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www.BookOfLinks.com THE BIG PICTURE GROSS ANATOMY www.BookOfLinks.com Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the infor- mation contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. www.BookOfLinks.com THE BIG PICTURE GROSS ANATOMY David A. Morton, PhD Associate Professor Anatomy Director Department of Neurobiology and Anatomy University of Utah School of Medicine Salt Lake City, Utah K. Bo Foreman, PhD, PT Assistant Professor Anatomy Director University of Utah College of Health Salt Lake City, Utah Kurt H. Albertine, PhD Professor of Pediatrics, Medicine, and Neurobiology and Anatomy Associate Dean of Faculty Administration Editor-In-Chief, The Anatomical Record University of Utah School of Medicine Salt Lake City, Utah New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto www.BookOfLinks.com BCME856HN /MN '72N 0E.K8?;N [email protected] A0 N >?N F956HGN F2G2EJ21 N L02CHN .GN C2F@9HH21N IA12EN H62N )A9H21N &H.H2GN BCMF956HN 0HN B3N ABN C.FHN B3N H79GN CI/?90.H8BAN @.MN /2N E2CFB1I021N BFN 19GHF9/IH21N 9AN .AMN 3BE@N BFN /MN .AMN @2.AGN BFN GHBF21N 9AN .N 1.H./.G2N BFN F2HF92J.>N GMGH2@N K9H6BIHN H62N CF9BEN KE8HH2AN C2F@8GG8BAN B3N H62N CI/>9G62F N &!N N 0-07-178534-5 '62N @.H2F9.>N 9AN H78GN 2BB=N .>GBN .CC2.FGN 8AN H62N CF9AHN J2EG9BAN B3N H69GN H9H>2N &!N N >>N [email protected]=GN .F2N [email protected]=GN B3N H629FN F2GC20H9J2N BKA2FG N %.H62EN H6.AN CIHN .N [email protected]=N GM@/B?N .42EN 2J2EMN B00IFF2A02N B3N .N [email protected]=21N A.@2N K2N IG2N A.@2GN 9AN .AN 218HBF9.>N 3.G68BAN BA?MN .A1N HBN H62N /2A239HN B3N H62N [email protected]=N BKA2EN K9H6N ABN 8AH2AH9BAN B3N 9A3E8A52@2AHN B3N H62N [email protected]= N +62F2N GI06N 12G95A.H9BAGN .CC2.FN 9AN H69GN /BB=N H62MN 6.J2N /22AN CE8AH21N K8H6N 9A8H8.>N 0.CG N 0E.K9?:N 2BB=GN .F2N .J.9>./>2N .HN GC209.>N DI.AH9HMN 18G0BIAHGN HBN IG2N .GN CE2@9I@GN .A1N G.>2GN CFB@BH8BAGN BFN 3BFN IG2N 9AN 0BFCBF.H2N HF.9A9A5NCFB5F.@G N 'BN 0BAH.0HN .N F2CF2G2AH.H9J2N C>2.G2N [email protected]>N IGN .HN /I?=G.>[email protected]>? 0B@ N '69GN 9GN .N 0BCME856H21N KBF=N .A1N '62N 0F.K9>:N [email protected] A0 N 0E.K 9>:N .A1N 9HGN >902AGBFGN F2G2FJ2N .?>N F956HGN 9AN .A1N HBN H62N KBF= N )G2N B3N H69GN KBE=N 8GN GI/<20HN HBN H62G2N H2F@G N L02CHN .GN C2F@8HH21N IA12FN H62N BCME856HN 0HN B3N .A1N H72N F956HN HBN GHBE2N .A1N E2HE82J2N BA2N 0BCMN B3N H62N KBF=N MBIN @.MN ABHN 120B@C9?2N 19G.GG2@/>2N F2J2FG2N 2A59A22FN F2CFB1I02N @B193MN 0E2.H2N 12F9J.H9J2N KBF=GN /.G21N ICBAN HF.AG@9HN 19GHF9/IH2N [email protected] G2>>N CI/>9G7N BFN GI/>902AG2N H72N KBF=N BFN .AMN C.FHN B3N 9HN K8H7BIHN 0E.K9>>GN CF9BFN 0BAG2AH N -BIN @.MN IG2N H62N KBE=N 3BEN MBIEN BKAN ABA0B@@2F09.>N .A1N C2FGBA.>N IG2N .AMN BH62EN IG2N B3N H62N KBE=N 9GN GHE90H>MN CFB69/8H21 N -BIEN E856HN HBN IG2N H62N KBF=N @.MN /2N [email protected] 93N MBIN 3.9?N HBN 0B@C>MN K9H6N H62G2N H2F@G N 'N +"%N &N #%"*N &N & N 0%+ N !N '&N !&"%&N N !"N )%!'&N "%N +%%!'&N &N '"N 'N )%-N $)-N "%N " #'!