Anatomy Final All Questions (New)

Anatomy questions final
1. Subject, object and content of anatomy, modern directions and methods of research.
Ans- Anatomy (Greek anatomē, 'dissection') is the branch of biology concerned with the study of
the structure of organisms and their parts.[1] Anatomy is a branch of natural science which deals
with the structural organization of living things. It is an old science, having its beginnings in
prehistoric times.[2] Anatomy is inherently tied to developmental biology, embryology,
comparative anatomy, evolutionary biology, and phylogeny,[3] as these are the processes by
which anatomy is generated, both over immediate and long-term timescales. Anatomy and
physiology, which study the structure and function of organisms and their parts respectively,
make a natural pair of related disciplines, and are often studied together. Human anatomy is one
of the essential basic sciences that are applied in medicine.
The discipline of anatomy is divided into macroscopic and microscopic. Macroscopic anatomy, or
gross anatomy, is the examination of an animal's body parts using unaided eyesight. Gross
anatomy also includes the branch of superficial anatomy. Microscopic anatomy involves the use
of optical instruments in the study of the tissues of various structures, known as histology, and
also in the study of cells.
The history of anatomy is characterized by a progressive understanding of the functions of the

organs and structures of the human body. Methods have also improved dramatically, advancing
from the examination of animals by dissection of carcasses and cadavers (corpses) to 20th century
medical imaging techniques including X-ray, ultrasound, and magnetic resonance imaging.
2. The early stages of human embryogenesis. The doctrine of embryonic leayers.
Ans Human embryonic development, or human embryogenesis, refers to the development and
formation of the human embryo. It is characterised by the processes of cell division and cellular
differentiation of the embryo that occurs during the early stages of development. In biological
terms, the development of the human body entails growth from a one-celled zygote to an adult
human being. Fertilisation occurs when the sperm cell successfully enters and fuses with an egg
cell (ovum). The genetic material of the sperm and egg then combine to form a single cell called a
zygote and the germinal stage of development commences.[1] Embryonic development in the
human, covers the first eight weeks of development; at the beginning of the ninth week the
embryo is termed a fetus. Human embryology is the study of this development during the first
eight weeks after fertilisation. The normal period of gestation (pregnancy) is about nine months or
40 weeks.
The initial stages of human embryonic development
The germinal stage refers to the time from fertilization through the development of the early
embryo until implantation is completed in the uterus. The germinal stage takes around 10 days.[2]
During this stage, the zygote begins to divide, in a process called cleavage. A blastocyst is then
formed and implanted in the uterus. Embryogenesis continues with the next stage of gastrulation,
when the three germ layers of the embryo form in a process called histogenesis, and the processes
of neurulation and organogenesis follow.
3. Short information about the history of anatomy (Hippocrates, Galen, Vesalius, Garvey,
Malpighiy, etc.).
Ans-The history of anatomy extends from the earliest examinations of sacrificial victims to the
sophisticated analyses of the body performed by modern scientists. The study of human anatomy
can be traced back thousands of years, at least to the Egyptians, but the science of anatomy, as we
know it today, did not develop until far later. The development of the study of anatomy gradually
built upon concepts that were understood during the time of Galen and slowly became a part of
the traditional medical curriculum.[1] It has been characterized, over time, by a continually
developing understanding of the functions of organs and structures in the body
4. The bones of the cranium, their development. The cranial bones of a newborn child.
AnsThe skull is a bony structure that forms the head in vertebrates. It supports the structures of
the face and provides a protective cavity for the brain.[1] The skull is composed of two parts: the
cranium and the mandible. In humans, these two parts are the neurocranium and the
viscerocranium (facial skeleton) that includes the mandible as its largest bone. The skull forms the
anterior-most portion of the skeleton and is a product of cephalisation—housing the brain, and
several sensory structures such as the eyes, ears, nose, and mouth.[2] In humans these sensory
structures are part of the facial skeleton.
Functions of the skull include protection of the brain, fixing the distance between the eyes to
allow stereoscopic vision, and fixing the position of the ears to enable sound localisation of the
direction and distance of sounds. In some animals, such as horned ungulates (mammals with
hooves), the skull also has a defensive function by providing the mount (on the frontal bone) for
horns
The skull is made up of a number of fused flat bones, and contains many foramina, fossae,
processes, and several cavities or sinuses. In zoology there are openings in the skull called
fenestrae.
The soft parts of the newborn baby’s skull are known as fontanelles. While there are six
fontanelles found in the skull of a newborn, only two are commonly known. The one in the
middle of the head, on the top portion is known as the Anterior fontanelle. It is shaped like a
diamond and takes about a year to close. The one in the rear portion of the head is called the
posterior fontanelle. It is triangular in shape and closes within a couple of months after birth.
5. The bones of the facial skull.
Ans The facial skeleton serves to protect the brain; house and protect the sense organs of smell,
sight, and taste; and provide a frame on which the soft tissues of the face can act to facilitate
eating, facial expression, breathing, and speech. The primary bones of the face are the mandible,
maxilla, frontal bone, nasal bones, and zygoma. Facial bone anatomy is complex, yet elegant, in
its suitability to serve a multitude of functions. The image below provides an overview of the
anterior features of the skull.
6. Cranial base and calvaria. Foramens in skull. Joints of skull bones.
Ans The domed dorsal portion of the neurocranium is called the calvaria (skull cap) and is formed
by the flat portions of the bones of the neurocranium. The ventral portion of the neurocranium is
called the cranial base and is much more irregularly shaped. The cranial base contains numerous
foramina of various sizes for the passage of the cranial nerves, blood vessels, and the spinal cord.
Except for the mandible, all skull bones are joined together by sutures —synarthrodial
(immovable) joints.
The skull contains air-filled cavities called sinuses. Their functions are debatable, but may be
related to lessening skull weight, contributing to voice resonance, and warming and moistening
inspired air.
7. Orbita, its connection and structure. Vessels and nerves that pass through the superior orbital
fissura and the optic canal.
Ans orbit is the cavity or socket of the skull in which the eye and its appendages are situated.
"Orbit" can refer to the bony socket,[1] or it can also be used to imply the contents.[2] In the adult
human, the volume of the orbit is 30 millilitres
The orbital contents comprise the eye, the orbital and retrobulbar fascia, extraocular muscles,
cranial nerves II, III, IV, V, and VI, blood vessels, fat, the lacrimal gland with its sac and duct, the
eyelids, medial and lateral palpebral ligaments, check ligaments, the suspensory ligament,
septum, ciliary ganglion and short ciliary nerves
8. The nasal cavity, its walls. Additional nasal cavities, connection with the nasal cavity.
Ans The nasal cavity is a large, air-filled space above and behind the nose in the middle of the
face. The nasal septum divides the cavity into two cavities,[1] also known as fossae.[2] Each
cavity is the continuation of one of the two nostrils. The nasal cavity is the uppermost part of the
respiratory system and provides the nasal passage for inhaled air from the nostrils to the
nasopharynx and rest of the respiratory tract.
The paranasal sinuses are connected to the nasal cavity through small orifices called ostia. Most
of these ostia communicate with the nose through the lateral nasal wall, via a semi-lunar
depression in it known as the semilunar hiatus. The hiatus is bound laterally by a projection
known as the uncinate process.
Frontal sinuses are in the frontal bone, above the nose and behind the eyebrows. They are 2
cavities divided by a thin wall of bone. Ethmoid sinuses are small cavities in the ethmoid bone,
above the nasal cavity and between the eyes. They can vary in number and size.
9. The temporal and infratemporal fossa, their borders and contents.

Ans The fossa is closely associated with both the pterygopalatine fossa, via the pterygomaxillary
fissure, and also communicates with the temporal fossa, which lies superiorly
The boundaries of this complex structure consists of both bone and muscle:
Lateral – condylar process and ramus of the mandible bone
Medial – lateral pterygoid plate; tensor veli palatine, levator veli palatine and superior constrictor
muscles
Anterior – posterior border of the maxillary sinus
Posterior – carotid sheath
Roof – greater wing of the sphenoid bone
Floor – medial pterygoid muscle
The roof of the infratemporal fossa, formed by the greater wing of the sphenoid bone, provides an
important passage for the neurovascular structures transmitted through the foramen ovale and
spinosum. Among these are the mandibular branch of the trigeminal nerve and the middle
meningeal artery.
10. The pterygopalatine fossa, its borders, connection and structure.
Ans The borders of the pterygopalatine fossa are formed by the palatine, maxilla and sphenoid
bones:
Anterior: Posterior wall of the maxillary sinus.
Posterior: Pterygoid process of the sphenoid bone.
Inferior: Palatine bone and palatine canals.
Superior: Inferior orbital fissure of the eye.
Medial: Perpendicular plate of the palatine bone
Lateral: Pterygomaxillary fissure
Contents
The Pterygopalatine Fossa contains many important neurovascular structures.
Maxillary Nerve
The maxillary nerve is the second branch of the trigeminal nerve (CNV2). It passes from the
middle cranial fossa into the pterygopalatine fossa through the foramen rotundum.
Pterygopalatine Ganglion
The pterygopalatine ganglion sits deep within the pterygopalatine fossa near the sphenopalatine
foramen. It is the largest parasympathetic ganglionMaxillary Artery
The maxillary artery is a terminal branch of the external carotid artery. The terminal portion of the
maxillary artery lies within the pterygopalatine fossa. Here, it separates into several branches
which travel through other openings within the fossa to reach the regions they supply.
These branches include, but are not limited to:
Sphenopalatine artery (to the nasal cavity).
Descending palatine artery – branches into greater and lesser palatine arteries (hard and soft
palates).
Infraorbital artery (lacrimal gland, and some muscles of the eye).
Posterior superior alveolar artery (to the teeth and gingiva).
11. Classification of joints
A joint is defined as a connection between two bones in the skeletal system.
Joints can be classified by the type of the tissue present (fibrous, cartilaginous or synovial), or by
the degree of movement permitted (synarthrosis, amphiarthrosis or diarthrosis).
Fibrous – bones connected by fibrous tissue.
Cartilaginous – bones connected by cartilage.
Synovial – articulating surfaces enclosed within fluid-filled joint capsule.
Synarthrosis – immovable.
Amphiarthrosis – slightly moveable.
Diarthrosis – freely moveable.
12. The structure of the joint. Classification of joints based by the form of articulating surfaces
and by the function.
Ans-Joints, particularly hinge joints like the elbow and the knee, are complex structures made up
of bone, muscles, synovium, cartilage, and ligaments that are designed to bear weight and move
the body through space. The knee consists of the femur (thigh bone) above, and the tibia (shin
bone) and fibula below. The kneecap (patella) glides through a shallow groove on the front part of
the lower thigh bone. Ligaments and tendons connect the three bones of the knee, which are
contained in the joint capsule (synovium) and are cushioned by cartilage.
The structural classification divides joints into fibrous, cartilaginous, and synovial joints
depending on the material composing the joint and the presence or absence of a cavity in the joint.
The functional classification divides joints into three categories: synarthroses, amphiarthroses,
and diarthroses.
13. Temporomandibular joint, its shape. The structure of the muscle that acts on it. Blood supply
of the joint.
Ans-the temporomandibular joints (TMJ) are the two joints connecting the jawbone to the skull. It
is a bilateral synovial articulation between the temporal bone of the skull above and the mandible
below; it is from these bones that its name is derived. This joint is unique in that it is a bilateral
joint that functions as one unit. Since the TMJ is connected to the mandible, the right and left
joints must function together and therefore are not independent of each other
The joint seen from the inner surface.
Details
Artery
Superficial temporal artery
Nerve
Auriculotemporal nerve, masseteric nerve
Latin
Articulatio temporomandibularis
14. The vertebral column: its structure, connections, movements. The muscles that provide
movements.
Ans-Structure of vertebral column

