Anatomy Society

Guide to
Year 1

By Jonnie Gibson
Disclaimer: This guide is not affiliated
with Birmingham Medical School. It is
intended to supplement and aid
students learning and ease the
transition from sixth form to university
education. Whilst all efforts are to
ensure that the information provided is
correct, some errors may remain.

1
Contents
How to Study Anatomy 3

MTM
Anatomical terminology 6

Epithelial cells 8

Connective tissue 9

Skin 12

CEP
Thyroid gland 13

Parathyroid gland 15

Pituitary gland 16

Pancreas 18

Adrenal gland 19

NAS
Structure of nervous tissue 20

Somatic nervous system 22

2
Basic brain topography 24

Cranial nerves 26

Basic topography of spinal cord and 28

spinal nerves

Autonomic nervous system 30

Regional Anatomy
Anatomical Spaces 31

Concept of the body wall 31

Thoracic Wall 32

Vertebral Column 34

Mammary gland 36

Lungs and Pleura 38

Heart and Mediastinum 40

About the author 44

3
How to Study Anatomy
Like with every subject, there is no one way to study anatomy, you
have to find your way. Often a combination of different methods
is the best approach. In this short introduction to studying
anatomy, we will outline a few approaches.

When learning anatomy there are a few useful resources. For

those who are a fan of textbooks, Grey’s Anatomy for Students is
amazing. Personally, if you are able to, I would recommend
buying a copy as I much prefer to get away from screens where I
can but the version on Clinical Key works fine. This is also very
useful in learning how anatomists talk about anatomy which helps
when answering questions.

There are a few apps/tools which the University recommends

which work well as well. Clinical Key is essentially a large textbook
bank which includes books on anatomy.

Complete anatomy is a fantastic way to see the different

relationships of structures. With this app, I wouldn’t worry about all
the information on the side as it is just overwhelming, intimidating
and unnecessary. Stick to the information in your anatomy
practicals and in this booklet and use the other tools to help with
understanding.

Although there is the opportunity to use the Anatomage tables,

be warned: they are the slowest things known to planet Earth!

Perhaps the most common way is resorting to a medical student’s

best friend: Anki. The flashcard app has a bit of a reputation
amongst medics but for good reason: it works! Try to vary your
flashcards otherwise, very shortly will it become tedious. A key
feature when learning anatomy is your spatial awareness and
utilising Anki’s image occlusion add-on is amazing for this. To

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download this add on: 1374772155. In case you couldn’t tell, I am
a big Anki fan.

For the more creative, you can’t get much better than drawing
things out. It really tests your knowledge and builds an
understanding but is quite time-consuming. For the less artistic
(myself included!) simplify things into simple shapes such as
triangles and circles. Use it to try and gain an understanding of
where structures lie.

Lastly, a few website recommendations. I am going to mention

the controversial Teach Me Anatomy. I know students are told to
avoid it like the plague due to incorrect information. Granted,
there may be the very, very, very, rare error, however, it is so
simple and well explained that I would still use it. It is at this point
that I must reiterate that this is just from experience and we are not
affiliated to the Medical School.

Other useful websites include KenHub and Sam Webster on

YouTube.

5
MTM
Anatomical Terminology
When practising medicine, it is important that we can describe the
location of something to another professional without ambiguity. If
a patient says their arms hurt near their hands it may lead to a
different diagnosis to their arm hurting near their shoulder. If
someone says they have pain in their chest, how do we know
where the chest ends and begins? How do we explain this? We
use common terminology.

The first part is to determine the basic position – what we call the
anatomical position. This is when you are standing up, looking
forward with your palms facing the front.

The second part is dividing the body into regions.

Head Cephalic

Neck Cervical

Chest Thoracic

Upper arm Brachial

Forearm Antebrachial

Wrist Carpal

Hand Manual

Belly Abdominal

Hips Pelvic

Pubic Pubic

Groin Inguinal

6
Bottom Gluteal
We then have planes. You will come across these a lot in
textbooks and imaging as they show which way the cross-section
has been taken.

Sagittal Plane – this divides the

body into left and right.

Coronal Plane – this divides the

body into front and back.

Transverse Plane – this divides the

body into up and down.

Lastly, we have directional terms. These explain where things are in

relation to each other.

Medial – closer to the midline

Lateral – further from the midline

Superior – Closer to the head

Inferior – Further from the head.

Anterior – Closer to the front

Posterior – Closer to the back

Superficial – Closer to the body’s surface

Deep – Further from the body’s surface (further inside the body)

Proximal – Closer to the start of the limb

Distal – Further from the start of the limb

TOP TIP: Do not worry about learning these fluently straight away.
Instead, when talking with peers try to drop the words in
conversation. You will easily learn them in time for your first exams!

7
Epithelial Tissue
There are 4 basic types of tissue: muscle, connective, nervous and
epithelial tissue. Epithelial tissue is the lining tissue. It lines your skin
and the passages in your body. This chapter will look at the basics
of histology and epithelial tissue in a bit more detail.

Histology – The study of things under a microscope.

When preparing a slide there are certain steps that must be taken.

- Preparation – includes fixation to prevent degradation. In an

electron microscope, this is osmium tetroxide. This then gets
embedded in paraffin and cut into thin strips by a
microtome.
- Staining – this increases the contrast of organelles. The most
common stain is H&E (haematoxylin and eosin.)

