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Get the foundations right! Introduce your students to anatomy in the most effective way by covering the basics first. an@tomedia: General Anatomy – Principles and Applications is a practically orientated book to introduce general anatomy concepts to medical, nursing and allied health students. The book integrates both regions and systems in a concise and easily understandable text.

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General Anatomy - sample

  1. 1. G E N E R A L ANATOMY principles and applications 00 Eizenberg-Anatomy 27/9/07 11:02 AM Page i
  2. 2. 00 Eizenberg-Anatomy 27/9/07 11:02 AM Page ii
  3. 3. G E N E R A L ANATOMY principles and applications NORMAN EIZENBERG CHRISTOPHER BRIGGS CRAIG ADAMS GERARD AHERN www.anatomedia.com 00 Eizenberg-Anatomy 27/9/07 11:02 AM Page iii
  4. 4. 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 editors 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 editors, 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. Readers are encouraged to confirm the information 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 book 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. First edition 2008 Text © 2008 Anatomedia Publishing Pty Limited Illustrations and design © 2008 McGraw-Hill Australia Pty Ltd Additional owners of copyright are acknowledged on the acknowledgments page. Every effort has been made to trace and acknowledge copyrighted material. The authors and publishers tender their apologies should any infringement have occurred. Reproduction and communication for educational purposes The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10% of the pages of this work, whichever is the greater, to be reproduced and/or communicated by any educational institution for its educational purposes provided that the institution (or the body that administers it) has sent a Statutory Educational notice to Copyright Agency Limited (CAL) and been granted a licence. For details of statutory educational and other copyright licences contact: Copyright Agency Limited, Level 15, 233 Castlereagh Street, Sydney NSW 2000. Telephone: (02) 9394 7600. Website: www.copyright.com.au Reproduction and communication for other purposes Apart from any fair dealing for the purposes of study, research, criticism or review, as permitted under the Act, no part of this publication may be reproduced, distributed or transmitted in any form or by any means, or stored in a database or retrieval system, without the written permission of McGraw-Hill Australia including, but not limited to, any network or other electronic storage. Enquiries should be made to the publisher via www.mcgraw-hill.com.au or marked for the attention of Rights and Permissions at the address below. National Library of Australia Cataloguing-in-Publication Data General anatomy: principles and applications. Bibliography. Includes index. ISBN 9780070134676 (pbk.). 1. Human anatomy. I. Eizenberg, Norman. (Series: an@tomedia). 611 Published in Australia by McGraw-Hill Australia Pty Ltd Level 2, 82 Waterloo Road, North Ryde NSW 2113 Publisher: Nicole Meehan Associate Editor: Hollie Zondanos Managing Editor: Kathryn Fairfax Art Director: Steve Randles Production Editor: Nicole McKenzie Copy Editor: Kathy Kramar Cover and internal design: Patricia McCallum Illustrator: Porcellato & Craig Typesetter: Midland Typesetters Proofreader: Terry Townsend Indexer: Max McMaster Printed in China on 80 gsm matt art by CTPS 00 Eizenberg-Anatomy 27/9/07 11:02 AM Page iv
  5. 5. ‘Anatomy is destiny.’ Sigmund Freud (1856–1939) During most of the history of medicine, anatomy was not only the destiny of those who ventured to practice medicine but also the science of medicine. Even at the turn of the 20th century, when Sigmund Freud used the above quote to illustrate his claim that gender determined one’s main personality traits, anatomy was the major component of any medical curriculum. With the development of technology and growth of medical knowledge, anatomy—the scientific empire and a foundation stone of medicine—has shrivelled to a marginal and unattractive discipline, and a small part of a medical curriculum with less and less direct dissection on cadavers. Unjustly so, because at the same time there has been an enormous development of imaging methods to show and analyse the anatomy of a living body, as well as microsurgical procedures where anatomical details determine clinical practice. As a student, you have to keep in mind that without comprehensive morphological education and knowledge, you will not be able to interpret the images you will see daily on ultrasound, CT or MRI scans. Don’t be overconfident in the power of technology, because it is still you, a human being with knowledge of morphology, who will have to interpret the morphology you see and make the best clinical decision for your patient. To do this