تشريح فاينل جميع المحاضرات

‫نظام المحاضرات االلكتروني‬
•Anatomical Planes
Are based on four imaginary planes
1. median
2. sagittal
3. frontal, and
4. transverse

• Flexion indicates bending or decreasing the angle
between the bones or parts of the body.
• Dorsiflexion describes flexion at the ankle joint, as occurs
when walking uphill or lifting the toes off the ground.
• Plantarflexion turns the foot or toes toward the plantar
surface
• Extension indicates straightening or increasing the angle
between the bones or parts of the body. Extension usually
occurs in a posterior direction, but extension of the knee
joint occurs in an anterior direction. Extension of a limb or
part

Basic anatomical structures

• the skin is readily accessible and is one of the
best indicators of general health.
• 1. Epidermis, a superficial cellular layer,

• 2. Dermis, a deep connective tissue layer

SKIN
•The nails are keratinized plates on the
dorsal surfaces of the tips of the fingers
and toes. The proximal edge of the plate is
the root of the nail. With the exception of
the distal edge of the plate, the nail is
surrounded and overlapped by folds of skin
known as nail folds. The surface of skin
covered by the nail is the nail bed

Muscles
•The muscular system consists of all the
muscles of the body.
•Functions of Muscles
•Muscles serve specific functions in moving
and positioning the body.

•Skeletal muscle
• Cardiac striated muscle

• Smooth Muscle

The circulatory system transports fluids
throughout the body; it consists of the
cardiovascular and lymphatic systems. The heart
and blood vessels make up the blood
transportation network, the cardiovascular
system. Through this system, the heart pumps
blood through the body's vast system of blood
vessels.

The Neuron
•Most of the neurons in the CNS are
found in the cortex.
•Collections of neurons situated deeply

are called nuclei

Cranial Nerves
There are 12 pairs of cranial nerves
that leave the brain and pass through
foramina in the skull.

Spinal Nerves
• A total of 31 pairs of spinal nerves leave the spinal
cord and pass through intervertebral foramina in the
vertebral column.
• The spinal nerves are named according to the region
of the vertebral column with which they are
associated: 8 cervical, 12 thoracic, 5 lumbar, 5
sacral, and 1 coccygeal. Note that there are eight
cervical nerves and only seven cervical vertebrae
and that there is one coccygeal nerve and four
coccygeal vertebrae.

‫‪Bones‬‬

A joint (articulation) is a union or
junction between two or more bones
or rigid parts of the skeleton.

Bones of the skull
• The skull is composed of several separate bones
united at immobile joints called sutures. The
connective tissue between the bones is called a
sutural ligament
• The skull bones are made up of external and internal

parts of compact bone separated by a layer of
spongy bone. The internal part is thinner and more
brittle than the external part. The bones are covered
on the outer and inner surfaces with periosteum .

The skull is composed of two main parts: the
cranium and the facial bones
• .The cranium is formed by 8 flattened bones two of
which are paired which include
• Frontal bone: 1
• Parietal bones: 2
• Occipital bone: 1
• Temporal bones: 2
• Sphenoid bone: 1
• Ethmoid bone: 1
•
Bones of the face
• There are 14 facial bones, all except the mandible being
united by sutures that are immovable.
• Zygomatic bones:
• Maxillae: 2
• Nasal bones: 2
• Lacrimal bones: 2
• Vomer: 1
• Palatine bones: 2
• Inferior conchae: 2
• Mandible: 1

Base of the Skull
The interior of the base of the skull is divided into

three cranial fossae: anterior, middle, and posterior.
The anterior cranial fossa is separated from the
middle cranial fossa by the lesser wing of the
sphenoid, and the middle cranial fossa is separated
from the posterior cranial fossa by the petrous part
of the temporal bone.

Anterior Cranial Fossa
The anterior cranial fossa lodges the frontal lobes of

the cerebral hemispheres. It is bounded anteriorly by
the inner surface of the frontal bone, and in the
midline is a crest for the attachment of the
falxcerebri. Its posterior boundary is the sharp lesser
wing of the sphenoid, which articulates laterally
with the frontal bone and meets the anteroinferior
angle of the parietal bone, or the pterion.

Posterior Cranial Fossa
• The posterior cranial fossa is deep and

lodges the parts of the hindbrain, namely, the
cerebellum, pons, and medulla oblongata.
Anteriorly the fossa is bounded by the
superior border of the petrous part of the
temporal bone, and posteriorly it is bounded
by the internal surface of the squamous part
of the occipital bone.

• Middle Cranial Fossa
The middle cranial fossa consists of a small median

part and expanded lateral parts. The median raised
part is formed by the body of the sphenoid, and the
expanded lateral parts form concavities on either
side. It is bounded anteriorly by the lesser wings of
the sphenoid and posteriorly by the superior borders
of the petrous parts of the temporal bones. Laterally
lie the squamous parts of the temporal bones, the
greater wings of the sphenoid, and the parietal bones

Meninges
The structures of the central nervous system

(brain and spinal cord) are covered by 3
connective tissue layers collectively called
the meninges. the dura mater, the arachnoid
mater, and the pia mater. (The spinal cord in
the vertebral column is also surrounded by
three meninges).

Parts of the brain
• The brain is that part of the central nervous system

that lies inside the cranial cavity. It is continuous
with the spinal cord through the foramen magnum
• The ridges present on the surface of the cortex are

called gyri

The cerebrum into its four lobes
The frontal lobe is situated in front of the central

sulcus and above the lateral sulcus. The parietal lobe
is situated behind the central sulcus and above the
lateral sulcus. The occipital lobe lies below the
parieto-occipital sulcus. Below the lateral sulcus is
situated the temporal lobe.

• The precentral gyrus lies immediately anterior to the
central sulcus and is known as the motor area.
• The large motor nerve cells in this area control
voluntary movements on the opposite side of the
body.
• In the motor area, the body is represented in an
inverted position, with the nerve cells controlling the
movements of the feet located in the upper part and
those controlling the movements of the face and
hands in the lower part.

Ventricles of the brain
The brain has four fluid filled spaces that

communicate with each other called ventricles.
There are two lateral ventricles and two midline (the
third and fourth) ventricles. The two lateral
ventricles communicate with the third ventricle
through the interventricular foramina. Fluid
(cerebrospinal fluid) produced within the brain
circulates through the ventricles of the brain and
around the spinal cord.

Blood Supply of the Brain
• Arteries of the Brain
• The brain is supplied by the two internal carotid and

the two vertebral arteries. The four arteries
anastomose on the inferior surface of the brain and
form the circle of Willis (circulusarteriosus).

Veins of the Brain
• The veins of the brain have no muscular tissue in

their thin walls, and they possess no valves. They
emerge from the brain and drain into the cranial
venous sinuses. Cerebral and cerebellar veins and
veins of the brainstem are present. The great
cerebral vein is formed by the union of the two
internal cerebral veins and drains into the straight
sinus.

CRANIAL NERVES
Cranial nerves are nerves that

emerge directly from the brain stem
in contrast to spinal nerves which
emerge from segments of the spinal
cord.

The scalp
The scalp consists of skin and subcutaneous tissue,
which cover the neurocranium, from the superior
nuchal lines on the occipital bone to the supraorbital
margins of the frontal bone. Laterally, the scalp
extends over the temporal fascia to the zygomatic
arches

The scalp is composed of five layers. Each
letter in the word scalp serves as a memory
key for one of its five layers.
• Skin: thin, except in the occipital region.

• Connective tissue: forms the thick, dense, richly vascularized
subcutaneous layer .
• Aponeurosis (epicranial aponeurosis): the broad, strong,
tendinous sheet that covers the calvaria. Collectively
• Loose areolar tissue: a sponge-like layer including potential
• Pericranium: a dense layer of connective tissue that forms the
external periosteum of the neurocranium. It is firmly attached
but can be stripped easily

Muscles of the Scalp
Occipitofrontalis
• when this muscle contracts, the first three layers of the scalp
move forward or backward, the loose areolar tissue of the
fourth layer of the scalp allowing the aponeurosis to move on
the pericranium.
• The frontal bellies of the occipitofrontalis can raise the
eyebrows in expressions of surprise

• Sensory Nerve Supply of the Scalp
• The main trunks of the sensory nerves lie in the
superficial fascia.
• The following nerves are present:
• The supratrochlear nerve, a branch of the
ophthalmic division of the trigeminal nerve
• The supraorbital nerve, a branch of the ophthalmic
division of the trigeminal nerve.
• The zygomaticotemporal nerve, a branch of the
maxillary division of the trigeminal nerve, supplies
the scalp over the temple.

‫الفسلجة والتشريح‪ /‬الفصل الحادي عشر‬
‫المرحلة الثانية‬
‫مدرس المادة‪ :‬د‪ .‬عباس فضال حمادي‬
‫‪1‬‬
The cardiovascular system: consists of the heart, blood vessels, and
blood.
—1- The heart:

— is a muscular pump consisting of four chambers; two atria and
two ventricles.
— 1-1-Right and left atria:- the two atria are separated from each
other by the interatrial septum. They receive blood from
veins “R.atria” from vena cava superior and inferior, and
the “left atria” from the four pulmonary arteries.
— 1-1-1-The atrial functions:
— 1- primarily as reservoirs, where the blood returning from veins

collects before it enters the ventricles.
— 2- contraction of the atria forces blood into the ventricles to

complete ventricular filling.
2
— 1-2- the right and left ventricles: they are the major pumping chambers
of the heart. They eject they blood into arteries “ R.ventricle into
pulmonary trunk to pulmonary circulation, and left ventricle into aorta
to systemic circulation throughout all the body”. The two ventricles are
separated from each other by the muscular interventricular septum.
The wall of the L.ventricle is thicker than the wall of R. ventricle because
it does more work than the R.ventricle “ the pressure approximately 120
mmHg in the L.ventricle, while in the R.ventricle reach only to one fourth
of the pressure in the L.ventricle during systole”.
3
1-3-The heart valves:
— 1-3-1- atrioventricular valves:
They are located between R. atrium and R. ventricle, and L. atrium and L.
ventricle. Their function to allow blood to flow from the atria into
ventricles but prevent the backflow of blood from ventricles into the
atria.
— 1- The valve between the R.A. and R.V. have three flaps, or cusps
of fibrous tissue known as the tricuspid valve.
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— 2- the valve between L.A. and L.V. has only two flaps, or cusps
known as bicuspid or mitral valve.
— Each ventricle contains cone-shaped muscular pillars called

papillary muscles, which attached by thin, strong connective tissue
fibers called chordae tendineae to the cusps of A.V. valves. their
function to prevent the valves from opening into the atria so
much by pulling on the chordae tendineae.
— 1-3-2- aortic and pulmonary semilunar valves: each valve consists

of three pocketlike semilunar cusps “half moon-shaped”. Blood
flowing out the ventricles pushing against each valve; forcing it
open. When blood flow back toward ventricles; it enter the
pockets of the cusps, causing them to meet in the center of the
Aorta and the pulmonary trunk and closing them to prevent the
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backflow of blood from the Aorta into L. ventricles. And from the
pulmonary trunk into R. ventricles.
—
1-4- Connective tissue of the heart:
— A-The connective tissue of the heart include abundant collagen

and elastic fibers that wrap around each cardiac muscle cell and
tie together adjacent cells. These fibers:
— 1- provide support for the cardiac muscle fibers, blood vessels,

and nerves of the myocardium.
— 2- add strength and prevent overexpansion of the heart.
— 3- help the heart to return to normal shape after contraction.
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— B- Connective tissue also forms the fibrous skeleton of the heart
as a plate of fibrous connective tissue rings around the
atrioventricular and semilunar valves, its functions:
— 1- provide a solid support for the valves.
— 2- serves as electrical insulation between the atria and ventricles.
— 3- provide a rigid site of attachment for cardiac muscle, so it called

