局部解剖学（双语） 精品课程 课件pptgeneral review

Regional Anatomy Review,Based on the organization of the body into parts: the head, neck, thorax, abdomen, pelvis, and paired upper and lower limbs.Emphasis is placed on the relationships of various systemic structures (e.g., muscles, nerves, and arteries),Neck,Superficial structuresFascia of NeckThyroid area,Neck: Cervical Regions,A. SCM region- Lesser supraclavicular fossa (1),B. Posterior cervical region,C. Lateral cervical regionOccipital triangle (2) Omoclavicular triangle (3),D. Anterior cervical regionSubmandibular triangle (4) Submental triangle (5) Carotid triangle (6) Muscular triangle (7),Landmark muscles: Sternocleidomastoid (SCM), Trapezius , Omohyoid, Digastric,Superficial veins, nerves, and lymph nodes,external jugular vein (EJV) subclavian vein cutaneous branches of the cervical plexus emerge around the middle of the posterior border of the SCM, often called the nerve point of the neck, and supply the skin of the neck superficial cervical lymph nodes inferior deep cervical lymph nodes supraclavicular lymph nodes,Fascia of Neck,superficial cervical fascia deep cervical fasciainvesting layerpretracheal layer carotid sheath The common & internal carotid arteries.The internal jugular vein (IJV).The vagus nerve (CN X) prevertebral layer,Where is the ICA located in the neck?What anatomical layers should be passed through to reach the ICA?What important anatomy structures is along with ICA in the carotid sheath?,The thyroid gland is located anteriorly in the neck. It lies deep to the sternothyroid and sternohyoid muscles from the level of the C5T1 vertebrae. It consists of right and left lobes and isthmus.Parathyroid glands are located in the back of thyroid glands, usually 2 in each lobe.The thyroid gland produces thyroid hormone, which controls the rate of metabolism.The parathyroid glands produce parathormone (PTH), which controls the metabolism of phosphorus and calcium in the blood.,Thyroid and parathyroid glands,superior and inferior thyroid arteries & related nervesExternal laryngeal n.Recurrent laryngeal n. Three pairs of thyroid veins usually drain the thyroid plexus of veins on the anterior surface of the thyroid gland and trachea,Thyroidectomy,Which nerve should be blocked with an anesthetic agent for a local anesthesis?What muscles should be cut in order to explore the left lobe of the thymus?To avoid bleeding, which arteries were ligated during the surgery?To avoid hoarseness or aphonia, which nerves should be carefully protected during surgery?A patient showed a severe neurologic syndrome characterized by muscle twitches and cramps days after he received a thyroidectmy. His serum calcium level decreased. What organs were damaged during the surgery on him?,Thorax,Chest wall structuresIntercostal spaceMammary gland & Its lymph drainage Concept of Pleura and pleura cavity Trachea, bronchi, lungs and bronchopulmonary segment Mediastinum & its contents,Chest wall- structure,SkinSubcutaneous tissueDeep faciaPectoral musclesRibsIntercostal mIntercostal a & vIntercostal nEndothoracic facia,Contents of typical intercostal space,The order of the structures in the costal groove, from superior to inferior:as VAN, for vein, artery, and nerve.,The lymphatic drainage of the breast is important because of its role in the metastasis (spread) of cancer cells.Most lymph ( 75%) drains to the axillary lymph nodes The remaining lymph drains to the parasternal lymph nodes Lymph from the axillary nodes drains to infraclavicular and supraclavicular nodes and from them to the subclavian lymphatic trunk.,Lymphatic drainage of breast,Thoracic Viscera,PleuraeLungsMediastinumIt is the central compartment of the thoracic cavity and covered on each side by mediastinal pleura It contains all the thoracic viscera and structures, except the lungs.,Pleura & pleural cavity,Inset: A fist invaginating an underinflated balloon demonstrates the relationship of the lung (represented by fist) to the walls of the pleural sac (parietal and visceral layers of pleura). The cavity of the pleural sac (pleural cavity) is comparable to the cavity of the balloon. The pleural cavitythe potential space between the visceral and the parietal layers of pleuracontains a capillary layer of serous pleural fluid, which lubricates the pleural surfaces and allows the layers of pleura to slide smoothly over each other during respiration. Costodiaphragmatic recesses of the pleural cavities.,Trachea, Bronchi, Lungs,The two main bronchi (primary bronchi) pass inferolaterally from the bifurcation of the trachea to the lungs The main bronchi enter the hila of the lungs and branch in a constant fashion within the lungs to form the bronchial tree. Each main bronchus divides into lobar bronchi (secondary bronchi), two on the left and three on the right, each of