you need to have a sound knowledge of anatomy, so that you don’t see too much or too little. With such new and ‘live’ anatomy in practice, teaching anatomy must also change, not by just restructuring the old content, but by introducing a completely new concept. an@tomedia is indeed a new approach to medical education: a single tool to replace different didactic tools for transmission of three-dimensional notion, it is at the same time a photographic atlas, a gross anatomy dissector, a radiology overview, a set of coloured overlays and an anatomy textbook. General Anatomy, the first book in a series to follow the nine an@tomedia interactive CD modules, is a most valuable introduction to modern anatomy. It will show you the human body from four perspectives: systems and regions as the principles of body construction, and dissection and imaging as the principles of body deconstruction. I’ll finish with another quote from a physician and a famous novelist, W. Somerset Maugham (1874–1965), who gave the following advice to first-year medical students: ‘You will have to learn many tedious things which you will forget the moment you have passed your final examination, but in anatomy it is better to have learned and lost than never to have learned at all.’ Don’t be afraid of learning anatomy—you really need to know it. And by mastering the principles and applications of general anatomy, you will become not only a collector of important facts but their master, too. ANA MARUSIÇ, MD, PHD Professor of Anatomy President, Council of Science Editors (CSE) Past-President, World Association of Medical Editors (WAME) School of Medicine, Zagreb University Croatia v FOREWORD 00 Eizenberg-Anatomy 27/9/07 11:02 AM Page v
  6. 6. vi Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Design Features of this Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x Objectives of this Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiv Credits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvi About an@tomedia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii Structure of an@tomedia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xviii PART 1 THE HUMAN BODY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Introduction ‘Anatomy accommodates ancestry’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Chapter 1 Human Anatomical Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Chapter 2 Human Form and Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Chapter 3 Human Sexual Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 PART 2 BODY SYSTEMS AND ORGAN STRUCTURE . . . . . . . . 22 Introduction ‘Structure mirrors function’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Chapter 4 Skeletal System and Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Chapter 5 Articular System and Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Chapter 6 Muscular System and Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Chapter 7 Integumental System and Skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Chapter 8 Visceral Systems and Viscera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Chapter 9 Nervous System and Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Chapter 10 Arterial System and Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Chapter 11 Venous System and Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Chapter 12 Lymphatic System and Lymph Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 PART 3 BODY REGIONS AND ORGAN POSITION . . . . . . . . . . . 166 Introduction ‘Everything is somewhere’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Chapter 13 Regions of the Human Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Chapter 14 Arrangement of Body Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Chapter 15 Body Compartments and Fascial Planes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Chapter 16 Body Walls and Cavities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Chapter 17 Neurovascular Pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 CONTENTS 00 Eizenberg-Anatomy 27/9/07 11:02 AM Page vi
  7. 7. PART 4 HUMAN DEVELOPMENT AND VARIATION . . . . . . . . . . 194 Introduction ‘Derivation determines destiny’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Chapter 18 Growth and Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Chapter 19 Normal Variation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Chapter 20 Anatomical Variation in Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Chapter 21 Anatomical Variation in Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 Chapter 22 Pathological Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 PART 5 PRACTICAL PERSPECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . 226 Introduction ‘Anatomy involves exploration’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227 Chapter 23 Surface and Functional Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Chapter 24 Radiographic Anatomy and Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 Chapter 25 Sectional Anatomy, CT and MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 Chapter 26 Ultrasound Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Chapter 27 Endoscopic Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263 Chapter 28 Clinical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268 Chapter 29 Post-mortem Examination of Organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280 Chapter 30 Cadaver Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284 Appendix A Anatomical Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 Appendix B Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Glossary Derivation of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298 Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 vii 00 Eizenberg-Anatomy 27/9/07 11:02 AM Page vii
  8. 8. General Anatomy This book is about the human body. Anatomy (from the Greek: ‘apart + cut’ ) is the study of the structure of the (human) body. The subject known as gross or topographic anatomy includes the study of normal structures (that can be seen with the naked eye) and their arrangement into systems and regions. It is the focus of this book. This is complemented by histology (microscopic anatomy), embryology (developmental anatomy) and the study of evolution (incorporating comparative anatomy). Anatomy also interfaces with physiology (through the correlation of structure with function) and pathology (by the recognition of abnormal structure), together with many clinical disciplines (by applying knowledge of normal and abnormal structure). The new vista of general anatomy introduces the foundations of organ structure (before launching into the detailed study of a particular body system) and the general rules governing arrangement of organs within regions (before launching into detailed descriptions of relationships). As well as being the foundation of systemic, regional and practical perspectives, general anatomy is the glue that holds the specifics together, as shown in Figure 1. This book is primarily designed for medical, dental, physiotherapy and health science students. It is equally applicable for integrated (problem-based) courses or for traditional (discipline-based) courses, as both require a foundation of anatomical literacy coupled with an understanding of the fundamentals. Students will be equipped with the necessary intellectual tools to then master specific subject matter met in any sequence (see Figure 2). The book is also designed for medical and allied health practitioners to fill gaps left by a lack of emphasis on principles in their own training (including associated books), creating a bridge for new concepts and advances in anatomy. General Anatomy: Principles and Applications is complemented by the (A New Approach TO Medical Education Developments In Anatomy): General Anatomy CD-ROM. However, either may be used independently. This book has a linear (sequential) organisation and provides a road map for the CD-ROM. In contrast, the CD-ROM has a non-linear (hierarchical) organisation with freedom for the user to choose the order, rate and depth of study. It is also interactive, with instant feedback to questions requiring identification of objects on images and explanations of events (particularly their associated clinical phenomena). Principles and applications This book is conceptual, a concept being the idea of an object or an event. A principle is a recurring pattern of linked concepts. Principles provide general rules relating viii PREFACE Figure 1 ‘General anatomy’ and ‘specific anatomy’ Ultrasound imaging Sectional anatomy, CT & MRI Radiographic anatomy & imaging Endoscopic anatomy Dissection Surface anatomy Physical examination Clinical procedures PRACTICAL Upper limb Pelvis Abdomen Lower limb Thorax Head Neck Back REGIONAL Lymphatic & haemopoetic Cardio- vascular Nervous Integumental Urogenital & endocrine Musculo- skeletal Respiratory Digestive SYSTEMIC SPECIFIC ANATOMY GENERAL ANATOMY Figure 2 Components of general anatomy Theoretical perspectives Practical perspectives General Anatomy Principles (recurring patterns linking concepts) and their clinical applications Anatomical terms, concepts (ideas of objects & events) and their functional correlation Body systems & organ structure Body regions & organ position Imaging modalities Clinical procedures Systemic Regional Visual Manual 00 Eizenberg-Anatomy 27/9/07 11:02 AM Page viii
