| Anatomy•Neuroanatomy•Embryology•Histiology |
■Gross anatomy ☉Lateral Quadrangular space: Axillary n.+ post.humeral circumflex a. Medial Triangular space: Circumflex scapular a. ☉Pectoralis major: lat. med. pectoral n./thoracoacromial a.（老大在外） Pectoralis minor: med. pectoral n/thoracoacromial a. Teres minor & Deltoid: axillary n./suprascapular a. ☉Supraglenoid tubercle: biceps long head Infraglenoid tubercle: triceps long head ☉Brachial plexus: medial: ulnar n. lateral: musculocutaneous n.(piercing coracobracialis m.) posterior: radial n. ☉Axillary sheath first portion of the axillary artery is enclosed, together with the axillary vein and the brachial plexus, in a fibrous sheath—continuous above with the deep cervical fascia. ☉Axillary a. 1st: supreme thoracic a. 2nd: thoracoacromial a.(supply pectoral m.), lateral thoracic a.(breast) 3rd: subscapular a., circumflex scapular a. ant/post circumflex humeral a. ☉Lat. epicondyle: Brachioradialis + Common extensors + Supinator Med. epicondyle: Common flexors + Pronators ☉Snuff box extensor pollicis longus/brevis, abductor pollicis longus ☉Thenar muscles(median n.) 1.Abductor pollicis brevis 2.Opponens pollicis 3.Flexor pollicis brevis ☉Hypothenar muscles(ulnar n.) 1.Abductor digiti minimi 2.Opponenes digiti minimi 3.Flexor digiti minimi ☉The only abdutor: dorsal interosseus ☉Spinal cord: L1-2 (8 wk): whole vertebral canal (birth):L3 (3 y/o):L1-2 Subarachnoid space: S2 人骨共206塊 ☉Hemi/Azygos v: ←sup. intercocstal v. post. intercostal v.subcostal v. ascending lumbar v. ☉Breast blood supply 1.internal thoracic a. 2.Lateral thoracic a.★ 3.intercostal a. ☉Pulmoary a. 在aorta之前（前者像大衛畫作中止戰的女神）。瓣膜排列分別為(ant/rt/lt)(post/rt/lt) ☉moderator band (heart, anatomy) The septomarginal trabecula of the right ventricle, originally termed the moderator band because wrongly it was thought to limit the expansion of the chamber, is a muscular thickening extending from the interventricular septum to the base of the★anterior papillary muscle. Its main function is to convey the right branch of the ★atrioventricular bundle of the conducting system. ☉Bronchus 右：斜下角度大，接十個肺葉 左：比較長，接八個肺葉 ☉Inspiratory muscle Intercostales xterni Transversus thoracis Levator costarum Seratus post. ☉Esophageal supply: inf. thyroid a. bronchial a. aorta left gastric a. phrenic a. ☉Diaphragm →from ant. to post: IVC(T8), esophagus(T10), aorta(T12) （也是高中低的順序） →Vena cava hiatus: central tendon →Esophaeal hiatus: 有vagus n.伴行，T10 level（食道：十道） →Aortic hiatus: 有azygus v.與thoracic duct（左側才有）伴行 ☉Retroperitoneal organs kidney, pancreas, duodenum, ascending colon ☉Omental foramen: sup: caudate lobe of liver inf: duodenum, 1st ant: portal triad post: IVC, diaphragm ☉Lesser sac: hepatoduodenal lig ☉Celiac trunk: left gastric, common hepatic, splenic a. ☉Gastric supplies: 1.Left/right gastric a. (celiac/ common hepatic) 2.Left/right gastro-omental a. (splenic/ gastroduodenal) 3.Short gastric a. (splenic a.) ☉Duodenal supplies: 1.Supraduodenal a. 2.Right gastro-omental a. 3.Sup/inf. pancreaticoduodenal a. →back wall: gastroduodenal a. rupture ☉Liver Quadrate lobe: between gallbladder & ligamentum teres(→falciform lig/round lig) Caudate lobe: between IVC & ligamentum Bare area: damarcated by coronary lig. adjacent to the diaphragm, not covered by peritoneum. ☉Ligament of treitz, the suspensory ligament of the 4th duodenum: a band of connective tissue arising from the region of the crus of the right diaphragm and the connective tissue around the coeliac artery inserting into the third and fourth parts of the duodenum. The duodenojejunal junction lies to the left of this at the level of the duodenal cap and the pedicle of the second lumbar vertebra. The base of the mesentery in normal patients extends from the duodenojejunal junction to the caecum. In patients with malrotation this wide base is absent. ☉Pancreatic supplies: 1.Splenic a. 2.sup/inf.ant/post. pancreaticoduodenal a. ☉小腸長7公尺。