TM FIFTH EDITION Gross Anatomy TM FIFTH EDITION Gross Anatomy Ronald W. Dudek, PhD Professor Brody School of Medicine East Carolina University Department of Anatomy and Cell Biology Greenville, North Carolina Thomas M. Louis, PhD Professor Brody School of Medicine East Carolina University Department of Anatomy and Cell Biology Greenville, North Carolina Acquisitions Editor: Crystal Taylor Product Manager: Lauren Pecarich Manufacturing Coordinator: Margie Orzech Production Project Manager: Alicia Jackson Designer: Teresa Mallon Compositor: Aptara, Inc. Fifth Edition Copyright © 2015, 2011, 2008, 2002, 1997 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street Two Commerce Square/2001 Market Street Baltimore, MD 21201 Philadelphia, PA 19103 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Dudek, Ronald W., 1950- author. High-yield gross anatomy / Ronald W. Dudek, Thomas M. Louis. – Fifth edition. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4511-9023-6 (alk. paper) I. 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Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. PREFACE High-Yield Gross Anatomy addresses many of the recurring clinical themes of the USMLE Step 1. The information presented in this text prepares you to handle not only the clinical vignettes found on the USMLE Step 1, but also the questions concerning basic gross anatomy concepts. Like the USMLE Step 1, the discussions are comprehensively illustrated with a combination of drawings, MRIs, CT scans, radiographs, and cross-sectional anatomy. This edition is particularly excit- ing because we have included colored diagrams and figures to assist the learning process. In addition, High-Yield Gross Anatomy directly addresses clinical issues and common clinical techniques (e.g., liver biopsy, tracheostomy, and lumbar puncture) that require knowledge of basic gross anatomy to deduce the correct answer. For High-Yield Gross Anatomy, Fifth Edition, Dr. Thomas Louis has again contributed his consider- able gross anatomy teaching experience to improve and narrow the focus of the book. Dr. Louis has taught gross anatomy for about 30 years in both cadaver-dissection and computer-assisted distance- learning gross anatomy courses. He has been a leader in developing computer-assisted distance learn- ing at the Brody School of Medicine and has received national recognition for his efforts. Dr. Louis used High-Yield Gross Anatomy in his physician assistant gross anatomy course for 4 years with excellent success and supplemented the clinical anatomy presented in the book with critical basic anatomy figures and diagrams to assist students in learning the gross anatomy relationships of these clinically relevant areas. Dr. Louis and I have added some of these colored figures and diagrams to further enhance your understanding. I would appreciate your comments or suggestions about this book, especially after you have taken the USMLE Step 1, so that future editions can be improved and made more relevant to the test. You may contact me at [email protected]. Ronald W. Dudek, PhD v CONTENTS Preface v 1 VERTEBRAL COLUMN 1 I. The Vertebral Column 1 II. Normal and Abnormal Curvatures of the Vertebral Column 2 III. Vertebral Levels of Various Anatomical Structures 3 IV. Joints 4 V. Vasculature of the Vertebral Column 5 VI. Clinical Considerations 5 VII. Normal Radiology 10 2 SPINAL CORD AND SPINAL NERVES 14 I. Components of the Spinal Cord 14 II. Meninges and Spaces 14 III. Arterial Supply of the Spinal Cord 16 IV. Components of a Spinal Nerve 16 V. Dermatomes 18 VI. Clinical