the skeleton of the heart.
1-5- conducting system of the heart:
— These are specialized cardiac muscle cells in the wall of the heart
that form the conducting system of the heart. It consists of:
— 1-5-1-Sinoatrial node(SA):- it is the pacemaker of the heart;

located in the upper posterior wall of the right atrium, which
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initiates the contraction cycle activity of the heart by origination
the action potentials in the SA node and spread it over the R. & L.
atria and the rest of conducting system. Pacemaker cells
depolarized rapidly and spontaneously, generating 70-80 action
potentials per minute. This results in a heart rate or 70 -80 beats
per minute(bpm).
— After the stimulus for a contraction is generated at SA node, it

must be distributed so that;
— 1- the atria contract together, before the ventricles.
— 2- the ventricles contract together, in a wave that begins at the

apex and spreads toward the base. When the ventricles contract
in this way, blood is pushed toward the base of the heart into
Aorta and pulmonary trunk.
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— 1-5-2- Atrioventricular(AV) node: it is located in the lower portion
of the R. Atrium. The action potential spread slowly through the
AV node (with 100 msec delay time) to allows the atria to
complete their contraction before action potentials are delivered
to the ventricles. AV node generate only 40-60 action potentials
per minute spontaneously.
— 1-5-3- Atrioventricular bundle or bundle of His: it receives action

potentials from AV node, and divided into two branches of
conducting tissues :-
— 1- 5-4- right and left bundle branches: at the tips of these

branches forms many small bundles;
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— 1-5-5- purkinje fibers: they extend to the cardiac muscle cells of
the both ventricles wall.
— Conducting system spread action potentials more rapidly than

cardiac muscle fibers; within 225 msec the action potentials
travels from the AV node to purkinje fibers, and the contraction
cycle then be completed.
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1-6-The electrocardiogram(ECG or EKG):
— Action potentials conducted through the heart during the cardiac

cycle produce electric current that can be measured at the surface
of the body. Electrodes placed on the surface of the body and
attached to a recording system, which can detect the small
electric changes resulting from the action potentials in all of the
cardiac muscles cells. The record of these electrical events is an
electrocardiogram.
— The normal ECG consists of a P wave, QRS complex, and T wave.
— the P wave results from atrial depolarization, which precedes the

onset of atrial contraction.
— The QRS complex consists of three individual waves the Q, R, and

S waves. It results from ventricular depolarization which precedes
ventricular contraction.
— The T wave represents ventricular repolarization which precedes

ventricular relaxation.
— A wave represents atrial repolarization which cannot be seen

because it occur during QRX complex.
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— P-Q or P-R interval represents the time between the beginning of
the P wave and the beginning of the QRS complex, during this
time atria contract and begin to relax.
— Q-T interval extends from the beginning of the QRS complex to

the end of the T wave and represents the length of time required
for ventricular depolarization “contraction” and repolarization
“relaxation”
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1-7- The heart sounds and murmurs:
— The heart sounds and murmurs can be detect by simple

instrument called stethoscope, which is used to listen for heart
sounds. The normal heart sounds are usually describe by the
syllables lubb - dupp.
— Lubb: is the first heart (systolic) sound, is longer, lower pitched

sound, which produced as AV valves close and the semilunar
valves open. It marks of ventricular systole ‘V contraction’.
— Dupp: is the second heart sound, is shorter and sharper. Occurs at

the beginning of ventricular diastole, when the semilunar valves
close.
13
— Third and fourth heart sounds are very faint and seldom
detectable in healthy adults. These sounds are associated with
atrial contraction and blood flowing into the ventricles rather than
with valve action.
— Murmurs: is an abnormal sounds due to faulty action of the

valves( because of the narrowing or dilatation of the valves) or
congenital defect as septal defect.
— Clinically; ventricular systole occurs between the first and the

second heart sounds, while the ventricular diastole occurs
between the second heart sound and the first heart sound of the
next beat.
14
1-8- control of the heart rate:
— The heart rate originated spontaneously within the heart itself by

the Sinoatrial node. The heart rate can be influence by the
following factors:
— Sympathetic nervous system stimulation increases HR lead to

tachycardia (HR over 100 beat/minute).
— Parasympathetic nervous system stimulation decreases HR lead to

bradycardia (HR less than 60 beat/minute).
— Other factors as hormones “epinephrine increase HR”. Ions and

drug.
— Arrhythmia: is a regular or irregular variation in heart beat due to

changes in the rate .
— Premature beats: also called extrasystoles are beats that come in

before the expected normal beats.
1-9- Heart dynamics:
— The term heart dynamics refers to movements and forces

generated during cardiac contractions. Each time the heart beats,
the two ventricles eject equal amounts of blood.
— Stroke volume (SV): the amount of blood ejected by a ventricle

during a single beat (average 80 ml/beat).
— Cardiac output (CO): the amount of blood pumped by each

ventricle in one minute.
— Cardiac output can be calculated by multiplying the average stroke

volume by the heart rate (HR).
— CO = SV X HR, for example. If the average SV is 80ml/beat and

the heart rate is 70 bpm, the CO will be:
— CO = 80ml/beat x 70bpm = 5600 ml/min (5.6 L/min).
15
2- Blood vessels:
— The blood vessels, together with for heart chambers form a closed
system for the flow of blood. On the basis of function; the blood
vessels may be divided into three groups;
— Arteries: carry blood from the ventricles of the heart out to the
capillaries in organs and tissues. The smallest arteries are called
arterioles.
— Veins: drain capillaries in the tissues and organs and return the
blood on the heart. The smallest veins are the venules.
— Capillaries: allow for exchanges between the blood and body

cells, or between the blood and air in the lung tissues. The
capillaries connect the arterioles and venules.
— All vessels together may be subdivided into two groups of circuits:

pulmonary and systemic circuits.
— 1- Pulmonary circuit: these vessels carry blood to and from the

lungs. This circuit functions to eliminate carbon dioxide from the
blood and replenish its supply of oxygen.
— 2- systemic circuit: transports blood to and from the rest of the

body.
2-1- The structure of blood vessels:
— A- The arteries and veins: have three coats(tunics) but arteries

have thicker wall than veins because they must receive blood
pumped under high pressure from the ventricles of the heart. The
coats are:
— 1- endothelium: is a flat epithelial cells making up the internal

smooth surface over which the blood may easily move.
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— 2- middle layer: more bulky layer is made of smooth involuntary
muscle combined elastic connective tissue. In veins this layer is
relatively thin, therefore, veins are easily collapsed. In addition to
this, most veins have one-way valves that permit blood to flow in
only one direction; toward the heart.
— 3- An outer tunic: is made of a supporting connective tissue.
— B- capillary walls: have the thinnest walls of any vessels; have only
one cell layer “endothelium.
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2-2- Names of the systemic arteries:
— The aorta and its parts: aorta is the largest artery, is about 2.5cm
in diameter. It extends from the left ventricle. Aorta is one
continuous artery, but it may be divided into sections:
18
— 1- The ascending aorta(‫)الصاعد‬, is near the heart and give left and
right coronary arteries to the heart muscle.
— 2- the aortic arch(‫)قوس األورطي‬, is a curves from the right to the left
also extends backward; gives off three large branches:
— A- the brachiocephalic trunk (supply the right upper extremity and

the right side of the head).
— B- left common carotid artery(‫ الوداجي‬supply left side of the head).
— C- left subclavian artery "supply the left upper extremity.
— 3- the thoracic aorta, lies in front of thoracic vertebral column

“supply the chest organ and thoracic wall”.
— 4- the abdominal aorta, lies in the abdominal cavity and supply the
abdominal part of the body and both lower extremities.
19
21
2-3- Anastomoses:
— Is a communication between two arteries, so blood reaches vital

organs by more than one route. For example:
— 1- the circle of Willis; receives blood from the two internal carotid
arteries as well as from the basilar artery, which is formed by the
union of two vertebral arteries. This arterial circle lies just under
the center of the brain and send branches to the cerebrum and
other parts of the brain.
— 2- the volar arch; is formed between radial and ulnar arteries in

the hand it send branches to the hand and fingers.
2-4- Names of systemic veins:
— 1- superficial veins: these veins are found near the surface under
the skin, as those in the extremities.
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— 3- deep veins: the deep veins tend to parallel arteries and usually
have the same names as the corresponding arteries as femoral
vein.
— 3- superior vena cava: it collect blood from head, neck, upper

extremities, and the chest; then goes to the heart.
— 4- inferior vena cava: it is much longer than the superior vena

cava. It collect blood from the part of the body below the
diaphragm and goes to the heart.
— 5- venous sinuses: is a large channel that drains deoxygenated

blood but does not have the usual tubular structure of the veins.
Such as coronary sinus which receives of most of the blood from
the veins of the heart.
3- The physiology of circulation:

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— 3-1- How capillaries work: the blood flows through capillaries
surrounding the air sacs in the lungs, it picks up oxygen and
unloads carbon dioxide; later when this oxygenated blood is
pumped to capillaries in other parts of the body, it unloads the
oxygen and picks up carbon dioxide as well as other substances
resulting from cellular activities.
— 3-2- Vasoconstriction and vasodilatation: Vasoconstriction; refers

to a decrease in the diameter of a blood vessel.
-vasodilatation; refers to an increase in the diameter of a blood vessel.

3-3- Regulation of blood pressure:
— Many factors includes in regulation of blood pressure:
— 1- Vasomotor activities: serve in part to regulate blood pressure
— 2- total blood volume.
— 3- cardiac output.
— 4- blood viscosity.
— 5- peripheral resistance.
— When blood vessels dilate; blood pressure decrease, and when
vessels constrict; blood pressure increase.
3-4- Blood distribution:
— Vasomotor activities regulate the amount of blood that flows to
various parts of the body. Some organs, such as brain, liver, and
kidneys, event at rest require large quantities of blood. Other
organs, such as skeletal muscles and digestive organ need an
increased supply of blood during increased activity( the blood flow
in muscle can increase 20 times during exercise).
— This done by vasomotor changes, particularly by vasodilatation of
arterioles which allows delivery of more blood to the tissues,while
it decrease by vasoconstriction.
23
—
3-5- Return of blood to the heart:
— The blood return to the heart is done by two mechanism:
— By skeletal muscles contraction which squeeze the blood in the

veins forward to the heart through the veins’ valves, which
prevent blood from flowing backward.
— During inspiration the chest expand, and the pressure in the chest
cavity drops(negative pressure), causing the large veins in the
chest “vena cava inferior and superior” to expand and draw blood
back toward the heart.
24
3-5- Pulse and blood pressure:
— 3-5-1-Pulse: is the force of ventricular contraction starts a wave of

increased pressure that begins at the heart and travels along the
arteries. It’s about 70-80 times per minute. It can be felt in any
artery that is relatively close to the surface; such as radial(‫)كعبري‬,
carotid(‫)سباتي‬, and dorsalis pedis (‫)ظهر القدم‬arteries. It is important
to measure:
— 1- strength., 2- the regularity, 3- the rate.
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3-5-2- blood pressure and its determination:
— Blood pressure: is the force that the blood produced against the
blood vessels wall. It measured by instrument called a
sphygmomanometer.
— Two variables are measured:
— 1- systolic pressure: occurs during heart muscle contraction;

average around 120 mmHg and is expressed in millimeter of
mercury.
— 2- diastolic pressure: occurs during relaxation of the heart muscle;

average around 80mmHg
— Procedure method: the sphygmomanometer is essentially a

graduated column of mercury connect to an inflatable cuff. The
26
cuff is wrapped around the patient’s arm above of the right or left
elbow joint; and then inflated it with air by hand bulbe until the
brachial artery is compressed and the blood flow cutoff. Then,
listening with stethoscope placed over the artery distal to the cuff;
slowly lets air out of the cuff by opening the valve on the bulbe
until the first pulsation are heard, at this time the pressure is
equal to the systolic pressure, and this pressure is read off the
mercury column. Then, more air is let out until the pulse’s sound
become characteristic muffled or disappears, at this point it
indicates diastolic pressure. The distinctive sounds heard during
this test are called sounds of korotkoff. When the blood pressure
is recorded, systolic and diastolic pressures are usually separated
by a slash, as in “120/80”(read "one twenty over eighty”)
27
D.U.C. Assist. Lec.
Faculty of Dentistry General Physiology Ihsan Dhari
Second grade Lec.9
Physiology of Digestive System I