The vertebral column usually consists of 33 vertebrae: 24 presacral vertebrae (7 cervical, 12
thoracic, and 5 lumbar) followed by the sacrum (5 fused sacral vertebrae) and the coccyx (4
frequently fused coccygeal vertebrae). The 24 presacral vertebrae allow movement and hence
render the vertebral column flexible.
Functions
The vertebral column has four main functions:
Protection – encloses and protects the spinal cord within the spinal canal.
Support – carries the weight of the body above the pelvis.
Axis – forms the central axis of the body.
Movement – has roles in both posture and movement.Functions
The vertebral column has four main functions:
Protection – encloses and protects the spinal cord within the spinal canal.
Support – carries the weight of the body above the pelvis.
Axis – forms the central axis of the body.
Movement – has roles in both posture and movement.There are three intermediate intrinsic back
muscles – the iliocostalis, longissimus and spinalis. Together these muscles form a column,
known as the erector spinae. The erector spinae is situated posterolaterally to spinal column,
between the vertebral spinous processes and the costal angle of the ribs.
15. The thorax, structure of the joints of the ribs with vertebrae and the sternum.
Ans-The thoracic cage (rib cage) is the skeleton of the thoracic wall. It is formed by the 12
thoracic vertebrae, 12 pairs of ribs and associated costal cartilages and the sternum.
The thoracic cage takes the form of a domed bird cage with the horizontal bars formed by ribs and
costal cartilages. It is supported by the vertical sternum or breastbone (anteriorly) and the 12
thoracic vertebrae (posteriorly). The thoracic cage can also be described as an osteocartilaginous
cage formed by the sternum, 12 pairs of ribs and costal cartilages, 12 thoracic vertebrae and the
intervertebral (IV) discs interposed between them.
The thoracic cage, like skeletal tissue in most parts of the body, serves to support the thorax. It
also has several functions, such as:
protecticting vital thoracic and abdominal internal organs from external forces
resisting the negative internal pressures generated by the elastic recoil of the lungs and
respiration-induced movements
providing attachment for and supporting the weight of the upper limbs
providing the anchoring attachment (origin) of many of the muscles that move and maintain the
position of the upper limbs relative to the trunk.
Key facts
Sternum
Manubrium: suprasternal and clavicular notches, articulates with the body, first two ribs, and
clavicles
Body: articulates with the costal cartilages of second to seventh ribs and the xiphoid process
(xiphisternal joint)
Xiphoid process: T10 level, inferior limit of the central part of the thorax
Thoracic Vertebrae
Twelve in total, containing a body, arch, and costal facets
Ribs
Typical: head, beck, tubercle, body
Atypical: one or two facets and a tuberosity (1st, 2nd, 10th-12th)
True: 1st to 7th, contain their own costal cartilages and attach directly to the sternum
False: 8th, 9th, 10th of which their respective cartilages connect to the costal cartilage of the rib
above
Floating: 11th and 12th rib hang freely and only articulate with the vertebra
Intercostal Spaces
Named according to the rib forming the superior border and contain intercostal muscles, vessels,
and nerves
Joints
Xiphisternal: xiphoid process and body of sternum
Intervertebral: between vertebrae
Sternochondral: sternum and costal cartilages

Sternoclavicular: manubrium and clavicles
Manubriosternal: manubrium and body of sternum
Costochondral: costal cartilage and rib
Costovertebral: formed by the ribs and bodies of the vertebrae.
Interchondral: joining the costal cartilages to one another
16. The development and the structure of the skeleton of the upper limb. Abnormalities of the
development of the upper limb.
Ans The upper limb is divided into three regions. These consist of the arm, located between the
shoulder and elbow joints; the forearm, which is between the elbow and wrist joints; and the
hand, which is located distal to the wrist. There are 30 bones in each upper limb . The humerus is
the single bone of the upper arm, and the ulna (medially) and the radius (laterally) are the paired
bones of the forearm. The base of the hand contains eight bones, each called a carpal bone, and
the palm of the hand is formed by five bones, each called a metacarpal bone. The fingers and
thumb contain a total of 14 bones, each of which is a phalanx bone of the hand.
Ossification of Appendicular Bones. All of the girdle and limb bones, except for the clavicle,
develop by the process of endochondral ossification. This process begins as the mesenchyme
within the limb bud differentiates into hyaline cartilage to form cartilage models for future bones.
Radial club hand or congenital absence of the radius is a complex pre-axial deformity that affects
not only the skeleton but also all of the pre-axial structures of the upper limb(13). Other
abnormalities have also been reported, such as in the glenoid, humeral head, coro-noid fossa,
capitellum and distal humerus.
17. Joints of the shoulder bones. The muscles that act on them. Blood supply of the shoulder joint.
Ans-Four joints are present in the shoulder: the sternoclavicular (SC), acromioclavicular (AC),
and scapulothoracic joints, and glenohumeral joint.
The primary muscle group that supports the shoulder joint is the rotator cuff muscles. The four
rotator cuff muscles are supraspinatus, infraspinatus, teres minor, and subscapularis. Together the
rotator cuff muscles form a musculotendinous cuff as they insert on the proximal humerus
The shoulder joint is supplied by the anterior and posterior circumflex humeral arteries, which are
both branches of the axillary artery. Branches of the suprascapular artery, a branch of the
thyrocervical trunk, also contribute. Innervation is provided by the axillary, suprascapular and
lateral pectoral nerves.
18. Elbow joint and joints of the forearm bones. Muscles that provide movements in the elbow
joint, its innervation and blood supply.
Ans The orientation of the bones forming the elbow joint produces a hinge type synovial joint,
which allows for extension and flexion of the forearm: Extension - triceps brachii and anconeus.
Flexion - brachialis, biceps brachii, brachioradialisJoints of the
forearm
The radius and ulna articulate with one another proximally and distally.
Type of joint: pivot joint, allowing only uniaxial rotational movement (i.e., forearm pronation and
supination)
Proximal radioulnar joint: articulation of the head of the radius and the radial notch on the ulna.
The arterial supply to the elbow joint is from the cubital anastomosis, which includes recurrent
and collateral branches from the brachial and deep brachial arteries. Its nerve supply is provided
by the median, musculocutaneous and radial nerves anteriorly, and the ulnar nerve posteriorly
19. The wrist joint, its structure, shape, movements. The muscles that perform these movements.
Blood supply and innervation of the joint.
Ans-The wrist is an ellipsoidal (condyloid) type synovial joint, allowing for movement along two
axes. This means that flexion, extension, adduction and abduction can all occur at the wrist joint.
EXTENSOR CARPI RADIALIS LONGUS.
EXTENSOR CARPI RADIALIS BREVIS.
EXTENSOR CARPI ULNARIS.
FLEXOR CARPI RADIALIS.
FLEXOR CARPI ULNARIS.
PALMARIS LONGUS.
Flexion – Produced mainly by the flexor carpi ulnaris, flexor carpi radialis, with assistance from
the flexor digitorum superficialis.
Extension – Produced mainly by the extensor carpi radialis longus and brevis, and extensor carpi
ulnaris, with assistance from the extensor digitorum.
.Innervation to the wrist is delivered by branches of three nerves: Median nerve - Anterior
interosseous branch. Radial nerve - Posterior interosseous branch. Ulnar nerve - deep and dorsal
branches.
The blood supply to the deep flexor and extensor muscles of the forearm is supplied via the ulnar
artery which divides into anterior and posterior interosseous arteries.
20. Hand, its bones, joints, muscles
.The bones of the hand provide support and flexibility to the soft tissues. They can be divided into
three categories:
Carpal bones (Proximal) – A set of eight irregularly shaped bones. These are located in the wrist
area.
Metacarpals – There are five metacarpals, each one related to a digit
Phalanges (Distal) – The bones of the fingers. Each finger has three phalanges, except for the
thumb, which has two.
The wrist is comprised of 8 carpal bones. These wrist bones are attached to the radius and ulna of
the forearm to form the wrist joint. They connect to 5 metacarpal bones that form the palm of the
hand. Each metacarpal bone connects to one finger at a joint called the metacarpophalangeal joint
or MCP joint
The muscles of the hand are the skeletal muscles responsible for the movement of the hand and
fingers. The muscles of the hand can be subdivided into two groups: the extrinsic and intrinsic
muscle groups. The extrinsic muscle groups are the long flexors and extensors. They are called
extrinsic because the muscle belly is located on the forearm. The intrinsic group are the smaller
muscles located within the hand itself. The muscles of the hand are innervated by the radial,
median, and ulnar nerves from the brachial plexus.
Hand Muscles
Interossei (dorsal and palmar) The interossei muscles begin between the bones of the hand. ...
Hypothenar. ...
Thenar. ...
Lumbricals. ...
Adductor Pollicis. ...
Abductor pollicis longus. ...
Etc
21. Development and structure of the skeleton of the lower limb.
The lower limb contains 30 bones. These are the femur, patella, tibia, fibula, tarsal bones,
metatarsal bones, and phalanges (see Figure 6.51). The femur is the single bone of the thigh. The
patella is the kneecap and articulates with the distal femur. The tibia is the larger, weight-bearing
bone located on the medial side of the leg, and the fibula is the thin bone of the lateral leg. The
bones of the foot are divided into three groups. The posterior portion of the foot is formed by a
group of seven bones, each of which is known as a tarsal bone, whereas the mid-foot contains five
elongated bones, each of which is a metatarsal bone. The toes contain 14 small bones, each of
which is a phalanx bone of the foot.
The first tarsal bone to ossify is the calcaneus (5-6 mo). The talus ossifies at 8 months, and the
cuboid may be ossified at birth. In summary, intrauterine development of the lower extremity
consists of outgrowth, rotation, and regional morphologic development of structure (thigh, leg,
and foot).
22. The pelvic bones, their joints. The sizes of the female pelvis.
Ans-There are four articulations within the pelvis: Sacroiliac joints (x2) – between the ilium of
the hip bones, and the sacrum. Sacrococcygeal symphysis – between the sacrum and the coccyx.
Pubic symphysis – between the pubis bodies of the two hip bones.
There are three bones of the pelvis: the hip bone, sacrum and coccyx. These bones connect the
axial skeleton to the lower limbs, and therefore play a role in bearing the weight of the upper
body. These bones also act as attachments for many muscles and ligaments within the pelvis and
lower limbs.
The woman’s pelvis is adapted for child bearing, and is a wider and flatter shape than the male
pelvis. The pelvis is composed of pairs of bones, which are fused together so tightly that the joints
are difficult to see. We will describe each of the bones in turn, and their major landmarks.
23. The hip joint, structure, shape, movements, muscles that perform them. Innervasion and blood
supply of the joint.
Ans-The hip joint is the junction where the hip joins the leg to the trunk of the body. It is
comprised of two bones: the thighbone or femur, and the pelvis, which is made up of three bones
called ilium, ischium and pubis.
The ball of the hip joint is made by the femoral head while the socket is formed by the
acetabulum. The acetabulum is a deep, circular socket formed on the outer edge of the pelvis by
the union of three bones: ilium, ischium and pubis. The lower part of the ilium is attached by the
pubis while the ischium is considerably behind the pubis. The stability of the hip is provided by
the joint capsule or acetabulum and the muscles and ligaments that surround and support the hip
joint.
The head of the femur rotates and glides within the acetabulum. A fibrocartilaginous lining called
the labrum is attached to the acetabulum and further increases the depth of the socket.
Articular cartilage is the thin, tough, flexible and slippery surface lubricated by synovial fluid that
covers the weight-bearing bones of the body. It enables smooth movements of the bones .
Flexion – iliopsoas, rectus femoris, sartorius, pectineus. Extension – gluteus maximus;