There are 2 main types of epithelia – covering and glandular.

Covering epithelia line cavities and cover surfaces.

Glandular epithelia are secretory.

There is a certain nomenclature for epithelia to classify the cells.

Layers

Simple – one layer Stratified – many layers

8
Shape

Cuboidal Columnar Squamous

Odd ones out

Pseudostratified – This looks like it is stratified but the

apical cells are also attached to the basement
membrane. It looks like it is stratified but it is still only
one cell thick.

Transitional Epithelia – also known as urothelium. This lines the

bladder. The cell type changes across the tissue and can be
stretched to accommodate changes in the bladder.

Epithelia are attached to a basement

membrane – a sheet that holds the tissue
together. The basement membrane is
stained using PAS. The cells are attached to
the basement membrane by junctions
called hemidesmosomes. Desmosomes
attach neighbouring cells.

Connective Tissue
The next tissue to look at is connective tissue.

Connective tissue consists of two components. Extracellular matrix

and cells. The extracellular matrix is made of ground substance (a
jelly-like substance) and fibres as a support network.

9
There are 2 main types of connective tissue cells: fixed and
wandering. The fixed cells are adipocytes (fat cells) and
fibroblasts.

Fibroblasts

With cells, the term ‘blast’ means it makes things. Fibroblasts

therefore make extracellular matrix and ground substances.

Fibroblasts are spindle-shaped with a cigar-shaped nucleus.

Fibroblast is the term given to the active ‘making’ cell, fibrocyte is
the inactive cell.

Wondering Connective Tissue

Cell Appearance Function

Plasma Cells Oval nucleus Produce antibodies

Eosinophils 2 lobed nuclei Produce

eosinophilic droplets

Neutrophils Multilobed nuclei Phagocytosis

Lymphocytes Round nuclei Small cytoplasm

Mast Cells Basophilic Produce histamine

Ground Substance

Ground substance is an amorphous substance (it doesn’t have a

fixed shape.) It has a GAG (glycosaminoglycan) backbone and
contains many glycoproteins such as fibronectin. There are also
carbohydrates in ground substance with the most common being
chondroitin sulphates.

Elastin

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Another common protein found as part of connective tissue is
elastin. This is a protein that allows elasticity (the ability to return to
its original shape after being stretched NOT the ability for it to be
stretched.)

Elastin is stained using a silver-based stain called Elastin van

Gieson which stains the elastin fibres black.

The elastin fibres are produced by fibroblasts as a precursor called

tropoelastin. The tropoelastin when paired with a fibrillin
glycoprotein scaffold polymerises.

Collagen

The basic structure of collagen is secreted as procollagen by

fibroblasts which is converted to tropocollagen and then to
collagen. It has a triple alpha helix structure which is thick and
unbranched. Collagen is stained blue by Mason’s Trichrome stain.

There are 28 forms of collagen: the first 4 types are the most
important to learn about.

Type What it makes Condition if

damaged

I Bone/skin/tendons Osteogenesis
imperfecta (brittle
bones)

II Cartilage Chondrodysplasia

III Reticular Ehlers Danlos

IV Basement Marfan’s Syndrome

membrane

We can remember what is produced by each of the types of

collagens by the mnemonic: Be So Totally Cool Read Books.

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The last thing we need to look at with connective tissue is how we
classify it. The first thing to look at is whether it is dense or loose. If
the tissue is loose, there is a lot of ground substance and less fibres.
There is less ground substance and more fibres in dense
connective tissue.

Dense connective tissue can further be classified as either regular

or irregular. This describes the orientation of the tissues.

Skin
When we combine both the epithelial tissue we talked about and
the connective tissue, we can look at the skin in a bit more detail.

Skin has 3 main layers: epidermis, dermis, and hypodermis.

Epidermis

This is that tough layer you can feel on your skin. The epidermis is
made of keratinised stratified squamous epithelia. The keratin is
produced by keratinocytes. When we break down the name, we
essentially have many squamous epithelial cells that have been
keratinised. The epidermis has different layers: stratum corneum,
stratum lucidum, stratum granulosum, stratum spinosum and
stratum basale.

Stratum corneum

This is that tough layer of keratinised squamous cells.

Stratum lucidum

This is only present in thick skin.

Stratum Granulosum

This is 3-5 cell layers thick. Here we see the transition from cuboidal
cells to squamous epithelial cells. The cells also start to keratinise so
we can see the keratohyalin granules.

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Stratum spinosum

This is 8-10 cell layers thick and is connected by desmosomes.

Cytokeratin is produced at this level.

Stratum basale

Cuboidal cells are attached to the basement membrane. It is only

at the basement membrane where mitosis happens to replenish
the above layers. It is at this level where we find melanocytes (UV
protection) and Merkel cells (free nerve endings.)

Dermis

The dermis is split into two sections: the papillary layer and the
reticular layer. In the dermis, there is a high level of elastin
throughout the layer. It is also in the dermis where you see the first
blood vessels. There are two layers of arteries and veins. These
form a ball and complex called an anastomosis. It is this
anastomosis which is important in thermoregulation.

Hair and Sweat Glands

Hairs develop from hair follicles which are invaginations (inwards

folds) of the epidermis. The hair follicles are attached to erector
pilli muscles which can make your hair stand up! This muscle is
innervated by the sympathetic nervous system.

