Autonomic Nervous System and Visceral Reflexes
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Anatomical Planes in Rectal Cancer Surgery
DOI: 10.4274/tjcd.galenos.2019.2019-10-2 Turk J Colorectal Dis 2019;29:165-170 REVIEW Anatomical Planes in Rectal Cancer Surgery Rektum Kanser Cerrahisinde Anatomik Planlar Halil İbrahim Açar, Mehmet Ayhan Kuzu Ankara University Faculty of Medicine, Department of General Surgery, Ankara, Turkey ABSTRACT This review outlines important anatomical landmarks not only for rectal cancer surgery but also for pelvic exentration. Keywords: Anorectal anatomy, pelvic anatomy, surgical anatomy of rectum ÖZ Pelvis anatomisini derleme halinde özetleyen bu makale rektum kanser cerrahisi ve pelvik ezantrasyon için önemli topografik noktaları gözden geçirmektedir. Anahtar Kelimeler: Anorektal anatomi, pelvik anatomi, rektumun cerrahi anatomisi Introduction Surgical Anatomy of the Rectum The rectum extends from the promontory to the anal canal Pelvic Anatomy and is approximately 12-15 cm long. It fills the sacral It is essential to know the pelvic anatomy because of the concavity and ends with an anal canal 2-3 cm anteroinferior intestinal and urogenital complications that may develop to the tip of the coccyx. The rectum contains three folds in after the surgical procedures applied to the pelvic region. the coronal plane laterally. The upper and lower are convex The pelvis, encircled by bone tissue, is surrounded by the to the right, and the middle is convex to the left. The middle main vessels, ureters, and autonomic nerves. Success in the fold is aligned with the peritoneal reflection. Intraluminal surgical treatment of pelvic organs is only possible with a projections of the lower boundaries of these folds are known as Houston’s valves. Unlike the sigmoid colon, taenia, good knowledge of the embryological development of the epiploic appendices, and haustra are absent in the rectum. -
Vagus Nerve (CN X) That Supply All of the Thoracic and Abdominal Viscera, Except the Descending and Sigmoid Colons and Other Pelvic Viscera
DR. HAYTHEM ALI ALSAYIGH Assistant prof. BOARD CLINICAL SURGICAL ANATOMY F.I.M.B.S.-MB.CH,B COLLEGE OF MEDICINE –UNIVERSITY OF BABYLON III. Autonomic Nervous System in the Thorax Is composed of motor, or efferent, nerves through which cardiac muscle, smooth muscle , and glands are innervated. Involves two neurons: preganglionic and postganglionic. It may include general visceral afferent (GVA) fibers because they run along with general visceral efferent (GVE) fibers . Consists of sympathetic (or thoracolumbar outflow) and parasympathetic (or craniosacral outflow)systems. Consists of cholinergic fibers (sympathetic preganglionic, parasympathetic preganglionic, and postganglionic) that use acetylcholine as the neurotransmitter and adrenergic fibers (sympathetic postganglionic) that use norepinephrine as the neurotransmitter (except those to sweat glands [cholinergic]). A. Sympathetic nervous system Enables the body to cope with crises or emergencies and thus often is referred to as the fight-or-flight division. Contains preganglionic cell bodies that are located in the lateral horn or intermediolateral cell column of the spinal cord segments between T1 and L2. Has preganglionic fibers that pass through the white rami communicantes and enter the sympathetic chain ganglion, where they synapse. Has postganglionic fibers that join each spinal nerve by way of the gray rami communicantes and supply the blood vessels, hair follicles (arrector pili muscles), and sweat glands. Increases the heart rate , dilates the bronchial lumen , and dilates the coronary arteries. 1. Sympathetic trunk Is composed primarily of ascending and descending preganglionic sympathetic fibers and visceral afferent fibers, and contains the cell bodies of the postganglionic sympathetic (GVE) fibers. Descends in front of the neck of the ribs and the posterior intercostal vessels. -
Detailed and Applied Anatomy for Improved Rectal Cancer Treatment