semimembranosus, semitendinosus and biceps femoris (the hamstrings) Abduction – gluteus
medius, gluteus minimus, piriformis and tensor fascia latae.
The hip joint is innervated primarily by the sciatic, femoral and obturator nerves. These same
nerves innervate the knee, which explains why pain can be referred to the knee from the hip and
vice versa. Fig 2 – The medial and lateral circumflex femoral arteries are the major blood supply
to the hip joint.
24. Knee joint and,movements, muscles that perform them. Innervasion and blood supply of the
joint.
Ans-The knee is a modified hinge joint, a type of synovial joint, which is composed of three
functional compartments: the patellofemoral articulation, consisting of the patella, or "kneecap",
and the patellar groove on the front of the femur through which it slides; and the medial and
lateral tibiofemoral articulations
the knee joint permits: Extension: Produced by the quadriceps femoris, which inserts into the
tibial tuberosity. Flexion: Produced by the hamstrings, gracilis, sartorius and popliteus. Lateral
rotation: Produced by the biceps femoris.the25. Bones of the leg and the foot, their joints and
muscles.
The blood supply to the knee joint is through the genicular anastomoses around the knee, which
are supplied by the genicular branches of the femoral and popliteal arteries
26. The foot bones, joints, muscles that act on them. Arches of foot.
Ans-The 26 bones of the foot consist of eight distinct types, including the tarsals, metatarsals,
phalanges, cuneiforms, talus, navicular, and cuboid bones.
The joints between the tarsal bones of the foot are known as the intertarsal joints. The specific
intertarsal joints of the foot include the subtalar joint, talocalcaneonavicular joint, calcaneocuboid
joint, cuneonavicular joint, cuboideonavicular joint, and the intercuneiform joint
The posterior leg muscles that insert on the foot are the: gastrocnemius, plantaris, soleus, tibialis
posterior, flexor digitorum longus, and flexor hallucis longus. Collectively, the posterior leg
muscles work to plantarflex and invert the foot. They are innervated by the tibial nerve.
The foot has three arches: two longitudinal (medial and lateral) arches and one anterior transverse
arch. These arches are formed by the tarsal and metatarsal bones and are supported by the
ligaments and tendons in the foot.
27. General anatomy of the muscles. Classification, structure of the muscles as an organ.
Development of skeletal muscles.
Ans-Muscle tissues are derived from the mesodermal layer of embryonic germ cells in a process
known as myogenesis. There are three types of muscle, skeletal or striated, cardiac, and smooth.
Muscle action can be classified as being either voluntary or involuntary. Cardiac and smooth
muscles contract without conscious thought and are termed involuntary, whereas the skeletal
muscles contract upon command.[1] Skeletal muscles in turn can be divided into fast and slow
twitch .
28. Muscles of the back. Topographical and embryological classification. The superficial muscles
of the back, their characteristic, innervation and blood supply.
ans-The muscles of the back can be divided into three groups – superficial, intermediate and deep:
Superficial – associated with movements of the shoulder.
Intermediate – associated with movements of the thoracic cage.
Deep – associated with movements of the vertebral column.
The superficial back muscles are situated underneath the skin and superficial fascia. They
originate from the vertebral column and attach to the bones of the shoulder – the clavicle, scapula
and humerus. All these muscles are therefore associated with movements of the upper limb.
The muscles in this group are the trapezius, latissimus dorsi, levator scapulae and the rhomboids.
The trapezius and the latissimus dorsi lie the most superficially, with the trapezius covering the
rhomboids and levator scapulae.
The posterior, or dorsal, primary rami of the spinal nerves innervates only the intrinsic or true
back muscles. Ventral rami of the spinal nerves innervate the extrinsic muscles (trapezius,
latissimus dorsi, levator scapulae, and rhomboid muscles).
29. Muscles of the back. Topographical and embryological classification. Deep muscles of the
back, characteristic, innervation and blood supply.
30. Nuscles of the thorax. Classification, characteristic, innervation and blood supply.
There are five muscles that make up the thoracic cage; the intercostals (external, internal and
innermost), subcostals, and transversus thoracis. These muscles act to change the volume of the
thoracic cavity during respiration.
There are some other muscles that do not comprise the thoracic wall, but do attach to it. These
include the pectoralis major, minor, serratus anterior and the scalene muscles.
Details
Origin
ribs 1-11
Insertion
ribs 2-12
Artery
intercostal arteries
Nerve
intercostal nerves
Actions
Elevation or Depression of the thorax.
Both the external and internal muscles are innervated by the intercostal nerves (the ventral rami of
thoracic spinal nerves),T1-11.
31. Respiratory muscles. Diaphragm: structure, innervation and blood supply.
Ans-From a functional point of view, there are three groups of respiratory muscles: the
diaphragm, the rib cage muscles and the abdominal muscles. Each group acts on the chest wall
and its compartments, i.e. the lung-apposed rib cage, the diaphragm-apposed rib cage and the
abdomen.
The diaphragm is a thin skeletal muscle that sits at the base of the chest and separates the
abdomen from the chest. It contracts and flattens when you inhale. This creates a vacuum effect
that pulls air into the lungs. When you exhale, the diaphragm relaxes and the air is pushed out of
lungs.
The blood supply to the diaphragm is from the superior phrenic, musculophrenic, inferior phrenic,
pericardiacophrenic, and lower internal intercostal arteries
The halves of the diaphragm receive motor innervation from the phrenic nerve. The left half of
the diaphragm (known as a hemidiaphragm) is innervated by the left phrenic nerve, and vice
versa. Each phrenic nerve is formed in the neck within the cervical plexus and contains fibres
from spinal roots C3-C5.
32. Abdominal muscles: classification, characteristic, innervation and blood supply. The vagina
of rectus muscle of the abdomen.
Ans-These muscles of the anterolateral abdominal wall can be divided into four groups: the
external obliques, the internal obliques, the transversus abdominis, and the rectus abdominis.
Muscles of the anterior abdominal wall consists of two vertical muscles located on the midline
and bisected by linea alba; Rectus abdominis and pyramidalis and three flat muscles on the
anterolateral side arranged from superficial to deep; external abdominal oblique, internal
abdominal oblique, transversus abdominis.
Innervation. The transverse abdominal is innervated by the lower intercostal nerves
(thoracoabdominal, nerve roots T7-T11), as well as the iliohypogastric nerve and the ilioinguinal
nerve.
the superficial epigastric and superficial circumflex iliac) of the femoral artery, the chief arteries
of the abdominal wall are two above (the superior epigastric and musculophrenic) from the
internal thoracic artery and two below (the inferior epigastric and deep circumflex iliac artery.
The rectus sheath, also called the rectus fascia, is formed by the aponeuroses of the transverse
abdominal and the internal and external oblique muscles. It contains the rectus abdominis and
pyramidalis muscles. It can be divided into anterior and posterior laminae.
33. The inguinal canal, its walls, the deep and superficial ring, the contents of the inguinal canal.
The two openings to the inguinal canal are known as rings.
The deep (internal) ring is found above the midpoint of the inguinal ligament. which is lateral to
the epigastric vessels. The ring is created by the transversalis fascia, which invaginates to form a
covering of the contents of the inguinal canal.
The superficial (external) ring marks the end of the inguinal canal, and lies just superior to the
pubic tubercle. It is a triangle shaped opening, formed by the evagination of the external oblique,
which forms another covering of the inguinal canal contents. This opening contains intercrural
fibres, which run perpendicular to the aponeurosis of the external oblique and prevent the ring
from widening.
Contents
The contents of the inguinal canal include:
Spermatic cord (biological males only) – contains neurovascular and reproductive structures that
supply and drain the testes. See here for more information.
Round ligament (biological females only) – originates from the uterine horn and travels through
the inguinal canal to attach at the labia majora.
Ilioinguinal nerve – contributes towards the sensory innervation of the genitalia
Note: only travels through part of the inguinal canal, exiting via the superficial inguinal ring (it
does not pass through the deep inguinal ring)
This is the nerve most at risk of damage during an inguinal hernia repair.
Genital branch of the genitofemoral nerve – supplies the cremaster muscle and anterior scrotal
skin in males, and the skin of the mons pubis and labia majora in females.
Walls
Anterior wall – aponeurosis of the external oblique, reinforced by the internal oblique muscle
laterally.
Posterior wall – transversalis fascia.
Roof – transversalis fascia, internal oblique, and transversus abdominis.
Floor – inguinal ligament (a ‘rolled up’ portion of the external oblique aponeurosis), thickened
medially by the lacunar ligament.
34. Muscles and neck, fascia, classification. Superfitial muscles of the neck, muscles of the hyoid
bone: characteristic, innervation and blood supply.
Ans-Levator scapulae. The levator scapulae muscle is attached at the top four cervical vertebrae
(C1 to C4) and runs down the side of the neck to attach at the top of the shoulder blade (scapula).
...
Sternocleidomastoid (SCM). ...
Trapezius. ...
Erector spinae. ...
Deep cervical flexors
Suboccipitalis
There are two fascias in the neck – the superficial cervical fascia and the deep cervical fascia.
superficial muscles of the neck
Platysma muscle function. The platysma muscle lowers the lower jaw and allows you to: ...
Sternocleidomastoid muscle function. The sternocleidomastoid muscle protects some of the

