Anatomy I_Trunk_2019

[1-22]

Wanna 5??

seewhy_724 피,땀,눈물 by
SeewhY_724 Lee, Chang Yong (C.Y)
T 1-2
Tuesday, May 26, 2020 4:24 AM

1. The vertebral column: gross anatomy, syndesmology and X-ray anatomy.

2. Functional anatomy of the atlantooccipital and atlantoaxial joints.

Atlantoocciptal joint
It is paired joint b/w the atlas and occipital bone
• Joint type
ü synovial joint- ellipsoidal
• Articulation surface
ü B/w 1. condyle of the occipital bone and
2. superior articular process of the atlas
• Ligaments & Remarks
There is capsule attached to circumferences of the articular surfaces
1. anterior atlantooccipital membrane
2. posterior atlantooccipital membrane
• Movement
1. Anteflexion
2. Retroflexion
§ Fexion & Extension in the Sagittal axis,
§ Ordinary forward and backward nodding of the head)
Atlantoaxial Joints (2 types) : Median Atlantoaxial Joints &Lateral Atlantoaxial Joints
1. Median Atlantoaxial Joints (1st type)
It is unpaired joint b/w the atlas and axias
§ Joint type
ü Pivot joint
§ Articulation surface
ü b/w the atlas and axis in the midline
ü b/w the front dens of the axis + Ant. & Post. Surf. of anterior arch of the atlas
§ 6 ligaments
1. Apical lig of dense
2. Tectorial membrane
3. Longitudinal bands
4. Alar ligaments
5. Cruciate ligament
6. Transverse Lig of atlas
§ Movements
ü rotation of the atlas around the dens in each direction (30 Degree)
2. Lateral Atlantoaxial Joints (2nd Type)
It is paired joint b/w the atlas and axial
§ Articular surface
ü B/w 1. inferior articular facet of the atlas
2. superior articular facet of the axis
ü Paired lateral articulation b/w the atlas and axis
§ Joint type
ü Plane Joint
§ Remarks
ü There is cavity
superior articular facet of the axis
T 3-4
Tuesday, May 26, 2020 4:30 AM

3. The bones and joints of the thorax. The movements of respiration.

Bones of the Thorax

1. Thoracic vertebrae (12) / Kyphosis
ü Heart shaped body
ü Small & round Vertebral Foramen
ü Inferior Superiorly faced Spinous Process
2. 12 pairs of ribs
(1) True (1-7)
ü Attached by cartilage directly to the sternum
(2) False (8-12)
ü Connected by cartilage to the ribs directly above
(3) Floating (11-12)
ü Not connected to sternum
§ Compoment of Rib
(1) Head :
ü Articulate with the vertebral body (costal facet)
(2) Tubercle of rib
ü Articulates with the transverse process
(3) Costal Groove
ü A groove on the caudal margin of the dorsal surface of a rib
ü Transmits the intercostal vein, artery and nerve
(4) 1st rib
ü has Scalene tubercle
- the insertion of the scalenus anterior
ü has groove for subclavian artery and vein
ü No crest on its head
(5) 2nd rib
ü Tuberosity for serratus anterior
- The origin of one of the digitations of the serratus anterior
3. Costal Cartilage
ü Cartilaginous extension on the ventral end of the ribs
ü The costal cartilage of the true ribs articulates with the sternum
ü The costal cartilages of the false ribs articulate with the next rib above
ü It is not present in floating ribs
4. Sternum
(1) Manubrium
ü Jugular Notch (Palpable)
ü Clavicular Notch
- Interclavicular Lig.
ü 1st Costal Notch
- Facet for 1st rib (Synchondrosis: it is AmphiArthrosis-> cartilagenous Joint)
ü Sternal angle (T4-T5) (angle of louis)
(2) Body of sternum
ü Starting from 2nd rib, it contains costal notches till 7th rib
(3) Xiphoid process
ü A process of variable length and shape
ü Can be bifurcated and may be partially of fully composed of cartilage

Thorax: Joint (8)