Procedures 18 VII. Clinical Considerations 21 3 AUTONOMIC NERVOUS SYSTEM 24 I. General Features of the Nervous System 24 II. Sympathetic Division of the ANS (Thoracolumbar) 24 III. Parasympathetic Division of the ANS (Craniosacral) 28 IV. Summary Table of Sympathetic and Parasympathetic Motor Actions 32 4 LYMPHATIC SYSTEM 33 I. Central Lymphatic Drainage 33 II. Summary Diagram of Specific Lymphatic Drainage 34 5 CHEST WALL 36 I. General Features of the Thorax 36 II. Bones of the Thorax 36 III. Muscles of the Thorax 37 IV. Movement of the Thoracic Wall 38 V. Arteries of the Thorax 39 VI. Veins of the Thorax 39 vi Contents vii VII. Nerves of the Thorax 39 VIII. Breast 39 IX. Anterior Chest Wall 42 X. Lateral Chest Wall 45 XI. Posterior Chest Wall 47 XII. Mediastinum 47 XIII. Radiology 49 6 PLEURA, TRACHEOBRONCHIAL TREE, LUNGS 53 I. Pleura 53 II. Tracheobronchial Tree 55 III. Lungs 57 IV. Clinical Considerations 59 V. Cross-sectional Anatomy 63 7 THE HEART 70 I. The Pericardium 70 II. Heart Surfaces 71 III. Heart Borders 71 IV. Fibrous Skeleton of the Heart 73 V. Valves and Auscultation Sites 73 VI. Arterial Supply of the Heart 74 VII. Venous Drainage of the Heart 76 VIII. The Conduction System 76 IX. Innervation of the Heart 77 X. Gross Anatomy of the Heart 78 XI. Clinical Considerations 80 XII. Radiology 83 8 ABDOMINAL WALL 89 I. Abdominal Regions and Quadrants 89 II. Muscles 90 III. Clinical Procedure 90 IV. Inguinal Region 91 V. The Scrotum 93 9 PERITONEAL CAVITY 95 I. Peritoneal Cavity 95 II. Omentum 97 III. Intraperitoneal and Extraperitoneal Viscera 97 IV. Clinical Considerations 97 viii Contents 10 ABDOMINAL VASCULATURE 98 I. Abdominal Aorta 98 II. Venous Drainage of Abdomen 100 III. Hepatic Portal System 102 11 ABDOMINAL VISCERA 104 I. Esophagus 104 II. Stomach 107 III. Duodenum 108 IV. Jejunum 111 V. Ileum 111 VI. Innervation of the Small Intestine 112 VII. Large Intestine 112 VIII. Innervation of the Large Intestine 114 IX. Appendix 115 X. Gallbladder 116 XI. Extrahepatic Biliary Ducts 116 XII. Liver 119 XIII. Pancreas 121 XIV. Cross-sectional Anatomy 123 XV. Radiology 126 12 SIGMOID COLON, RECTUM, AND ANAL CANAL 129 I. Sigmoid Colon 129 II. Rectum 131 III. Anal Canal 132 IV. Defecation Reflex 133 V. Radiology 134 13 SPLEEN 135 I. General Features 135 II. Arterial Supply 135 III. Venous Drainage 135 IV. Clinical Considerations 136 V. Radiology 137 14 KIDNEY, URETER, BLADDER, AND URETHRA 138 I. General Features 138 II. Kidney Surface Projections 139 III. Internal Macroscopic Anatomy of the Kidney 139 IV. Arterial Supply 140 V. Venous Drainage 141 Contents ix VI. Innervation 142 VII. Clinical Considerations of the Kidney 142 VIII. Ureter 143 IX. Urinary Bladder 145 X. Urethra 151 XI. Radiology 152 15 SUPRARENAL (ADRENAL) GLANDS 157 I. General Features 157 II. Arterial Supply 158 III. Venous Drainage 158 IV. Innervation 158 V. Adrenal Cortex 158 VI. Adrenal Medulla 160 16 FEMALE REPRODUCTIVE SYSTEM 162 I. Ovaries 162 II. Uterine Tubes 162 III. Uterus 164 IV. Cervix 167 V. Ectocervix 167 VI. Vagina 168 VII. External Genitalia 170 VIII. Innervation of the Female Reproductive System 171 17 MALE REPRODUCTIVE SYSTEM 172 I. Testes 172 II. Epididymis 176 III. Ductus Deferens 176 IV. Contents of the Spermatic Cord 177 V. Ejaculatory Duct 177 VI. Seminal Vesicles 177 VII. Bulbourethral (BU) Glands of Cowper 177 VIII. Prostate Gland 178 IX. Penis 180 X. Innervation of the Male Reproductive System 182 XI. Erection, Secretion, Emission, and Ejaculation 182 18 PELVIS 183 I. Bones of the Pelvis 183 II. Greater and Lesser Sciatic Foramina 185 III.