The alimentary tract provides the body with a continual supply of water,
electrolytes, vitamins, and nutrients. This requires (1) movement of food
through the alimentary tract; (2) secretion of digestive juices and
digestion of food; (3) absorption of digestive products، water,
electrolytes, and vitamins; (4) circulation of blood to carry away absorbed
substances; and (5) nervous and hormonal control of all these functions.
Neural Control of Gastrointestinal Function (Enteric Nervous

System)
The Gastrointestinal Tract Has Its Own Nervous System، Called the
Enteric Nervous System. It lies entirely in the wall of the gut, beginning
in the esophagus and extending all the way to the anus. The enteric
system is composed mainly of two plexuses:
1
D.U.C. Assist. Lec.
Second grade Lec.9
• The Myenteric plexus, or Auerbach’s plexus, is an outer plexus

located between the muscle layers. Stimulation cause (1) increased
intensity of rhythmical contractions، (2) increased rate of
contraction, (3) increased velocity of conduction. (4)The myenteric
plexus is also useful for inhibiting the pyloric sphincter which
controls emptying of the stomach), the sphincter of the ileocecal
valve (which controls emptying of the small intestine into the
cecum), and the lower esophageal sphincter (which allows food to
enter the stomach).
• The Submucosal plexus, or Meissner’s plexus, is an inner plexus
that lies in the submucosa. In contrast to the myenteric plexus, it is
mainly concerned with controlling function in the inner wall of
each minute segment of the intestine. For instance, many sensory
signals originate from the gastrointestinal epithelium and are
integrated in the submucosal plexus to help control local intestinal
secretion, local absorption، and local contraction of the submucosal
muscle.
Autonomic Control of the Gastrointestinal Tract
The Parasympathetic Nerves Increase the Activity of the Enteric

Nervous System. The parasympathetic supply to the gut is made up of
cranial and sacral divisions:
• The cranial parasympathetics innervate, by way of the vagus

nerves, the esophagus, stomach, small intestine، pancreas, and first
half of the large intestine.
• The sacral parasympathetics innervate, by way of the pelvic nerves,
the distal half of the large intestine. The sigmoidal, rectal, and anal
regions have an especially rich supply of parasympathetic fibers.
The Sympathetic Nervous System Usually Inhibits Activity in the

Gastrointestinal Tract, Causing Many Effects Opposite to Those of the
Parasympathetic System.
2
D.U.C. Assist. Lec.
Second grade Lec.9
Functional Movements in the Gastrointestinal Tract
Two types of movement occur in the gastrointestinal tract:
Propulsive (Peristalsis) movements and mixing movements
Peristalsis Is the Basic Propulsive Movement of the Gastrointestinal

Tract. Distention of the intestinal tract causes a contractile ring to appear
around the gut، which moves anal ward a few centimeters before ending.
At the same time, the gut sometimes relaxes several centimeters down
toward the anus, which is called receptive relaxation, allowing the food to
be propelled more easily toward the anus. This complex pattern does not
occur in the absence of the myenteric plexus; therefore the complex is
called the myenteric reflex, or peristaltic reflex. The peristaltic reflex plus
the direction of movement toward the anus is called the law of the gut.
Ingestion of food: followed by Mastication (Chewing) and Swallowing

(Deglutition)
Mastication (Chewing): The teeth are designed for chewing, the anterior
teeth (incisors) providing a strong cutting action and the posterior teeth
(molars), a grinding action.
Most of the muscles of chewing are innervated by the motor branch of the
fifth cranial nerve, and the chewing process is controlled by medulla of
brain stem and cerebral cortex.
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Much of the chewing process is caused by a chewing reflex, which may

be explained as follows: The presence of food in the mouth at first initiate
inhibition of the muscles of mastication, which allows the lower jaw to
drop. The drop in turn initiates stretch of jaw muscles that leads to
rebound contraction. This automatically raises the jaw to cause closure of
the teeth, but it also compresses the food again against the linings of the
mouth، which inhibits the jaw muscles once again, allowing the jaw to
drop and rebound another time; this is repeated again and again.
Chewing is important for:
Digestion of all foods, but especially important for most fruits and
raw vegetables because these have indigestible cellulose
membranes around their nutrient portions that must be broken
before the food can be digested.
Chewing aids the digestion of food for simple reason: Digestive
enzymes (in saliva) act only on the surfaces of food particles;
therefore the rate of digestion is absolutely dependent on the total
surface area exposed to the digestive secretions.
Grinding the food to a very fine particulate consistency prevents
excoriation of the gastrointestinal tract and increases the ease with
which food is emptied from the stomach into the small intestine،
then into all succeeding segments of the gut.
Saliva & Salivary glands: The principal glands of salivation are the
parotid, submandibular، and sublingual glands; in addition, there are
many very small buccal glands. Daily secretion of saliva normally
ranges between 800 and 1500 ml. Saliva contains two major types of
protein secretion:
• The serous secretion (watery saliva) contains ptyalin (α-amylase)

which is an enzyme for digesting starches.
• The mucous secretion contains mucin for lubrication and for
surface protection.
 Saliva Contains High Concentrations of potassium and Bicarbonate
Ions and Low Concentrations of sodium and chloride Ions.
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Saliva secretion: Salivary secretion is a two-stage operation:
The first stage involves the acini, and the second, the salivary ducts. The
acini secrete a primary secretion that contains ptyalin and mucin in a
solution of ions in concentrations not greatly different from those of
typical extracellular fluid. As the primary secretion flows through the
ducts, two major active transport processes take place that markedly
modify the ionic composition of the fluid in the saliva.
First: sodium ions are actively reabsorbed from all the salivary ducts and
potassium ions are actively secreted in exchange for the sodium.
Therefore, the sodium ion concentration of the saliva becomes greatly
reduced, whereas the potassium ion concentration becomes increased.
However, there is excess sodium reabsorption over potassium secretion,
and this creates electrical negativity in the salivary ducts; this in turn
causes chloride ions to be reabsorbed passively. Therefore, the chloride
ion concentration in the salivary fluid falls to a very low level, matching
the decrease in sodium ion concentration.
Second: bicarbonate ions are secreted by the ductal epithelium into the
lumen of the duct. This is at least partly caused by passive exchange of
bicarbonate for chloride ions, but it may also result partly from an active
secretory process.
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The result of these transport processes is that:
 Under resting conditions (lowest flow rate) the concentrations of

sodium and chloride ions in the saliva is very low. Conversely, the
concentration of potassium and bicarbonate ions very high.
 During maximal salivation (highest flow rate) the salivary ionic
concentrations change considerably because the rate of formation
of primary secretion by the acini can increase as much as 20-fold.
This acinar secretion then flows through the ducts so rapidly that
the ductal reconditioning of the secretion is considerably reduced.
Therefore, when copious quantities of saliva are being secreted, the
concentration of ions in saliva is close to that of plasma.
Function of Saliva for Oral Hygiene: saliva plays an important role for
maintaining healthy oral tissues. The mouth is loaded with pathogenic
bacteria that can easily destroy tissues and cause dental caries. Saliva
helps prevent the deteriorative processes in several way:
1. The flow of saliva itself helps wash away pathogenic bacteria as

well as food particles that provide their metabolic support
2. Saliva contains several factors that destroy bacteria. One of these is
thiocyanate ions, several proteolytic enzymes (lysozyme) that
attack the bacteria, aid the thiocyanate ions in entering the
bacteria where these ions in turn become bactericidal, and digest
food particles.
3. Saliva often contains significant amounts of protein antibodies that
can destroy oral bacteria, including some that cause dental caries.
In the absence of salivation, oral tissues often become ulcerated
and otherwise infected, and caries of the teeth can become
rampant.
Salivation Is Controlled Mainly by Parasympathetic Nervous Signals.

The salivatory nuclei in the brain stem (between pons & medulla) are
excited by taste and tactile stimuli from the tongue, mouth, and pharynx.
Salivation can also be affected by higher centers of the brain.
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Swallowing (Deglutition)
Swallowing is a complicated mechanism, principally because the pharynx

subserves respiration as well as swallowing. In general, swallowing can
be divided into:
(1) A voluntary stage in oral cavity which initiates the swallowing

process; When the food is ready for swallowing, it is voluntarily pushed
into the pharynx by the tongue.
(2) A pharyngeal stage, which is involuntary and constitutes passage of

food through the pharynx into the esophagus, The food stimulates
swallowing receptors, and impulses from these receptors pass to the brain
stem to initiate a series of automatic pharyngeal muscle contractions as
follows:
The soft palate is pulled upward, preventing reflux of food into the
nasal cavities.
The vocal cords are strongly approximated, the larynx is pulled
upward and anteriorly by the neck muscles، and the epiglottis
swings backward over the opening of the larynx. These effects
prevent passage of food into the trachea.
The upper esophageal sphincter relaxes, allowing food to move
into the upper esophagus.
A fast peristaltic wave originating in the pharynx forces food into
the upper esophagus.
(3) An esophageal stage, involuntary phase that transports food

from the pharynx to the stomach: The Esophagus Exhibits Two Types
of Peristaltic Movement: Primary Peristalsis and Secondary Peristalsis
Primary peristalsis is a continuation of the peristaltic wave that

begins in the pharynx. This wave, mediated by the vagus nerves,
passes all the way from the pharynx to the stomach.
Secondary peristalsis results from distention of the esophagus
when the primary peristaltic wave fails to move the food into the
stomach: it does not require vagal innervation.
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Stomach
There Are Three Functions of the Stomach:
Storage of food until the food can be processed in the duodenum

Mixing of food with gastric secretions until it forms a semifluid
mixture called chyme.
Emptying of food into the small intestine at a rate suitable for
proper digestion and absorption
Motility of Stomach:
Retropulsion” Is an Important Mixing Mechanism of the Stomach. Each

time a peristaltic wave passes over the antrum toward the pylorus, the
pyloric muscle contracts which further impedes emptying through the
pylorus. Most of the antral contents are squirted backward through the
peristaltic ring toward the body of the stomach.
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The Stomach Mucosa Has Two Important Types of Gland:
The oxyntic (acid-forming) glands are located in the body and

fundus. They contain three types of cells:
1. mucous secreting cells, which secrete mainly mucus but also
some pepsinogen.
2. Peptic (chief) cells, which secrete pepsinogen.
3. Parietal (oxyntic) cells, which secrete hydrochloric acid and
intrinsic factor.
The pyloric glands, which are located in the antrum، secrete
mainly mucus for protection of the pyloric mucosa but also some
pepsinogen and, importantly، the hormone gastrin.
Hydrochloric Acid Is as Necessary as Pepsin for Protein Digestion in

the Stomach. The pepsinogens have no digestive activity when they are
first secreted‫ ؛‬however, as soon as they come into contact with
hydrochloric acid, they are changed to form active pepsin.
“Intrinsic Factor”is essential for absorption of vitamin B12 in the ileum.
Chyme: After food in the stomach has become thoroughly mixed with
the stomach secretions, the resulting mixture that passes down the gut is
called chyme. The degree of fluidity of the chyme leaving the stomach
depends on the relative amounts of food، water, and stomach secretions
and on the degree of digestion that has occurred. The appearance of
chyme is semifluid or paste.
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Physiology of Digestive system II

Small Intestine
Motility of small intestine: Distention of the Small Intestine Elicits
Mixing Contractions Called Segmentation Contractions. These are
concentric contractions that have the appearance of a chain of sausages.
These segmentation contractions usually promote progressive mixing of
the solid food particles with the secretions of the small intestine. Chyme
is Propelled through the Small Intestine by Peristaltic Waves. They move
toward the anus .Peristalsis is Controlled by Nervous and Hormonal
Signals.
Secretions of the Small Intestine
Secretion of Mucus by Brunner’s Glands in the Duodenum
An extensive array of compound mucous glands, called Brunner’s

glands, is located in the wall of the first few centimeters of the
duodenum, mainly between the pylorus of the stomach and the papilla of
Vater where pancreatic secretion and bile empty into the duodenum.
These glands secrete large amounts of alkaline mucus in response to:
1. Tactile or irritating stimuli on the duodenal mucosa.