deeper structures, including the carotid artery and jugular vein. …
Trapezius muscle function is to stabilze scapula
infrahyoid muscles, or strap muscles, are a group of four pairs of muscles in the anterior (frontal)
part of the neck. The four infrahyoid muscles aresternohyoid, sternothyroid, thyrohyoid and
omohyoid muscles.
suprahyoid muscles are four muscles located above the hyoid bone in the neck. They are the
digastric, stylohyoid, geniohyoid, and mylohyoid muscles.
C V innervation.
Blood supply- occipital,lingual and facial.
35. Muscles and neck, fascia, classification. Deep neck muscles: characteristic, innervation and
blood supply. Topography of the neck.
A large group of muscles in the cervical area, responsible for the movement of the head in all
directions
Anterior muscles of the neck
Superficial muscles: Platysma, sternocleidomastoid
Suprahyoid muscles: Digastric, mylohyoid, geniohyoid, stylohyoid
Infrahyoid muscles: Sternohyoid, sternothyroid, thyrohyoid, omohyoid
Anterior vertebral muscles: Rectus capitis, longus capitis, longus colli
Lateral (vertebral) muscles of the neck
Scalene muscles: Anterior scalene, middle scalene, posterior scalene muscles
Posterior muscles of the neck
Superficial layer: Trapezius, splenius capitis, splenius cervicis
Deep layer: Cervical transversospinales muscles (semispinalis capitis, semispinalis cervicis)
Deepest layer: Suboccipital muscles (rectus capitis posterior major, rectus capitis posterior minor,
obliquus capitis inferior, obliquus capitis inferior)
C1-C2: Rectus capitis anterior and lateralis.
C1-C3: Longus capitis.
C2-C3: Prevertebral muscles and sternocleidomastoid.
C3-C4: Levator scapulae, trapezius and scalenus medius.
The neck is supplied by arteries other than the carotids. The right and left subclavian arteries give
rise to the thyrocervical trunk. From this trunk, several vessels arise, which go on to supply the
neck. The ascending cervical artery arises from the inferior thyroid artery, as it turns medially in
the neck.
The first thoracic vertebra lies at the highest part of the sloping thoracic inlet. From its upper
border rises the cervical spinal column, gently convex forwards, and supporting the skull. A mass
of extensor musculature lies behind the vertebrae, supplied segmentally by posterior rami of
cervical nerves that emerge from intervertebral foramina. A much smaller amount of prevertebral
flexor musculature, covered by prevertebral fascia, lies in front of the vertebrae and behind the
pharynx, supplied segmentally by anterior rami.
Deep and superficial fascia of neck.
36. Masticating muscles: development, characteristics, innervation and blood supply.
Ans-There are four muscles:
Masseter.
Temporalis.
Medial pterygoid.
Lateral pterygoid.
The muscles of mastication develop from the first pharyngeal arch. Thus, they are innervated by a
branch of the trigeminal nerve (CN V), the mandibular nerve
.The arterial supply to the muscles of mastication is via the maxillary artery, a branch of the
external carotid artery.
37. Facial muscles: development, characteristics, innervation and blood supply. The difference
between facial muscles from other skeletal muscles.
The facial muscles start to develop between the third and eighth weeks when the mesoderm of the
second branchial arch starts to thicken just caudal to the first branchial groove.
The muscles of the face have different characteristics compared to the skeletal musculature,
limbs, and trunk. The face has muscles with a more complex pattern of innervation of extrafusal
fibers; they have a larger percentage of slow type fiber.
The facial muscles are supplied by the facial nerve (cranial nerve VII), with each nerve serving
one side of the face. In contrast, the nearby masticatory muscles are supplied by the mandibular
nerve, a branch of the trigeminal nerve (cranial nerve V).
The maxillary artery branches from the common carotid and supplies the maxilla region of the
face. The submental artery runs under the chin and supplies the muscles located inferior to the
mandible—the superficial temporal artery branches near the ear and supplies the forehead region
of the face.
38. Muscles of the shoulder girdle: characteristics, innervation and blood supply.
AnsDeltoid.
"Rotator cuff" supraspinatus. infraspinatus. teres minor. subscapularis.

Teres major.
Coracobrachialis.
Biceps brachii (long head)
Triceps brachii (long head)
Three main groups of muscles in the shoulder participate in the control of arm movement: (a)
trapezius, levator scapula, rhomboid, serratus anterior, which arise from the main skeleton and
insert on the scapula, moving and stabilizing this structure; (b) the rotator cuff muscles: teres
minor, infraspinatus,supraspinatus
The shoulder joint is supplied with blood by branches of the anterior and posterior circumflex
humeral arteries, the suprascapular artery and the scapular circumflex artery.
39. Shoulder muscles: characteristics, innervation and blood supply.
Ans The primary muscle group that supports the shoulder joint is the rotator cuff muscles. The
four rotator cuff muscles are supraspinatus, infraspinatus, teres minor, and subscapularis.
The lower subscapular nerve (C5-C6) innervates teres major; and both the upper and lower
subscapular nerves innervate the subscapularis, the third muscle of the rotator cuff apparatus. The
thoracodorsal nerve (C6-C8), which also arises from the posterior cord, innervates the levator
scapulae.
40. Axillary fossa and cavity, its walls, triangles, openings and contents.
Axillary spaces or triangles—
They consist of the quadrangular space, triangular space, and triangular interval.
Quadrangular space
This space is in the posterior wall of the axilla. It is a quadrangular space bounded laterally by
surgical neck of the humerus, medially by long head of triceps brachii and inferiorly by teres
major. It is bounded superiorly by subscapularis in front, capsule of the shoulder joint in the
middle, and behind by teres minor. The axillary nerve and posterior humeral circumflex artery
and vein pass through this space.
Triangular space
This space is also in the posterior wall of the axilla. It is a triangular space bounded medially by
teres minor, laterally by long head of triceps brachii, and inferiorly by teres major. The scapular
circumflex artery and scapular circumflex vein pass through this space.[3]
Triangular interval
This space is in the inferior to the posterior wall of the axilla. The triangular interval is bounded
medially by long head of triceps brachii, laterally by medial border of humerus (some say the
lateral head of the triceps), and superiorly by teres major. The radial nerve and profunda brachii
artery and vein passes through this space.
Openings-
The apex of the axilla region is an opening between the clavicle, first rib and the scapula. In this
apex, the vessels and nerves may become compressed between the bones – this is called
thoracic outlet syndrome.
Walls-
Medially - serratus anterior, thoracic wall
Laterally - intertubercular sulcus of the humerus
Anteriorly - pectoralis major and minor
Posteriorly - subscapularis, latissimus dorsi, teres major muscles
Contents-
Muscles - coracobrachialis, pectoralis minor, and the biceps brachii
Blood vessels - axillary artery and vein
Nerves - brachial plexus
Lymphatics - axillary lymph nodes (pectoral, subscapular, lateral, central, infraclavicular groups)
41. Muscles of the forearm: their group characteristics, innervation and blood supply.
Group characteristics
deep fascia, the interosseous membrane, and the fibrous intermuscular septa create an anterior
compartment that contains the flexor muscles, and a posterior one that contains the extensor
muscles.
All flexor muscles origin from the medial epicondyle so it is called the common flexor origin.
Muscles:
- Extensors:
superficial (brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor
digitorum, extensor digiti minimi, extensor carpi ulnaris, and the anconeus) and
deep (supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, and
extensor indicis)
- Flexors:
superficial (flexor carpi ulnaris, palmaris longus, flexor carpi radialis, and pronator teres),
intermediate (flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis
longus) and
deep (pronator quadratus).
superficial
Muscle Artery Nerve Action
pronation of
ulnar artery and median forearm, flexes
pronator teres radial artery nerve elbow
Flexion and
flexor carpi Median abduction at
radialis ulnar artery nerve wrist
median
palmaris longus ulnar artery nerve wrist flexor
muscular flexion and
flexor carpi branches of adduction of
ulnaris ulnar artery ulnar nerve wrist
flexor of fingers
(primarily at
proximal
flexor digitorum median interphalangeal
superficialis ulnar artery nerve joints)
deepmuscle Artery Nerve Action

median nerve
(anterior
pronator anterior interosseous interosseous pronates the
quadratus artery nerve) forearm
median
(anterior
interosseous),
muscular flex hand,
flexor digitorum anterior interosseous branches of interphalangeal
profundus artery ulnar joints
Anterior
interosseous
nerve (branch
of median
flexor pollicis Anterior interosseous nerve) (C8, Flexion of the
longus artery T1) thumb
Posterior superficial
Muscle Artery Nerve
posterior
interosseous extension of
extensor nerve (C7, hand and
digitorum C8) fingers
posterior interosseous
artery which originates
from the common posterior
interosseous artery interosseous extends the
extensor digiti and more proximally, nerve (C7, little finger at
minimi the ulnar artery C8) all joints
posterior
interosseous extends and
extensor carpi nerve (C7, adducts the
ulnaris ulnar artery C8) wrist
Flexion of
brachioradialis radial recurrent artery radial nerve forearm
extensor at the
wrist joint,
abducts the
extensor carpi hand at the
radialis longus radial artery radial nerve wrist
extensor and
posterior abductor of
extensor carpi interosseus the hand at
radialis brevis radial artery nerve the wrist joint
Deep
Muscle Artery Nerve Action
posterior
interosseus
radial recurrent nerve (C7,
supinator artery C8) supinates forearm
posterior
interosseous
nerve (C7, extends index finger,
extensor indicis C8) wrist
posterior
interosseous
abductor nerve (C7, abduction, extension
pollicis longus C8) of thumb
posterior
posterior interosseous extension of thumb at
extensor pollicis interosseous nerve (C7, metacarpophalangeal
brevis artery C8) joint
posterior extension of the

interosseous thumb
extensor nerve (C7, (metacarpophalangeal
pollicis longus C8) and interphalangeal)
42. Muscles of hand: characteristics, innervation and blood supply. Bone-fibrous canals,
synovial vagina.
The common synovial sheath for the flexor tendons or the ulnar bursa[1] is a synovial sheath in
the carpal tunnel of the human hand.
It contains tendons of the flexor digitorum superficialis and the flexor digitorum profundus, but
not the flexor pollicis longus.[2]
The sheath which surrounds the flexores digitorum extends downward about halfway along the
metacarpal bones, where it ends in blind diverticula around the tendons to the index, middle,
and ring fingers. It is prolonged on the tendons to the little finger and usually communicates
with the mucous sheath of these tendons.
Thenar
Muscle Origin Insertion Artery Nerve Action
trapezium
and metacarpal
transverse bone of the
carpal thumb on its median Opposition of the
opponens pollicis ligament radial side nerve thumb
median
nerve, deep
branch of
trapezoid, thumb, ulnar nerve
flexor pollicis flexor proximal (medial
brevis retinaculum phalanx head) Flexes the thumb
Transverse Radial base
carpal of proximal
ligament, phalanx of
the scaphoid thumb and
abductor pollicis and the thumb Median
brevis trapezium extensors nerve Abducts the thumb
Transverse
head:
anterior
body of the
third
metacarpal
Oblique
head: bases
of the medial side
second and of the base
the third of the
metacarpals proximal
and the phalanx of
adjacent the thumb deep
trapezoid and the branch of adducts the thumb at
and capitate ulnar ulnar nerve the carpometacarpal
adductor pollicis bones sesamoid (T1) joint
Medial volar