空腸Jejunem較厚而有較多血管。 ☉腎門: 前後是VAD 肺門：前後是VAD 肝門：還是VAD 大腿三角：由內而外是VAN ☉門脈 動脈：glomerulus 靜脈：肝臟，腦下腺 ☉Inguinal triangle: (Hesselbachs Triangle) inf. epigastric a. inguinal lig. rectus abdominis ☉Conjoint tendon transversus + int. oblique ☉Spermatic cord internal spermatic fascia: from transversalis fascia(No transversus abdominus!)（deep ring） Cremaster muscle: from int. oblique m.（夾心的提睪肌）(genitofemeral n.) external spermatic fascia: from ext. oblique m.（superficial ring） ☉屁股肌/神經 Gluteus: 大中小（大：inf. gluteal n. 中小：sup. gluteal n.）（不倫不類） Gemellus:上下（上：n to internal obturator下：n to quadratus femoris）（寄人籬下） Obturator: 內外 梨狀肌 四頭肌 ☉sacrospinal ligament separates the greater and lesser sciatic foramina ☉Left ovarian v.→left renal vein Right ovarian v.→IVC ☉Rectal a. sup: IMA mid: int. iliac a. inf: internal pudendal a. ☉Urogenital region 1.superficial perineal fascia 2.superficial perineal pouch →bulbospongiosus, ischiocavernosus, transverse perineal sup. m. →greater vestibular gland(female!!)前庭腺 3.Urogenital diaphragm →sup fascia →inf fascia: perineal membrane 4.deep perineal pouch →transverse perineal deep m. →urethral sphincter, membranous urethra →bulbourethra glands(Male!!)尿道球腺 →internal pudendal a. & n. 5.Perineal body 6.Anococcygeal raphe ☉Internal iliac a.(Common iliac 在L4分出來） Ant: inf. gluteal, int. pudendal, iliolumbar a..... Post: sup. gluteal, lat. sacral a.... →→Umbilical a: after giving off sup. vesicle a, it becomes medial umbilical ligament. ☉Femoral triangle 1.base: inguinal lig 2.lat: med. satorius 3.med: lat. adductor longus apex→→adductor canal: 1.ant: satorius 2.post: adductor longus & magnus 3.lat: vastus medialis contents: femoral a. v. saphenous n. n to vastus medialis ☉Femoral sheath: 3 compartments lat: femoral a int: femoral v med: femoral canal→fat,deep LN, femoral hernia ☉Femoral m. innervation ant: femoral n.(Flexors) med: obturator n.(Adductors...) post: sciatic n.(Hamstring muscles→biceps/semi-) ☉Joints Ball-&-socket joint: Condyloid joint: Plane (or Gliding) joint: Hinge joint: Pivot joint: Saddle joint: ☉Triangles of the Neck The neck is arbitrarily subdivided into two triangles by the sternocleidomastoid muscle: 1.Anterior: submental (smen) submandibular (sm) muscular-visceral (mus) carotid (car) 2.Posterior: occipital supraclavicular (omoclavicular) ☉suboccipital triangle bounded by the: rectus capitis (posterior) major muscle inferior oblique muscle superior oblique muscle contains: vertebral a. pot.arch of atlas, suboccipital n.(BUT no Occipital Artery!!) ☉carotid triangle posterior belly of digastric muscle (pbd) superior belly of the omohyoid muscle (so) anterior border of sternomastoid muscle (st) ☉carotid sheath Internal jugular v. Common carotid a. CN X Ansa cevicalis Deep cervical lymph nodes ☉muscular triangle Sup. omohyoid sternocleidomastoid ant. margin of neck ☉submandibular triangle mastoid & mandible above anterior belly of digastric anteriorly (abd) posterior belly of digastric (pbd) and stylohyoid posteriorly (sh) ☉Digastric Muscle →→Innervation is derived from: anterior belly: mylohyoid nerve, a branch of the mandibular division of the trigeminal nerve posterior belly: nerve from posterior auricular branch of facial nerve →→The actions of digastric are to: depress and retract the mandible, so assisting the lateral pterygoid muscles in opening the mouth elevation of the hyoid bone, utilised during swallowing and speech ☉The only tongue protruder: Genioglossus ☉Tongue: anterior 2/3, posterior 1/3 Taste(SVA) VII（甜味） IX（苦味） Sensory(GSA) V IX ☉Ear: Tympanic membrane→Malleus→Incus→Stapes→Oval window (MISO) ☉Vocal cord: tense: cricothyroid m.