Documenti di Didattica
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l Dear students, you can use this presentation like a guide during your
preparing for GA exams.
l It does NOT cover all material of the Gross Anatomy course.
100 must important l To complete GA material you should work with ALL professorís
GA conceptions presentations.
l Good Luck and All the best!
Dr. Mavrych, MD, PhD, DSc
Dr. Bolgova, MD, PhD
Dr. Mavrych
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
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l DID
DIP - FDP
Distal Interphalangeal Joint
DIPS- Flexor Digitorum Profundus
Birth injury or Fall causes
Ulnar and Median ns Superior Trunk Damage:
Erb's Palsy
MCPs- Lumbricals
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Metacarpal phalangeal joint
Median n lesion: Ape hand/benediction with lateral 3 digits are extended, wrist is extended
Ulnar n lesion: Claw hand with medial 2 digits extended
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Radial n lesion: Drop Wrist with flexion of the wrist
Cutaneous innervation
of the hand Inradial
reality, in case of superficial branch of
nerve lesion it will be skin deficit 13. Cardiac catheterization
between 1 & 2 digits on the dorsum of the
hand ONLY because of nerve overlapping
l The femoral artery is
used for cardiac
catheterization
l It can be cannulated
for left cardiac
angiography & also
for visualizing the
coronary arteries ñ a
long, slender catheter
is inserted
percutaneously and
passed up the
external iliac artery,
common iliac artery,
aorta, to the left
ventricle of the heart
Dorsum: 1,5-U and 3,5 R Palm: 1,5-U and 3,5 M
A catheter can also be passed through a peripheral vein (femoral vein) into IVC, the
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com R atrium,
Dr. Mavrych, R ventricle,
MD, PhD, pulm trunk and pulm arteries. Intracardiac pressures, blood
DSc prof.mavrych@gmail.com
samples, and visualization of great vessels using Xray
Superior gluteal
nerve injury Injury to inferior gluteal nerve
possibly also due to Piriformis syndrome
Normal Right l The superior gluteal nerve
superior may be injured during surgery,
gluteal nerve posterior dislocation of the l Weakened hip extension
injury hip or poliomyelitis. (gluteus maximus), most
l Paralysis of the gluteus noticeable when climbing
medius and gluteus minimus stairs or standing from a
muscles occurs so that the seated position
ability to pull the pelvis up l Cause of injury: posterior
and abduction of the thigh
are lost. hip dislocation, surgery in
this region
Trendelenburg sign:
l If the superior gluteal nerve on
the right side is injured, the left Inferior gluteal n passes through inferior
pelvis falls downward when the piriformis fossa with the sciatic n,
patient raises the left foot off the posterior femorial cutaneous n, Superior
Patient stands and raises
ground.
gluteal a & v, pudendal n, and internal
l Note that side is contralateral to
L leg, if the L leg drops, it the nerve injury. pudendal a & v
is standing right leg nerve
injury
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
passes through superior piriformis fossa w/ inferior gluteal a & v
tearing off
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
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Prepatellar bursa
Suprapatellar bursa Knee jerk reflex
articularis l Prepatellar bursa: between
genu m superficial surface of patella l The patellar reflex
and skin. May become is tested by tapping
the patellar Rectus femoris m
inflamed and swollen ligament with a
(prepatellar bursitis). reflex hammer to
elicit extension at
the knee joint. Both
l Suprapatellar bursa: superior afferent and
extension of synovial cavity efferent limbs of
between distal end of femur the reflex arch are
in the femoral
and quadriceps muscle and nerve (L2-L4).
tendon. Usual place for intra-
articular injections. May l Knee jerk reflex:
become inflamed and swollen tests spinal nerves
(suprapatellar bursitis). L2-L4.