&&N "N "%N %&)(&N '"N N "'!N %" N )&!N 'N +"%N !)!N !-N !"% '"!N ''N !N N &&N '%")N 'N +"%N *N -#%!N "%N "'%+&N !N ,#%&&-N & N !-N +%%!'-N ,#%&&N "%N #N !)!N )'N !"'N 'N '"N #N +%%!'&N "N %!''-N "%N '!&&N "%N N #%')%N #)%#"& N 0F.K8>;N .A1N 9HGN ?902AGBEGN 1BN ABHN K.FE.AHN BEN 5I.E.AH22N H6.HN H62N 3IA0H8BAGN 0BAH.9A21N 9AN H62N KBF=N K9>>N @22HN MBIEN F2DI9E2@2AHGN BEN H6.HN 9HGN BC2F.H9BAN K9?>N /2N IA9AH2FFICH21N BFN 2FFBFN 3F22 N !29H62FN 0E.K9>:N ABFN 9HGN >902AGBFGN G6.>?N /2N >9./>2N HBN MBIN BEN .AMBA2N 2?G2N 3BEN .AMN 9A.00IF.0MN 2FFBEN BFN B@8GG8BAN E25.F1>2GGN B3N 0.IG2N 9AN H62N KBF=N BEN 3BFN .AMN [email protected] E2GI?H9A5N H62F23FB@ N 0F.K9?:N 6.GN ABN E2GCBAG9/9?9HMN 3BFN H62N 0BAH2AHN B3N .AMN [email protected] .002GG21N H6EBI56N H62N KBE= N )A12EN ABN [email protected] G6.??N 0E.K9?:N .A1BFN 8HGN >902AGBFGN /2N ?9./>2N 3BFN .AMN 9A19E20HN 9A0912AH.>N GC208.>N CIA8H8J2N 0BAG2DI2AH9.>N BEN G9@9?.EN [email protected] H6.HN F2GI?HN 3EB@N H62N IG2N B3N BFN 9A./8>8HMN HBN IG2N H62N KBE=N 2J2AN 93N .AMN B3N H62@N 6.GN /22AN .1J8G21N B3N H62N CBGG8/9>9HMN B3N GI06N [email protected] N '69GN >[email protected] B3N >9./9?9HMN G6.>>N .CC?MN HBN .AMN 0>.8@N BFN 0.IG2N K6.HGB2J2EN K72H62EN GI06N 0>.8@N BFN 0.IG2N .F9G2GN 8AN 0BAHF.0HN HBEHN BFN BH62EK9G2N www.BookOfLinks.com DEDICATION To Jared, Ireland, Gabriel, Max, and Jack; and their cousins Lia, Sophia, Joshua, Cayden, Ethan, Nathan, Kelsey, Robert, Stefani, Ella, Reid, Roman, Marcus, Jared, Hannah, Tanner, Liam, Maia, Riley, Sydney, Luke, Cole, Desiree, Celeste, Connlan, Isabelle, Nathan, Simon, Thomas, Alexandre, Lyla, Logan and Andilynn. I could not ask for a better family. —David A. Morton To my devoted family: my wife, Cindy, and our two daughters Hannah and Kaia. —K. Bo Foreman To Erik, Kristin, and Laura. Thank you for your patience with and understanding of my efforts to contribute to biomedical education and research. —Kurt H. Albertine www.BookOfLinks.com This page intentionally left blank www.BookOfLinks.com CONTENTS - www.BookOfLinks.com Preface . xi CHAPTER 5 Superior and Posterior Mediastina ..63 Divisions of the Mediastina 64 Acknowledgments . xii Sympathetic Trunk and Associated Branches 66 About the Authors . xiv Azygos Veins, Thoracic Duct, and Thoracic Aorta 68 Esophagus 70 SECTION 1: BACK Superior Mediastinum 72 Study Questions 74 CHAPTER 1 Back ...............................3 Answers 76 Skin of the Back 4 Superficial Back Muscles 6 Deep Back Muscles 8 SECTION 3: ABDOMEN, PELVIS, AND PERINEUM Vertebral Column 10 Spinal Meninges 12 CHAPTER 6 Overview of the Abdomen, Spinal Cord 14 Pelvis, and Perineum ...............79 Spinal Roots, Spinal Nerves, and Rami 16 Osteologic Overview 80 Study Questions 20 Gut Tube 82 Answers 21 CHAPTER 7 Anterior Abdominal Wall ..........85 Partitioning of the Abdominal Region 86 SECTION 2: THORAX Superficial Layers of the Anterior Abdominal Wall 86 CHAPTER 2 Anterior Thoracic Wall .............25 Deep Layers of the Anterior Abdominal Wall 88 Surface