2. Vagal stimulation, which causes increased Brunner’s glands
secretion concurrently with increase in stomach secretion.
3. Gastrointestinal hormones, especially secretin .
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The function of the mucus secreted by Brunner’s glands is to
 Protect the duodenal wall from digestion by the highly acid gastric
juice emptying from the stomach.
 The mucus contains a large excess of bicarbonate ions, which add
to the bicarbonate ions from pancreatic secretion and liver bile in
neutralizing the hydrochloric acid entering the duodenum from the
stomach.
Brunner’s glands are inhibited by sympathetic stimulation.
Secretion of Intestinal Digestive Juices by the Crypts of

Lieberkühn
Located over the entire surface of the small intestine are small pits called
crypts of Lieberkühn , These crypts lie between the intestinal villi. The
surfaces of both the crypts and the villi are covered by an epithelium
composed of two types of cells:
1. A moderate number of goblet cells, which secrete mucus that

lubricates and protects the intestinal surfaces.
2. A large number of enterocytes, which, in the crypts, secrete large
quantities of water and electrolytes and, over the surfaces of adjacent
villi, reabsorb the water and electrolytes along with end products of
digestion.
Pancreatic Secretion
The pancreatic digestive enzymes are secreted by pancreatic acini, and
large volumes of sodium bicarbonate solution are secreted by the small
ductules and larger ducts leading from the acini. The combined product of
enzymes and sodium bicarbonate then flows through a long pancreatic
duct that normally joins the hepatic duct immediately before it empties
into the duodenum through the papilla of Vater, surrounded by the
sphincter of Oddi.
Digestive Enzymes Are Secreted by the Pancreatic Acini:

 The more important enzymes for digestion of proteins are trypsin,
chymotrypsin, and carboxypolypeptidase, which are secreted in the
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inactive forms trypsinogen, chymotrypsinogen, and

procarboxypolypeptidase.
 The pancreatic digestive enzyme for carbohydrates is pancreatic
amylase, which hydrolyzes starches, glycogen, and most other
carbohydrates (except cellulose( to form disaccharides and a few
trisaccharides.
 The main enzyme for fat digestion is pancreatic lipase, which
hydrolyzes triglycerides into fatty acids and monoglycerides;
cholesterol esterase, which causes hydrolysis of cholesterol esters;
and phospholipase, which splits fatty acids from phospholipids.
Bicarbonate Ions and Water Are Secreted by Epithelial Cells of

the Ductules and Ducts. Bicarbonate ion in the pancreatic juice
serves to neutralize acid emptied into the duodenum from the
stomach.
Secretion of Bile by the Liver & Gallbladder
Bile Is Important for (1) Fat Digestion and Absorption. (2) Waste
Product Removal from the Blood.
Fat digestion and absorption: Bile salts help emulsify the large
fat particles into minute particles that can be attacked by the lipase
enzyme secreted in pancreatic juice. They also aid in the transport
and absorption of the digested fat end products to and through the
intestinal mucosal membrane.
Waste product removal: Bile serves as a means for excretion of
several important waste products from the blood, especially
bilirubin, an end product of hemoglobin destruction, and excess
cholesterol synthesized by the liver cells.
Absorption in small intestine:

Absorption of Water: Water Is Transported through the
Intestinal Membrane by Diffusion.
Absorption of Ions: Sodium, Calcium, Iron, Potassium,
Magnesium, and Phosphate Ions Are Actively Absorbed.
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Absorption of Carbohydrates: Essentially All Carbohydrates Are

Absorbed in the Form of Monosaccharides. The most abundant of
the absorbed monosaccharides is glucose, usually accounting for
more than 80% of the absorbed carbohydrate calories .Glucose is
the final digestion product of our most abundant carbohydrate
food, the starches. Glucose Is Transported by a Sodium Co-
Transport Mechanism. While fructose is transported by facilitated
diffusion
Absorption of Proteins: Most Proteins Are Absorbed by sodium
co-transport mechanisms through the Luminal Membranes of the
Intestinal Epithelial Cells in the Form of Dipeptides, Tripeptides,
and Free Amino Acids . A few amino acids do not require this
sodium co-transport mechanism but, instead,they are is transported
via facilitated diffusion.
Absorption of Fats: Monoglycerides and Fatty Acids Diffuse
Passively through the Enterocyte Cell Membrane to the Interior
of the Enterocyte and they make their way into the central lacteals
of the villi and are then propelled, along with the lymph, upward
through the thoracic duct to be emptied into the great veins of the
neck.
Large Intestine (colon):

The principal functions of the colon are (1) absorption of water and
electrolytes from chyme and (2) storage of fecal matter until it can be
expelled. The proximal half of the colon is concerned principally with
absorption, and the distal half is concerned with storage.
Contraction of Circular and Longitudinal Muscles in the Large Intestine

Causes Haustrations to Develop. These combined contractions cause the
unstimulated portion of the large intestine to bulge outward into baglike
sacs called haustrations. The haustral contractions perform two main
functions.
Propulsion: Haustral contractions at times move slowly

toward the anus during their period of contraction and
thereby provide forward propulsion of the colonic contents.
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Mixing: Haustral contractions dig into and roll over the

fecal material in the large intestine. In this way, all the fecal
material is gradually exposed to the surface of the large
intestine, and fluid and dissolved substances are
progressively absorbed.
Secretions of the Large Intestine
Most of the Secretion in the Large Intestine Is Mucus. The mucus

protects the large intestine wall against excoriation, provides the adherent
medium for fecal matter, protects the intestinal wall from bacterial
activity, and provides a barrier to keep acids from attacking the intestinal
wall.
Absorption in the Large Intestine: Formation of Feces
The Proximal Half of the Colon Is Important for Absorption of

Electrolytes and Water. The mucosa of the large intestine has a high
capability for active absorption of sodium, and the electrical potential
created by absorption of sodium causes chloride absorption as well. The
tight junctions between the epithelial cells are tighter than those of the
small intestine, which decreases back diffusion of ions through these
junctions. This allows the large intestinal mucosa to absorb sodium ions
against a higher concentration gradient than can occur in the small
intestine. The absorption of sodium and chloride ions creates an osmotic
gradient across the large intestinal mucosa, which in turn causes
absorption of water.
The Large Intestine Can Absorb a Maximum of about 5 to 7 L of Fluid

and Electrolytes Each Day. The Feces Normally Are about Three-
Fourths Water and One-Fourth Solid Matter. The solid matter is
composed of about 30% dead bacteria, 10% to 20% fat ,10 %to 20%
inorganic matter, 2% to 3% protein, and 30 %undigested roughage of the
food and dried constituents of digestive juices, such as bile pigment and
sloughed epithelial cells. The brown color of feces is caused by
stercobilin and urobilin, which are derivatives of bilirubin. The odor is
caused principally by indole, skatole, mercaptan, and hydrogen sulfide.
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Egestion (Defecation)
Most of the time, the rectum is empty of feces. This results partly from
the fact that a weak functional sphincter exists about 20 centimeters from
the anus at the juncture between the sigmoid colon and the rectum. There
is also a sharp angulation here that contributes additional resistance to
filling of the rectum. When a mass movement forces feces into the
rectum, the desire for defecation occurs immediately, including reflex
contraction of the rectum and relaxation of the anal sphincters.
Gastrointestinal disorders
Disorders of Swallowing and the Esophagus Paralysis of the

Swallowing Mechanism Can Result from Nerve Damage, Brain
Damage, or Muscle Dysfunction. Achalasia is a Condition in
Which the Lower Esophageal Sphincter Fails to Relax. Swallowed
material builds up, stretching the esophagus; and over months and
years the esophagus becomes markedly enlarged, a condition
called megaesophagus.
Disorders of the Stomach :
 Gastritis Means Inflammation of the Gastric Mucosa. The
inflammation can penetrate the gastric mucosa, causing atrophy.
Gastritis can be acute and chronic, with ulcerative excoriation of
the stomach mucosa. It may be caused by chronic bacterial
infection of the gastric mucosa or irritant substances, such as
alcohol
and drugs .
Chronic Gastritis Can Lead to
 Hypochlorhydria means diminished acid secretion.
 Achlorhydria means simply that the stomach fails to
secrete hydrochloric acid.
 Peptic Ulcer Is an Excoriated Area of the Mucosa Caused
by the Digestive Action of Gastric Juice or Bacterial
Infection by Helicobacter Pylori Breaks Down the
Gastroduodenal Mucosal Barrier and Stimulates Gastric
Acid Secretion. At least 75% of peptic ulcer patients have
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recently been found to have chronic infection with

bacterium H. pylori.
Disorders of the Small Intestine
 Pancreatitis Means Inflammation of the Pancreas.caused
by excess alcohol ingestion (chronic pancreatitis) or
blockage of the papilla of Vater by a gallstone (acute
pancreatitis).
Disorders of the Large Intestine
 Severe Constipation Can Lead to Megacolon. When large
quantities of fecal matter accumulate in the colon for an
extended time, the colon can distend to in diameter.
 Diarrhea Often Results from the Rapid Movement of Fecal
Matter through the Large Intestine.
Other disorders:
The Vomiting Act Results from a Squeezing Action of Abdominal

Muscles with Sudden Opening of the Esophageal Sphincters.
7
. I o/, o/l t,l
Respiratory SYstem
(A
,i
,t
ResPiratory sYstem
r The respiratory system is divided into:
t Upper respiratory tract (nose, pharynx,
larynx)
g Lower resPiratory tract (trachea
downward)
L
I
I o/, o/l ,tl
-- *l Gg
EF.*6I
Id :I -.
The Nose
o The nose consists of

the external nose
and the nasal
cavitY,
* Both are divided bY
a sePtum into right
and left halves.
Nasal CavitY
r The nasal cavitY ha
. a floor,
r A rOOf,
r a lateral wall,
f
*M iill'Mrrgffinrffi
The Paranasal Sinuses
t,
r.t\
9-r)
vl
f o/, o/t, t l
E::%IffiEGrc!
Thoracic Cage /Cavity
Shape- bony, conical shape, narrower at top borders - it is defined
by:
o Sternum - 3 parts: manubrium, body, xiphoid process
o Ribs - 12 pairs, 1st seven attach to the sternum (costal
cartilages) Ribs 8,9,&10 attach to the costal cartilage
above, Ribs 1 1 & 12 are floating ribs
. '12Thoracic vertebrae
. Diaphragm - the floor, separates the thoracic cavity from
the abdomen
E-!I:. E
lntercos
-
r
?- r
O: lnferior border of rib above l: Superior border of rib below
Fibers run OBLIQUE (down and forvr-ard)
Aid in lnspiration (lift ribcage, increase dimensions)
-rsl lnternal lntercostals
w e O: Superior border of rib below l: lnferior border of rib above

r Fibers run at RIGHT ANGLES to extemal intercostals
Aid in forced expiration (depress ribcage, decrease
dimensions)
Innermost lntercostals, Subcostals, Transversus thoracis
" Attachments similar to lnternal lntercostals, Attach ribs
c Small, variable, function unclear t
5
fe/. c/l , a I
[.leurovascular Bund le
of lntercostal Muscles
a, V .N (vein, artery, nerve)
o lntercostal vein
. lntercostal artery
c lntercostal nerve
$ Sit in Subcostal Groove
t Between lnternal lntercostal and
lnnermost intercostal layer
}!L!L!!!!!.!S!}r
lntercostal muscles and