flexor
retinaculum
(medial), superficial
palmar branch of
palmaris brevis aponeurosis palm ulnar nerve wrinkle skin of palm
Hypothenar
base of the
proximal
phalanx of
the 5th digit
on the ulnar deep
abductor digiti or medial ulnar branch of Abduction of little
minimi pisiform side artery ulnar nerve finger
deep
flexor digiti hamate ulnar branch of
minimi brevis bone little finger artery ulnar nerve flexes little finger
Draws 5th
metacarpal anteriorly
and rotates it,
Hook of deep bringing little finger
hamate and Medial branch of (5th digit) into
opponens flexor border of 5th ulnar ulnar nerve opposition with
digiti minimi retinaculum metacarpal artery (C8 and T1) thumb
Intermediate

superficial
palmar
arch,
common
palmar
digital
arteries,
deep deep
palmar branch of
arch, ulnar flex
flexor dorsal nerve, metacarpophalangeal
digitorum extensor digital median joints, extend
lumbrical profundus expansion artery nerve interphalangeal joints
Dorsal
metacarpal
artery and
palmar deep
proximal metacarpal branch of
dorsal interossei metacarpals phalanges artery ulnar nerve abduct finger
deep
proximal branch of
palmar interossei metacarpals phalange ulnar nerve adduction
43. Pelvic muscles: group, characteristics, innervation and blood supply.

closing in
the back
sacral part of the
sacrospinous nerves: S4, outlet of
coccygeus ligament S5 or S3-S4 the pelvis
Levator ani
levator
ani nerve
(S4)
inferior
ischial spine rectal nerve
and from from
the pudendal
posterior nerve (S3, supports
part of the S4) the
tendinous coccyx and coccygeal viscera in
arch of the anococcygeal plexus pelvic
iliococcygeus pelvic fascia raphe cavity
back of the
pubis and controls
from the urine flow
anterior part and
of the contracts
obturator coccyx and during
pubococcygeus fascia sacrum orgasm
lower part of S3, S4.
the pubic levator ani inhibit
puborectalis symphysis nerve defecation
44. Muscles and fascia of the thigh: their characteristics, innervation and blood supply.
Adductor canal.
The adductor canal (subsartorial or Hunter’s canal) is an aponeurotic tunnel in the middle third
of the thigh, extending from the apex of the femoral triangle to the opening in the adductor
magnus, the adductor hiatus.
The canal contains the subsartorial artery (superficial femoral artery), subsartorial vein
(superficial femoral vein), and branches of the femoral nerve (specifically, the saphenous nerve,
and the nerve to the vastus medialis).[1] The femoral artery with its vein and the saphenous
nerve enter this canal through the superior foramen.
anterior compartment
Pulling the
suprapatellar
bursa during
suprapatellar femoral femoral extension of
articularis genu femur bursa artery nerve the knee.
flexion,
lateral
rotation and
medial side abduction of
of the upper thigh; flexion
superior to the tibia in the and medial
anterior superior pes femoral femoral rotation of
sartorius iliac spine anserinus artery nerve leg
Patella and
Tibial
tuberosity Knee
combined rectus via the extension;
quadriceps femoris and Patellar femoral Femoral Hip flexion
femoris vastus muscles ligament artery nerve (R.Fem. only)
anterior inferior
iliac spine and
the exterior Patella and
surface of the Tibial
bony ridge tuberosity
which forms the via the knee
iliac portion of Patellar femoral femoral extension;
rectus femoris the acetabulum ligament artery nerve hip flexion
Greater patella and
trochanter, tibial
Intertrochanteric tuberosity
line, and Linea via the Extends and
aspera of the patellar femoral femoral stabilizes
vastus lateralis femur ligament artery nerve knee
patella and
tibial
tuberosity
via the
vastus antero/ lateral patellar femoral femoral
intermedius femur ligament artery nerve extends knee
patella and
tibial
tuberosity
via the
patellar femoral femoral
vastus medialis femur ligament artery nerve extends knee
posterior compartment/hamstring

long head:
medial flexes knee
(tibial) part joint,
the head of of sciatic laterally
the fibula inferior nerve, rotates leg at
which gluteal short head: knee (when
long head: articulates artery, lateral knee is
tuberosity of the with the perforating (common flexed),
ischium, short back of the arteries, fibular) part extends hip
head: linea lateral tibial popliteal of sciatic joint (long
biceps femoris aspera, femur condyle artery nerve head only)
flexes knee,
inferior extends hip
gluteal joint,
artery, sciatic medially
tuberosity of the pes perforating (tibial, L5, rotates leg at
semitendinosus ischium anserinus arteries S1, S2) knee
flexes knee,
extends hip
profunda joint,
Medial femoris, medially
tuberosity of the surface of gluteal sciatic rotates leg at
semimembranosus ischium tibia artery nerve knee
medial compartment

adductor muscles obturator adduction of
of the hip pubis femur, tibia nerve hip
adduction of
hip, flexion
anterior of hip,
branch of medial
inferior pubic tibia (pes obturator obturator rotation of
gracilis ramus anserinus) artery nerve knee
femoral
nerve,
lesser sometimes flexion &
superior pubic trochanter, Obturator obturator adduction of
pectineus ramus linea aspera artery nerve hip
the lesser
trochanter anterior
anterior surface and linea branch of
of the inferior aspera of the obturator obturator adduction of
adductor brevis pubic ramus femur artery nerve hip
anterior adduction &
pubic body just middle third branch of medial
below the pubic of linea obturator obturator rotation of
adductor longus crest aspera artery nerve hip
posterior
branch of
obturator
nerve
(adductor)
femur and and tibial
adductor part of
adductor tuberosity of the tubercle of obturator sciatic adduction of
magnus ischium femur artery nerve hip
45. Muscular and vascular lacuna. Femoral canal.

The muscular lacuna (Latin: lacuna musculorum) is the lateral compartment of the thigh inferior
to the inguinal ligament, for the passage of the iliopsoas muscle, the femoral nerve and the
lateral cutaneous nerve of the thigh; it is separated by the iliopectineal arch from the vascular
lacuna.
The vascular lacuna (Latin: lacuna vasorum) is the compartment beneath the inguinal ligament
which allows for passage of the femoral vessels,[1] lymph vessels and lymph nodes. Its
boundaries are the iliopectineal arch, the inguinal ligament, the lacunar ligament, and the
superior border of the pubis. The structures found in the vascular lacuna, from medial to lateral,
are:
• Cloquet's node;
• Femoral vein;
• Femoral artery; and
• Femoral branch of the genitofemoral nerve.
The vascular lacuna is separated from the muscular lacuna by the iliopectineal arch. The lacunar
ligament can be a site of entrapment for femoral hernias.
The femoral canal is the passageway by which femoral structures exit from the abdomen into
the upper thigh. Its boundaries are:
• anteriorly: inguinal ligament
• medially: pubic bone and lacunar ligament
• laterally: iliopsoas muscle
• posteriorly: pubic ramus and pectineus muscle
It is divided into two compartments by the medial border of the femoral vein. The medial
compartment is the femoral ring. The lateral compartment contains the following structures
from medial to lateral:
• femoral vein
• femoral artery
• genitofemoral nerve
• femoral nerve
The femoral artery and vein are enclosed by the femoral sheath, an extension of the
transversalis fascia.
46. Muscles and fascia of the leg: their characteristics, innervation and blood supply.
Fascia
at the anterior part of the leg, there is only subcutaneous tissue of the tibia on the medial side.
On the anterolateral side of the leg, there is a deep fascia of the leg. The deep fascia of the leg
covers only muscles,
anterior compartment

medial
cuneiform and
first Deep
metatarsal anterior Fibular dorsiflex and
bones of the tibial (peroneal) invert the
tibialis anterior body of tibia foot artery nerve foot
middle Extends the

portion of the big toe and
fibula on the assists in
anterior dorsal side of dorsiflexion of
surface and the base of Deep the foot at
the the distal anterior Fibular the ankle.
extensor hallucis interosseous phalanx of the tibial (peroneal) Also is a weak
longus membrane Hallux artery nerve invertor
Lateral
Condyle of Middle and
tibia and Distal Deep
superior ¾ of phalanges of anterior Fibular extension of
extensor interosseous lateral four tibial (peroneal) toes and
digitorum longus membrane digits artery nerve ankle
Deep
distal anterior dorsal surface anterior Fibular dorsi flexes
surface of the of metatarsal tibial (peroneal) and everts
fibularis tertius fibula 5 artery nerve foot
posterior compartment
Superficial

achilles posterior
tendon, tibial
triceps surae calcaneus artery tibial nerve plantarflexion
tibial nerve
from the
sciatic,
femur(medial specifically, plantarflexion,
and lateral sural nerve roots flexion of
gastrocnemius condyles) calcaneus arteries S1, S2 knee (minor)
tibial nerve,
fibula, medial specifically,
border of tibia tendo sural nerve roots
soleus (soleal line) calcaneus arteries L5–S2 plantarflexion
lateral tendo
supracondylar calcaneus
ridge of femur (medial side,
above lateral deep to Plantar flexes
head of gastrocnemius sural foot and
plantaris gastrocnemius tendon) arteries tibial nerve flexes knee
Deep

middle facet
of the lateral
surface of the Medial
lateral posterior tibia rotation and
femoral under the popliteal flexion of
popliteus condyle tibial condyles artery tibial nerve knee
tarsal tunnel
Peroneal
artery
(peroneal flexes all
branch of joints of the
fibula, the Hallux,
posterior base of distal posterior tibial nerve, plantar
flexor hallucis aspect of phalanx of tibial S1, S2 flexion of the
longus upper 1/3 hallux artery nerve roots ankle joint
distal
phalanges of posterior
flexor lateral four tibial Primary action
digitorum longus medial tibia digits artery Tibial nerve is Flex digits
inversion of
the foot,
plantar
navicular, posterior flexion of the
tibialis medial tibial foot at the
posterior tibia, fibula cuneiform artery tibial nerve ankle
lateral compartment
fibularis muscles:

first superficial
metatarsal, fibular fibular
medial (peroneal) (peroneal) plantarflexion,
longus fibula cuneiform artery nerve eversion
superficial
fibular fibular
fifth (peroneal) (peroneal) plantarflexion,
brevis fibula metatarsal artery nerve eversion
47. Muscles and fascia of the foot: their characteristics, innervation and blood supply.
The superficial fasciae of the foot are both fibrous and loose, and vary in thickness (strength)
and texture.
The deep fasciae of the foot divide the sole into three compartments, which are:
• Medial compartment of the sole - covered by the medial plantar fascia
• Central compartment of the sole – invests, superficially by the dense plantar aponeurosis
• The lateral compartment of the sole – covered by the thinner lateral plantar fascia.
The plantar fascia has a thick central part and weaker medial and lateral parts. The thick
central part forms the dense plantar aponeurosis mentioned above. This plantar aponeurosis
resembles the palmar aponeurosis of the palm of the hand, but it is tougher, denser, and
elongated.
Dorsal

deep
extensor peroneal extends digits
digitorum brevis calcaneus toes nerve 2, 3, and 4
base of
proximal deep
extensor hallucis phalanx of peroneal Extension of
brevis calcaneus hallux nerve hallux
Plantar
1st layer
medial
process of
calcaneus, medial side
flexor of base of
retinaculum, proximal medial
plantar phalanx of plantar
abductor hallucis aponeurosis first digit nerve abducts hallux
medial
process of
calcaneus,
plantar
aponeurosis, middle medial
flexor digitorum intermuscular phalanges of plantar flexes lateral
brevis septa digits 2-5 nerve four toes
lateral
lateral plantar
abductor digiti Plantar Fifth toe or plantar nerve (S1, flex and abduct
minimi aponeurosis Phalanges artery S2) the fifth toe
2nd layer
Assists Flexor
Tendons of lateral Digitorum
Flexor plantar Longus in
quadratus Digitorum nerve (S1, flexion of DIP
plantae Calcaneus Longus S2) joints
lateral
lateral plantar
medial plantar nerve
aspect of artery and (lateral
extensor plantar three
expansion of arch, and lumbricals) maintain
tendons of proximal four and medial extension of
flexor phalanges of plantar plantar digits at
digitorum lateral four metatarsal nerve (first interphalangeal
lumbrical muscle longus digits arteries lumbrical) joints
3rd layer

medial
flexor hallucis plantar
brevis nerve flex hallux
Plantar
adductor hallucis nerve adducts hallux
lateral
plantar
fifth nerve extend and
flexor digiti metatarsal phalanx of (superficial adduct the fifth
minimi brevis bone the fifth toe branch) toe
4th layer

plantar
dorsal interossei nerve abduct toes
proximal plantar
plantar interossei metatarsals phalanges nerve adduct toes
48. The oral cavity. The walls, palate, their structure, innervation and blood supply.
The palate is a bony/muscular partition that forms the roof of the oral cavity and the floor of the
nasal cavities. It consists of two main parts; the hard palate and soft palate. The hard palate is
the anterior bony portion, while the soft palate is the posterior muscular part.
Walls
The lateral walls of the oral cavity are formed by the cheeks. The buccal mucosa is composed of
the inner lining of the cheeks. It is contiguous with the lips and has the same structure.
The muscle of the cheek is the buccinator. The buccal fat pad is superficial to the fascia covering
the buccinator muscle and gives the cheeks a rounded contour.
Mouth
levator anguli oris smile
(elevates
modiolus of facial angle of
(caninus) maxilla mouth artery facial nerve mouth)
depressor anguli mandibular depresses
oris tubercle of modiolus of facial branch of angle of
(triangularis) mandible mouth artery facial nerve mouth
skin and
muscle of buccal
the upper lip superior branch of
levator labii medial infra-orbital (labii labial the facial Elevates the
superioris margin superioris) artery nerve upper lip
integument
of the lower
lip,
oblique line of the orbicularis
mandible, oris fibers,
between the its fellow of inferior Depresses
depressor labii symphysis and the the opposite labial the lower
inferioris mental foramen side artery facial nerve lip
elevates
and
wrinkles
mandibular skin of chin,
branch of protrudes
mentalis anterior mandible chin facial nerve lower lip
alveolar processes compress

of the maxillary the cheeks
bone and in the fibres buccal against the
mandible, of the branch of teeth
pterygomandibular orbicularis buccal the facial (blowing),
buccinator raphe oris artery nerve mastication.
maxilla and skin around pucker the
orbicularis oris mandible the lips lips
draw back
facial angle of
risorius parotid fascia modiolus artery mouth
Zygomatic muscles
buccal draws angle
branch of of mouth
anterior of modiolus of facial the facial upward and
major zygomatic bone mouth artery nerve laterally
facial
nerve,
skin of the buccal elevates
minor zygomatic bone upper lip branch upper lip
Mastication
elevation
(as in
closing of
coronoid the mouth)
process and and
zygomatic arch and ramus of masseteric masseteric retraction
masseter maxilla mandible artery nerve (V3) of mandible
third branch
(mandibular
nerve) of elevation
temporal lines on coronoid the and
the parietal bone process of deep trigeminal retraction
temporalis of the skull the mandible temporal nerve of mandible
Pterygoid muscles
external
pterygoid pterygoid
branches nerve from
great wing of of the
sphenoid and condyle of maxillary mandibular depresses
lateral pterygoid plate mandible artery nerve mandible
deep head: medial

side of lateral
pterygoid plate
behind the upper elevates
teeth mandible,
closes jaw,
helps
lateral
superficial head: mandibular pterygoids
pyramidal process nerve via in moving
of palatine bone medial angle nerve to the jaw
and maxillary of the medial from side to
medial tuberosity mandible pterygoid side
Tongue
Extrinsic
Complex -
Inferior
fibers
protrude
the tongue,
middle
fibers
depress the
tongue, and
Superior part of Dorsum of its superior
mental spine of tongue and fibers draw
mandible body of Lingual hypoglossal the tip back
genioglossus (symphysis menti) hyoid artery nerve and down
side of the hypoglossal depresses
hyoglossus hyoid tongue nerve tongue
depresses
tongue
(some
consider
intrinsic this muscle
lesser cornu and muscular to be part
body of the hyoid fibers of the hypoglossal of
chondroglossus bone tongue nerve hyoglossus)
elevates
Styloid process of Hypoglossal and retracts
styloglossus temporal bone tongue nerve tongue
vagus nerve
and cranial raising the
palatine accessory back part of
palatoglossus aponeurosis tongue nerve the tongue
Intrinsic

shortens,
turns tip
close to the upward,
epiglottis, from the turns lateral
superior median fibrous edges of the hypoglossal margins
longitudinal septum tongue nerve upward
narrows
median fibrous sides of the hypoglossal and
transversus septum tongue nerve elongates
shortens,
retracts,
inferior apex of the Hypoglossal pulls tip
longitudinal root of the tongue tongue nerve downward
inferior
surface
borders of hypoglossal
verticalis muscle dorsum of tongue tongue nerve flattens
Soft palate

Aids in
swallowing
by elevating
levator veli temporal bone, palatine facial the soft
palatini Eustachian tube aponeurosis artery vagus nerve palate
Aids in
swallowing
medial by
pterygoid controlling
medial pterygoid of the tension
tensor veli plate of the mandibular of the soft
palatini sphenoid bone nerve palate
Moves and
changes
pharyngeal shape of
musculus uvulae hard palate plexus the uvula
Aids in
respiration
vagus nerve by raising
and cranial the back
palatine accessory part of the
palatoglossus aponeurosis tongue nerve tongue
upper border
of thyroid Aids in
cartilage vagus nerve respiration
palatine (blends with and cranial by pulling
aponeurosis and constrictor facial accessory the pharynx
palatopharyngeus hard palate fibers) artery nerve and larynx
49. Teeth: parts, substance, formula. Terms of teeth protrusion. Innervation and blood supply.
Parts of the teeth include:
• Enamel: The hardest, white outer part of the tooth. Enamel is mostly made of calcium
phosphate, a rock-hard mineral.
• Dentin: A layer underlying the enamel. It is a hard tissue that contains microscopic tubes.
When the enamel is damaged, heat or cold can enter the tooth through these paths and cause
sensitivity or pain.
• Pulp: The softer, living inner structure of teeth. Blood vessels and nerves run through the pulp
of the teeth.
• Cementum: A layer of connective tissue that binds the roots of the teeth firmly to the gums
and jawbone.
• Periodontal ligament: Tissue that helps hold the teeth tightly against the jaw.
Protruding teeth are one of the most visible dental complaints, affecting many patients with an
overbite or angled tooth line. The good news is that protruding teeth can often be treated
relatively easily, depending on what has caused the protrusion in the first place.
2123/2123
Innervation of Posterior superior alveolar nerve (branch of maxillary nerve (V2)

maxillary teeth Anterior superior alveolar nerve (branch of infraorbital nerve)
Middle superior alveolar nerve (branch of infraorbital nerve)
Blood supply of Branches of maxillary artery:

maxillary teeth Posterior superior alveolar artery
Middle superior alveolar artery
Anterior superior alveolar artery
Innervation of Inferior alveolar nerve (branch of mandibular nerve V3)

mandibular teeth
Blood supply of Inferior alveolar artery (branch of maxillary artery)

mandibular teeth
50. Tongue: development, function, structure, innervation and blood supply.

The tongue begins development in the 4th week of gestation. It is derived from pharyngeal arches
1-4 (forms the mucosa of the tongue) and the occipital somites (forms the musculature of the
tongue).
Pharyngeal Arches (Mucosa)
In the first stage of development, lingual and medial swellings appear:
• Lateral lingual swellings (x2) – derived from the 1st pharyngeal arch. Contributes to the
mucosa of the anterior 2/3 of the tongue.
• Medial swellings (x3):
o Tuberculum impar – derived from the 1st pharyngeal arch. Contributes to the
mucosa of the anterior 2/3 of the tongue.
o Cupola (hypobranchial eminence) – derived from the 2nd, 3rd and 4th pharyngeal
arches. Forms the mucosa of the posterior 1/3 of the tongue.
o Epiglottal swelling – derived from the 4th pharyngeal arch. Forms the epiglottis.
During the 4th week, the lateral lingual swellings overgrow the tuberculum impar
and merge together – forming the mucosa of the anterior 2/3 of the tongue. Their line of fusion is
marked by the median sulcus of the tongue.
Within the cupola, the 3rd pharyngeal arch component overgrows the 2nd arch, and forms the
mucosa of the posterior 1/3 of the tongue. The anterior 2/3 and posterior 1/3 fuse – forming a V-
shaped groove known as the terminal sulcus. At the centre of this groove is the foramen cecum, a
pit which represents the place of origin of the thyroid gland.
As the tongue forms, it is initially is tethered to the floor of the oral cavity. A process of carefully
programmed cell death known as sculpting apoptosis releases the tongue, leaving in place
the lingual frenulum to anchor the tongue in the mouth.
Extrinsic