which supplies a lobe of the lung. Each lobar bronchus divides into segmental bronchi (tertiary bronchi) that supply the bronchopulmonary segments. Each bronchopulmonary segment is pyramidal, and is named according to the segmental bronchus that supplies it.,Bronchogram,Subdivision of the Mediastinum,Location: Superior: thoracic apertureInferior: diaphragm Anterior: sternum and costal cartilages Posterior: thoracic vertebraeThe superior mediastinum: from the superior thoracic aperture to the horizontal plane (transverse thoracic plane) passing through the sternal angle and the IV disc of the T4T5 vertebra. The inferior mediastinum, between the transverse thoracic plane and the diaphragm, is further subdivided by the pericardium into anterior mediastinum middle mediastinum pericardium, heart, roots of the great vesselsmain bronchiposterior mediastinum,Radiograph and cardiovascular shadows,The composition of the margins of the cardiovascular shadow (cardiac silhouette) are identified:Left: 4 archesRight: 2 archesCommon types of cardiovascular shadows.,Abdomen,Abdominal wallInguinal tube and hernia Peritoneum and Peritoneal Cavity Abdominal aorta and its main branches Lumbar plexus and its innervation,Abdominal wall: muscles,A. the obliquus externus abdominis & aponeurosis, sheath of rectus abdominis & rectus abdominis. B. the obliquus externus abdominis C. obliquus internus abdominis D. transverses abdominis,Abdominal wall layers,Above the inter-illiac plane Skin, subcuobliquus externus abdominisobliquus internus abdominis transversus abdoministransversalis facia parietal peritoneum Skin, subcuAnterior layer of sheath of rectus abdominis rectus abdominis posterior layer of sheath of rectus abdoministransversalis facia parietal peritoneum,Above the inter-illiac planeSkin, subcuaponeurosis of obliquus externus abdominisobliquus internus abdominis transversus abdoministransversalis facia parietal peritoneum Skin, subcuAnterior layer of sheath of rectus abdominis rectus abdominis transversalis facia parietal peritoneumMidlineThe linea alba formed by the fusion of the aponeurosis of all three flat abdominal muscles.,Linea alba,Inguinal Area,The inguinal canal is formed in relation to the descent of the gonad (testes or ovary) during fetal development. The inguinal canal in adults is an approximately 4-cm-long, inferomedially directed oblique passage The main occupant of the inguinal canal is the spermatic cord in males and the round ligament of the uterus in females. The inguinal canal also contains blood and lymphatic vessels and the ilioinguinal nerve in both sexes. The inguinal canal has an opening at each end.The deep (internal) ring The superficial (external) inguinal ringThe inguinal canal has two walls (anterior and posterior), a roof, and a floor:Anterior wall: formed by external oblique aponeurosis throughout the length of the canalPosterior wall: formed by transversalis fascia; Roof: formed laterally by transversalis fascia, centrally by the musculoaponeurotic arches of internal oblique and transverse abdominal muscles, Floor: formed laterally by the iliopubic tract, centrally by the superior surface of the inguinal ligament,Characteristics of Inguinal Hernias,A hernia occurs when the abdominal wall weakens and the inner lining of the abdomen pushes through the weakened area, forming a sac. To correct this problem, the surgeons goal is to patch the abdominal wall in a way that will permanently strengthen it, precluding the possibility of another hernia later.,Peritoneum and Peritoneal Cavity: divisions,The peritoneum is a glistening, transparent serous membrane that consists of two continuous layers:Parietal peritoneum, lining the internal surface of the abdominopelvic wallVisceral peritoneum, investing viscera (organs). The relationship of the viscera to the peritoneum is as follows:Intraperitoneal organs are almost completely covered with visceral peritoneum (e.g., the spleen and stomach)Extraperitoneal, retroperitoneal, and subperitoneal organs are only partially covered with peritoneum such as the kidneysThe peritoneal cavity is divided into a greater sac (pink)an omental bursa (blue),Mesentery mesoappendix2. Mesocolon transverse, sigmoid,Abdominal organs,Appendix,The vermiform appendix, a blind intestinal diverticulum, extends from the cecum inferior to the ileocecal junction. The appendix varies in length and has a short triangular mesentery, the mesoappendix, The appendicular artery is in the free edge of the mesoappendix The pain of appendicitis usually commences as a diffusive visceral pain in the periumbilical region because afferent pain fibers enter the spinal cord at the T10 level through visceral fibers in thoracic spinal nerve Later, severe pain moved to the right lower quadrant, and it results from irritation of the parietal peritoneum lining the posterior abdominal wall Digital pressure over the McBurney point registers the root of the appendix. the McBurney point is one third of the way along the oblique line joining the right anterior superior iliac spine to the umbilicus,(2) Appendicitis & appendectomy,Acute inflammation of the appendix is a common abdominal disease. An emergency surgical removal of the infected appendix (appendectomy) should be performed. The incision is made over McBurneys point which represents the position of the base of the appendix. Where the McBurneys point located?