（此肌肉唯一不被recurrent laryngeal n.所支配） loose: cricoarytenoid m. abduction: post. cricoarytenoid m. ■Neuroanatomy ☉Skull base sup. orbital fissure: 3,4,6, V1 foramen rotundum: V2(→pterygopalatine fossa) foramen ovale: V3+ lesser petrosal n(9)（三色蛋） foramen spinosum: mid. meningeal a.（最常造成EDH）+ V3 jugular foramen: 9,10,11 internal acoustic meatus: 7,8 ☉Cerebellum Excitatory: Mossy, Climbing, Parallel fibers（沿著蘚苔爬山很興奮） Inhibitory: Purkinje, Basket, Stellate, Golgi cell ☉Parathypathetic n.（三七仔就是） III: ciliary ggl→pupil VII: pterygopalatine→lacrimal gl. sup. salivary nucleus→submandibular ggl→submandibular/sublingual gl. IX: inf. salivary nucleus→otic ggl→parotid gl. ☉Facial nerve palsy In the central type, the lesion is located above the pontine nuclei (producing contralateral facial paralysis excluding the forehead muscles). In the peripheral type, the lesion is between the pontine nuclei and the end branches of the facial nerve (producing ipsilateral facial paralysis of all facial muscles). ☉V3,VII,IX,X: SVE(from brachial arch) VII: SVE+ GVE+ SVA ☉Eye movement 1. Coordinated gaze: Abducens nucleus→MLF(medial longitudinal fasciculus)→contralateral III nucleus 2. Saccadic eye movement: FEF(frontal eye field)→PPRF(paramedian pontine reticular formation)負責水平運動→MLF→.... 3. Smooth pursuit eye movement: Parieto-occipital eye field→...... 4. Vertical eye movement: riMLF(rostral interstitial nucleus of MLF) ☉Nucleus gracilis: One of the dorsal column nuclei. Receives ascending fibers in the dorsal column (fasciculus gracilis) of the spinal cord entering below the level of the sixth thoracic spinal segment. Axons of neurons in this nucleus form the internal arcuate fiber system, cross in the midline (at more rostral levels), and form the medial lemniscus. ☉Stretch reflex: muscle spindle→Ia→α→extrafusal muscle Inverse stretch reflex: Golgi tendon→Ib→interneuron→α→extrafusal muscle CNS voluntary: γ→intrafusal apparatus→muscle spindle→Ia→α→extrafusal muscle ■Embyology ☉Placental membrane vasculo-syncytiotrophoblast ☉Branchial cleft cysts, sinuses, and fistulas First: in close proximity or in communication with the ★external auditory canal Second: the majority, the external opening or cyst found along the anterior border of the ★sternocleidomastoid muscle, into the ★oropharynx in the area of the tonsillar fossa Third: the anterior border of the sternocleidomastoid muscle and are lateral and superior to the common carotid. opens into the ★piriform sinus Fourth: ★Branchial Arches: 1st: mandibular arch←→malleous& incus←→CN V 2nd: hyoid arch←→ stapes←→CN VII 3rd: hyoid(inf)←→ CN IX 4-6th: laryngeal cart←→ CN X ★Branchial Pouches: 1st: middle ear 耳 2nd: tonsil口 3rd: thymus, parathyroid gland(inf)喉 4th: C cells(parafollicular cells) in thyroid gland ☉Eye development 1.Neuroectoderm(Optic cup): retina, iris, optic n. ciliary epithelium 2.Surface ectoderm: lens 3.Mesoderm: mesenchyme: ciliary muscle ☉Respiratory development 1.Endoderm from laryngotracheal groove: epithelium 2.Splanchnic mesenchyme from foregut: ct. m. cart.