Neurovascular bundle
ltrlcfirrl lnlcrcoaLl m.
h$cr.flo.rfnlcrcortal rll-
r o/, ./t ,, I
t!E*-E3
-
Supra$omal notch
Manubdostemal
(angl. d Loft)
Ccl6ho.|drel
ir.m.lio.r
Eody ol slomum
Xphold prcasg
l
r o/, o/)ll 1
ryry@ret%!85ry@trel
Tracheal & Bronchial Tree
* The trachea & bronchi provide the
passage for air to get into the lungs
from the environment = Dead Space
ho air exchanqe takes place herel
, \'A
* Bronchi
e Secrete mucus - captures particles
o Cilia - moves the trapped particles up to be
expelled or swallowed
* Acinus
Functional respiratorv unit consisting of,
"
* Bronchioles, alveolar ducts, alveolar sacs, &
alveoli
E Gaseous exchange in alveolar duct &
{veoli
ls
A
o
f,
ll
l
I 7
{ar1<{ra_a-111r-
'4i,-
G717;V.)
- fo/,o/ltrt
w%Mww
Reference Lines
{gnnterior Chest
* Midsternal line
a Midclavicular line
+ Posterior Chest
a Vertebral line - midspinal
::::i:'11'17
l
I
ut
* Lateral Chest
a Anterior Axillary line
o Posterior Axillary line
r Mid-axillary line
!
fo/. o/t t, t
!!!:!*!lLt-!.!L!
,.b
,)
,l u
/o
f o/. o/l , t I
!L!.!!t-L!!ts!r!!i
)"2
\1
t,
- fo/,o/l ,tt
Lung Borders
+ Anterior Chest -
* Apex 3 -4 cm. t inner 1i3 of the clavicles
.a Base - rests on the diaphragm, 6th rib, MCL
+ Lateral Chest
* Extends from Axilla apex to 7th -Bth rib
+ Posteriorly
n Apex of lung is at C7 - Base T10 (on deep
.::Tl::::"') . b,rt!!Lr-t-!t-!!sl
,',
I I \,
ry@ry@!re! wry@!
o Right Lung
r 3lobes, upper, middle , lower
e Shorter due to liver
* Left Lung
o LUL = Left Upper and Lower ( 2 lobes)
o Narrower due to heart
'L
ll
ro/,o/lttt
I- __ E
-! - -
-
--.."- --
3 lmportant Points
1. Left Lung - no middle lobe
2. Anterior chest contains upper & middle

lobes with very little lower lobe
3. Posterior chest has almost all lower

lobe. Rt middle lobe does not project
j nlq lf'e ppgjgIlo-r" q l' 99.1,
i,
t, I
I*--
--
Pleurae
l
t The Pleurae form an envelope b/t the lungs & chest

wall
U--,.,
t Visceral pleura - lines outside of lungs
e Parietal pleura - lines inside of chest wall &

diaphragm
s Pleural Cavity - the inside bf the envelope- space b/t

visceral & parietal pleura, lubrication. Normally has a
vacuum or neg. pressure
t,
\f
:J
fo/,o/latt
c.boE .-llao. --
E=EffiE=I
Tracheal & Bronchial Tree
* Trachea - anterior to
c 10-11 cm.long, begins"uopnrgu.-
at cricoid cartilage
r Bifurcates just below the sternal angle
(angle of Louis, manubriosternal angle)
into the :
r Right Main Stem Bronchus - shorter,
wider, more vertical ( lntubation - listen to
breath sounds bilaterally)
r Left Main Stem Bronchus
\
I
I
.-l
tr
'1'Urf-'leYil\r \\/
,4 *o\., r^
--/' \J /
Blood Supply of the Brain
Y i,-''
1 - |
!tel!lgre!!q319l199-
-ttrE[arises from tne common carotid arteries
and enter the middle lossa ol the cranial cavity
through the carotid canal which opens into the
side of the foramen tacerum above the closed
inferior opening.
- lt tums upward to reach the side ofthe body
o, sphenoid bone. lt then tums torward in the
cavernous sinus to reach the medial aspect ol
lr, -#"--- the anterior clinoid process and lies lateral to
the optic chiasma.
- lts course follows a series of bends ( carotid
syphon ).
Branches (internal carotid system ):
1- Hypophyseal arteries
-They arise from the intracavernous section of
the internal carotid to suPPlY the
neurohypophysis.
-They also fo.m the pituitary portal systom of
vessels by which releasing factols are carried
from the hypothalamus to adenohypophysis.
- lt!-asses into the orbit through the optic foramen

- lt supplies the structu.es o, the orbit, frontal and
ethmoidal sinuses, frontal part oI the scalp and
dorsum of the nose.
3. Anterior choroidal artery:

- lt suppli€s the optic tract, choroid plexu3 of the
lateral ventricle, hippocampus and some of the deep
structures of the hemisphere, including the intemal
capsule and globus Pallidus
4- Anterior cerebral artery:

- lt passes medially above the optic nerve and then
passes into the great longitudinal tissure between tho
frontal lobes where it joins the corresponding vessels
of the opposite side by anterior communicating artery.
- lt follows the curvature of corpus callosum within the

great longitudinal fissure. lt ramifying over the medial
surface of the frontal and parietal lobes and supplies
them. Also, baanches extehd out of the great
longitudinal fissure to supply a natrow lateral band of
frontal and parietal cortices.
-The territory supplied by it includes the motor and

cortices for the lower limb.
l .y'. o/\.t i \
5- Posterior communicating artery:

.#* .
- lt is the largest branch of the 3

cerebral arteries and its cortical
territory is the largest. lt passes
laterally to enter the lateral fissure
within which it subdivides.
- lts branches supply the whole of the

lateral surface of the frontal, parietal
and temporal lobes except those
areas which are supplied by the
anterior cerebral artery.
- lt supplies the primary motor and

sensory cortices for the whole body
excluding the lower limb. The
auditory cortex and the insula in the
depth of the lateral fissure.
Vertebral Artery
VtJ/ l.
- lt arises from the 'lst part ot subclavian artery
and ascends through the foramina transversaria 4,^-+1
of the upper 5 cervical vertebrae and enters the
cranialcavity through foramen magnum along
side the ventrolateral aspect of the medulla.
.Along its course, it gives riss to a number of

branches including the anterior and posterior \
spinal arteries which supply the medulla and
spinal cord, v'v-h
- lts largest branch is the posterior interior
cerebellar artery which supplies the lnferior
aspect of tho cerobellum.
-The 2 vertqbral arteriesUlite at the iunction

between medulla and pons to form tl].e basilar
artery which runs the iength of the poEXJfu*
supplies it by pontine branches. At the iunction
of pons and midbrain it divides into 2 pairs of
vessels, the superioa cerebellar arteries and the
postedor cerebral arteries.
N.B. The brain stem, carebellum and occipjtat

lobe are supplied by the vertebrobasilar system.
,)
l./.o/\!f1
t{e.-
2. Anterior inferior cerebellar artery
It supplies the anterior and inferior '
ast
portion of ihe cerebellum.
3. Labyrinthine artery
It passes into the intemal acoustic A

m€atus to supply the inner ear. ''-f--"-*-( <-=-
4. Superior cerebellar artery
It supplies the superior aspect of the

cerebellum.
5, Posterior cerebral artery:
It curves around th6 midbrain to supply

the visual cortex of the occipital lobe
and the infero medialaspect of the
The internal carotid and vertebrobasilar

systeh-aE-j6'inid by 2 thii vefs6t-
which are the posterior communicating
arteries. They pass rostrocaudally
between the ends of the posterior
cerebral and the internal carotid
arteries,
Circle of Willis
r(r,',.a,,er€ .ltis an arterial anastomosis in the
interpeduncular fossa at the base of the
brain. This fossa is formed anteriorly by {
optic chiasma. Posteriorly by the upper
border of the pons. Anterolaterally by
.,.*. -.'.. the 2 optic tracts. Posterolaterally by
the 2 cerebral peduncles.
- lt is formed of:
Anterior cerebral; anterior
communicating; internal carotid;
posterior communicating and posterior
ce.eb.al arieiies.
)
./. o/\ 1! \
From the arteries of circ16 of Willis numerous

small vessels penetrate the surface of the
brain. These are perforating arteries
( central or ganglionic ).
1- Anterior perforating arteries:
They arise from the anierior cerebral

artery Anterior communicating artery
and the region of origin of the middle
cerebral artery. They enter the brain in the
reqion between the optic chiasma and
termination of the olfactory tract ( anterior
perforated substance ). They supply basal
ganglia, optic chiasma, internal capsule
and hypothalamus.
2- Posterior perforating arteries:

They arise from the posterior cerebral
and posterior communicating arteries.
They enter the brain ( posterior
perforating substance ) to supply the
ventral portion of the midbrain and parts
of the subthalamus and hypothalamus,
Arterial Circulation of the Brain, lnclucting Carotid Arteries
Right Middle
Cerebral Artery
Exteroal
Carolid Artenes
Carolicl Arleries
\
5
i , :.ir.:
'..;i.:
, : :;.
].::i.1]-'
I
I
I
I
I
51t11;\r\ $0 at:"rt)
,17\
I ./. o/\ i i'l
Venous Drainage of the Brain
*1**' 1- Superficial veins;
\.:rv They lie within the subarachnoid space.
a. Superior cerebral veins

They drain the lateral surface of the cerebral
hemispheres and empty into the superior
sagittal sinus.
b. The superficial middle cerebral vein

It runs along the line of the lateral fissure
and empties into the cavernous sinus.
c. Superior ( great ) anastomotic vein

It drains into the superior sagittal sinus.
d. lnferior anastomotic vein

It drains into the transverse sinus-
N.B. The circular sinus is a venous circle

around the hypophysis.
D_
2- Deeo cerebralveins:
Supeior saginal sinus
lnfeior sagifial -They drain the internal structures o,
sinus the forebrain
Gr€al cerebGl -They are the thalamosiriate vein and

vein the choroidal vein. They drain the
basal ganglia, thalamus, internal
Slrarghl
capsule, choroid plexus and
srnus
hippocampus.
-These vessels merge to form the 2

internal cerebral veins.
-These 2 internal cerebral veins unitg

ln the midline to rorm theggt
ce!qEg!_ye!4 which lies beneath the
splenium of the corpus cal,osum
Conltuerce ol
lhe sinuses
- Thus the great cerebral vein draina
the deep structures o, the forebrain
and the inferior sagittal sinus.
- lt continuous with theslfaigbf

sinus which !ies !^ the mid!ine of the
..iintorium
cerebelli.
{
.). o7r.: I r
3- Dural venous sinuses
- The dural
vehous sinuses aae
connected lo extracranial veins via
, Vrs.z\
emrssary v€lns.
L,
- Cerebral damage caused by venous \i{l
tlr
infarction manifests as eDlleptic
attacks and focal paralysis o, the
limbs. ----i-
, t\
.
\
9'/
l,/ !'l€/.)
/l
Disorders of Blood Supply of the Brain
) )----) \
- The sudden occlusion of the cerebral arterv leads to death of brain tissue
t". (infarction l.Eupture ot a orood vessel EGes cereurat tri6fr6iGgel