Anatomy 26 Vascular Supply and Innervation of the The Breast 28 Anterior Abdominal Wall 90 Thoracic Muscles 30 Inguinal Canal 92 Thoracic Skeleton 32 Scrotum and Spermatic Cord 94 Vessels and Lymphatics of the Thoracic Wall 34 CHAPTER 8 Serous Membranes of the Diaphragm 36 Abdominal Cavity .................97 Peritoneum 98 CHAPTER 3 Lungs ............................41 Pleura 42 CHAPTER 9 Foregut ..........................101 Anatomy of the Lung 44 Big Picture 102 Hilum of the Lung 46 Liver and Gallbladder 104 Respiration 48 Pancreas and Spleen 106 Vascular Supply of the Foregut 108 CHAPTER 4 Heart .............................51 Pericardium 52 CHAPTER 10 Midgut and Hindgut ..............111 Overview of the Heart 52 Midgut 112 Coronary Circulation 54 Hindgut 114 Chambers of the Heart 56 Innervation of the Midgut and Hindgut 116 Innervation of the Heart 58 Portal System 118 Circulatory Pathway Through the Heart 60 www.BookOfLinks.com viii Contents CHAPTER 11 Posterior Abdominal Wall..........121 CN V: Trigeminal Nerve 196 Muscles 122 CN VII: Facial Nerve 198 Vessels of the Posterior Abdominal Wall 124 CN VIII: Vestibulocochlear Nerve 198 Somatic Nerves of the Posterior CN IX: Glossopharyngeal Nerve 200 Abdominal Wall 126 CN X: Vagus Nerve 202 Autonomics of the Posterior Abdominal CN XI: Spinal Accessory Nerve 204 Wall 128 CN XII: Hypoglossal Nerve 204 Adrenal Glands, Kidneys, and Ureters 132 Autonomic Innervation of the Head 206 CHAPTER 12 Pelvis and Perineum ..............135 CHAPTER 18 Orbit ............................211 Pelvic Floor 136 Orbital Region 212 Perineum 138 The Eye 214 Pelvic Vasculature 140 Extraocular Muscle Movement 216 Pelvic Innervation 142 Innervation of the Orbit 220 Rectum and Anal Canal 144 Vascular Supply of the Orbit 222 Ureters and Urinary Bladder 146 CHAPTER 19 Ear ..............................225 CHAPTER 13 Male Reproductive System .........149 The Ear 226 Male Reproductive System 150 Male Sex Act 154 CHAPTER 20 Superficial Face ..................231 Cutaneous Innervation and Vasculature CHAPTER 14 Female Reproductive System ......157 of the Face 232 Female Reproductive System 158 Muscles and Innervation of the Face 234 Study Questions 162 Parotid Gland 236 Answers 165 CHAPTER 21 Infratemporal Fossa ...............239 Overview of the Infratemporal Fossa 240 SECTION 4: HEAD Temporomandibular Joint 240 Innervation and Vascular Supply of the CHAPTER 15 Scalp, Skull, and Meninges ........169 Infratemporal Fossa 242 Anatomy of the Scalp 170 Skull 172 CHAPTER 22 Pterygopalatine Fossa .............245 Cranial Fossae 174 Overview of the Pterygopalatine Fossa 246 Meninges 176 CHAPTER 23 Nasal Cavity .....................249 CHAPTER 16 Brain ............................181 Overview of the Nasal Cavity 250 Anatomy of the Brain 182 Paranasal Sinuses 254 Ventricular System of the Brain 184 CHAPTER 24 Oral Cavity ......................257 Blood Supply to the Brain 186 Overview of the Oral Cavity 258 CHAPTER 17 Cranial Nerves .................