Complex -
Inferior
fibers
protrude
the tongue,
middle
fibers
depress
the tongue,
Superior part and its
of mental superior
spine of Dorsum of fibers draw
mandible tongue and the tip
(symphysis body of Lingual hypoglossal back and
genioglossus menti) hyoid artery nerve down
side of the hypoglossal depresses
hyoglossus hyoid tongue nerve tongue
depresses
tongue
(some
consider
lesser cornu intrinsic this muscle
and body of muscular to be part
the hyoid fibers of the hypoglossal of
chondroglossus bone tongue nerve hyoglossus)
Styloid elevates
process of and
temporal Hypoglossal retracts
styloglossus bone tongue nerve tongue
vagus nerve raising the
and cranial back part
palatine accessory of the
palatoglossus aponeurosis tongue nerve tongue
Intrinsic

shortens,
close to the turns tip
epiglottis, upward,
from the turns
median lateral
superior fibrous edges of the hypoglossal margins
longitudinal septum tongue nerve upward
median narrows
fibrous sides of the hypoglossal and
transversus septum tongue nerve elongates
shortens,
retracts,
inferior root of the apex of the Hypoglossal pulls tip
longitudinal tongue tongue nerve downward
inferior
surface
dorsum of borders of hypoglossal
verticalis muscle tongue tongue nerve flattens
51. Salivary glands. Classification. Parotid gland, topography, structure, excretory duct,
innervation and blood supply.
Types
Serous: parotid gland
Mucous: sublingual gland, minor salivary gland
Mixed: submandibular gland
Parotid gland
Location: between ramus of mandible and sternocleidomastoid muscle
Excretory duct: Stensen's duct (opens on the buccal wall at the level of maxillary second molar)
Blood is supplied by the posterior auricular and superficial temporal arteries. They are both
branches of the external carotid artery, which arise within the parotid gland itself. Venous
drainage is achieved via the retromandibular vein. It is formed by unification of the superficial
temporal and maxillary veins.
The parotid gland receives sensory and autonomic innervation. The autonomic innervation
controls the rate of saliva production.
Sensory innervation is supplied by the auriculotemporal nerve (gland) and the great auricular
nerve (fascia).
The parasympathetic innervation to the parotid gland has a complex path. It begins with the
glossopharyngeal nerve (cranial nerve IX). This nerve synapses with the otic ganglion (a
collection of neuronal cell bodies). The auriculotemporal nerve then carries parasympathetic
fibres from the otic ganglion to the parotid gland. Parasympathetic stimulation causes an
increase in saliva production.
Sympathetic innervation originates from the superior cervical ganglion, part of the paravertebral
chain. Fibres from this ganglion travel along the external carotid artery to reach the parotid
gland. Increased activity of the sympathetic nervous system inhibits saliva secretion, via
vasoconstriction.
52. Sublingual and submandibular salivary glands, topography, structure, excretory ducts,
Submandibular gland Location: beneath the tongue

Excretory duct: Wharton's duct (opens at sublingual papilla under tongue)
Blood supply
The facial and lingual arteries contribute to the blood supply of the submandibular gland and in
turn their venous drainage is provided by the corresponding veins.
nnervation
The secretory mechanism of the submandibular gland is regulated directly by the

parasympathetic nervous system by which it is stimulated, and indirectly by the sympathetic
nervous system by which it is inhibited.
These exact fibers include presynaptic fibers from the facial nerve (CN VII) via the chorda
tympani to the submandibular ganglion and postsynaptic fibers from cells in the submandibular
ganglion that together make up the parasympathetic secretomotor fibers. The vasoconstrictive
sympathetic fibers stir from the superior cervical ganglion.
Sublingual gland Location: beneath the sublingual fold

Excretory duct: multiple ducts that open along sublingual folds
Innervation
The nervous supply of the sublingual gland reflects that of the submandibular
gland. It occurs via the chorda tympani, which carries fibers that originate
from the facial nerve (CN VII) and are classed as secretomotor fibers.
Blood supply
There are two separate arterial supplies that contribute to the vascularisation of the sublingual
gland, which are venously drained via their corresponding veins. The first is that of the lingual
artery which branches into the sublingual artery.
53. Pharynx: topography, parts, structure, lymphoepithelial ring, innervation and blood
supply.
Waldeyer's tonsillar ring (pharyngeal lymphoid ring, Waldeyer's lymphatic ring, or tonsillar ring)
is a ringed arrangement of lymphoid organs in the pharynx. Waldeyer's ring surrounds the naso-
and oropharynx, with some of its tonsillar tissue located above and some below the soft palate
(and to the back of the mouth cavity).
The ring consists of the (from top to bottom):
• 1 pharyngeal tonsil (or "adenoid"), located on the roof of the nasopharynx, under the
sphenoid bone.
• 2 tubal tonsils on each side, where each auditory tube opens into the nasopharynx
• 2 palatine tonsils (commonly called "the tonsils") located in the oropharynx
• lingual tonsils, a collection of lymphatic tissue located on the back part of the tongue

pharynge
al
branches elevate the
of larynx,
ascending elevate the
temporal styloid thyroid cartilage pharynge glossopharynge pharynx,
stylopharyngeus process (pharynx) al artery al nerve swallowing
posterior vagus nerve
fasciculus of the and cranial raise the
salpingopharynge cartilage of the pharyngopalatin accessory nasophary
us Eustachian tube us muscle nerve nx
Pharyngeal muscles
pharynge
al
branches
of external
ascending laryngeal
cricoid and pharyngeal pharynge branch of the
inferior thyroid cartilage raphe al artery vagus Swallowing
pharyngeal vagus
middle hyoid bone raphe nerve Swallowing
medial pterygoid
plate, pharyngeal
pterygomandibul raphe,
ar raphé, pharyngeal
superior alveolar process tubercle vagus nerve Swallowing
54. Esophagus: its topography, parts, structure, innervation and blood supply.
Anatomical Course
The esophagus begins in the neck, at the level of C6. Here, it is continuous superiorly with the
laryngeal part of the pharynx (the laryngopharynx).
It descends downward into the superior mediastinum of the thorax, positioned between the
trachea and the vertebral bodies of T1 to T4. It then enters the abdomen via the oesophageal
hiatus (an opening in the right crus of the diaphragm) at T10.
The abdominal portion of the esophagus is approximately 1.25cm long – it terminates by joining
the cardiac orifice of the stomach at level of T11.
Anatomical Structure
The oesophagus shares a similar structure with many of the organs in the alimentary tract:
• Adventitia – outer layer of connective tissue.
Note: The very distal and intraperitoneal portion of the oesophagus has an outer
covering of serosa, instead of adventitia.
• Muscle layer – external layer of longitudinal muscle and inner layer of circular muscle.
The external layer is composed of different muscle types in each third:
1. Superior third – voluntary striated muscle
2. Middle third – voluntary striated and smooth muscle
3. Inferior third – smooth muscle
• Submucosa
• Mucosa – non-keratinised stratified squamous epithelium (contiguous with columnar
epithelium of the stomach).
Food is transported through the oesophagus by peristalsis – rhythmic contractions of the
muscles which propagate down the oesophagus. Hardening of these muscular layers can
interfere with peristalsis and cause difficulty in swallowing (dysphagia).
Vasculature
In respect to its arterial and venous supply, the oesophagus can be divided into its thoracic and
abdominal components.
Thoracic
The thoracic part of the oesophagus receives its arterial supply from the branches of the thoracic
aorta and the inferior thyroid artery (a branch of the thyrocervical trunk).
Venous drainage into the systemic circulation occurs via branches of the azygous veins and the
inferior thyroid vein.
Abdominal
The abdominal oesophagus is supplied by the left gastric artery (a branch of the coeliac trunk)
and left inferior phrenic artery. This part of the oesophagus has a mixed venous drainage via two
routes:
• To the portal circulation via left gastric vein

• To the systemic circulation via the azygous vein.
These two routes form a porto-systemic anastomosis, a connection between the portal and
systemic venous systems.
Innervation
The esophagus is innervated by the oesophageal plexus, which is formed by a combination of

the parasympathetic vagal trunks and sympathetic fibres from the cervical and thoracic
sympathetic trunks.
Two different types of nerve fibre run in the vagal trunks. The upper oesophageal sphincter and
upper striated muscle is supplied by fibres originating from the nucleus ambiguus. Fibres
supplying the lower oesophageal sphincter and smooth muscle of the lower oesophagus arise from
the dorsal motor nucleus.
55. Stomach: development, topography, parts, structure, relation to the peritoneum,
ligaments, innervation and blood supply.
Development of the stomach

The stomach develops from the foregut and has a dorsal and ventral mesogastrium. The dorsal
mesogastrium gives rise to the greater omentum.
Due to more rapid growth of its dorsal portion, the stomach expands, leading to a greater and lesser
curvature. It also undergoes two rotations:
• 90 degrees about its long axis (see animation)
• Anti-clockwise around a dorso-ventral axis
This results in the greater curvature of the stomach lying to the left of the midline.
Topography
The stomach, is an intraperitoneal digestive organ located between the oesophagus and
the duodenum.
It has a ‘J’ shape, and features a lesser and greater curvature. The anterior and posterior surfaces
are smoothly rounded with a peritoneal covering.
By TeachMeSeries Ltd (2018)
Fig 1 – The parts of the stomach.

The stomach has four main anatomical divisions; the cardia, fundus, body and pylorus:
• Cardia – surrounds the superior opening of the stomach at the T11 level.
• Fundus – the rounded, often gas filled portion superior to and left of the cardia.
• Body – the large central portion inferior to the fundus.
• Pylorus – This area connects the stomach to the duodenum. It is divided into the pyloric
antrum, pyloric canal and pyloric sphincter. The pyloric sphincter demarcates the
transpyloric plane at the level of L1.
Greater and Lesser Curvatures