CEP
Thyroid Gland
The thyroid gland is made of two lobes joined together by a sheet
called the isthmus.

Gross Location

13
The thyroid gland is at the front of
your neck and sits just anterior to
your trachea. There are also 2
pairs of parathyroid glands found
on the posterior surface of the
thyroid glands.

Embryology

The thyroid gland forms at the back of the tongue called the
foramen caecum and migrates inferiorly and anteriorly via the
thyroglossal duct to the location of the thyroid gland. Once the
thyroid gland has fully descended, the thyroglossal duct is broken
down. This is important clinically as if the thyroid gland does not
fully descend it can be found in another location. This is also
important as part of the thyroid gland can be left along the tract.

Histology

The thyroid gland exists in follicles. These are essentially cells which
create a space called a colloid. The follicles allow transport of
iodine in high concentrations to make the thyroid hormones
without damaging the other tissues.

Function

The main function of the thyroid gland is to produce 2 hormones.

Thyroxine (T4) and tri-iodothreonine (T3.) A third hormone is
produced called calcitonin which lowers calcium. This is produced
by C-cells.

Blood supply

The thyroid gland is mainly supplied

by the superior and inferior thyroid
arteries. The superior thyroid artery is
formed from the external carotid

14
artery. The inferior thyroid artery is formed from the thyrocervical
trunk which is a branch from the subclavian artery.

Some people have a third artery called the thyroid ima artery.

The venous drainage of the thyroid gland is formed from a

superior, middle and inferior vein which forms a venous plexus. This
plexus then drains into the brachiocephalic vein.

Innervation

The thyroid gland is innervated by the sympathetic trunk (see NAS)

Parathyroid Gland
Location

The parathyroid gland is found in 2

pairs on the posterior surface of the
thyroid gland. It is separated from the
thyroid gland by the thyroid capsule.

Embryology

The superior parathyroid gland

develops from the 4th pharyngeal
pouch. The inferior parathyroid gland
develops from the 3rd pharyngeal
pouch.

Histology

Parathyroid glands have a main chief or principal cell.

Blood Supply

The parathyroid gland receives its blood supply from the inferior
thyroid arteries and drains into the thyroid plexus.

Function

15
The parathyroid gland produces PTH (parathyroid hormone) which
is responsible for increasing the calcium levels in the blood.

Pituitary Gland
The pituitary is made of both endocrine (secretory epithelial) and
nervous tissue. The two different parts of the pituitary gland are
therefore called adenohypophysis and neurohypophysis
respectively.

Location

The pituitary gland sits in a bony

fossa (space) in the frontal bone
called the sella turcica. Anterior
and inferior to the pituitary gland is
the sphenoid sinus and laterally is
the cavernous sinus. The pituitary
gland also sits in close relation to
the optic nerve. If there is a
pituitary tumour the tumour can
compress the outer parts of the
optic nerve which causes loss of outer vision in both eyes
(bitemporal hemianopsia.)

Embryology

The embryology of the

pituitary gland is commonly
tested in exams and
explains how the gland has
both endocrine and nervous
abilities.

The anterior pituitary gland

starts at the roof of the

16
mouth. Part of this starts to grow upwards and forms the Rathke
cleft. In the diencephalon (brain) an invagination starts to form
called the craniopharyngeal duct. These two growths grow
towards each other and join together. Where the anterior pituitary
gland had grown upwards, seals and reforms the roof of the
mouth.

Histology

The anterior pituitary gland contains many blood vessels and

endocrine cells. The endocrine cells are named after what they
produce.

Gonadotrophs FSH and LH

Somatotrophs GH

Lactotrophs Prolactin

Thyrotrophs TSH

Corticotrophs ACTH

The posterior pituitary gland contains neurosecretory cells and

pituicytes.

Function

The anterior pituitary gland

(adenohypophysis) is responsible for
TSH, ACTH, GH, FSH, LH and prolactin
release. The posterior pituitary gland
(neurohypophysis) is responsible for
ADH and oxytocin release.

Blood Supply

17
The blood supply of the pituitary gland is complicated due to the
two different parts of the gland. First, we will look at the anterior
pituitary gland.

The arterial blood enters into the hypothalamus. At this point, the
hypothalamic hormones enter the bloodstream and can trigger
the release of the anterior pituitary hormones.

With the posterior pituitary gland, there is no need for the

transmission of hypothalamic hormones as the signals are nervous.
Therefore, the blood supply is solely to the posterior pituitary gland.

Pancreas
The Pancreas has 5 main parts: head, uncinate process, neck,
body, and tail.

Location

Besides the tail, the pancreas is a retroperitoneal organ. It sits

posterior to the stomach and slightly anterior and medial to the
spleen. The pancreas is found at the transpyloric level (L1.)

Histology

There are three main cell types in the pancreas. There are alpha,
beta and delta cells. The pancreas contains Islets of Langerhans
which are compact spherical
masses of exocrine tissue. In
the Islets of Langerhans, you
will find the 3 productive cells.

Function

Alpha cells produce glucagon

and are on the periphery of
the Islets. Beta cells produce
insulin and are central in the

18
islets. Lastly, the delta cells produce somatostatin which are
dotted throughout the Islets.