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    Deep Neck Infections 55 Behrad B. Aynehchi Gady Har-El Deep neck space infections (DNSIs) are a relatively penetrating trauma, surgical instrument trauma, spread infrequent entity in the postpenicillin era. Their occur- from superfi cial infections, necrotic malignant nodes, rence, however, poses considerable challenges in diagnosis mastoiditis with resultant Bezold abscess, and unknown and treatment and they may result in potentially serious causes (3–5). In inner cities, where intravenous drug or even fatal complications in the absence of timely rec- abuse (IVDA) is more common, there is a higher preva- ognition. The advent of antibiotics has led to a continu- lence of infections of the jugular vein and carotid sheath ing evolution in etiology, presentation, clinical course, and from contaminated needles (6–8). The emerging practice antimicrobial resistance patterns. These trends combined of “shotgunning” crack cocaine has been associated with with the complex anatomy of the head and neck under- retropharyngeal abscesses as well (9). These purulent col- score the importance of clinical suspicion and thorough lections from direct inoculation, however, seem to have a diagnostic evaluation. Proper management of a recog- more benign clinical course compared to those spreading nized DNSI begins with securing the airway. Despite recent from infl amed tissue (10). Congenital anomalies includ- advances in imaging and conservative medical manage- ing thyroglossal duct cysts and branchial cleft anomalies ment, surgical drainage remains a mainstay in the treat- must also be considered, particularly in cases where no ment in many cases. apparent source can be readily identifi ed. Regardless of the etiology, infection and infl ammation can spread through- Q1 ETIOLOGY out the various regions via arteries, veins, lymphatics, or direct extension along fascial planes.
  • Distal Radial Approach Through the Anatomical Snuff Box for Coronary Angiography and Percutaneous Coronary Intervention

    Distal Radial Approach Through the Anatomical Snuff Box for Coronary Angiography and Percutaneous Coronary Intervention

    Korean Circ J. 2018 Dec;48(12):1131-1134 https://doi.org/10.4070/kcj.2018.0293 pISSN 1738-5520·eISSN 1738-5555 Editorial Distal Radial Approach through the Anatomical Snuff Box for Coronary Angiography and Percutaneous Coronary Intervention Jae-Hyung Roh, MD, PhD, and Jae-Hwan Lee , MD, PhD Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea ► See the article “Feasibility of Coronary Angiography and Percutaneous Coronary Intervention via Left Snuffbox Approach” in volume 48 on page 1120. Received: Aug 27, 2018 The anatomical snuffbox, also known as the radial fossa, is a triangular-shaped depression Accepted: Sep 17, 2018 on the radial, dorsal aspect of the hand at the level of the carpal bones. It is clearly observed Figure 1 1)2) Correspondence to when the thumb is extended ( ). The bottom of the snuffbox is supported by carpal Jae-Hwan Lee, MD, PhD bones composed of the scaphoid and trapezium. The medial and lateral borders are bounded Division of Cardiology, Department of Internal by tendons of the extensor pollicis longus and the extensor pollicis brevis, respectively. The Medicine, Chungnam National University proximal border is formed by the styloid process of the radius. Within this narrow triangular Hospital, Chungnam National University space, various structures are located, including the distal radial artery (RA), a branch of the School of Medicine, 282, Munhwa-ro, Jung-gu, radial nerve, and the cephalic vein. Daejeon 35015, Korea. E-mail: [email protected] The anatomy of the hand arteries is illustrated in Figure 2.
  • Ultrasound-Guided Access of the Distal Radial Artery at the Anatomical Snuffbox for Catheter-Based Vascular Interventions: a Technical Guide

    Ultrasound-Guided Access of the Distal Radial Artery at the Anatomical Snuffbox for Catheter-Based Vascular Interventions: a Technical Guide

    Title: Ultrasound-guided access of the distal radial artery at the anatomical snuffbox for catheter-based vascular interventions: A technical guide. Authors: Anastasia Hadjivassiliou, MBBS, BSc; Ferdinand Kiemeneij, M.D, PhD; Sandeep Nathan, M.D, MSc; Darren Klass, M.D, PhD DOI: 10.4244/EIJ-D-19-00555 Citation: Hadjivassiliou A, Kiemeneij F, Nathan S, Klass D. Ultrasound-guided access of the distal radial artery at the anatomical snuffbox for catheter-based vascular interventions: A technical guide. EuroIntervention 2019; Jaa-625 2019, doi: 10.4244/EIJ-D-19-00555 Manuscript submission date: 10 June 2019 Revisions received: 24 July 2019 Accepted date: 01 August 2019 Online publication date: 06 August 2019 Disclaimer: This is a PDF file of a "Just accepted article". This PDF has been published online early without copy editing/typesetting as a service to the Journal's readership (having early access to this data). Copy editing/typesetting will commence shortly. Unforeseen errors may arise during the proofing process and as such Europa Digital & Publishing exercise their legal rights concerning these potential circumstances. Ultrasound-guided access of the distal radial artery at the anatomical snuffbox for catheter-based vascular interventions: A technical guide Anastasia Hadjivassiliou, MBBS, BSc1; Ferdinand Kiemeneij, MD, PhD2; Sandeep Nathan, MD, MSc3; Darren Klass, MD, PhD1 1. Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Canada 2. Department of Cardiology, Tergooi Hospital, Blaricum, the Netherlands 3. University of Chicago Medicine, Chicago, IL, USA Short title: Ultrasound guided distal radial artery access at the anatomical snuffbox Corresponding author: Dr Darren Klass Department of Radiology, Vancouver General Hospital 899 West 12th Avenue, V5Z 1M9, Vancouver, BC, Canada Email address: [email protected] Disclaimer : As a public service to our readership, this article -- peer reviewed by the Editors of EuroIntervention - has been published immediately upon acceptance as it was received.