1. Costovertebral Joint (synovial Plane jont)
ü B/w Head of Rib + Costal Facet in Verbetral Body
2. CostoTransverse Joint (Synchondrosis)
ü B/w 1. Tubercle of Rib
2. Transverse Costal Facet
ü Costotransverse Lig (Sup. & Lat.)
ü Accessory Lig
3. SternoCostal / SternoChondral Joint (Synovial Plane Joint)
ü B/w 1. 2nd to 7th rib
2. Costal notches of sternum
ü Small sliding movement
4. Synchondrosis of first rib (Hyaline Cartilage)
ü B/w 1st Sternal End of rib + 1st notch of Sternum
ü No Movement
5. Costochondral Joint (Synchondrosis)
ü B/w Sternal End of rib (2-12) + lateral edge of the costal cartilage
ü No Movement
6. Interchondral Joint (Synovial Plane Joint)
ü B/w Costal Cartilages of 6-10th Rib (9th-10th: Fibrous joint)
ü Samll sliding movement
ü Lat. & Med. Interchondral Lig
7. XiphiSternal joint Symphysis
ü B/w Inf. Margin of Sternum body + Sup. Margin of Xyphoid
ü Ossification is frequent
8. manubriosternal Symphysis (True Symphysis)
ü B/w Sup. Margin of Sternum Body + Inf. Margin of Manubrum of Sternum

Movements of Thorax
1. Ribs expand and contract the thorax
ü Producing the inspiration and expiration movements of breathing
ü Through costovertebral joints and sternocostal joints
2. In inspiration
ü External Intercostal Musc. contract
ü Diaphragm contracts and becomes flattened
3. In expiration
ü Internal Intercostal Musc. contract while the external intercostals are relaxed
ü Diaphragm is also relaxed and takes up its original dome shape

Thorax
compoents
1. Thoracic cage
ü Bordered by the ribs / sternum / thoracic vertebral column
2. Superior thoracic aperture
ü Thoracic inlet
3. Inferior thoracic aperture
ü Thoracic outlet
4. Right and left costal margin
ü Forms The costal arches

4. The diaphragm
Diaphragm
§ Intro
ü Dom-shaped MuscularTendinous Sheath
ü Forms a horizontal septum b/w the thoracic and abdominal cavity
ü 3 origins -> All intert to Central Tendon Insertion
§ Parts (3 muscular parts)
1. Lumbar part
ü Arise from Med. and Lat. Arcuate Lig
ü Transmit 2 sympathetic trunk
2. Costal part
ü Arise from 6th rib merges with Transverse Abdominis muscle
3. Sternal part
ü Arise from Xiphoid Process
ü Connected with central fibrous tendon
ü Transmit Sup. Epigastric Argery and Vein
§ Innervation
1. Motor Innervation
ü Phrenic Nerve (C3-C5)from cervical plexus (4th cervical segment)
2. Seonsory Innervation at Central Teninous Part
ü Phrenic Nerve
3. Peripheral Muscular Portion
ü Intercostal Nerve (6th to 11th)
§ Blood Supply
1. Vessels from Lower Thoracic Aorta + Upper part of abdominal Aota
ü Superior Phrenic Artery
ü Inferior Phrenic Artery
2. Vessels from Internal Thoracic Artery from (Subclavian Artery)
ü MusculoPhrenic Artery
ü PericadiacoPhrenic Artery
§ Special region
1. Sternocostal triangle (Morgagni)
ü Small zones lying b/w costal & sternal attachment of diaphragm
ü Transmit Sup. Epigastric Argery and Vein
2. Lumbocostal Triangle (Bochdalek)
ü Space b/w the costal and lumbar parts of the diaphragm
§ Apertures
1. Vena Caval hiatus (T8)
ü Inferior Vena Cava
ü Phrenic nerve (occasionally)
2. Esophageal hiatus (T10)_Right Crus
ü Esophagus / esophageal branch of left gastric artery & vein
ü Vagus nerve (Right & Left)
3. Aortic Hiatus (T12)
ü Transmits the descending aorta
ü Thoracic duct
ü Azygos vein
ü Greater Splanchnic N. (occasionally)
§ Function of the diaphragm
1. Main muscle of inspiration
2. Important postural muscle
3. Separates the thoracic cavity from the abdominal cavity
§ Diaphram Movement
1. Inspiration
ü External Intercostal Musc. contract
ü Diaphragm contracts and becomes flattened
2. Expiration
ü Internal Intercostal Musc. contract while the external intercostals are relaxed
ü Diaphragm is also relaxed and takes up its original dome shape
T5
Tuesday, May 26, 2020 4:32 AM