- Strokes related to the carotid artery and its cerebral branches are associated
2" ,r1 i -i
with focal epilepsy ; a contralateral sensory & motor deficit and a psychological
")-.*rrV,, deficit (aphasia ).
-
- Strokes involving the vertebrobasillar circulation lead to a focal brain stem
\\*-
-* E2 slllLome. Recovery of function can occur but take up to 2 years anTiEi-be
incomplete.
. An an€1{vsm is an abnormal, balloonlike, swelling of an artery. Rupture of this
artery may cause subarachnoid haemorrhage or intracerebral haemorrhage. A _.
*: y;:
\i"=
and neck stiffness are followed by qQEa-and
::iliffiffi:che
PI 5_t; (, -An angioma or arteriovenous malformation is a congenital collection of swollen,
blood vessels that can rupture causing -cergplalbelrorrhage or steal blood from
adiacent brain regions leadiig- t-toefilepsy Ind a foEi cerebral syndrome.
1
*
v
'5,
20:3-2llg
;i;Lall
UrJt :bJ,l
lt
t\ :(Ptilt
g< \J,
L'iitlt A+IsJt cjit.r {$tull
:, - :Jr-Jl
..-{ \')
"' / C'L'a
-n'o As\Q/3lq .i;i
The e etids
-7uT
are m;trfiie foiJs which €"iiY;*
asa Sh utta\., Ttir(itobting eye frfmintYirv or
EXCESS ve light.
r Both the ppper ald

lolryg eyelids meet at OrbilolPorrion ol lid
medial and lateral Tdrl.l Dottron of iid
jr999l ,onit','
canthi with the opening Icrrol portio,r ol lid
lnferiot polpcbrol fu now
the pafpebralfisS-ure Orbiio portion ol lid
between them.
-z/--- il
I
SURFAC ATOMY
Superior G),)
Palpebral Sulcus
( ir-a';
Lateral Canthus
u ffiedial Canthus
Falpebral Frssure
g telveer-J
a
/-
(r1
ON THE MEDIAL SIDE
.)
Semilunor fold -
r Lacus lacrimalis, Locrimol popilloe
Caruncula lacrimalis ' t.'
PIica semiluh?l'is,
,: '/
L ocrimol puncium
Fron t edge of lid Orifices of tcrsol g!cn.1:
3
b
t,. :
The medial 1/6th is distinct and it

contains
\ r papilla lacrimalis
1 r punctum lacrimalis
'\ r canaliculus lacrimalis.

I
,.\r^
1*\
,'--
t '
\4
tu
THE STRUCTURE
The margin of each eyelid is 2mm thick and 30mm lonq
It contains eyelashes and just posterior to it are the
meibomian qlands oriliges . ':-{) ;j-( 1Jr
The tissues of the lids from anterior (cutancous) to posterior
>N\
conjunctival aspects as follows'.-
, r skln
z r subcutaneous areolar tissue
)n
layer of stUetted muscle (orbiculalq eculi) .,:rr f'
- r sub.muscular areolar tis*que

- r layer of non-striated muscle
; ! the fibrous layer:including tarsal plate
1a COnjUnCtiVa - lj.cr
,,:.J
.Il
Itf.
\\*{ \.\
t'\\q5'-
\$\:
_\_--_----_>
-.---.-.-.\.---
--.----.-.--\:
\=\=----_-.-=--
f^r
ldL
\r
L
M0ller's muscle Frontal sinus
Levator palpebrae superioris muscle

-A!-n
; Superior rectus muscle
Frontalis muscle
0rbitalfat
SePtum
0ra senala
Zonules
Orbicularrs oculi muscle
Retina
lris
Cornea
PuPil Fovea centralis
Central retina vein
Anterior chamber
Central retina artery
Mglgrnqn g!_ands 0ptic nerve

lnferior rectus muscle
0ptic disc
Tarsal plate
Ciliary body
Sclera
lnferior oblique
Fig.8,1 Cross'section of the eye and orbit (sagittal view),

/f 6
THE SKIN
It is thinnest and marked
by sulci.
The superior sulci is due
to aponeurosis of levalor 0rbilol Portion ol lid
\
Superior ccloei:ro
pa-lpgblae superior *.* r r Frrrcw
inserted into the skin. Tcrsol cortion oi lid Ccr';ni:e
Loletcl lonlhus lJ,eCici t:rrii'rr

The less obvious lower Torcl poriior ol lid
sulci is due to the skin Inlericr oclpebrol f',;,rnw
being tethered to the Cirilci poJion o{ lid
underlying periosteum.
Histologically it consist cf
epidermis, sebaceous
and sweat gland and
melanocytes.
/
("
EYE LASHES ?r)t
r 100 in upper lid ir,.
r 50 in lower lid
! Originate from anterio r lamella in two or
.
three irregular [gws ^*;-*rrj
E The upper lid Iashes are directed upwardy
and outwards
r The lower lid lashed are directed downward-
and outwards
1,o
'l
THE SUBCUTANEOUS
AREOLAR TISSUE
r It is a loose connective tissue containing

no fat.
rlt s absent at medial and lateral angles,
ci iary margin and at sulci.
q
(,,
' ",, f-'.
THE ORIBICULARIS OCULI 1',1.'111 \
Part, Position Function
i r Orbital Surrounds the orbital Forced

', lid
-- closure
-
1t Preseptal ln front of the orbital pull lacrimal fascia

Septum laterally and
create a relative
vacuum in lacrima
SAC.
.\ . Pretarsal in front of the tarsal Close lid and pull
Plate lacrimal r:-
ouncta
medially'-
i0
THE FIBROUS LAYER--.ORBITAL
SEPTUM AND TARSAL PLATE
Attached to the orbital Tendon Of le\,a(x
palpe0rae supcliorr.s
Orbrt,,rlsepurm
margin. SLlpl't:1rI !iiri:l -) i!L('
Lies post to the medial I
palpebral ligament and L;lteral

palpebral
lateral palpebral raphe Iigamenr
medially and laterally.

With in the lids it is
thickened to form tarsa n
plates-embedded in it lnferior rar5al
are tarsal glands.
ll
f.
,,7
Iarsal glands
.f
/'
l./
V
Lateral
arrqle
( Ducu of
of e,ve
farsalglands
Anterior margin of iid

Pcstericr margin of lid
12 Llwer iicj
\! ,
I THE LIGAMENTS
r The medial palpebral liggnent attaches the

medial end of tarsi to lacrimal crest and
frontal process of maxllla.
r The lateral palpebral ligament attach the
lateral end of trei to margin tubercle on
marginal tubercle of zygomatic bone.
\3
/tE
LEVATOR..P PEBRAE
SUPERIOR
I Originate from lesser wing
of sphelctd lene and is
inserted an aponeurosis Superior t.rr!Jl piarle
on the ant surface of I

.:t
.\, 'l
superior tarsal plate, skin, ti. l
lat palpebral ligament,

medial palpebral ligament
Orbiral sepum
From its inferior surface

arises the superior tarsal
I
muscle.
\q (,(
CONJUNGTIVA ,\!\
c.,,--J
r Thin mqe;ous rnembrane lined by n_Qn-

kegtinized stratified squamous
epithelium.
r rr@arized
lt has a + Substantia i
''Y'Y'/f iu'/'
propria
E At the margin of the eyelids it is
continuous wlth the skin.
)s rB
ARTERIAL SUPPLY
1r The lateral palpebral SupraorDital artery
Artery---lacri mal artery, Supratrochlear,riterY
Peripherai arrcrial al(tl
\r medial patpebral MaiE4aLglgr.rt arct':

n
zr-
artery---Ophthalmic lvledial-Plftrrl
artefles
l-atetajPalPeJial
Artery. drteriel
1 r Marginal and I
l
-t
Marginal ?-
arrcrial arci)
Peripheral arcades. zysc,inaii(.,,i,rres Peripl'telal i]llerisl alch
il
' hfraorbitil ariery
\/ I
\r.
(,t t
VENOUS DRANAGE
r Medially - Ophthalmic and angular vein

r Laterally-superficial temporal vein
/7
(,7
-0
--,,
Upper eyelid supraorbitat nerve iV

i
Supra orbital nerve Lacrimalnerve lV,J
' Supra trochlear nerve

Supratrochlear nerve iV j
r Infra trochlear nerve

" Lacrimal nerve
infi'atrochlear nerve
iV i
Lower eyelid
n Infra trochlear nerve hkaorl)ii3l ner,ie lV,)
r Infra orbital nerve
\% i^
12"
LYMPHATIC NRAINAGE
I
t
i
__..
i
\\"^,. -Nii':: :. '
--.,,-.,-.-.:-.
Subrnaitoibt-rlar
ilzmph riodes
/4' (,'
SECRETION OF THE EYELIDS
Glands Tear Film Layer Location
IM
plate
EG ands of Zei's Oily layer yelashes
Eye
!rG ands of Wolfring Aquecus layer Tarsal plate
rG ands of Krause Aqueous layer Fornix
tv
(..
Blinking
There are two main types of blinking
r Reflex blinking
r Spontaneous Blinking
,2,1,.. ,r7
Reflex Blinking
. Cortical Connection
. Dimunation of sensitivity in contact lens
wearer ,.ooY ) =-V; \
Dazzle r
: . Bright light '
', " Optic nerve--- Superior colliculus

. Associated fiber to facial nuclei
Menace
. Sudden presence cf near object
" Optic nerve--- Cortical Connection
,' r " Predominarltly contical in natu (Ltl
tA
Spontaneous Blinking
t,,
- Occurs at regular bas s without an apparent
external stiquli
- Mechanics facilitates the drainage of tear film.

. \*_--/
- Present in blind as no retinal stimuli are

required . ,,t
i
l
i /.
,/o -
".ii ,
. t ,lt
_/;r,
,JPl
.t ,ln)
,
I
q
contraction of
E
Forcible closure of the lids.
&
Its role in sLJrgicai prccedures.
Anterior segment injury.
.\(-
ffi
ffi s
s
* *
K
* ffi
i* 0dE(, fifriaru* i&
ffi i--...-r-clr tl ,
r&
* ffi
s
* *
*
w AD|L de
*
K Crt r.J'^.a+ll gll.riii :;ill
*&
* -,
^l
t ) c t)l
va fil :6.rLll
l>"''
s
* I&
* rJsYt :al.;'.tl r&
,jtiJl u"JJSll r&
* i&
ffi i&
s
* s
)}v.r^e- L,.rr.r- fLe ffi
* *
* ffi
?& *&
,l
ffiE Tue
--___.__
Structure of the Eye
The eyebail is embedded in orbital ftt hrt is frrom it by the
fascial sheath of the eyebatl. Th€ eyeball consists of three cq4ts,
which, from without inward" are tlre fibrous coat tlre vascular
pigmented coat, and the nenous coa1. \ 'l-
3
rir..rsdc) - T
Coats of the Evebrll

) Fibrous Coct
- The fibrous coat is made up ola posterior opaque Fart, thesglg!", ard
an anterior transparent part, the cornea-
) ', q-n')t Ux
The n'hite of your eye is called the sclera" This is a p'roective layer
tvhich covers all the eyeball except the cggg* The opggue sclera is
composed of denr fibrous tissue and is white. Postcriorly, it is
,...--:-6 pigg3d by the optic nerve and is fused wi$ ttr dural slrcattr of that
fierve.
-- TIte sctera is also pierced by the ciliar;'art€ri{'s and nerves erd their
associated veins, the venae vorticosae. The sclera is directly
continuous in &ont wirh the cornea at the comeoecleral junction, or
limbos.
Sfir.
ltr
ftilr
Onnid
Cilu
qtcthtii
Pr?J
lhat
hrr
Rtn
Cryx$n
TheCornea
Ihc tqnsparent comea is largely respon!-rble iglh€_lef{Aelron of fie
light entering tfr eye. It is in contact posteriorly witft the aqueous
humor.
Blood Suoolv
The cornea is ayassrlar and devoid of lymphatic drainage. tt is

nourished by diffision from the aqueous hrmror and fro{n ltte
capillaries at its edge.
Nene Suonlv
Long ciliary nerye* from the ophthalrnic division of the trigeminal
nerve
Function of the Cornea