  • Trigeminal Nerve, Mandibular Division Basic Anatomy and a Bit More

    Trigeminal Nerve, Mandibular Division Basic Anatomy and a Bit More

    The palate and the faucial isthmus He who guards his mouth and his tongue keeps himself from calamity. Proverbs 21:23 Ph.D., Dr. David Lendvai Parts of the oral cavity Parts of the oral cavity 1. Vestibule of the oral cavity Borders: - lips and cheek (bucca) - dental arches 2. Oral cavity proper Borders: - roof: hard and soft palate - floor: oral diaphragm (mylohoid m.) - antero-laterally: dental arches - posteriorly: isthmus of the fauces Etrance of the oral cavity - Philtrum - Upper & lower lip - Angulus - Rubor labii - Nasolabial groove (Facial palsy) Sobotta Szentágothai - Réthelyi Aspectus anterior 1 zygomatic process 2 frontal process 2 4 alveolar process 1 4 Faller (left) lateral aspect 1 zygomatic process 2 frontal process 3 orbital surface 4 alveolar process 2 3 Sobotta 1 4 Faller (right) Medial aspect Sobotta Superior aspect Sobotta Inferior aspect Sobotta http://www.almanahmedical.eu Sobotta Florian Dental – Dr. S. Kovách Fehér Fehér Szél Szél http://www.hc-bios.com Structures of the hard palate - incisive papilla - palatine rugae - palatine raphe - torus Hard and soft palate Muscles of the soft palate - Levator veli palatini m. - Tensor veli palatini m. - Palatoglossus m. - Palatopharyngeus m. - M. uvulae Muscles of the soft palate Muscles of the soft palate Structures of the hard and soft palate - mucous membrane - palatine glands - bone / muscles Histology of the hard palate Mucoperiosteum Histology of the soft palate NASAL SURFACE - pseudostratified ciliated columnar epithelium - lamina propria - mucous glands - striated
  • Normal Gross and Histologic Features of the Gastrointestinal Tract

    Normal Gross and Histologic Features of the Gastrointestinal Tract

    NORMAL GROSS AND HISTOLOGIC 1 FEATURES OF THE GASTROINTESTINAL TRACT THE NORMAL ESOPHAGUS left gastric, left phrenic, and left hepatic accessory arteries. Veins in the proximal and mid esopha- Anatomy gus drain into the systemic circulation, whereas Gross Anatomy. The adult esophagus is a the short gastric and left gastric veins of the muscular tube measuring approximately 25 cm portal system drain the distal esophagus. Linear and extending from the lower border of the cri- arrays of large caliber veins are unique to the distal coid cartilage to the gastroesophageal junction. esophagus and can be a helpful clue to the site of It lies posterior to the trachea and left atrium a biopsy when extensive cardiac-type mucosa is in the mediastinum but deviates slightly to the present near the gastroesophageal junction (4). left before descending to the diaphragm, where Lymphatic vessels are present in all layers of the it traverses the hiatus and enters the abdomen. esophagus. They drain to paratracheal and deep The subdiaphragmatic esophagus lies against cervical lymph nodes in the cervical esophagus, the posterior surface of the left hepatic lobe (1). bronchial and posterior mediastinal lymph nodes The International Classification of Diseases in the thoracic esophagus, and left gastric lymph and the American Joint Commission on Cancer nodes in the abdominal esophagus. divide the esophagus into upper, middle, and lower thirds, whereas endoscopists measure distance to points in the esophagus relative to the incisors (2). The esophagus begins 15 cm from the incisors and extends 40 cm from the incisors in the average adult (3). The upper and lower esophageal sphincters represent areas of increased resting tone but lack anatomic landmarks; they are located 15 to 18 cm from the incisors and slightly proximal to the gastroesophageal junction, respectively.