  9. 9. ix objects and events to each other. This enables deductive (from the Latin: ‘from + lead’ ) reasoning where the specifics are examples derived from a generalisation. In contrast, inductive (Latin: ‘to + lead’ ) reasoning allows patterns to emerge after gathering all the detailed information and reflecting on them, the specifics lead to generalisations. Versatile learners require both forms of reasoning. Essential (core) factual information is trapped between the pincers of a principle and its application. The challenge for any curriculum is to extract this from extraneous descriptive detail (see Figure 3). The application of anatomical principles is primarily to clinical contexts. The prime goal of this book is to help the learner competently (and confidently) meet new situations in future practice, armed with the capacity to reason from first principles. Understanding anatomical principles is the basis for recognising clinical manifestations of disease processes. Anatomical principles are comprehensively constructed, organised and explained in this book. They are missing or receive only scant reference in introductory sections of most anatomy textbooks. A goal of this book is neither to replace nor to attempt to cover the entire scope of large descriptive books, but to complement these books, helping to make them more meaningful and easier to learn from. New directions This book incorporates both theoretical and practical perspectives. The former enables the body to be constructed from its components, systemically and regionally, while the latter enables an intact body to be deconstructed, with the hands, e.g. dissection or clinical procedures, or with the eyes, e.g. imaging, endoscopy. Looking forward Even if the human body may not seem to change, ways of viewing it, conceptualising it and intervening on it certainly do. New developments in viewing the body are occurring through special imaging techniques, e.g. three- dimensional reconstructions. New concepts are being developed, e.g. angiosomes, venosomes and neurosomes, and new terms will be required to replace outmoded terms. New advances are continually evolving in surgical techniques, such as endoscopic or reconstructive surgery, and in interventional radiology, such as balloon angioplasty. Looking back With new discoveries, there is also a need to be aware of anatomical variants that may impact on them. This requires accessing past documentation of such variants, which have been described in great detail although not in the context of surgical interventions previously unimaginable. Furthermore, it is increasingly important that investigators of anatomy obtain access to cadavers to verify surgical techniques (ideally) prior to them being performed on living patients. Complications resulting from a new procedure can be due to the presence of an unexpected anatomical variant. The dissecting room may be used to refine the technique to take this possibility into account rather than abandon an otherwise valid surgical advance. Thirty years ago, who would have thought that cardiac surgeons would now be contemplating variance of radial and ulnar arterial supply to the hand when grafting coronary arteries? Figure 3 Selecting appropriate content PRINCIPLE APPLICA TION Essential factual material Identifications (lowest level) Explanations (highest level) Descriptions (intermediate level) 00 Eizenberg-Anatomy 27/9/07 11:02 AM Page ix
  10. 10. x ■ New terms and their Latin (L), Greek (G) or French (F) derivations ■ Parts (with an Introduction) DESIGN FEATURES OF THIS BOOK Evolutionary history of the human body All animals evolved from a common ancestor. Humans (Homo sapiens) share many features with other animals on our family tree but may be categorised via a hierarchy of progressively more specific characteristics. THE HUMAN ‘IDENTITY CARD’ IS: Kingdom: Animal Superphylum: Coelomate Phylum: Chordate Subphylum: Vertebrate Class: Mammal Order: Primate Family: Hominid Genus: Homo Species: Homo sapiens Developmental history of the human body During development from a single cell (itself the product of fertilisation of an ovum by a sperm) to an adult human (male or female), features from each of the above categories appear, at least transiently. For example, all developing verte- brates acquire precursors of gills and a tail, even though they may subsequently disappear or become modified beyond recognition. It is also no accident that this reflects the evolution from unicellular organism to Homo sapiens, as at the earliest stages of their development embryos of differ- ent animals tend to resemble each other (a human embryo even up to six weeks is almost indistinguishable from one of other mammals). However, from then on they progressively diverge, both in form (external appearance) and in struc- ture (internal construction). The respective genetic blueprint (modified by mutations) predetermines this. According to Haeckel’s Biogenetic Law: Ontogeny recapitulates phylogeny. PART 1 THE HUMAN BODY 1 Human Anatomical Terms 5 2 Human Form and Structure 9 3 Human Sexual Characteristics 19 2 3 INTRODUCTION ‘ANATOMY ACCOMMODATES ANCESTRY’ Visceral systems Viscera (L. ‘sticky’) have a variety of structures and func- tions. Collectively they are responsible for regulating the