REVIEW ARTICLE Annals of Gastroenterology (2019) 32, 1-10 Detailed and applied anatomy for improved rectal cancer treatment Τaxiarchis Κonstantinos Νikolouzakisa, Theodoros Mariolis-Sapsakosb, Chariklia Triantopoulouc, Eelco De Breed, Evaghelos Xynose, Emmanuel Chrysosf, John Tsiaoussisa Medical School of Heraklion, University of Crete; National and Kapodistrian University of Athens, Agioi Anargyroi General and Oncologic Hospital of Kifisia, Athens; Konstantopouleio General Hospital, Athens; Medical School of Crete University Hospital, Heraklion, Crete; Creta Interclinic, Heraklion, Crete; University Hospital of Heraklion, Crete, Greece Abstract Rectal anatomy is one of the most challenging concepts of visceral anatomy, even though currently there are more than 23,000 papers indexed in PubMed regarding this topic. Nonetheless, even though there is a plethora of information meant to assist clinicians to achieve a better practice, there is no universal understanding of its complexity. This in turn increases the morbidity rates due to iatrogenic causes, as mistakes that could be avoided are repeated. For this reason, this review attempts to gather current knowledge regarding the detailed anatomy of the rectum and to organize and present it in a manner that focuses on its clinical implications, not only for the colorectal surgeon, but most importantly for all colorectal cancer-related specialties. Keywords Anatomy, rectum, cancer, surgery Ann Gastroenterol 2019; 32 (5): 1-10 Introduction the anal verge [AV]) to a given landmark (e.g., the part from the sacral promontory) [1]. This study can be considered as Even though rectal anatomy is considered by most indicative of the current overall knowledge on rectal anatomy clinicians to be a well-known subject, it is still treated as a hot across CRC-related specialties. -
A Narrative Review on the Impact of Nerve Sparing Surgery on Urinary Function in Pelvic Surgery for Endometriosis
5 Review Article Page 1 of 5 A narrative review on the impact of nerve sparing surgery on urinary function in pelvic surgery for endometriosis Beth Leopold1, Jordan S. Klebanoff2, Sara Rahman3, Sofiane Bendifallah4,5,6, Jean Marc Ayoubi7, Gaby N. Moawad3 1Department of Obstetrics and Gynecology, Mount Sinai Medical Center, New York, NY, USA; 2Department of Obstetrics and Gynecology, Main Line Health, Wynewood, PA, USA; 3Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA; 4Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; 5UMRS-938, Sorbonne University, Paris, France; 6Groupe de Recherche Clinique 6 (GRC6-Sorbonne Université): Centre Expert En Endométriose (C3E), France; 7Department of Obstetrics and Gyncology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest (UVSQ), Suresnes, France Contributions: (I) Conception and design: B Leopold, JS Klebanoff, GN Moawad; (II) Administrative support: None; (III) Provision of study materials or patients: B Leopold, JS Klebanoff, S Rahman, GN Moawad; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Gaby N. Moawad, MD. Department of Obstetrics & Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC 20037, USA. Email: [email protected]. Abstract: Endometriosis is an all too common benign inflammatory condition that impacts the lives of countless women around the world. Not only is there typically a delay in diagnosis of this devastating condition, but women are often mismanaged until they reach a provider with expertise in the condition. -
The Neuroanatomy of Female Pelvic Pain
Chapter 2 The Neuroanatomy of Female Pelvic Pain Frank H. Willard and Mark D. Schuenke Introduction The female pelvis is innervated through primary afferent fi bers that course in nerves related to both the somatic and autonomic nervous systems. The somatic pelvis includes the bony pelvis, its ligaments, and its surrounding skeletal muscle of the urogenital and anal triangles, whereas the visceral pelvis includes the endopelvic fascial lining of the levator ani and the organ systems that it surrounds such as the rectum, reproductive organs, and urinary bladder. Uncovering the origin of pelvic pain patterns created by the convergence of these two separate primary afferent fi ber systems – somatic and visceral – on common neuronal circuitry in the sacral and thoracolumbar spinal cord can be a very dif fi cult process. Diagnosing these blended somatovisceral pelvic pain patterns in the female is further complicated by the strong descending signals from the cerebrum and brainstem to the dorsal horn neurons that can signi fi cantly modulate the perception of pain. These descending systems are themselves signi fi cantly in fl uenced by both the physiological (such as hormonal) and psychological (such as emotional) states of the individual further distorting the intensity, quality, and localization of pain from the pelvis. The interpretation of pelvic pain patterns requires a sound knowledge of the innervation of somatic and visceral pelvic structures coupled with an understand- ing of the interactions occurring in the dorsal horn of the lower spinal cord as well as in the brainstem and forebrain. This review will examine the somatic and vis- ceral innervation of the major structures and organ systems in and around the female pelvis. -