（外籍勞工） ☉Larynx development 1.epithelium: endoderm 2.cartilages: neural crest cells 3.vocal cord: laryngeal ventricles 4.epiglottis: hypobranchial eminence 5.laryngeal m: myoblasts ☉Lung devepoment 1.Pseudoglandular period(5-17 wk) 2.Canalicular period(16-25 wk): highly vascular 小管血管期 3.Terminal sac period(24wk -): blood-air barrier, surfactant(II)氣囊期，早產兒可存活 4.Alveolar period(late fetal-childhood): alveolocapillary membrane thin enough for gas exchange, 95％ alveoli postnatally ☉Liver development 1.Hematopoiesis: from 6 wk 2.Bile: 12 wk ☉Foregut 1.primordial pharynx 2.lower respiratory system 3.esophagus & stomach→ 90 deg clockwise 4.duodenum (proximal to bile duct opening) 5.liver, biliary apparatus, pancreas ☉Midgut (Duodenum to right 1/2-2/3 transverse colon) 1.Physiological umbilical herniation: 6 wk 2.Rotation of midgut loop: 90 deg counterclockwise around SMA axis 3.Return of the midgut to abdomen: 180 deg counterclockwise 4.Fixation of the intestines ☉Umbilical ligaments and ligamentum teres hepatis Median umbilical ligament is a fold of parietal peritoneus over the urachus Medial umbilical ligaments are folds of parietal peritoneus over the umbilical arteries Lateral umbilical ligaments are folds of peritoneum over the inferior epigastric arteries Supravesicle fossa is the depression between the median and medial umbilical ligaments Medial umbilical fossa is the depression between medial and lateral umbilical ligaments Lateral umbilical fossa is the depression lateral to the lateral umbilical ligament The ligamentum teres hepatis is the remnant of the umbilical vein The falciform ligament is the fold of parietal peritoneum covering the ligamentum teres hepatis ☉Intermidiate mesoderm→→urogenital ridge Woffian duct(Mesonephric duct): epidydimis, efferent ductus→ejaculatory duct Muellerian duct(paramesonephric duct)（故曰第二性）: uterine, tube, vagina upper portion ☉Gonad 3 sources 1.mesothelium 2.mesenchyme→gonad ridges 3.Primodial germ cells(PGC)←yolk sac endodermal cells migration ☉Gonad→(Testis determing factor from chr. Y, TDF)→testis（否則變成卵巢）（以此角度言之，女人為第一性） →Leydig cell(respond to LH)(equivalent to corpus luteum) →(hCG)→Testosterone→Wolffian duct(Mesonephrine duct) →Sertoli cell(respond to FSH)(equivalent to follicle)(blood-testis barrier)→Muellerian inhibition factor(MIF)（故男性沒有Mueller的女性器官） ☉Woffian ducts regress to Gartner's ducts in female ■Histology ☉Mitosis 1.Prophase: 2.Metaphase: 都靠在中間 3.Anaphase: 開始分手 4.Telophase: 分裂完成 ☉blood Neutrophil: Barr body(drumstick, sex chromatin) Eosinophil: lamellatd crystalloids ☉三大名器（由淺而深） Merkel cells: pain, touch Meissner's corpuscles: tactile Pacinian corpuscles: pressure洋蔥狀 ☉cartilage growth 1.interstitial: within lacuna 2.appositional: perichondrium（★只有fibrocartilage(articular discs)沒有！！） ☉Bone architecture 1.Spongy bone: trabeculae, BM 2.Compact bone: concentric lamina(Harversian) →Harversian system/ volkmann's canal ☉bone growth 1.Intramembranous: mesenchyme→osteoblast 2.Endochondrial: →primary diaphyseal occification center →secondary epiphyseal occification center →periosteal bone collar ☉Muscle contraction A band: 黑暗地帶永遠不變 I band: 亮帶縮短 Z band: sarcomere 縮短 ☉Arteries 1.Elastic(conducting): tunica media含elastic, collagen fibers, sparse smooth m. 2.Muscular(distributing): intima 含internal elastic membrane, media含 smooth m. 以及其形成之elastic fibers 3.Arterioles: media: smooth m. ☉Veins: media/intima都很弱，但是adventitia超多smooth muscle ☉Salivary glands Most serous(acinar, Zymogens): parotid gland Most mucinous(tubular,PAS+): sublingual gland ☉Stomach: Parietal cells (HCl, intrinsic factor!!) and Chief Cells (Pepsinogen) Ileum: (Peyer's Patches) ☉Small intestine 1.Mucosa →Villi →Paneth cells on crypts of Lieberkuehn base, eosinophic granules 2.Submucosa →Plica circularis（在空腸Jejunum最多！！） →Duodenal(Brunner) glands →Peyer's patch（在回腸ileum最多！！