, as permitted under the Act, no part of thispublication may be reproduced, distributed or transmitted in any form or by any means, or stored in a database or retrieval system,without the written permission of McGraw-Hill Australia including, but not limited to, any network or other electronic storage.
Enquiries should be made to the publisher via www.mcgraw-hill.com.au or marked for the attention of Rights and Permissions atthe address below.
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
00 Eizenberg-Anatomy 27/9/07 11:02 AM Page iv
‘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
00 Eizenberg-Anatomy 27/9/07 11:02 AM Page v
vi
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
00 Eizenberg-Anatomy 27/9/07 11:02 AM Page vi
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
vii
00 Eizenberg-Anatomy 27/9/07 11:02 AM Page vii
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
00 Eizenberg-Anatomy 27/9/07 11:02 AM Page viii
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)
00 Eizenberg-Anatomy 27/9/07 11:02 AM Page ix
x
■ 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
00 Eizenberg-Anatomy 27/9/07 11:03 AM Page x
xi
■ 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
00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xi
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
xii
00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xii
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
xiii
00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xiii
xiv
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
00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xiv
xv
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
00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xv
Top Related