5. The muscles and layers of the thoracic wall. The intercostal space.

Muscles of the Thoracic Wall

§ 10 Muscle groups
1. External Intercostals (11 pairs) ///
ü Run InferioAnteriorly from the rib above to the rib below,
ü Continuous with External Oblique of the abdomen
ü Actions: Inspiration Musc. Elevates the ribs, increasing the thoracic volume.
ü Innervation: Intercostal nerves (T1-T11)
2. Internal Intercostals \\
ü flat muscles lie deep to the external intercostals
ü Run InferoPosteriorly from the rib above to the one below
ü Continuous with the Internal Oblique Muscle of the abdominal wall.
ü Actions: Expiration Musc. Depressing the ribcage, and the interchondral part elevates the ribs.
ü Innervation: Intercostal nerves (T1-T11).
3. Innermost Intercostals ||
ü Deepest Musc. of the intercostal muscles
ü Separated from the internal intercostals by the intercostal neurovascular bundle
ü Found in the most lateral portion of the intercostal spaces.
ü Actions: Expiration Musc. / Depressing the ribcage, and the interchondral part elevates the ribs.
ü Innervation: Intercostal nerves (T1-T11)
4. Transversus Thoracis Musc.
ü Give continuation to transversus abdominis inferiorly
ü Actions: Weakly depress the ribs
ü Innervation: Intercostal nerves (T1-T11)
5. Subcostalis Musc
ü Inferior portion of the thoracic wall.
ü comprise of thin slips of muscle
ü he direction of the fibres parallels that of the innermost intercostal.
ü Actions: depress the ribs
ü Innervation: Intercostal nerves (T1-T11)
6. Diapragm
7. Pectorales
ü Actions: Flextion of humeres
ü Innervation: Med. / Lat. Perctoral Nerve
8. Subclavius
ü Thin spindle shape
ü Below clavicle
ü Action: stabilizes clavicle
ü Innervation: subclavian Nerve
9. Serratus Anterior
ü Thin spindle shape
ü Below clavicle
ü Action: stabilizes clavicle
ü Innervation: subclavian Nerve
10. Levatores costarum
ü From Transvere process (C7-T11) + Sup. Surf. of Rib
ü Action: assist in elavation of thoracic rib
ü Insertion: Intercostal nerves (T1-T11)

Layers of the Thoracic Wall

1. Skin & subcutaneous layer
2. Supf. Pectoral fasica
ü Covers the mammary gland
3. Deep Pectoral fascia (encloses the pectoralis major
4. ClaviPectoral fascia
ü located under the pectoralis major
ü spreads between the clavicle, coracoid process, costal cartilages and pectoralis minor
ü encloses the pectoralis minor and subclavius
5. Thoracic fascia
ü the superficial fascia of all ribs and Intercostal spaces
6. Intercostal space
7. endothoracic fascia
ü Forms the suprapleural membrane
8. Parietal pleura

Intercostal Space
§ Intro
1. Anatomical space b/w 2 ribs
2. There are total 11 intercostal spaces
§ 3 principal layers
A. External intercostal muscles (inhalation)
B. Internal intercostal muscle (expiration)
C. Innermost intercostal muscle
§ Content of intercostal space
1. Intercostal Veins
2. Intercostal Arteries
3. Intercostal Nerves
4. Intercostal Lymph nodes
T 6-8
Tuesday, May 26, 2020 5:35 AM

6. The muscles of the posterior abdominal wall and the deep muscles of the back.

Post. Abdominal Musc

§ 5 Post. Muscle
1. Quadratus Lumbarum Musc.
§ Subcostal N.
§ Flexion Vertebral Column
§ Flexion & External Rotation of Hip Joint
2 & 3. Iliopsoas Musc.
§ Lumbar Plexus
§ Flexion & Extension of Hip Joint
4. Iliacus (from Iliopsoas)
§ Femoral N.
§ Flex Vertebral Column
5. Diaphragm
(1) Motor Innervation
Phrenic Nerve (C3-C5)from cervical plexus (4th cervical segment)
(2) Seonsory Innervation at Central Teninous Part
Phrenic Nerve
(3) Peripheral Muscular Portion
Intercostal Nerve (6th to 11th)
(1) Inspiration Movement
ü External Intercostal Musc. contract
ü Diaphragm contracts and becomes flattened
(2) Expiration Movement
ü Internal Intercostal Musc. contract while the external
intercostals are relaxed
ü Diaphragm is also relaxed and takes up its original dome
shape

Deep Back Musc

§ Introduction
1. Extended from Sacrum to Base of Skull
§ Movement
1. Control Posture
2. Movement of Vertebral Column

§ 3 Muscle Group
1. Erector Spinalis Muscle (Cervical N.)
(1) Iliocostalis Musc. (Lat)
(2) Longisimus Musc.
(3) Spinalis Musc. (Med)
2. Transversospinalis Musc. (Occipital N.)
(1) Semi Spinalis Musc. (Supf)
(2) Multifidus Musc.
(3) Rotators (Deep)
3. Deepest Musc. (Dorsal Rami of Spinal N.)
(1) Interspinalis Musc. (Lat)
(2) Intertransversus Musc. (Med)