The comsa is the most i@tlr eye. This
rcfractiye por,ver oc€urs on the anterior surface of tlre cornea" where
the rcfractive index of the cornea (1.38) differs grcatly from that of
the air. The irnportance of thc tear film in maintairing the normat
environm€nt fcr ttrc corneal epithclial celts should be sfisssed.
z-:- gttr e li lr"ti { let =-

.-jJt..l- ["fu
The vascular pigmented coat consists, fnom behind forward, of the
choroid. the ciliarl'body, and the iris.
^ The Chorokl
'The choroid is crnnposed o!'an outer pigmented layer and an inner"
highly vascular layer.
, The Cillan Bodv

- Thc ciliary body is continws posteriorty' wift th€ ctmroid" and
aoteriorly h lies belrird the peripheral margin of tk-TG. tt is
composd of the ciliary ring the ciliary promseq and tttc ciliary
mgtsle. '\""'--=-
The ciliqry rins is the posierior part of the body, and its surface has
i shallo* grcloves, rhc ciliqDjq_iae.
> 7rY- | -z'--3-
.*'L-"/ J\ Ihe ciliarl' pri{ess*$ are radialll arranged i<li{is" i}r ddges" t<l th*
l"rrt*.i.r, i*f**s r,.f *hich
art connected lhe suspensorl IilranrenLr ef
$e lglts. c.t--/)t
The ciliary muscle is compod sf meridiaral and circular fibers of
smoodr muscle. The meridianal fibers run backwatd from tlre rcgion
of &e corrrcsclcrat jtretion to *te silisry prooesses. Thc cireular
fibers are fewer in number ard lie internal to ttc rneridiansl fibers.
Actioa: Cbntractio-n ellthe-g,iliery muscle, especially thc rncridianal

fibem, pulls the ciliary body forwad- This relieves tbe tsrsion in the
suspensory lignmenr, and &e elastic lens becom€s more convex- This
inc
tt" Lrafty tr(!fl5/'
Antcrior Chember
The space between the cornea and iris filled with Aqueous Humor'
Porterior Chember
Th. bet*eerr the iris and the front of the lens filled with
"p-".
Aqucous Humor.
Cocr*a' charrtb,aa
:"'Ll t/,'/\
The lfis rnd Puni!
The coloured part of your eye is called the iris. The iris is made up of
muscle fibrcs which help to control the size of fu-+tupil. It is
suspended in tlre aqueous hurnor between the oornea aad tlre lens.
The periphery of the iris is artached to the anrsrim surface of the

ciliary body. It divides the space between the lens aod the cornea into
an anterior and a posterior chamber.
The muscle fibers of the iris are inyglUntaV and consist of circular
and radiatine fibers.
-1-
;-The circular fibers form the spt iqSlg.

-egpillae aod arc arranged
around the margin of the pupil.
t . ,Ls.r{f.ru411''- .-
The pupil is not an actual structure but tlre cireular ppelng in the
middle of the iris. The pupil appears as the dark central pnrt af the
eye. The pupil can change size depending on the amount of tight
(/
tM
' -\ going through it. In darkness your pupils will gct bigger to allo* morr
-
lieht fr-A_
Ncre supply: The sphirrter pupille is supplicd by pqlyrynthetic
fibers from the ocplomotor ne*e. f!'
Action: The sphincter pupillae cons-Jdclg$x pupil in the presence, oll ;)
bright light urd duringaccommodation. \'tr '-
.ar fi,. {!gt"fgfpt]!E i!@s the pupil in the prcsence of light of$w
inEtg or in ,the presenc€ of excessive sympothaic activity srrch as
occun in frigh{
.hns \
f,rjpii
rEE{
OCIT
ge
rP
wi
pyramid al bony caviti es,
ase in front, and its apex a The orbit
behind
.The orbitalmargin is formed
&$r*dtl(n,
s'^u
r*h
above by the f ron'gql bone with -*l I PIrr:{Q, itiYttxld
ha
' *rj
the supraorbital notch or foramen i ixffl:r,n
.$*.l*€.
trb,rot ilgevf
'The lateral margin is formed by
the processes of frontal and
F9.rltil 2.6,n ^^'r t t
zygo_matic bones sartArr -tJ
"The inferior margin is formed by :*erxx
zygomafi- bone and maxilla cr8td' 'Lyy- a
,'
bt.r.r
'The medial margin by the
processes of maxilla and the
rr\a Iit''n
froqlal bones
ird3].da agvr:rri
tlrlr?ff'l
4-. )-.
)'(
1. Roof: frontal
bone, sphenoid
bone
2. Lateral Wall:
Orbital Walls
sphenoid
bone, zygomatic
bone
3. Floor: maxillary
bone, zygomatic
bone
4. Medial Wall:
ethmo,id, lacrimal
bone, frontal
bone, maxillary
bone
)
Relatlonship to Sinuses r
!
u/'
;-/'-
Frontal sinus: above
Maxillary sinus: below
Ethmoid & sphenoid
sinuses: medial
lnl"r.rirr YiAils
lrrlrrcrk ll.hi<ol{
\,*l\\^-'z
; i.{r
Orbitalopenin$ lies Opening in the orbital cavity
anteriorly, o(poses 1\6 of the
eye
Supraorbital foramen or ---
notch; situated in the |{lsrrrJts *!$rrli}{j
ft{t&,fr#
superior orbital margin, it {r$$nl ft*.,firc
transmits sgp4or$ta! n grve

and vessels. Ftrrrrc*r
fi1*,l6Jrrr
lnfraorbital groove and
klkror
canal; situated in the floor, in {{h&s
orbital plate of
maxilla, tra nsmits i nfra orbita I
nerve and vessels
Antarq}l *tlrisr(,
llilradrsn
5
lnferior orbital fissure; Opening in the orbltal mvity
locate d posteriorly, between
maxilla and greater wing of
sphenoid, $q8t{&dre
comrnunicates with Fq*erru( *skf}.x$
ptergopalatine fossa,
fdd$S {$iYeS
--transmits maxillary nerve, and its
zygomatrc or
o p hth almi,c,v_ei n, a nd sym pathet
nerveS" f*exlgvr '
&}i!.1&.r{{
Superior orbital {issure;
located posteriorly, between
greater and lesser wings of
sphenoid bone,
com municQGg wltLlLe m idd|e
cranialfossa,
_ transmitting the lacrimal
nerve, fronlal nerv-E-,trs€hlear
- nerve, oculornotor nerve
(anterior and poste rior divisions)
abdqcent nerve, na segliary
nervd and superlor opntfrbtmic
vein
6
Optic canal; 1. fl
located posteriorly in the
$LW &r:t t,{r$l
lesser wing of sphenoid ,

communicalles with the
middle_cranial fossa,
{'vrr
$+.s.,s,
std* tta$ca -*""
transmitting the optic rsi*io

&
rsr'rrrr'r!
nerve and thg ophifratmic
lrlforti.
a rtery. s't'i|$ r!*{r'
Anterior and posterior mX

ethmoidalforamina; u ?
located in the medial
walt, the ethmoid bone,
tra nsmitting nterior and
a
posterior ethmoidal
nerves.
7
Zygom at icotempora I a nd
Zygomatlcofascial
foramina;
located in the lateral wall,
transmitting the
Zygomaticotempora I and
Zygo maticofa scia I nerves.
Nasolacrimalcanal ;
located anteriorly on the
medial wall,
communicates with the
inferior meatus of the
nose,
tra nsmits nasolacrimal
duct.
q,
Orbital Contents rY
The contents of the orbit are a

a
a
hsc-ia
,
nenffi$
a
t
KL
.-a
o
@
I
The extraocular muscles are the
six muscles that control movetnent of
the eye and one muscle that
controls eyelid elevation (levalp_f
palpebrae). The actions of the six
muscles responsible for eye
movement depend on the position of
the eye at the time of muscle
contraction.
fr
Levator Palpebrae Superioris, , jl ,;,
ol,q
))lJ-,
Attachments: oMinates from the lesser wing of the

sphegild bone, immediately above the optic
foramen. lt attaches to the superiorl_aEal_plate of the
-q,,,
upper eyelid (a thick plate of connective tissue).
5/Actions: Elevates the upper eyelid.
superioris is
innervated by the oculomotor n lll). The
superior t4sal muscle (located within the LPS) is
innervated by the sympathetic nervous system.
Lt
Levator palpebrae
superioris
Superior tarsal
plate
.-
l'l"
:::'; fi
J&
* $'l ra:*mffiffit#f?xy
11-
Recti Muscles
There are four recti muscles; superior rectus, inferior
rectus, medial rectus and lateral rectus.
These muscles characteristically originate from
the common tendinous ring. This is a ring of@rs'-t'1,
tissue, which surrounds the optic canal at the back of
the orbit. From their origin, the muscles pass anteriorly
to attach to the sclera of the eyeball.
Superior Rectus
Attachments: Originates from the superior part of the
common tendjnous ring, and attaches to the superior
and anterior aspect of the sclera.
Actions. Main movement is elevation. Also contributes
to adduction and medial rotati-fr of the eyeball.
Innervation: Oculomotor nerve (CN lll).
t7
lnferior Rectus
Attachments: Originates from the inferior part of the common
tendinous ring, and attaches to the inferior and anterior aspect of the
sclera.
Actions: Main movement is depression. Also contributes to adduction
and lateral rotation of the eyeball.
I n nervation : Ocu lomotor nerve (C_Mll).
Medial Rectus
Attachments: Originates from the medial part of the common
tendinous ring, and attaches to the anterio-medial aspect of the
sclera.
Actions: Adducts the eyeball,
..P.
lnnervation: Oculomotor nerve (CN lll).

Lateral Rectus
Attachments: originates from the lateral part of the common
tendinous ring, and attaches to the anterio-lateral aspect of the sclera.
Actions: $0_ducts the eyeball.
lnnervation: Abducens nerve (CN Vl).
\v
Extrinsic Eye Muscles
Superior oblique muscle ----
Trochlea
Supefiorobliquetendon Superior Superior

rectus oblique
'
Superior rectus muscle
Lateral Medial r
*w
rectus rectus I
Lateralrectusmuscle q.,-
Common rnJ,io, ,nlno,/

tendinous rectus oblique
ring muscle muscle
view of the right eye (b)Anterior view of the right eye

t5
\
I Levator palpebrae supmioris
Isuperiorohlique
lnferiorohlique
ffi
f superiorrtrctus
tla*i*reililr
@
f r*emtrecttrx
mru*orrscrus
ffi
t*achm*llrr*tomy
Oblique Muscles
There are two qblique muscles - the superior and inferior
obliques. l.-,lnlike the recti group of muscles, they dq not
tendinous rins ajv
3lnJ::fJ3il,Xf"'ommon i"\'t I **-'*,u
Attachments: Originates from the body of the sphenoid bone
rF Its tendon passes through a trocl'rlear, and then attaches to
the sclera of the eye, poltefr5ffiih-e superior rectus.
Actions: Depresses, abducts and Dedially rotates the eyebal
tnnervation: Trochlear nerve
: (C@t
Inferior Oblique
Attachments: Originates from the anterior aspect of the
orbital floor. Attaches to the sclera of the eye, posterior to the
lateral rectus
Actions: Elryates, abducts and lalrrally rotates the eyeball.
lnnervation: Oculomotor nerve (pN lll). O
/f
(.I
intraocular muscles of the e (\
The ciliary muscle is a ring of smooth muscletzllst i,

the eye's middle layer (vascular layer) that
controls accommodation for viewing objects at
varying distances and regulates the flow of .ag-ueouq
humour into Schlemm's canal. lt changes the shape
of the lens within the eye, not the size of the pupil
which is carried out by the sphincter pupillaq muscte
1 and dilator pupillae
01
flnnervation of the Orbit
orbit include thoseffintei through the

superior orbital fissure and supply the ocular
- rnuscles: oculomotor lll, trochlear, lV; and
abducent, Vl
o 3 CN lll supplies the levatorpalpebrae
superioris, superiqttectus, medl_al rectus,
i nfedor rectus, and inferialobl ique.
.. CN lV supplies the superiqloblique.