internal environment of the body. Viscera occupy cavities within the body framework and are involved with secre- tion, excretion, digestion and absorption. Viscera are either hollow or solid. They are typically organised into systems composed of a tract of hollow tubes and associated solid glands. Respiratory system The respiratory system consists of the respiratory tract and lungs (Fig. 8.1). The tract is made up of the nasal cavity, pharynx (nasal and oral parts), larynx, trachea and bronchial tree. It is shared with the digestive tract where the pathways for air and for food intersect. Digestive system The digestive system consists of hollow tubes—the diges- tive (alimentary) tract—together with solid viscera (the associated glands). The tract extends from the mouth to the anus. It is made up of the pharynx (oral and laryngeal parts), oesophagus, stomach, small intestine and large intestine. The associated glands are the (paired) salivary glands and the (unpaired) pancreas. The digestive system also includes the biliary system, made up of the liver, gall bladder and biliary tree (Fig. 8.2). 82 PART 2 Body Systems and Organ Structure I Visceral systems 82 I Hollow viscera 83 I Exocrine glands and ducts 85 I Endocrine glands 86 I Paired and unpaired viscera 87 I Serous membrane and mesenteries 88 I Muscle coats and sphincters 91 I Mucous membrane and junction zone 94 I Hilum and vascular segments 99 I Neurovascular supply of a viscus 99 CHAPTER 8 VISCERAL SYSTEMS AND VISCERA Figure 8.2 Digestive system HEAD NECK PELVIS THORAX ABDOMEN Rectum Anal canal Gall bladder Liver Bile duct Pancreas Stomach Duodenum Small intestine Large intestine Oropharynx Oral cavity Laryngopharynx Oesophagus Figure 8.1 Respiratory system HEAD NECK THORAX Bronchi Lungs Trachea Larynx Oropharynx Paranasal air sinuses Nasopharynx Nasal cavity ■ Chapter breakdown on each chapter opener 00 Eizenberg-Anatomy 27/9/07 11:03 AM Page x
  11. 11. xi ■ Photographs (of objects) 84 PART 2 Body Systems and Organ Structure numerous folds to increase their surface area for absorp- tion, e.g. in the small intestine (Fig. 8.6). Sites of normal constrictions The lumen of a tubular viscus may have a dilatation termed an ampulla (L. ‘flask’) or constrictions at particular sites. Normal constrictions of the lumen tend to occur at the beginning and end of a tubular viscus. These are often associated with orifices, mucosal folds or thickenings of the muscle wall to control passage through the lumen. The beginnings and ends of the ureters and the urethra have normal constrictions of the lumen (Fig. 8.7). Normal constrictions may also occur where adjacent structures compress a tubular viscus at particular sites along its course. Such normal constrictions occur where the ureter crosses the pelvic brim and where the urethra (in the male) passes through the urogenital diaphragm. Figure 8.7 Normal constrictions of urinary tract At the beginning of the ureter At the end of the ureter At the beginning of the urethra At the site of muscular thickening At the end of the urethra Figure 8.6 A typical hollow viscus (small intestine) Serosal surface Mesentery Mucosal surface (lumen opened) OBSTRUCTION OF A TUBULAR VISCUS Impairment of propulsion through a tubular viscus is termed visceral obstruction. This may occur directly by mechanical factors or indirectly by interference with its neurovascular supply (affecting wall function and/or vitality). Obstruction of a tubular viscus may be classified anatomically into three types (according to its relationship with the wall) (Fig. 8.8). Extramural (external) obstruction comes from outside compression of a tubular viscus, e.g. by a tight hernial orifice or fibrous adhesions. Intramural obstruction arises from within the wall, e.g. by a mucosal tumour, spasm of smooth muscle or occlusion of arteries supplying the wall. Intraluminal (internal) obstruction is from a blockage within the lumen, e.g. by a foreign body. Obstruction of a tubular viscus causes impaired passage of luminal contents.This, in turn, tends to produce distension (prox- imal to the obstruction), pain (due to stretching of the distended viscus) and, initially, increased peristalsis (to overcome the obstruction). As an example, intestinal obstruction typically produces the triad of constipation (reduced passage of faeces and flatus), abdominal distension and pain. These symptoms may be accompanied by altered bowel sounds (from peristalsis), detected on auscultation. Figure 8.8 Types of visceral obstruction External Intramural Internal ■ Anatomical principles highlighted (also collated in a review section for easy access) The photographs show concrete reality; some reveal the body in all its complexity. Certain photographs display the naked exterior of the body, others the exposed interior, which by their very nature is graphic (particularly those at autopsy). Images of embalmed and dissected human remains