回腸還吸收Vitamin, bile salts, Vit.B12） ☉Adrenal gland Zona glomerulosa: Minerocorticoid(Aldosterone) Zona fasciculata: Glucocorticoid(Cortisone)皮質「束」不在表皮 Zona reticularis: Androgen Medulla: Granular cells(Chromaffin cells): E, NE (←←preganglionic cholinergic sympathetic n) ☉Juxtaglomerular apparatus 1.Juxtaglomerular cells→baroreceptor, secret renin 2.Macular densa→regulate renin(secrete aldosterone?) 3.Mesangial cells: macrophage ☉Clara cells specialised cells which populate the epithelium of the respiratory tree from the level of terminal bronchiole to alveolar duct. 1. surfactant production; their product is not the same as that produced by the type II pneumocytes, but it may form one constituent of surfactant 2. detoxification; the number of Clara cells increases in response to increased exposure to pollutants e.g. chronic cigarette inhalation ☉Ovarian follicles of stroma Primordial Primary: zona pellucida Secondary: antrum, cumulus oophorus, corona radiata Mature(Graafian) follicle: 1.granulosa cells→→→lutein: produce progesterone（卵「黃囊」） 2.theca cells interna(from c.t. of stroma): secrete estrogen已經在濾泡外 ☉Stereocilia A specialized microvillus that superficially resembles a cilium and projects from the surface of certain cells (as the auditory hair cells and the superficial epithelial cells of the epididymis). ☉Cilia: Motile, utilize ATP for movement.Modified centriole that contains nine microtubule triplets in its core forming a ring structure.Each cilium contains an inner core of microtubules arranged in a 9+2 pattern. There are nine pairs or doublets of microtubules that are circularly arranged around 2 central microtubules. The microtubules composing each doublet are designated as the “A microtubule” and the “B microtubule". Where found: respiratory epithelium-nasal cavity, trachea, bronchus, oviducts. ☉Glands Audry's glands (Fordyce's disease) Enlarged ectopic sebacous glands in the mucosa of the mouth and genitals. Boerhaave's glands The sweat glands of the skin. Elschnig's conjunctivitis Chronic conjunctivitis associated with hyperplasia of the tarsal gland and the frothy secretions. Krause's glands (Karl Friedrich Theodor Krause) Accessory tear glands. Leydig's gland A portion of the mesonephros in vertebrates, of which the secretions are thought to stimulate the movement of spermatozoa. Lieberkühn's crypts (Lieberkühn's glands) Simple tubular glands which open into the intestine, present in the mucous membrane of the small and large intestines. Littre's glands The small mucous glands of the male urethra. Littreitis Inflammation of the urethral glands. Luschka's gland (Luschka's tonsils) A collection of more or less closely aggregated lymphoid nodules on the posterior wall of the roof of the nasopharynx. Meibomian conjunctivitis (Elschnig's conjunctivitis) Chronic conjunctivitis associated with hyperplasia of the tarsal gland and the frothy secretions. Meibomian cyst A small tumor of the eyelid resulting from inflammation of a meibomian gland. Montgomery's glands or tubercles A group of 12-15 sebaceous glands in the areola of the nipple. Rivinus' gland A sublingual gland. Robinson's disease Group of clear vesicles composed of cystic sweat glands usually around the eyes – hydrocystoma. Rosenmüller's gland The palpebral portion of the lacrimal gland. von Ebner's glands (Ebner's glands) Serous glands of the tongue, located beneath the circumvallate and foliate papillae. Waldeyer's gland Sweat glands of the eyelids. Wölfler's glands Accessory thyroid gland. |