Surgical Anatomy
1 Surgical Anatomy AnatomiA ChirurgicA Yiannis P Panayiotopoulos, MD, PhD 2 3 systems of organisation 4 INTEGUMENT [sKIN AND sUBCUTANEOUs TISSUes] Surface area= >2m2 Cleavage [crease] lines of Langer Divisions Epidermis Dermis [chorion] [400-2500] thick Stratified epithelium [20-1400 thick] Functions protection sensation secrertion individual characteristics Fascial layers Superficial layer Deep investing fascia Superficial layer Deep layer perimysium Camper's fascia Gruvellier's fscia Scarpa's fascia Colle's fascia [perineum] epimysium [abdomen] [perineum] [abdomen] fascial planes 5 mUsCULOSKeLETAL SYSTem BONES 206 bones axial skeleton appendicular skeleton Functions Protection & support of internal organs Biomechanical levers to produce movement Reservoir for irons Ca, PO4,CO3 Source of platelets red cells, granulocytes Bone composition Osteocytes Collagenous matrix Mineral content [connective tissue cells] Osteoblasts Osteoclasts provides tensile strength provides shear & compressive strength 6 Bone fractures Degree of Compression of Skin torn Nutrient foramina displacement fragments involved comminution compound avascular necrosis displaced not displaced Types of bones Long Flat [squamus] 2 plates of collar bone Diaphysis [shaft] containing spongy diploe Sesamoid Thin, spongy trabecular bone within tendons, to reduce attrition Marrow cavity & increase the lever arm of muscle Thick collar bone [cortical] Metaphysis trabecular bony network Thin cortical bone Epiphysis epiphyseal line epiphyseal disk 7 Bone healing fibroblasts collar of collagen [callus] Calcification Bone resorption Unorganised tissue proliferation [6 weeks] Remodeling [3-6 months] CARTILAGE Dense, irregular connective tissue, almost avascular, with a few living cells. 1. Hyaline [hyaluronic acid, muccopolysaccharides]: anterior portions of ribs and the articular cartilage. 2. Fibrocartilage [muccopolysaccharides, collagen, high content of water]: most symphyses. 3. Elastic [muccopolysaccharides & elastic fibres]: ear, tip of nose ARTICULATIONS 1. -
Name Kingsborough Community
Name ______________________________ Kingsborough Community College of The City University of New York Biology Department Biology 11 Examination ANS Return to ANS Facts Multiple Choice: use your scantron and darken the space of the letter of the best answer to each question. 1. The autonomic nervous system (ANS) is the motor portion for a. somatic reflexes b. visceral reflexes c. all peripheral reflexes d. skeletal muscular reflexes 2. Autonomic nerve impulses can be in response to sensory input from a. stretch receptors in blood vessels monitoring blood pressure b. stretch receptors in the urinary bladder or large intestine relating to their contents c. any internal receptor monitoring conditions of the tissues and organs d. the eyes, ears or nose sensing a dangerous situation e. any one of the preceding 3. Cytons (cell bodies) of preganglionic sympathetic neurons are located in the a. dorsal horns of gray matter b. anterior horns of gray matter c. lateral horns of gray matter d. pons and medulla oblongata e. S2-S4 segments of the spinal cord 4. Paravertebral ganglia contain cytons of a. parasympathetic postganglionic neurons b. parasympathetic preganglionic neurons c. sympathetic preganglionic neurons d. sympathetic postganglionic neurons 5. The sympathetic chain ganglia are found a. from cervical to coccygeal regions on either side of the vertebral column b. alongside the thoracic region of the vertebral column c. alongside the cervical and sacral regions of the vertebral column d. alongside the lumbar area of the vertebral column e. both b and d 6. Mass activation is a property of the _______ branch of the ANS. -