are provided to be educational, rather than sensational. In particular, they provide access to anatomical material that is not readily available, e.g. fetal dissections. ■ Diagrams (of events) The complementary diagrams are abstract conceptualisations either showing what cannot be made visible or helping provide a way to see what is otherwise obscured by complexity. All of the images (both photographs and diagrams) have been made as simple as possible but not simpler. ■ Clinical applications in boxes at strategic points Except where otherwise specified, the colours chosen for each figure represent types of anatomical structures according to the following convention: bone cartilage fibrous tissue membrane skeletal muscle smooth muscle fat gland nerve artery vein skin ■ Specially selected colours within images 00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xi
  12. 12. THIS BOOK AIMS TO ENABLE UNDERSTANDING PRINCIPLES AND APPLICATIONS OF: 1 Anatomical terms (and how to use them correctly) 2 Organ structure (correlating with function) and arrangement into systems 3 Organ position and subdivision of the body into regions 4 Human variation, appreciating range of normality of the living body 5 Surface anatomy and functional testing (for physical examination of a living body) 6 Imaging modalities and how a living body can be viewed (including endoscopically) 7 The anatomical basis for general clinical procedures 8 Manipulating anatomical structures (with instruments) using dissection skills. OBJECTIVES OF THIS BOOK 1. TERMS Terms of position, relationship, comparison and movement Communicating about anatomy 2. BODY SYSTEMS AND ORGAN STRUCTURE (a) Somatic systems Skeletal system Bone structure and bone marrow Bony features and cartilage Parts of a developing long bone Epiphysial plate and epiphysial line Roles (mechanical and haemopoietic) Growth of bones Blood supply of a long bone Fractures and epiphysial injuries Articular system Joint types (fibrous, cartilaginous and synovial) Articular surfaces and articular cartilage Synovial cavity and synovial membrane, Fibrous capsule, ligaments and special structures Trade-off between mobility and stability Joint degeneration Roles of synovial membrane and synovial fluid Dislocations and ligament injuries Muscular system Muscle structure and attachments Tendons and aponeuroses Fascial septa, sheets and sheaths Neurovascular hilum Myotomes Types of muscle contraction and actions Muscle and tendon injuries Roles and regional adaptations of fascia Motor point Motor units and muscle tone Integumental system Skin structure, appendages and specialisations Cutaneous nerve supply, axial borders and axial lines Neurosomes and dermatomes Angiosomes Lymphotomes Roles of skin and relaxed skin tension lines Nerve overlap and internervous lines Referred pain and sites of referral Vascular supply territories Watershed areas of lymph drainage (b) Visceral systems Respiratory, digestive, urogenital, endocrine systems Viscus (hollow tube or solid gland) structure Exocrine glands (with ducts) and endocrine glands Serous membrane and mesenteries Muscular wall and sphincters Mucous membrane and junction zones Motility of tubular viscera Exocrine secretion and endocrine secretion Mobility and fixation Role (and mechanisms) of sphincters Visceral obstruction and strangulation LEARNING OBJECTIVES CONCEPTS AND ASSOCIATED PRINCIPLES FUNCTIONAL AND CLINICAL APPLICATIONS xii 00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xii
  13. 13. CONCEPTS AND ASSOCIATED PRINCIPLES FUNCTIONAL AND CLINICAL APPLICATIONS (c) Supply systems 3. BODY REGIONS AND ORGAN POSITION 4. HUMAN VARIATION 5. SURFACE ANATOMY 6. IMAGING 7. CLINICAL PROCEDURES Incisions and wound closure Joint and body cavity taps Injections and nerve blocks Vascular access Selecting appropriate sites Layers traversed or pierced Structures endangered Implications of anatomical variants Plain radiographs and contrast studies CT and MRI Ultrasound Endoscopy Assessing bony and joint integrity on images Distinguishing soft tissues on images Interpreting properties of images Interior of hollow viscera and body or joint cavities Surface markings (features and projections) Sites where structures are palpable or accessible Mapping supply territories Functional testing of actions and reflexes Normal variation Anatomical variation Pathological changes (congenital and acquired) Constitutional and functional factors Range of normality Surgical and radiological implications Head, neck, trunk and limbs Paired and unpaired regions Flexor and extensor regions Compartments and layers Mobile and fixed fascial planes Body walls and parietal structures Serous sacs with body cavities Neurovascular bundles and pathways Midline and bilateral symmetry Coronal morphological plane Compartment syndrome Potential paths of direct spread Hernia Prolapse Neurovascular endangerment Nervous (central and