7. The surface projections of thoracic organs. Topography of the thoracic cavity, the divisions of the mediastinum

8. The anatomy, blood supply and lymphatic drainage of the female breast.

The breasts
§ located on
1. Ant. Thoracic wall (pectoral region)
2. Extends horizontally from the Lat. Border of Sternum to Mid-axillary line
3. Vertically, it spans b/w the 2nd and 6th intercostal cartilages
4. Lies superficially to the pectoralis major and serratus anterior muscles
§ Females breasts contain
1. mammary gland
- accessory gland of the female reproductive system
- Lactation

§ Brest composed of 2 regions

1. Papilla mammaria (nipple)
- Rich in nerve endings
- Open 15-20 lactiferous duct
2. Areola Mammae (pigmented area)
- Small, rounded elevations that
mark location of Sebaceous Gland (Gland of Montegorney)

§ Blood supply
1. Internal thoracic Artery
2. Intercostal Artery
3. Lateral Thoracic Artery
4. Pectoral Ramus of Thoracoacromial Artery
5. Veins

§ Nerve Supply
1. Supra clavicular Nerve
2. 2nd-5th Intercostal Nerves

§ Lymph Drainage of Breast

1. Axillary Lymph Node (Axillary Fossa)
5 groups
- Lat.
- Subscapular
- Pectoral
- Central
- Apical
2. InterPectoral Lymph Nodes (behind Pectoralis Maj.)
- Supra Clavicular Lymph nodes
- Infra Clavicular Lymph nodes
3. Retro/Para Sternal Lymph nodes
T 9-10
Tuesday, May 26, 2020 1:10 PM

9. The definition and structures of the superior mediastinum. Topography and developmental stages of the thymus.

Development
1. The thymus appears two flask-shaped endotherm diverticula,

2. extend lateralward and backward into the surrounding mesoderm in front of the ventral aortæ.

3. they meet and become joined to one another by connective tissue,

ü but there is never any fusion of the thymus tissue proper.
4. The pharyngeal opening of each diverticulum is soon obliterated,
ü but the neck of the flask persists for some time as a cellular cord.

5. buds of cells are formed, which become surrounded by the invading mesoderm.

6. lymphoid cells make their appearance, and are agregated to form lymphoid follicles.

7. Additional portions of thymus tissue are sometimes developed from the fourth branchial pouches.

8. Thymus continues to grow until the time of puberty and then begins to atrophy.

10. Upper airways: functional anatomy of the nasal cavity and paranasal sinuses. (without structures of the skull)
T 11-12
Tuesday, May 26, 2020 1:35 PM

11. The cartilages, ligaments and cavity of the larynx. The anatomy of the hyoid bone. Laryngoscopic image.

Hyoid Bone
§ Situated
1. At root of tongue
2. In front of neck
3. b/w lower jaw
Largest Cartilage of the Larynx (voice box)

12. The muscles, blood supply and innervation of the larynx. The histology of the larynx.
T 13-14
Tuesday, May 26, 2020 1:40 PM

13. The anatomy of the trachea. Organization of the bronchial system. The histological arrangement of the trachea, the bronchi and bronchioli.

14. Development of the respiratory system.

T 15
Tuesday, May 26, 2020 2:08 PM

15. The gross anatomy and histology of the lungs, the bronchopulmonary segments and pleura. The innervation of the pleura.
T 16-17
Tuesday, May 26, 2020 2:10 PM

16. The blood supply, innervation and lymphatic drainage of the lungs.

17. The anatomy of the pulmonary circulation, topography and branches of the pulmonary trunk.
T 18-20
Tuesday, May 26, 2020 2:55 PM

18. The tributaries of the superior vena cava. The azygos-hemiazygos system. The lymphatic drainage of the thoracic cavity.

19. The topography of the vagus nerve in the thoracic cavity. The anatomy and function of the phrenic nerve.

20. Organization of the thoracic part of the sympathetic chain.

T 21-22
Tuesday, May 26, 2020 3:04 PM

21. General embryology I: fertilization, implantation, cleavage, gastrulation, development of the neuroectoderm. Differentiation of intraembryonic mesoderm.