Unit #2 - Abdomen, Pelvis and Perineum
UNIT #2 - ABDOMEN, PELVIS AND PERINEUM 1 UNIT #2 - ABDOMEN, PELVIS AND PERINEUM Reading Gray’s Anatomy for Students (GAFS), Chapters 4-5 Gray’s Dissection Guide for Human Anatomy (GDGHA), Labs 10-17 Unit #2- Abdomen, Pelvis, and Perineum G08- Overview of the Abdomen and Anterior Abdominal Wall (Dr. Albertine) G09A- Peritoneum, GI System Overview and Foregut (Dr. Albertine) G09B- Arteries, Veins, and Lymphatics of the GI System (Dr. Albertine) G10A- Midgut and Hindgut (Dr. Albertine) G10B- Innervation of the GI Tract and Osteology of the Pelvis (Dr. Albertine) G11- Posterior Abdominal Wall (Dr. Albertine) G12- Gluteal Region, Perineum Related to the Ischioanal Fossa (Dr. Albertine) G13- Urogenital Triangle (Dr. Albertine) G14A- Female Reproductive System (Dr. Albertine) G14B- Male Reproductive System (Dr. Albertine) 2 G08: Overview of the Abdomen and Anterior Abdominal Wall (Dr. Albertine) At the end of this lecture, students should be able to master the following: 1) Overview a) Identify the functions of the anterior abdominal wall b) Describe the boundaries of the anterior abdominal wall 2) Surface Anatomy a) Locate and describe the following surface landmarks: xiphoid process, costal margin, 9th costal cartilage, iliac crest, pubic tubercle, umbilicus 3 3) Planes and Divisions a) Identify and describe the following planes of the abdomen: transpyloric, transumbilical, subcostal, transtu- bercular, and midclavicular b) Describe the 9 zones created by the subcostal, transtubercular, and midclavicular planes c) Describe the 4 quadrants created -
Anatomy of the Anterior Vagus Nerve: an Anatomic Description and Its Application in Surgery Leopoldo M
ogy: iol Cu ys r h re P n t & R y e s Anatomy & Physiology: Current m e Baccaro et al., Anat Physiol 2013, 3:2 o a t r a c n h DOI: 10.4172/2161-0940.1000121 A Research ISSN: 2161-0940 Research Article Open Access Anatomy of the Anterior Vagus Nerve: An Anatomic Description and its Application in Surgery Leopoldo M. Baccaro*, Cristian N. Lucas, Marcos R. Zandomeni, María V. Selvino and Eduardo F. Albanese Universidad del Salvador, School of Medicine, Tucumán 1845/49, Buenos Aires, Argentina Abstract Objective: Anatomic study of human corpses in order to obtain specific measurements of the anterior vagus nerve for its application in the surgical field. Methods: After analyzing the literature, dissections were performed on 15 human corpses, provided by the Universidad del Salvador. Descriptions were made of our observations. Results: The most frequently found structure in esophageal hiatus was a plexus. The cardial branch was present in 100% of the dissections. There were a constant number of gastric branches, between five and seven. The hepatic branch originated from the plexus in the majority of the cadavers. The distance between first and last branch points was variable. No relationship between the hepatic branch and left hepatic artery was observed. Conclusions: The structure most commonly found in the esophageal hiatus was the terminal plexus of the anterior vagus nerve. The hepatic branch most frequently originated directly from this plexus, although in a considerable number of cases its origin was found either proximal or distal to this structure. We could not confirm the literature stating the relationship between the hepatic branch and the left hepatic artery through our studies. -
Anatomy of Esophagus Anatomy of Esophagus
DOI: 10.5772/intechopen.69583 Provisional chapter Chapter 1 Anatomy of Esophagus Anatomy of Esophagus Murat Ferhat Ferhatoglu and Taner Kıvılcım Murat Ferhat Ferhatoglu and Taner Kıvılcım Additional information is available at the end of the chapter Additional information is available at the end of the chapter http://dx.doi.org/10.5772/intechopen.69583 Abstract Anatomy knowledge is the basic stone of healing diseases. Arteries, veins, wall structure, nerves, narrowing, curves, relations with other organs are very important to understand eso- phagial diseases. In this chapter we aimed to explain anatomical fundementals of oesophagus. Keywords: anatomy, esophagus, parts of esophagus, blood supply of esophagus, innervation of esophagus 1. Introduction Esophagus is a muscular tube-like organ that originates from endodermal