peripheral) systems Nerve structure Brain and spinal cord structure Spinal nerve roots and rami Nerve ganglia and plexuses Nerve branches and distribution Sensory and motor functional fibre types Somatic and visceral functional fibre types Reflexes and components of a reflex arc Segmental and peripheral nerve supply Reflex muscle spasm and nerve injuries Arterial (pulmonary and systemic) systems Artery structure Arterial branches and anastomoses End arteries Arterial flow and arterial supply Haemorrhage, thrombosis and embolism Arterial occlusion Venous (pulmonary, systemic and portal) systems Vein structure Valves Venous tributaries and communications Venous flow and venous drainage Varicose veins Venous spread Lymphatic and haemopoietic system Lymph vessel and lymph node structure Sites of entry and communications to venous system Lymphoid organs and tissue aggregates Lymph return and defense roles Lymph flow and lymph drainage Lymphatic spread 8. DISSECTION SKILLS Manipulating structures (incising, reflecting and separating) Exposure utilising instruments safely and correctly xiii 00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xiii
  14. 14. xiv Principal Authors Norman Eizenberg Project Leader of Anatomedia, ACB (U of M) Coordinator, Postgraduate Surgical Anatomy Member, Anatomy Committee RACS Contributor, RACS and RACDS Fellowship Courses Contributor, International Graduates MCQ Exam (AMC) Examiner in Anatomy RANZCR General Medical Practitioner Research: Medical education, anatomical variations Universitas 21 Award (2000) for ‘outstanding achievement’ Meritorious Service Award RACDS (2006) Christopher Briggs Deputy Head and A/Professor, ACB (U of M) Coordinator, Undergraduate Anatomy Contributor, Postgraduate Surgical Anatomy Contributor, Postgraduate Physiotherapy Anatomy Examiner in Anatomy RANZCR Consultant Forensic Anthropologist, VIFM Research: Applied Anatomy, Forensic Anthropology Craig Adams Head of Anatomy (University of Notre Dame, Sydney) Visiting A/Professor (Fiji School of Medicine) Coordinator, RACS Surgical Skills for GPs Contributor, International Graduates MCQ Exam (AMC) Excellence in Teaching Awards (1999, 2002) Gerard Ahern Coordinator, Postgraduate Anatomy (Monash University) Honorary A/Professor (Oceania University) Honorary Senior Fellow, ACB (U of M) Contributor, Postgraduate Surgical Anatomy Contributor, RACS Surgical Skills for GPs Contributor, International Graduates MCQ Exam (AMC) Medical journalist (Orthopaedics Today) ABOUT THE AUTHORS The authors are all current or former members of the Department of Anatomy and Cell Biology (ACB) at The University of Melbourne (U of M). They also contribute to the Royal Australasian Colleges of Surgery (RACS), Radiology (RANZCR), Dental Surgery (RACDS) and Physicians in Nuclear Medicine (ANZAPNM), the Victorian Institute of Forensic Medicine (VIFM) and the Australian Medical Council (AMC). Contributing Authors Priscilla Barker Principal Prosector ACB (U of M) Contributor, Physiotherapy and Science Anatomy Physiotherapist Research: Lumbar spine anatomy and biomechanics Spine, Young Investigator of the Year Award (2005) Ivica Grkovic Head of Anatomy (University of Split, Croatia) Coordinator and Professor, Undergraduate Anatomy Contributor, Postgraduate Anatomy PhD Courses Research: Neurobiology of autonomic nervous system Alexander Pitman Professor of Medical Imaging (U of M) Honorary Senior Fellow, ACB (U of M) General Radiologist and Specialist in Nuclear Medicine Author, Radiology Core Review Anatomy Coordinator RANZCR Councillor, ANZAPNM 00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xiv
  15. 15. xv Editorial consultants Henoh Dolezal (MBBS) Zdenek Dubrava (MBBS) Marius Fahrer (FRACS) John Furness (PhD) Jenny Hayes (MBBS) D.G. Macleish (FRACS) Robert Marshall (FRACS) Vernon Marshall (FRACS) Michael Murphy (FRACS) Priti Pandey (MD) Educational consultant Cyril Driver (MEd) Educational evaluation David Kennedy (PhD) Gregor Kennedy (PhD) Clinical consultants Karl Alexander (FANZCA) Christen Barras (MBBS) Tina Bryant (BVSc) Maurice Brygel (FRACS) Claude Fahrer (MBBS) Erica Fletcher (PhD) Jeremy Grummet (FRACS) Robert Heng (FRANZCR) Justin Kelly (FRACS) Elizabeth Penington (FRACS) Martin Richardson (FRACS) Andrew Rotstein (FRANZCR) Ramin Shayan (MBBS) G. Ian Taylor (FRACS) Jeff Wassertheil (FACEM) Photography Stuart Thyer (BAppSc) Dissections Priscilla Barker (PhD) Matt Jackson (BSc) Illustration and images Priscilla Barker (PhD) Diana Keshtiar (BSc) Graphic design Gavin Leys Chris Hanger (Supervision) CD development Daniel Robertson (BABSc) Website development Gordon Yau (MSc) Video digitising Russell Evans CD quality assurance Daniel Jones (BPhysio) Prototype illustrations Quang Minh Phan (MBBS) Yun Fan Lu (MBBS) Photographic assistance Michelle Gough (BAppSc) CREDITS 00 Eizenberg-Anatomy 27/9/07 11:03 AM Page xv

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