Posterior to Rectus femoris m
and vastis intermedialis m
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Pott's fracture
Eversion injury is Deltoid ligament at medial malleolus
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
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Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Popliteal Fossa is bordered by Semitendinosus, Semimembranosus, Biceps Adductor hallucis (oblique & transverse
Dr. Mavrych, MD, and
femoris, PhD, DSc prof.mavrych@gmail.com
quadracepts (gastronemius, plantaris, and soleus ms) heads), Quadratus Plantae, Flexor Digiti
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
minimi, abductor digiti minimi, DABs,
PADs, lateral 3 lumbricals
Common Fibular/Common Peroneal n does not pass in popliteal
fossa, instead it goes around neck of fibula
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
P-A projection
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Great cardiac v, middle cardiac v, small cardiac v, L marginal v drain into Coronary Sinus which empties in Triangle of Koch at RA
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
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Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
31. Mediastinum
Nerve supply of the pleura Superior
p mediastinum
Parietal Pleura ñ sensitive to general l Improperly done
sensibilities (pain, temperature, touch, sternal puncture
and pressure) - somatic sensory may affect
innervation: structures related
l costal pleura ñ intercostal nerves to the posterior
block may be used to decrease surface of the
thoracic pain manubrium
l mediastinal pleura ñ phrenic nerve sternum:
l diaphragmatic pleura ñ phrenic nerve
l In upper part ñ
over the domes and lower 6 intercostal
nerves around the periphery Left
brachiocephalic
vein
Visceral Pleura ñ sensitive to stretch but
insensitive to general sensibilities; l In lower part ñ
autonomic nerve supply from the Aortic arch
pulmonary plexus Azygous vein and ascending
aortic arches
Cervicothoracic Stellate Gangion down to T11 and Subcostal sympathetic ganglion comprise the thoracic Trachea and Pulmonary artery
sympathetic trunk Ribs 1-2 down to transverse thoracic bifurcations
Dr. muscles
Innervate Mavrych,ofMD,
the PhD, DSc prof.mavrych@gmail.com
ribs, abdominal wall, pulmonary and cardiac plexus, and esophageal plexus Dr. Mavrych, MD,plane
PhD,(T2)/Plane
DSc prof.mavrych@gmail.com
of ludwig/angle of louis esophagus and thoracic duct
Vagus CNX assists plexus of thorax for vocal cords and swallowing, and gives off recurrent laryngeal and change directions (cross over)
superior external laryngeal to the larynx muscles
Pericardial sinus: behind pulm trunk and aorta place fingers to
clamp/ligate great vessels during surgical procedures
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
TIE ICE
Transversalis Fascia becomes Internal Spermatic Fascia
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Internal Oblique m & Fascia becomes Cremasteric m & Fascia
External Oblique fascia becomes External Spermatic Fascia
Surrounds the Spermatic cord within the inguinal canal:
3 as: cremasteric (inferior epigastric), ductus deferans (internal iliac-inferior vesicle),
gonadal a (aorta)
3 ns: genital br (motor genitofemoral), ANS, ilioinguinal
3 others: Pampiniform plexus (IVC and Lrenal), Ductus Deferens, Lymphatics
Process Vaginalis/Gubernaculum
Males have a vesicorectal pouch, fluid can accumulate in these peritoneal areas if there is a pelvic abscess.
Dr. Mavrych, MD, PhD, DSc
Morrison's prof.mavrych@gmail.com
pouch Dr.kidney
is where fluid accumulates if the person is lying down (between Mavrych,
and MD,
liver)PhD, DSc prof.mavrych@gmail.com
McBurney's point lies 2/3 from umbilicus to ASIS OR 1/3 from ASIS to umbilicus
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
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Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
OFF Common Hepatic a of Celiac Trunk OFF Common Hepatic a of Celiac Trunk
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Mesenteric ischemia
l Atherosclerosis, which slows the
1 IMA Branches: amount blood flowing through arteries, is
a frequent cause of chronic mesenteric
l (1) Left colic artery ischemia.
l (2) Sigmoid arteries l Ischemia occurs when blood cannot flow
through arteries as well as it should, and
l (3) Superior rectal artery intestines do not receive the necessary
oxygen to perform normally. Mesenteric
ischemia usually involves SMA and small
intestine.
3 l Mesenteric ischemia primarily affects
organs which locate far away from
anastomoses with CA & IMA. Usually
blood supply of the Jejunum and Ileum is
most compromised.
l Mesenteric ischemia typically occurs in
2 people older than age 60 with history of
smoking and high cholesterol level.
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Tumor in the head of the pancreas can block the duct and cause jaundice
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Blockage of the cystic or common bile duct via gall stones can cause gall bladder rupture w/ refered
pain to the shoulder (C3-5 phrenic n), and backflow of pancreatic enzymes that digest the pancreas
and the spleen via splenic artery branches
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Cholelithiasis (gallstones)
Gallstones
l The distal end of the hepato- l The fundus [1] of the gallbladder is
pancreatic ampulla (Bile duct) is the in contact with the transverse colon
narrowest part of the biliary passages and thus gallstones erode through the
posterior wall of the gallbladder and
and is the common site for impaction enter the transverse colon. They are
of gallstones. passed naturally to the rectum 2
4 1 through the descending colon and
l As result of common hepatic (1), bile sigmoid colon.
duct (2), or hepatopancreatic
ampulla (3) obstruction patient will l Gallstones lodged in the body [2] of
have yellow eyes and jaundice the gallbladder may ulcerate through 1
2 the posterior wall of the body of the
l Gallstones may also lodge in the gallbladder into the duodenum
3 cystic duct. A stone lodged in the (because the gallbladder body is in
cystic duct (4) causes biliary colic contact with the duodenum) and may
be held up at the ileocecal junction,
(intense, spasmodic pain in the producing an intestinal obstruction.
gallbladder) but doesn't produce
jaundice.