Blood supply

At T12 vertebral level, a branch of the aorta forms the coeliac

artery. The coeliac artery has 3 branches, the splenic artery, the
common hepatic artery and the left gastric artery. The splenic
artery supplies the spleen and has three branches which supply
the pancreas. There is also a branch that forms off the common
hepatic artery called the gastroduodenal artery, this further splits
into the pancreaticoduodenal artery. The pancreaticoduodenal
splits and passes anterior and posterior to the head of the
pancreas.

Adrenal Gland
Location

The adrenal gland is a retroperitoneal (posterior abdomen) organ

found at the T11-T12 vertebral level. The adrenal glands sit on the
top of the kidneys and are encased by renal fascia that also
attaches to the diaphragm crura.

Histology

The adrenal glands have three main tissue layers, the capsule, the
cortex, and the medulla. The cortex is the middle layer and is
further divided into three layers.

Zona glomerulosa produces mineralocorticoids.

Zona fasciculata produces glucocorticoids.

Zona reticularis produces androgens.

The medulla is the innermost area and contains chromaffin cells

which secrete adrenaline and noradrenaline.

19
Function

The adrenal glands have a wide range of hormone production

functions. See histology of adrenal glands above for further
information.

Blood supply

There are three main

arteries which supply the
adrenal gland. The superior
adrenal artery arises from
the inferior phrenic arteries.
The middle adrenal gland
artery arises from the
abdominal aorta. The
inferior adrenal artery arises
from the renal arteries.

The venous drainage consists of the right adrenal vein which

drains into the inferior vena cava. The left adrenal vein drains into
the left renal vein.

NAS
Structure of Nervous Tissue
Efferent - is the EFFECTOR so is the motor neurone

Afferent - is the sensory neurone

There are two main classes of nervous tissue: there are neurones
and glia. To simplify, neurones are what you will have learnt so far,
these are your classic nerve cells that carry action potentials. The
glia assist cells which help with the functions of the neurones. They
don’t affect the neural activity but support the neurones.

20
Neurones

The neurone ultra structure required for Year 1 doesn’t get much
harder than A-Level. There are a few key terminology changes,
however. The cytoplasm of a neuron is called the perikaryon. The
cell body of the neurone is called the soma.

Neurones are incredibly active cells and in an exam, you may be

asked to give evidence for this. Neurones contain Nissl bodies,
these are large dense granules of rough endoplasmic reticulum
(RER) and many ribosomes. These indicate that the cell is
producing lots of proteins and is indicative of a high metabolic
activity.

Glia

These are the support cells of the neurones. There are many
different glia that support the neurones.

Schwann Cells

These myelinate cells in the peripheral nervous system. They can

also act as a skeleton framework for redeveloping axons. It is
important to note that one Schwann cell forms around one
segment of an axon which allows a very rapid transmission.

Oligodendrocytes

These are similar to Schwann cells but are found in the CNS. It is
these cells which are attacked and degenerated in multiple
sclerosis. One oligodendrocyte wraps around many axons so
although oligodendrocytes do increase the speed of transmission,
they do not increase the transmission as much as Schwann cells
do.

Astrocytes

21
Astrocytes are named “astro” as their processes are said to give
them a star-like appearance. There are 2 main types of astrocytes.

The first one we will look at is the protoplasmic astrocytes.

Protoplasmic astrocytes contain many shorter processes which are
imperative for the blood-brain barrier.

The other type of astrocyte is the fibrous astrocyte. These have

long processes and move neurones.

Ependymal Cells

These cells have cilia and waft the CSF to aid CSF movement.

Microglia

These are found in the CNS and act in the immune protection of
the CNS.

The last thing to consider when talking about the nervous system is
to consider how they are bundled together to form nerves.

Individual neurones are surrounded by endoneurium. The

endoneurium can contain a few capillaries. Several neurones can
be bundled together and surrounded by perineurium to form
fascicles. Many fascicles can be surrounded by epineurium which
forms the nerves.

Anatomy of the Somatic Nervous System

The somatic nervous system (SNS) is responsible for the conscious

control of our tissues.

The SNS can be further divided into the central and peripheral
nervous system. Here the junction between the two is called
Redlich Obersteiner’s zone. This can simply be defined as the point
Nervous system divided into CNS and PNS.
Cns divided into brain and spinal cord.
Pns divided into sensory and motor 22
Motor divided into somatic and autonomic
Autonomic divided into sympath and parasympath
at which myelination changes from oligodendrocytes in the CNS
to Schwann cells in the PNS.

There are important differences in terminology between central

and peripheral nervous system.

The main difference is that a collection of cell bodies in the CNS is

called a nucleus. In the PNS it is called a ganglion.

Motor neurones

These are multipolar cells. This

means they have many
dendrites that synapse with
many cells. They tend to be
myelinated. The bodies of motor
neurones are found in the ventral
root ganglion. The motor
neurones are further divided into
upper motor neurones and lower motor neurones. This division and
differentiation is important as they present with different clinical
signs.

Sensory neurones

Sensory neurones are

pseudounipolar. They are like a T
junction. The cell body is found in the
dorsal root ganglion and there are
three main levels of myelination:
heavy, light and unmyelinated
(C-fibres.)

23
Basic Brain Topography
The brain as an organ is incredibly complicated and is simplified in
this next chapter.

The first thing to look at is the bones or osteology. This is always a

great place to start as it is relatively simple and allows you to build
a basic framework to which you can add more and more layers.