(2) Why the pain of appendicitis usually commences as a diffusive visceral pain in the periumbilical region? (3) Why the severe pain moved to the right lower quadrant later (4) To fully explore the appendix, what layers of the abdominal wall are opened from the superficial to deep,?(5) To avoid bleeding, which artery should be identified and ligated before the appendix is removed? Where it is located?,Abdominal aortaCeliac trunkLeft gastric aHepatic aSpleen aSup mesenteric aInf mesenteric aPortal vein (drains poorly oxygenated, nutrient-rich blood from the alimentary system)Sup mesenteric vSpleen vInf mesenteric vInf vena cava,summary of abdominal blood supplies,Upper Limb,Regions: Axilla, Arm, Elbow, Cubital fossa, Forearm, Hand,Superficial veins Axillary fossa: walls & contains (major a., v., n, lymph nodes） 5 Major nerves axillary a., humeral a., radial a., ulnar a., superficial palmar arch major muscles of arm, groups of forearm muscles,Superficial Vessels of Upper Limb,The cephalic and basilic veins and their tributariesThe median cubital v. superficial lymphatic drainage to the lymph nodes: cubital lymph nodes axillary lymph nodes The dorsal venous network of hand,Axilla,The axilla is the pyramidal space inferior to the glenohumeral joint and superior to the skin and axillary fascia at the junction of the arm and thorax The apex is the cervicoaxillary canal, the passageway between the neck and the axilla. The arteries, veins, lymphatics, and nerves traverse this superior opening to pass to or from the arm.The base is formed by the concave skin, subcutaneous tissue, and axillary (deep) fascia extending from the arm to the thoracic wall forming the axillary fossa (armpit).The anterior wall is formed by the pectoralis major and minor and the pectoral and clavipectoral fascia associated with them. The anterior axillary fold is the inferiormost part that may be grasped. The posterior wall is formed chiefly by the scapula and subscapularis. The posterior axillary fold is the inferiormost part that may be grasped. The medial wall is formed by the thoracic wall (1st4th ribs and intercostal muscles).The lateral wall is the narrow bony wall formed by the in the humerus.,1. Location and walls of axilla,2. Axilla contains,Axillary artery & veinBrachial plexus: 3 cords 5 nervesMusclesPectoralis majorPectoralis minorDeltoidBiceps brachii subscapularis intercostalisSerratus anteriorbones ClavicleScapulaHumerusRibs,Brachial artery & veinMedian n. & Ulnar n.Muscles,Arm- anterior part,Arm- posterior part,Posterior circumflex humeral a. & axillary nDeep a. of arm & radial n.muscles,Cubital fossa,Superficial dissection,Deep dissection,Forearm,Radial a. & Radial n.Median n.Ulnar a. & Ulnar nmuscles,Hand,Superficial palmar arch & deep palmar archThe thenar & midpalmar spacesThe fascia of the palm the palmar aponeurosisFibrous digital sheathsDigital ns. & vesselsMuscles,Lower Limb,Regions: Gluteus, Thigh, Knee, Popliteal fossa, leg, foot,Superficial veinsSub-piriformis structures Femoral triangle: borders & contains (major a., v., n, lymph nodes) Thigh muscles, muscle groups of leg Femoral n., obturator n., sciatic n, tibial n., common peroneal n., deep peroneal n., superficial peroneal n.Femoral a., popliteal a., anterior tibial a., posterior tibial a.,Superficial Vessels of Lower Limb,Thigh,Femoral angle: linguinal lig.+sartorius+gracilisFemoral n., a. v.muscles,Gluteal & Posterior thigh,Piriformis mSuperior gluteal a. & n.Inferior gluteal a. & n.Internal pudenal a. & n.Sciatic nTibial nCommon fibular n.muscles,Popliteal fossa,The surface anatomy is demonstrated. diamond-shaped gap in the muscles overlying the fossaContains:Popliteal a. & v.Tibial n.Common fibular n.The genicular anastomosis,Leg & foot-ant. part,Common peroneal (fibular) n Anterior tibial a. & deep peroneal (fibular) n.Superficial peroneal (fibular) n.muscles,deep dissection, most of the soleus is cut away to show:Post. Tibial a.Tibial n.,Leg & foot-post. part,All answers are single choice,1.The greater sciatic foramen is the passageway for structures entering or leaving the pelvis, and the piriformis muscle divides the foramen into superior and inferior parts. What vessels and nerves run out inferior to the piriformis muscle? a) the super