# Fertilization
1. The union of a human egg + sperm
2. Location: Ampulla of the fallopian tube
3. After egg & sperm combine (Fertilization) -> egg becomes Zygote
4. The zygote then undergoes Cleavage (mitosis)
for 6-10 days (prenatal development)

>> Steps of fertilization <<

1. Sperm Capacitation
2. Penetration through corona radiata
3. Acrosome reaction
4. Penetration through zona pellucida
5. Membrane fusion
6. Zona reaction
7. Male and female ProNucleus in the cell
8. Two ProNuclei unite
9. Zygote (diploid cell)

# Implantation of the embryo

1. Implantation is the stage of pregnancy
2. fertilized egg adheres to the wall of the uterus
- The conceptus: BlastoCyst
- By this adhesion, the fetus receives oxygen and nutrients from the mother
- Happens after 9 days (6-12 days) after ovulation
3. Implantation window (Implantation is well happened)
- Reception-ready phase of the uterus;
- lasts about 4 days

>>STEPS OF IMPLANTATION<<
1. Hatching from Zona Pellucida
2. Syncytio Trophoblast attaches to the Epithelium of Endometirum
3. Molecular connections develop
4. Syncytio Trophoblast releases Apoptotic factors -> Endometrial cell Death
5. The embryo sinks into the Endometrium
6. Endometrium Closes above the Embryo

# Gastrulation (개스트 룰레이션)

1. It is a phase early in the embryonic development
- Single-layered blastula -> multilayered structure ( Gastrula )
- Three germ layers
(1) Ectoderm
▪ epidermis, nervous system, neural crest in vertebrates
(2) Mesoderm
▪ muscle, bone, connective tissue
(3) Endoderm
▪ epithelium, digestive system, respiratory system
2. After cleavage / before Organogenesis : internal organ development

# Development of the Neuroendoderm

§ Neurulation is the formation of the neural tube from the Ectoderm of the Embryo
§ Has 2 types of Neurulation
(1) The primary neurulation
the neural plate creases inward until the edges come in contact and fuse.
(2) The secondary neurulation
the tube forms by hollowing out of the interior of a solid precursor

# Differentiation of the Intra Embryonic Mesoderm

§ Intra-embryonic mesoderm on each side of notochord, divides into
1. Paraxial Mesoderm
on both sides of notochord
2. Intermediate Mesoderm
middle part of the mesoderm
3. Lateral plate Mesoderm
lateral part which communicates with that of the opposite side in front Prochordal plate

22. General embryology II: development of the amnion, yolk sacs, extraembryonic mesoderm. Formation of the placenta.

# Development of the amnion

1. It is Membrane that closely covers the embryo when first formed.
2. In 8th day after fertilization -> develp as a closed cavity in the Embryoblast
3. This cavity is roofed in by single layer of Flattened cells (AminoBlast)
& its floor consists of the Epibllast of the Embryonic Disc
4. Outside the Amniotic exoderm is a Thin layer of ExtraEmbryonic Mesoderm

# Development of yolk sac

1. Originates in the ExtraEmbryonic mesoderm
2. Forms the outer layer of the yolk sac membrane.
- It is a highly VasCularized layer, and gives rise to blood islands which are the site
of extraembryonic hematopoiesis.
3. Additionally, primordial germ cells can be found in this layer of the yolk sac.
4. Essential in Transfer of Nutrients to Embryo (2,3 weeks)

>>2Stages<<
1. Primary Yolk sac (on day 10)
§ Has wall compsed of only of ExtraEmbryonic Mesoderm Cells
§ Replaces cavity of Blastocyst after Heuser Membrane formation
§ Formed by Flat Cells Originated from HypoBlast Cells (9-10days)
2. Secondary Yolk sac (on day 13)
§ Has 2 layered wall lined by the Endoderm (proliferated from ebryonic disc)

# Development of Placenta
1. It develop from implantation of the blastocyst into the maternal endometrium.
2. The outer layer of the Blastocyst becomes the Trophoblast
- forms the outer layer of the placenta
- outer layer is divided into two layers
(1) Underlying Cytotro Phoblast layer
(2) Overlying Syncytiotro Phoblast layer
- Syncytio Trophoblast is a multinucleated continuous cell layer that covers the
surface of the placenta.
- It forms as a result of differentiation and fusion of the underlying cytotrophoblast cells
- The syncytiotrophoblast, thereby contributes to the barrier function of the placenta.
3. The placenta grows throughout pregnancy.
4. Development of the maternal blood supply to the placenta is complete by the
end of the first Trimester of pregnancy (approximately 12–13 weeks).

# Differentiation of the extraembryonic mesoderm

§ ExtraEmbryonic Coelom divides into ExtraEmbyonic Mesoderm to
(1) Extra Embryonic Somato Pleuric Mesoderm
- Lines the Trophoblast and Covers the Amnion
- Contstitute the Chorion
(2) Exra Embryonic Splanchno Pleuric Mesoderm
- Covers the Yolk Sac