Layers of the scalp

These can be made into the mnemonic SCALP

Skin

Connective tissue (dense)

Aponeurosis (fascia)

Loose connective tissue

Periosteum (bone)

(Meninges)

Meninges

These are essentially

continuations of the
endoneurium, perineurium and
epineurium in the CNS. They
are called the pia mater,
arachnoid and dura mater
respectively.

They surround the brain but

also continue throughout the spinal cord.

Dura Mater The thickest layer for protection

24
Arachnoid Like a spider’s web, thinner and
vascular.

Pia Mater This is the thinnest layer

Lobes of the cerebellum

Lobe Function Boundaries

Frontal Voluntary Central sulcus,

movements precentral gurus,
lateral fissure

Parietal Proprioception Parieto-occipital

Language sulcus, central
Processing sulcus, postcentral
sulcus.

Temporal Decoding sensory lateral sulcus,

input superior, middle,
Visual memory and and inferior
language temporal gyri
comprehension

Occipital visual processing parieto-occipital

sulcus

Limbic emotions, learning, medial surface of

memory each hemisphere
around corpus
callosum

Insular taste, balance, pain beneath cortex

where temporal,
parietal and frontal
lobes meet

25
Cranial Nerves
The cranial nerves are something you will need to learn, they are a
classic exam question. The main things to learn have been
summarised in the table below. The foramen are the holes in the
skull that the nerves pass through. They are important to learn as a
question may say there has been damage to a particular area,
which nerves are damaged.

It is important to note that the trigeminal nerve (CNV) is divided

further into 3 nerves: maxillary, ophthalmic and mandibular.

Number Name Function Foramen

I Olfactory Smell Cribriform

Plate

II Optic Vision Optic Canal

III Oculomotor Eye muscles Superior

Orbital Fissure
(SOF)

IV Trochlear Superior SOF

oblique
muscles

V1 Opthalmic sensation of SOF

eyes, nasal
cavity and
frontal sinus

V2 Maxillary Upper teeth Foramen

and upper lip Rotundum

V3 Mandibular Lower lip and Foramen

lower teeth Ovale

26
 Motor function
of chewing.

VI Abducens Lateral rectus SOF

muscle

VII Facial Taste from Internal

anterior acoustic
tongue, facial meatus
muscles

VIII Vestibulocochlear balance and Internal

hearing “acoustic
meatus

IX Glossopharyngeal Parotid gland, Jugular

posterior foramen
tongue and
stylopharynge
us muscle

X Vagus Motor Jugular

innervation of foramen
the gut, heart
lungs and
oesophagus

XI Accessory SCM and Jugular

trapezius foramen

XII Hypoglossal Intrinsic tongue Hypoglossal

muscles canal

27
Spinal Cord and Spinal Nerves
The spinal cord is a continuation of the brain and is a bit like a
nervous motorway in the body. The spinal cord is named by the
region that which the spinal cord resides: cervical, thoracic,
lumbar and sacral.

Much like a motorway, there are branches

of the spinal cord like junctions. These are
called spinal nerves and have a specific
structure which we will look closer at. These
spinal cords leave through gaps between
the vertebrae called intervertebral
foramina. The term segmental nerve is also
used to refer to spinal nerves.

At 4 main places in the body, spinal nerves join and sort of tangle
up. This is called a plexus. Spinal nerves weave and create what
looks like a mesh and then leave as nerves to innervate structures.
These are the cervical, brachial, lumbar, and sacral plexi.

One last key point regarding spinal nerves is that they carry
sensory information and motor innervation as they are mixed.
What this means is that as the motor innervation supplies the
muscle, there is sensory innervation from the skin also carried by
the spinal nerve. If a spinal nerve is going to innervate an organ
such as the heart, pain is felt in the relative dermatomal area. This
is known as referred visceral pain.

Before we have a further look at the structure of spinal nerves, we

will have a look at the cross-section of the spinal cord.

The spinal cord has two main sections, white and grey matter.
Grey matter is essentially where the unmyelinated somas reside

28
and the white matter is where the fatty myelinated axons reside.
The grey matter forms a shape similar to a butterfly.

The white matter forms tracts up and down the spinal cord. The
ascending tracts carry sensory information and the descending
tracts carry motor innervation.

In the centre of the spinal cord, there is a narrow tube called the
central canal where the cerebrospinal fluid (CSF) flows.

At the two posterior “tips of the butterfly” of grey matter exists the
dorsal horn, this is where sensory information enters the spinal cord.

At the two anterior tips exists the ventral horn where motor
innervation leaves the spinal cord.

Lastly, in the thoracic region, there exists the lateral horn. This is
where autonomic innervation is processed.

Now we have looked at the spinal cord closely, we can zoom out
and look at the organ as a whole.

There are 31 spinal nerve pairs. This occurs as the first spinal nerve
(C1) arises superior to the C1 vertebra, C2 spinal nerve passes
inferior to the C1 vertebra. This means there are 8 cervical spinal
nerves and 7 cervical vertebrae. The rest of the spinal nerves pass
inferior to their respective vertebra.