(4) R, L and middle colic vs anastamose with Esophageal branches of the L Gastric v will anastomose with azygous
Renal, suprarenal and gonadal vs, No clinical Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
name however represents as varicocele on the
abdomen
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Superior Rectal vein (IMV) anastomoses with middle and inferior rectal vs (internal iliac v &
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych,
internalMD, PhD,v)DSc
pudendal duringprof.mavrych@gmail.com
portal hypertension Rectal varices (Hemorrhoids)
Internal hemorrhoids are painless superior to pectinate line at internal rectal venous plexus.
External hemorrhoids are painful due to blockage of external rectal venous plexus, where
Nociceptors (pain) are located.
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
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Pampiniform plexus
54. Hydrocele
l Each testicular or ovarian vein is
formed by coalescence of a l The tunica vaginalis testis or
pampiniform plexus:
plexus the other remnants of the processus
testicular at the deep inguinal vaginalis may form a hydrocele
ring, the ovarian at the margin of or hematocele.
the superior aperture of the l In spermatic cord it is smooth
pelvis. sausage-shaped structure that
l The veins run accompanied by persists under gentle
the corresponding arteries. The compression and isnít disappear
left pampiniform plexus enters in supine position.
the left renal vein; the right one l In the scrotum with
enters directly the IVC inferior transillumination, a hydrocele
to the renal vein. produces a reddish glow,
l That is why varicocely whereas light will not penetrate
(engorgement of the pampiniform other scrotal masses such as a
plexus that produces a scrotal hematocele, solid tumor, or
mass) is more often located on herniated bowel. spermatocele
the left.
Testicular torsion is twisting of the testis within the
scrotum, it can cause ischemia to the blood vessels
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
and must be corrected quickly or may lose testis.
55. Hemorrhoids:
Venous drainage from rectum External hemorrhoids
l Above pectinate line: superior
rectal vein [1] into portal l Hemorrhoids are masses that
2 system [2]. typically protrude from anus
4 PAINLESS during defecation.
l Hemorrhoids are commonly
l Below pectinate line: inferior associated with constipation,
rectal vein [3] into inferior extended sitting and straining at
vena cava [4]. the toilet, pregnancy, and
disorders that hinder venous return.
PAINFUL
l 1. External hemorrhoids are
1 1 dilated tributaries of the inferior
rectal veins (IRV) BELOW THE
PECTINATE LINE and are painful
because the mucosa is supplied by
3 somatic afferent fibers of the
1 inferior rectal nerves (from
pudendal).
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Posterior lobe is mostly metastatic and spreads via Batson's plexus (male has lower back pain)
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Seminal vesicles secrete alkaline fructose solution that nourishes and provides energy for the sperm.
Prostate gland secretes a milky fluid (20% of semen volume) and plays role in sperm activation.
Bulbourethral glands (cowper's glands) secrete mucous solution that neutralizes urine within the urethra.
The 1st and 2nd parts of the urethra are urogenital endoderm and the external urethra meatus is ectoderm
The ductus deferens is intermediate mesoderm of the remaining mesonephric duct/tubules
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Muscle of the bladder is Detrusor m, the urinary trigone is where the
entrance of the 2 ureters and exit of bladder meet. Internal urethral
sphincters are involuntary.
Dr. Mavrych,CREMASTERIC
MD, PhD, DSc prof.mavrych@gmail.com
REFLEX: Genitofemoral Dr. Mavrych,
nerve L1-2, Genital branch: withinMD, PhD, DSc
inguinal prof.mavrych@gmail.com
canal with the cremasteric m and fascia acts as
motor division to pull testis up. Femoral branch is the sensory division of the reflex that is stimulated by touch and temperature
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Deep inguinal nodes-> superficial inguinal nodes-> internal & external iliac nodes-> lumbar nodes-> paraaortic nodes-> thoracic duct
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
81. Sinusitis
Sphenoiditis Ethmoiditis
l Relationships of the l Infection in the ethmoidal
sphenoidal sinus are clinically sinuses can erode the medial
important ; because of potential wall of the orbit, resulting in
injury during pituitary orbital cellulites that can
surgery and the possible spread to the cranial cavity.
spread of infection.
l In orbital cavity infection may
l Infection can reach the sinuses erode structures related to the
through their ostia from the medial orbital wall:
nasal cavity or through their
l Medial rectus muscle
floor from the nasopharynx.
l Superior oblique muscle
l Infection may erode the walls to
reach the cavernous sinuses, l Nasociliary nerve
Tensor veli palatini m prevents inhale of food and equalizes the air
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc toprof.mavrych@gmail.com
pressure protect tympanic membrane
Tensor tympani dampens the sound from chewing
Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com Dr. Mavrych, MD, PhD, DSc prof.mavrych@gmail.com
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Anterior inferior incisions based on cone of light for surgery
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