primitive gut, 25–28 cm long, approximately 2 cm in diameter, located between lower border of laryngeal part of pharynx (Figure 1) and cardia of stomach. Start and end points of esophagus correspond to 6th cervi- cal vertebra and 11th thoracic vertebra topographically, and the gastroesophageal junction cor- responds to xiphoid process of sternum. Five cm of esophagus is in the neck, and it descends over superior mediastinum and posterior mediastinum approximately 17–18 cm, continues for 1–1.5 cm in diaphragm, ending with 2–3 cm of esophagus in abdomen (Figure 2) [1, 2]. Sex, age, physi- cal condition, and gender affect the length of esophagus. A newborn’s esophagus is 18 cm long, and it begins and ends one or two vertebra higher than in adult. Esophagus lengthens to 22 cm long by age 3 years and to 27 cm by age 10 years [3, 4]. -
Ultrasound of the Uterosacral Ligament, Parametrium, and Paracervix: Disagreement in Terminology Between Imaging Anatomy and Modern Gynecologic Surgery
Journal of Clinical Medicine Review Ultrasound of the Uterosacral Ligament, Parametrium, and Paracervix: Disagreement in Terminology between Imaging Anatomy and Modern Gynecologic Surgery Marco Scioscia 1,* , Arnaldo Scardapane 2 , Bruna A. Virgilio 3, Marco Libera 3, Filomenamila Lorusso 2 and Marco Noventa 4 1 Unit of Gynecological Surgery, Mater Dei Hospital, 70125 Bari, Italy 2 Section of Diagnostic Imaging, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70100 Bari, Italy; [email protected] (A.S.); [email protected] (F.L.) 3 Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, Italy; [email protected] (B.A.V.); [email protected] (M.L.) 4 Department of Women and Children’s Health, Clinic of Gynecology and Obstetrics, University of Padua, 35121 Padua, Italy; [email protected] * Correspondence: [email protected] Abstract: Ultrasound is an effective tool to detect and characterize lesions of the uterosacral ligament, parametrium, and paracervix. They may be the site of diseases such as endometriosis and the later stages of cervical cancer. Endometriosis and advanced stages of cervical cancer may infiltrate the parametrium and may also involve the ureter, resulting in a more complex surgery. New functional, surgical anatomy requires the complete diagnostic description of retroperitoneal spaces and tissues that contain vessels and nerves. Most endometriosis lesions and cervical cancer spread involve the cervical section of the uterosacral ligament, which is close to tissues, namely the parametrium Citation: Scioscia, M.; Scardapane, and paracervix, which contain vessels and important nerves and nerve anastomoses of the inferior A.; Virgilio, B.A.; Libera, M.; Lorusso, F.; Noventa, M. -
Superior and Posterior Mediastina Reading: 1. Gray's Anatomy For
Dr. Weyrich G07: Superior and Posterior Mediastina Reading: 1. Gray’s Anatomy for Students, chapter 3 Objectives: 1. Subdivisions of mediastinum 2. Structures in Superior mediastinum 3. Structures in Posterior mediastinum Clinical Correlate: 1. Aortic aneurysms Superior Mediastinum (pp.181-199) 27 Review of the Subdivisions of the Mediastinum Superior mediastinum Comprises area within superior thoracic aperture and transverse thoracic plane -Transverse thoracic plane – arbitrary line from the sternal angle anteriorly to the IV disk or T4 and T5 posteriorly Inferior mediastinum Extends from transverse thoracic plane to diaphragm; 3 subdivisions Anterior mediastinum – smallest subdivision of mediastinum -Lies between the body of sternum and transversus thoracis muscles anteriorly and the pericardium posteriorly -Continuous with superior mediastinum at the sternal angle and limited inferiorly by the diaphragm -Consists of sternopericardial ligaments, fat, lymphatic vessels, and branches of internal thoracic vessels. Contains inferior part of thymus in children Middle mediastinum – contains heart Posterior mediastinum Superior Mediastinum Thymus – lies posterior to manubrium and extends into the anterior mediastinum -Important in development of immune system through puberty -Replaced by adipose tissue in adult Arterial blood supply -Anterior intercostals and mediastinal branches of internal thoracic artery Venous blood supply -Veins drain into left brachiocephalic, internal thoracic, and thymic veins 28 Brachiocephalic Veins - Formed by the