Some other key features of the spinal cord exist at the end of the
cord. At L2, the spinal cord tapers, this is known as the conus
medularis. After this, there are essentially loads of spinal nerves
free and less organised. This is known as the cauda equina as it is
said to resemble that of a horse’s tail. The cauda equina spans
from L2-S5. The last and final part of the spinal cord is called the
filum terminale. Here the pia mater extends to connect with the
coccyx.

29
Autonomic Nervous System
The autonomic nervous system can be divided into the
sympathetic and parasympathetic nervous systems. There are
differences between the two.

The parasympathetic nervous system has long pre-ganglionic

neurones and short post-ganglionic neurones. This means that the
cell bodies of the parasympathetic nervous system are found near
the tissue. There are 4 main ganglia in the parasympathetic
nervous system that are found in the head: ciliary,
pterygopalatine, submandibular and otic ganglia.

The sympathetic nervous system has a short pre-ganglionic

neurone and a short post-ganglionic neurone. The sympathetic
nervous system forms something called the sympathetic chain.
The sympathetic chain starts at T1 and ends at L2. It is a physical
chain of ganglia. It allows faster transmission and signals can be
sent up and down the chain for a faster spread of
communication. The exception to the sympathetic rules is the
supply of the adrenal medulla which synapses directly onto the
chromaffin cells of the medulla.

The cell bodies of the sympathetic pre-ganglionic neurones reside

in the lateral horn and exit via the ventral root. The signal is passed
along the white ramus to the sympathetic ganglion. This message
is then passed up and down the sympathetic chain as well as out
the grey ramus for effect at that spinal level. The signal is passed
up and down the sympathetic chain by interganglionic neurones.
Another name for the sympathetic ganglion is the paravertebral
ganglia. If a nerve leaves this ganglion without synapsing, this is
known as a splanchnic nerve.

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Regional Anatomy
Anatomical Spaces
Anatomical spaces or spatium as they are otherwise are
continuous areas of anatomy that are free and unoccupied. In
simpler terms an anatomical box.

These spaces are further divided into true anatomical spaces and
potential spaces. A true anatomical space is one that is always
there such as the abdominal cavity. A potential space is a space
that occurs during pathology (something wrong.)

The official definitions are as follows: true anatomical cavity:

demonstrable and occurs as part of normal anatomy; potential
space: does not exist as part of normal anatomy.

One example that is often looked at regarding true anatomical

spaces is those of the paranasal sinuses. Don’t worry too much
about learning these as they are covered in semester 2.

Abdominal Wall
The abdominal wall is also called the body wall as it is a
continuous layer that encloses the major body cavity.

The skin is the first layer of the body wall. The skin changes its
texture depending on the location. The skin is thinner anteriorly
and thicker posteriorly. Due to the way the skin has formed, there
are these invisible lines of cleavage. They are essentially rings of
the skin where the skin is meant to heal better when being cut.
These are lines one should consider when making an incision on a
patient.

The innervation of the skin depends on the location of the skin. The
skin above the second rib is supplied by the supraclavicular nerve

31
which forms from the cervical
plexus (web of nerves in the
neck.) Below the second rib, the
innervation of the skin is from
the spinal segmental nerves.

The rest of the body wall will be

simplified as more detail is
covered later.

Firstly, the anterolateral border is

made of three muscles: the external and internal obliques and the
transversus abdominis. The posterior border is made of the
posterior muscle group. More details on this group will be covered
in semester 2.

Thoracic Wall
When talking about any anatomical space it is important to
outline the boundaries, what makes the boundaries and then the
contents.

The boundaries of the thoracic cavity are:

Superior Superior thoracic aperture

Inferior Thoracic side of diaphragm

Antero-later-posterior Ribs

Posterior Thoracic vertebrae.

The superior thoracic aperture is the superior ring made of:

- First thoracic vertebrae

- 1st rib and costal cartilage of 1st rib
- Manubrium of sternum

32
It is also at this level where the suprasternal notch lies. This is a
palpable (can be felt) indent which is formed by the manubrium
of the sternum and the two clavicles.

As we have previously, we start by talking about the bones and

build on that.

The bones of the thorax are collectively known as the bony thorax.
There are 12 pairs of ribs, 12 thoracic vertebrae, the sternum and
the manubrium of the sternum.

When looking at the ribs they differ slightly. Ribs 1, 11 and 12 are
known as atypical ribs. Rib 1 has a fibrous joint and is attached to
the manubrium of the sternum. Ribs 2-7 are known as true ribs.
They have synovial (gliding) joints. Ribs 8-10 are false ribs, this is
because they don’t have their own costal cartilage but share with
the costal cartilage of rib 7. Ribs 11 and 12 are false and atypical,
this is because they have no costal cartilage, and they are not
attached at the anterior pole.

The next thing to look at when considering an area is other

connective tissues. Here is where we consider fascia. In the thorax,
there are 3 layers of fascia. The 2 most superficial layers are known
as fascia pectoralis. This is the confusing part. The two layers
together are known as fascia pectoralis but are technically two
layers: pectoral fascia and calvipectoral fascia. Clavipectoral
fascia is deeper than pectoral fascia.

Pectoral fascia separated the pectoralis major muscle from the

superficial breast tissue. The clavipectoral fascia separates the
pectoralis major and minor. The clavipectoral fascia continues to
travel to the clavicle (collar bone) and coracobrachialis (a
muscle in your arm) to form the axilla. The axilla is a true
anatomical space.