. o CN Vl supplies the lateral rectus.
t9
t"*ut*s palp+trx $ ff utrxri(lf rr -d!&e. liilIt*r*lr r&{lrr.
$rywmr r$:ltqr*
$r$sn$ {rhilir} {i*llur* -.
rw{ts
lnluior *b$qu*
{j${Mrilrr**tiilq
&r&fiihe$
Trrgrmrnrd UIrqiloo ffi:ttA$ lrrfsrict metus
[todxJ rodr]$
Cr$;l11grry;ron
La
Nerves of the Orbit
A. ophthalmic nerve (Ar^t'*'r{' ^r) \
.Enters the orbit through the superior orbital fissure and divides into
three branches.
1. Lacrimal nerve
.Enters the orbit through the superior orbital fissure.
.Enters the lacrimalglgrd, giving rise to branches to the lacrimal
gland, the conjunctiva, and the skin of the upper eyelid.
2. Frontal nerve
.Enters the orbit through the superior orbital fissure.
.Runs superior to the levator palpebrae superioris.
.Divides into the suplaorbital nerve , which passes through the
supraorbital notch or foramen and supplies the sqlp;fueheaf,frgntal
sinus, and upper eyqlid, and the supratror!]sel_l1erve, which passes
through the trochlea and supplies the scalp,_forehead, and q,pper
eyelid z I
3' NgsPctll-arY-nerve
ls the senselylr€we for the ey-e, enters the orbit through the superior
orbital fissure.
Gives rise to the following: Vnz "- Cke4.,
. A communicating branch to the ciliary ganglion.
. Shgrt_Q!_ll3ly_nerves , which carry postgang lion ic pglagym pathetic and
sympathetic fibers to the ciligq_bggy glq_Uis .
l. Lgg_qrharyJerves , which transmit postganglionic sympathetic fibers
to the dilator PlPillae. \vr, r
Y. The post_ejlarcthmoidal nerve , which passes through the posterior
ethmoidal foramen to the sphenoidal and posterior ethmoidal sinuses. I ",*l
fo The anteriog elhm_oidal nerve , which passes through tne anterior-
ethmoidal foramen to supply the anterio_r e_thmo_idal ar cells. lt divides
into internal nasal brqnches , which supply the septum and lateral walls
of the nasal cavity, and external nasiil lranches , which supply the skin
of the tip of the nose.
6. The inffalfoQhleaf ne-rve , which innervates the eyelids, conjunctiva,
skin of the nose, and lacrimal s_qg.
t.,
Lnl
B. Optic nerve d
Consists of the axons of the ganglion cells of the retina and
leaves the orbit by passing through the optic canal.
carries Special Sensory fibers fo1_v_1gign from the retina to the
brain and mediates the afferent limb of the pupillar
reflex.
Joins the optic nerve from the corresponding eye to form the
optle cb iasmauyy') 4'*1,
G. Oculomotor nerve i.i
Leaves the cranium through the superior orbital fissure.

,*Divldes into a superio-r-dMision , which innervates the suplior
rectus and levatel_palpebrae superioris muscles, and an
inferior division , which innervates the medial rectus, inferior
-- rectus, and inferior oblique muscles.
Its inferiordivision also carries preganglionic parasympathetic
fibers to the ciliaraganglion.
't3
D. Trochlear nerve
Passes through the lateral wall of the cavernous
sinus during its course.
Enters the orbit by passing through the superior
orbital fissure and innervates the superior oblique
muscle.
E. Abducens nerve N
Enters the orbit through the superior orbital fissure
and supplies the lateral rectus muscle.
F. Giliary ganglion ;
ls a paggy_mpathetic ganglion situated beXind the
eygball, between the optic nerve and the lateral
rectus muscle
t\
'..*Lt rr,i.
'&:
.
l,tcrimaln,
0culomotor n.,
(i,rith gland)
supriorbranch
0culomotor
Supnorbitaln,
n (CN llli lnternalcamtid
a vrith internal
omtidplaus
lnfra-
trochhar n.
Long
uv j.
ciliarynn,
Trochlear n.
(CN M) *- Naio.
(tphdralmic riliaryn
dki:ion '5hort
(tN v, ) dlirry nn,
Irigrminrl --
n. ((NV) /rili,:ry \
\ qrnqllon
i Irigenrin,rl .
\ qJnqlron , hhndibuhr Paruym.

patheti(
divilion
root
(cNV])
A,bducent n, lvlaxillary dlrision
{cNVli (cNV:)
0ptk n, (CN ll)

0culornotorn,, Syrnpa$etc Nasociliary
lnfedor bnnch root root 7e
.,'1,
$o!tS{rsS
.S,'"J *t,l
*u r{;rlsd*S-{*al4 A-1"i8u ,fuft;rx*,1nn
l*iiqj*$ilui
-',ff
'-.".+{, *!
i r",
j
s,}r,ii)lJ
&*r1r:
i*ri.?i*sc
fi'.^.
fi.\,i&l,l
f
{}u rr.ir"]$l j.i
,r*{t"i --i
l{} I
\.r*ttt,l\rpl
:r itii$r{rL{S.C}
{- ..'
sA"IsU s,*.Ja{J a{J;} i.r a-qj' u sr,"J&tj
l(}tr]!.d}"{)J ,{;*:1t>**o5g lstu$rJ ,0irq.,*{3tce J{:"*i!J:sjtsi{*ns
s
l
Blood Vessels of the Orbit
through the optic canal beneath the optic nerve.

Gives rise to the ocular and orbital vessels , which include the
following:
1. Gentral artery of the_rclina N
ls the most important branch of the ophthalmic artery.
Travels in optic nerve; it divides into superior and inferior
branches to-fre
the optic disk, lts an end-A(ery that does not
_ry Ellostomose with other arteries, and thus its occlusion results in
blindness. !'
2. Long posterior ciliary arteries
^"-J-Pgrce the sclera and supply the ciliar)
3. Shortposterior ciliary arteries
Pierce the sclera and supply the choroid.
z7
I
4. l-acrimal
..--.-^
artery
Passes along the superior border of the lateral rectus
and supplies the lacrimal gland, cgnjunctiva,and eyelids.
5. Medial palpebral arteries
Contribute to arcades in the uppgl ?nd lg"y_9l_gJe_!"igs.
6. Muscular branches
Supply orbital-mUscles and give off the antelqr ciliary
arteries, which supply the iris.
7. Suprasjbilal artery
Passes through the supraorbital notch (or foramen) and
supplies the forehgagl_pnd the scalp.rr),t,,
8. Posterior ethmoidal artery,
Passes through the posterior ethmoidal foramen to
the posterior ethmoidaEU ells. A
t\.rl 'l ", fr'
tta
9. Antenior ethmoidal artery
Passes through the anterior ethmoidal
foramen to the anterior and middle ethmo_ldal
air cells, frontal_sinus, nasal cavity, and
externq[nese.
1 0. Supratrochlear artery
Passes to the supraorbital margin and

supplies the forellead and the scalp.
11 . Dorsal nasal artery
Supplies the side of the_nose and the lacrimal
sac.
,>E
supratrochlear a. supraorbital a.
anterior ciliary a.
dorsal nasal a. zygomatico
{acial a.
anterior
ethmoidal a.
zygomatico
lemporal a.
$upefior
oblique m.
posterior medial
ethmoidal a. meningeal a.
posterior ciliary a.
1/o
rG;\
B. Ophth5lffi-ic veins
1. Superior ophthalmic vein 4'
.lsformed bythe qqi_on.of the s@ochlear, and

apgular veins. f
.Receives branches corresponding to most of those of the
ophthalmic artery and, in addition, receives the inferior
ophthalmic vein before draining into the cavernous sinus. <-
2. lnferior ophthalmic vein

.Begins by the uniopqf-s111a!!veins in the floor of the orbit.
.Communicates with the pterygoid venous plexus and often with
the infraorbital vein and terminates directly or indirectly in the <_
cavernous sinus
]1
Supraorbitalv.
Supratrochlear v.
Central retinalv.
,l
$uperior palpebralv,
Angular v.
lnlerior palpebralv.
Pterygoid lnlraorbitalv,
plexus
Vorticose v. I Facialv.
f
I
lnferior t
bphthalmic vJ
.:..-........-".*
)'
/.
''ril\
Lacrimal Appaqatus
v
. The lacrimal apparafus consists of: _,,. ,, S)_
r . Lacrimalglands, which secrete
lacrimal fluid -
. . Lacrimalducfs, which convey
lacrimal fluidTrom tre lacrimal glands
to the conjunctiva! sac
. Lacrimal ca4gliculi (L. small canals),
each commen-cing at d lacimal
-Sounctum (ooenino) on lhe lacrimal
- 'p6f"lilE-l@i tne rteOial angle of tlre
eye, whicfr convep the lacrimal fluid
from the lacrimal lak*a trianoular
space at the me-dial angte of the eye
where the tears collest-in he lacrimal
sac, the dila'-trTl"5uperior part of the
-fr-Osolacrirnal duct
\--_+
]j
{J
c
t{
1r\
"..it{ntr \olr\
>v5
?\rl )v --,
;rY <(\-
*^J fl}1trav ;r/4': "
t
t*f Y,
'i"r*
r\'(
\

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‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

• 1. Epidermis, a superficial cellular layer,

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

• Cardiac striated muscle

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

•Collections of neurons situated deeply

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

• The skull bones are made up of external and internal

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

The interior of the base of the skull is divided into

‫نظام المحاضرات االلكتروني‬

The anterior cranial fossa lodges the frontal lobes of

‫نظام المحاضرات االلكتروني‬

• The posterior cranial fossa is deep and

‫نظام المحاضرات االلكتروني‬

The middle cranial fossa consists of a small median

‫نظام المحاضرات االلكتروني‬

The structures of the central nervous system

‫نظام المحاضرات االلكتروني‬

• The brain is that part of the central nervous system

• The ridges present on the surface of the cortex are

‫نظام المحاضرات االلكتروني‬

The frontal lobe is situated in front of the central

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

The brain has four fluid filled spaces that

‫نظام المحاضرات االلكتروني‬

• Arteries of the Brain

• The brain is supplied by the two internal carotid and

‫نظام المحاضرات االلكتروني‬

• The veins of the brain have no muscular tissue in

‫نظام المحاضرات االلكتروني‬

Cranial nerves are nerves that

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

• Skin: thin, except in the occipital region.

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

‫نظام المحاضرات االلكتروني‬

‫مدرس المادة‪ :‬د‪ .‬عباس فضال حمادي‬

—1- The heart:

— 1-1-1-The atrial functions:

— 1- primarily as reservoirs, where the blood returning from veins

— 2- contraction of the atria forces blood into the ventricles to

— 1-3-1- atrioventricular valves:

— Each ventricle contains cone-shaped muscular pillars called

— 1-3-2- aortic and pulmonary semilunar valves: each valve consists

— A-The connective tissue of the heart include abundant collagen

— 1- provide support for the cardiac muscle fibers, blood vessels,

— 2- add strength and prevent overexpansion of the heart.

— 3- help the heart to return to normal shape after contraction.

— 1- provide a solid support for the valves.