33
The borders of the axilla will be covered in more detail during
semester 2.

The deepest layer of thoracic fascia is the endothoracic fascia.

This separates the muscles of the thoracic fascia from the pleura
(the bag the lungs sit in.)

Now we have looked at the bones and the fascial layers, we can
look at the thoracic wall as a whole.

The layers of the thoracic walls are as follows:

- Skin
- Superficial fascia
- Serratus Anterior
- External oblique
- Ribs
- Internal oblique
- Innermost oblique
- Endothoracic fascia
- Parietal pleura
- Visceral pleura.

The last thing to consider with the thoracic wall is some of the
clinical implications. If you see the picture above, there is a
sub-costal groove. It is in the groove that the intercostal
neurovascular bundle runs. To prevent damage to these larger
vessels, when inserting a chest drain, we insert along the superior
border of the rib.

Vertebral column
The vertebral column is the vertebrae bones and the ligaments
and joints between them. It provides the centre of gravity of the
body, passage and protection of the spinal cord and attachment
points for bones and muscles.

34
In the foetus during the development of the vertebral column,
there is one single curvature facing anteriorly. This is known as a
primary curvature. In adult life, this excessive anterior curvature is
known as kyphosis. The spine essentially looks like a “C”.

During development, the shape of the spine develops into an “S”

shape with the addition of posterior curvatures or secondary
curvatures. These form in the cervical and lumbar regions,
whereas the primary curvatures remain in the thoracic and sacral
regions.

The cervical region begins to develop when the child begins to lift
their head. This is because the muscles are strengthened. The
lumbar region begins to develop when the child begins to walk for
the same reasons.

In old age, the muscles begin to weaken so the secondary

curvatures begin to disappear and the continuous primary
curvatures re-establish. The vertebral column begins to revert back
to the C shape.

In between the vertebrae are these jelly-like pouches called

intervertebral discs. These act as shock absorbers.

There are two layers to an intervertebral disc: the annulus fibrosus

and the nucleus pulposus. The annulus fibrosus is the outer layer
and has many fibro-cartilaginous bands to provide the skeleton
framework for the disc.

The nucleus pulposus is like a large water reserve with a very high
oncotic pressure. This is where the turtle comes from. You may
have heard of a slipped disk. This is where the nucleus pulposus
herniates through the outer annular fibrosis and can compress the
spinal cord.

35
Mammary Gland
The first part to look at when considering the mammary gland is
the nipple. It is found in the 4th intercostal space and is essentially
a modified sweat gland adapted for milk secretion.

The next thing we need to do is build a base for us to expand our

knowledge. We will start by considering the mammary bed. This
consists of the deep fascia that covers the pectoralis major.
Another component of this mammary bed is the muscles serratus
anterior and the external oblique abdominis.

We can now build on this to consider the matrix of connective

tissue. There are three main parts of the breast to consider here.
The first is the inframammary ligament, found at the base of the
breast and prevents sagging. Providing a similar role are the
suspensory ligaments of Cooper to offer support and firmness.
Lastly, there is adipose tissue. This is what forms the bulk of the
breast.

Next, we can consider more of the functional structure of the

breast. In the mammary parenchyma, there are 15-20 lactiferous
lobules that produce milk; these are radially arranged around the
nipple. This is important to consider as incisions should also be
radial to prevent damage to the lobules. Connecting these
lactiferous lobules are lactiferous sinuses, which store the milk.

Lastly, we can consider the visible structure of the breast. There is a

circular pigmented area of the breast called the areola. The
areola contains some modified sebaceous glands called
Tubercles of Montgomery. These are important in lubrication
during breastfeeding to prevent cracking.

Now that we have considered the structure of the breast, we can

consider other aspects such as the innervation. The breast as a

36
whole is supplied by the 4th and 6th intercostal nerves. The nipple
and areola are highly sensitive and are supplied by the T4
dermatome. Milk production is stimulated by the hormone
prolactin. The ejection of milk is caused by an increase in oxytocin
levels which causes the myoepithelial cells to contract, ejecting
the milk.

The mammary gland develops and descends inferiorly along

something called the mammary milk line. This runs from the armpit
to the groin. If there are abnormalities during development you
can get changes in the mammary gland along this line.

No mammary gland amastia

No nipple athelia

Many nipples polythelia

Large mammary glands macromastia

Small mammary glands micromastia

The last part of the mammary gland is to consider some clinical
implications of the anatomy. This is where the lymphatics of the
gland are taken into account.

The mammary glands are divided into 4 quadrants. The different

quadrants have different lymphatic drainage. This is important
when considering breast cancer. If the area where a cancer is
present is detected, then the spread of the cancer can be
predicted and therefore treated. The more lateral the region, the
better the prognosis.

The regions and their lymph nodes have been summarised below.

Upper lateral Axillary

Infraclavicular

37
Lower lateral Axillary

Upper medial Supraclavicular

Parasternal

Lower medial Parasternal

Subdiaphragmatic
Sub peritoneal plexuses
The are 5 main signs of breast cancer

- Asymmetry of breasts and nipples

- Change in colour of skin
- Retraction of nipple
- Discharge from the nipple
- Oedema of the skin (Peau d’orange sign)

Lungs and pleura

Now we have considered the boundaries of the thoracic cavity
and the walls of the cavity, we can start to consider what is inside
the cavity.

The lungs are found in the thoracic cavity. The lungs are
surrounded by essentially a small bag called the pleura which
contains interstitial fluid to reduce friction. The interstitial fluid sits in
the pleural cavity. The side of this bag that is attached to the lungs
is the visceral pleura and the side attached to the body wall is the
parietal pleura. The structure of the pleura is described through a
balloon and fist model.

Imagine you have a balloon in the chest cavity when you are
developing. This balloon contains a little bit of liquid and is very
stretchy. As the lungs grow, they push on this balloon and start to
deform it. The lungs continue to push and push until they become
entirely embedded in these balloons so it looks like the lungs are

38
growing in the balloons however they are just surrounded by
them. This balloon is the pleura.

The lungs expand and retract during breathing. To accommodate

that the pleura is essentially 2 ribs width wider in all directions to
accommodate for the expansion of the ribs.

The turning points of the pleura are called reflections for example
where the diaphragm is situated, exists the costo-diaphragmatic
reflection.

A point at which the lung does not fully expand is called a recess.
An example of this is the costo-mediastinal recess as this is where
the heart sits.

To make life more confusing, the parietal pleura and visceral

pleura also have different innervation. The parietal pleura is
innervated by the phrenic and intercostal nerves. These are
somatic nerves and can therefore feel pain. The visceral pleura
however is supplied by autonomic visceral nerves and therefore
insensitive to pain.

The pleural space formed by the parietal and visceral pleura can
also be a site for pathology. If excess fluid (pleural effusion) or air
(pneumothorax) is in the pleural cavity this will affect the
breathing. The air or fluid will need to be drained.

We drain this by inserting a needle into an area called the safe

triangle using a technique called Seldinger’s technique. The safe
triangle has the following borders:

Superior Base of the axilla

Anterior Lateral edge of pectoralis

major

Inferior 5th intercostal space

39
Posterior Lateral edge of latissmus dorsi

Mediastinum
Inside the thoracic cavity is another key area: the mediastinum. Its
borders are as follows:

Superior Superior thoracic aperture

Inferior Diaphragm

Anteriorly Sternum

Posteriorly Thoracic vertebrae

Laterally Mediastinal pleura.

We then further divide the mediastinum into compartments. The

main dividing line is the Angle
of Louis. This separates the
superior and inferior
mediastinum.

The inferior mediastinum is

further divided into anterior,
middle and posterior
mediastinum.

First, we will look at the

superior mediastinum. The
superior mediastinum borders
are: superiorly the superior
thoracic aperture; inferiorly an
imaginary line drawn at the Angle of Louis. the anterior border is
formed by the manubrium of the sternum. The posterior border is
formed by the vertebral borders of T1-4. Lastly, the lateral borders

40
are formed by the pleurae of the lungs. The contents of the
superior mediastinum can be remembered simply by the
mnemonic: PVT left BATTLE.

Phrenic nerve
Vagus Nerve
Thoracic Duct

Left recurrent laryngeal nerve

Brachiocephalic veins/SVC
Aortic arch
Thymus
Trachea
Lymph nodes
Oesophagus

The next section to look at is the anterior mediastinum. The borders

of the anterior mediastinum are as follows:

Lateral Pleurae of the lungs

Anterior Sternum and transversus

thoracis muscles

Posterior Pericardium

Superior Imaginary line drawn at the

Angle of Louis

Inferior Diaphragm
The contents of the anterior mediastinum can be condensed into
the mnemonic: LIST.

Loose areola tissue

Interthoracic vessels

41
Sterno-pericardial ligaments
Thymus

Moving posteriorly we have the middle mediastinum. The borders

of the middle mediastinum are:

Anterior Anterior surface of the

pericardium

Posterior Posterior border of the

pericardium

Lateral Mediastinal pleura of the lungs

Superior Imaginary line drawn at the

level of the Angle of Louis

Inferior Superior surface of the

diaphragm

The mnemonic for the middle mediastinum is HARPPS.

Heart and pericardium

Ascending aorta
Roots of the great vessels
Pulmonary trunk
Pulmonary vein
SVC/IVC

The last section of the mediastinum is the posterior mediastinum.

Once again, the borders of the posterior mediastinum are:

Anterior Pericardium

42
Posterior T5-T12 vertebrae

Lateral Pleurae

Superior Imaginary line drawn at the

Angle of Louis

Inferior Superior surface of the

diaphragm
The contents of the posterior mediastinum can be memorised as
DATES.

Descending aorta
Azygous vein
Thoracic duct
Eosophagus/vagus
Sympathetic trunk/thoracic splanchnic nerves.

43
About the author
Hi, my name is Jonnie and I am your 2023/24 pre-clinical rep for
the University of Birmingham Anatomy Soc.

I know that studying anatomy doesn’t have the best reputation

and is notoriously difficult. The aim of this guide is to try and
combat this “unfair” reputation of anatomy and bridge the gap in
learning between A-Levels and universities.

If there is anything you would like to see anatomy related or have

any questions please do not hesitate to contact me at the email
address below.

jxg329@student.bham.ac.uk

If there are any issues found in this

guide, then please get in contact so I
can get those sorted.

ALSO I am currently in the process of

writing the guide to Semester 2 which
will hopefully be available in time for
the start of the new year!

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