The medial and lateral borders of the stomach are curved, forming the lesser and greater
curvatures:
• Greater curvature – forms the long, convex, lateral border of the stomach. Arising at the
cardiac notch, it arches backwards and passes inferiorly to the left. It curves to the right as
it continues medially to reach the pyloric antrum. The short gastric arteries and the right
and left gastro-omental arteries supply branches to the greater curvature.
• Lesser curvature – forms the shorter, concave, medial surface of the stomach. The most
inferior part of the lesser curvature, the angular notch, indicates the junction of the body
and pyloric region. The lesser curvature gives attachment to the hepatogastric
ligament and is supplied by the left gastric artery and right gastric branch of the hepatic
artery.
Relation to the stomach
The greater and lesser omenta are two structures that consist of peritoneum folded over itself
(two layers of peritoneum – four membrane layers). Both omenta attach to the stomach,
Neurovascular Supply
The arterial supply to the stomach comes from the celiac trunk and its branches. Anastomoses
form along the lesser curvature by the right and left gastric arteries and along the greater
curvature by the right and left gastro-omental arteries:
• Right gastric – branch of the common hepatic artery, which arises from the coeliac trunk.
• Left gastric – arises directly from the coeliac trunk.
• Right gastro-omental – terminal branch of the gastroduodenal artery, which arises from
the common hepatic artery.
• Left gastro-omental – branch of the splenic artery, which arises from the coeliac trunk.
The veins of the stomach run parallel to the arteries. The right and left gastric veins drain into
the hepatic portal vein. The short gastric vein, left and right gastro-omental veins ultimately drain
into the superior mesenteric vein.
Innervation
The stomach receives innervation from the autonomic nervous system:
• Parasympathetic nerve supply arises from the anterior and posterior vagal trunks, derived
from the vagus nerve.
• Sympathetic nerve supply arises from the T6-T9 spinal cord segments and passes to the
coeliac plexus via the greater splanchnic nerve. It also carries some pain transmitting fibres.
56. Small intestine: departments, their topography, structure, perineum relation, innervation
and blood supply.
It extends from the pylorus of the stomach to the ileocaecal junction, where it meets the large
intestine at the ileocaecal valve. Anatomically, the small bowel can be divided into three parts:
the duodenum, jejunum, and ileum.
Vasculature
Duodenum
The arterial supply of the duodenum is derived from two sources:
• Proximal to the major duodenal papilla – supplied by the gastroduodenal artery (branch
of the common hepatic artery from the coeliac trunk).
• Distal to the major duodenal papilla – supplied by the inferior pancreaticoduodenal

artery (branch of superior mesenteric artery).
This transition is important – it marks the change from the embryological foregut to midgut. The
veins of the duodenum follow the major arteries and drain into the hepatic portal vein.
Jejunum and Ileum

The arterial supply to the jejunoileum is from the superior mesenteric artery.
The superior mesenteric artery arises from the aorta at the level of the L1 vertebrae, immediately
inferior to the coeliac trunk. It moves in between layers of mesentery, splitting into approximately
20 branches. These branches anastomose to form loops, called arcades. From the arcades, long
and straight arteries arise, called vasa recta.
The venous drainage is via the superior mesenteric vein. It unites with the splenic vein at the
neck of the pancreas to form the hepatic portal vein.
Peritoneal relation
The initial 3cm of the superior duodenum is covered anteriorly and posteriorly by visceral
peritoneum, with the remainder retroperitoneal (only covered anteriorly).
57. Duodenum: development, topography, parts, structure, position within the peritoneum,
The Duodenum
The most proximal portion of the small intestine is the duodenum. Its name is derived from the
Latin ‘duodenum digitorum’, meaning twelve fingers length. It runs from the pylorus of
the stomach to the duodenojejunal junction.
The duodenum can be divided into four parts: superior, descending, inferior and ascending.
Together these parts form a ‘C’ shape, that is around 25cm long, and which wraps around the
head of the pancreas.
D1 – Superior (Spinal level L1)
The first section of the duodenum is known as ‘the cap’. It ascends upwards from the pylorus of
the stomach, and is connected to the liver by the hepatoduodenal ligament. This area is most
common site of duodenal ulceration.
The initial 3cm of the superior duodenum is covered anteriorly and posteriorly by visceral
peritoneum, with the remainder retroperitoneal (only covered anteriorly).
D2 – Descending (L1-L3)
The descending portion curves inferiorly around the head of the pancreas. It lies posteriorly to the
transverse colon, and anterior to the right kidney.
Internally, the descending duodenum is marked by the major duodenal papilla – the opening at
which bile and pancreatic secretions to enter from the ampulla of Vater (hepatopancreatic
ampulla).
D3 – Inferior (L3)
The inferior duodenum travels laterally to the left, crossing over the inferior vena
cava and aorta. It is located inferiorly to the pancreas, and posteriorly to the superior mesenteric
artery and vein.
D4 – Ascending (L3-L2)
After the duodenum crosses the aorta, it ascends and curves anteriorly to join the jejunum at a
sharp turn known as the duodenojejunal flexure.
Located at the duodenojejunal junction is a slip of muscle called the suspensory muscle of the
duodenum. Contraction of this muscle widens the angle of the flexure, and aids movement of the
intestinal contents into the jejunum.
The arterial supply of the duodenum is derived from two sources:
• Proximal to the major duodenal papilla – supplied by the gastroduodenal artery (branch
of the common hepatic artery from the coeliac trunk).
• Distal to the major duodenal papilla – supplied by the inferior pancreaticoduodenal

artery (branch of superior mesenteric artery).
This transition is important – it marks the change from the embryological foregut to midgut. The
veins of the duodenum follow the major arteries and drain into the hepatic portal vein.
Lymphatic drainage is to the pancreatoduodenal and superior mesenteric nodes.
58.Colon: their topography, parts, structure, position within the peritoneum, innervation and
blood supply.
Anatomically, the colon can be divided into four parts – ascending, transverse, descending and
sigmoid. These sections form an arch, which encircles the small intestine.
Anatomical Position
The colon averages 150cm in length, and can be divided into four parts (proximal to distal):
ascending, transverse, descending and sigmoid.
Ascending Colon
The colon begins as the ascending colon, a retroperitoneal structure which ascends superiorly
from the cecum.
When it meets the right lobe of the liver, it turns 90 degrees to move horizontally. This turn is known
as the right colic flexure (or hepatic flexure), and marks the start of the transverse colon.
Transverse Colon
The transverse colon extends from the right colic flexure to the spleen, where it turns another 90
degrees to point inferiorly. This turn is known as the left colic flexure (or splenic flexure). Here, the
colon is attached to the diaphragm by the phrenicocolic ligament.
The transverse colon is the least fixed part of the colon, and is variable in position (it can dip into
the pelvis in tall, thin individuals). Unlike the ascending and descending colon, the transverse colon
is intraperitoneal and is enclosed by the transverse mesocolon.
Descending Colon
After the left colic flexure, the colon moves inferiorly towards the pelvis – and is called
the descending colon. It is retroperitoneal in the majority of individuals, but is located anteriorly
to the left kidney, passing over its lateral border.
When the colon begins to turn medially, it becomes the sigmoid colon.
Sigmoid Colon
The 40cm long sigmoid colon is located in the left lower quadrant of the abdomen, extending
from the left iliac fossa to the level of the S3 vertebra. This journey gives the sigmoid colon its
characteristic “S” shape.
The sigmoid colon is attached to the posterior pelvic wall by a mesentery –

the sigmoid mesocolon. The long length of the mesentery permits this part of the colon to be
particularly mobile.
Paracolic Gutters
The paracolic gutters are two spaces between the ascending/descending colon and the
posterolateral abdominal wall.
These structures are clinically important, as they allow material that has been released from
inflamed or infected abdominal organs to accumulate elsewhere in the abdomen.
The large intestine has a number of characteristic features, which allows it to be distinguished from
the small intestine:
• Attached to the surface of the large intestine are omental appendices – small pouches of
peritoneum, filled with fat.
• Running longitudinally along the surface of the large bowel are three strips of muscle,
known as the teniae coli. They are called the mesocolic, free and omental coli.
• The teniae coli contract to shorten the wall of the bowel, producing sacculations known
as haustra.
• The large intestine has a much wider diameter compared to the small intestine.
These features cease at the rectosigmoid junction, where the smooth muscle of the teniae coli
broaden to form a complete layer within the rectum.
Blood supply
midgut-derived structures are supplied by the superior mesenteric artery, and hindgut-derived
structures by the inferior mesenteric artery.
The ascending colon receives arterial supply from two branches of the superior mesenteric
artery; the ileocolic and right colic arteries. The ileocolic artery gives rise to colic, anterior cecal
and posterior cecal branches – all of which supply the ascending colon.
The transverse colon is derived from both the midgut and hindgut, and so it is supplied by branches
of the superior mesenteric artery and inferior mesenteric artery:
• Right colic artery (from the superior mesenteric artery)

• Middle colic artery (from the superior mesenteric artery)
• Left colic artery (from the inferior mesenteric artery)
The descending colon is supplied by a single branch of the inferior mesenteric artery; the left colic
artery. The sigmoid colon receives arterial supply via the sigmoid arteries (branches of the
inferior mesenteric artery).
59. Caecum and appendix: their topography, structure, innervation and blood supply.
Anatomical Structure and Relations
The cecum is the most proximal part of the large intestine and can be found in the right iliac fossa
of the abdomen. It lies inferiorly to the ileocecal junction and can be palpated if enlarged due to
faeces, inflammation, or malignancy.
The cecum derives its name from its inferior blind-end (‘cecum’ is derived from the Latin word
‘caecus’, meaning ‘blind’). Superiorly, the cecum is continuous with the ascending colon. Unlike
the ascending colon, the cecum is intraperitoneal and has a variable mesentery.
Between the cecum and ileum is the ileocecal valve. This structure prevents reflux of large bowel
contents into the ileum during peristalsis and is thought to function passively, as opposed to a
defined muscular sphincter.
Note: In cases of large bowel obstruction, an incompetent ileocecal valve is paradoxically

advantageous as it allows the retrograde passage of bowel contents back into the ileum. This helps
to decompress the cecum and prevent “closed loop” obstructions and perforations.
The cecum is derived from the embryologic midgut. Therefore, the vascular supply is via branches
of the superior mesenteric vessels.
Arterial supply is from the ileocolic artery, a branch of the superior mesenteric artery. It
subsequently divides into anterior and posterior cecal arteries, which directly supply the
cecum. Venous drainage is provided by the corresponding ileocolic vein, and empties into the
superior mesenteric vein.
Sympathetic and parasympathetic branches of the autonomic nervous system innervate the cecum
and appendix. This is achieved by the ileocolic branch of the superior mesenteric plexus, which
follows the same course as the ileocolic artery and carries vagal and sympathetic nerve fibres.
60. Rectum: topography, parts, structure, innervation and blood supply.
The rectum begins at the level of the S3 (as a continuation of the sigmoid colon). It is
macroscopically distinct from the colon, with an absence of taenia coli, haustra, and omental
appendices.
The course of the rectum is marked by two major flexures:
• Sacral flexure – anteroposterior curve with concavity anteriorly (follows the curve of the
sacrum and coccyx).
• Anorectal flexure – anteroposterior curve with convexity anteriorly. This flexure is formed
by the tone of the puborectalis muscle, and contributes significantly to faecal continence.
There are additionally three lateral flexures (superior, intermediate and inferior), which are
formed by transverse folds of the internal rectum wall.
The final segment of the rectum, the ampulla, relaxes to accumulate and temporarily store faeces
until defecation occurs. It is continuous with the anal canal; which passes through the pelvic floor
to end as the anus.
Peritoneal Coverings
In the superior third of the rectum, the anterior surface and lateral sides are covered by peritoneum.
The middle third only has an anterior peritoneal covering, and the lower 1/3 has no peritoneum
associated with it.
In males, the reflection of peritoneum from the rectum to the posterior bladder wall forms
the rectovesical pouch. In females, the peritoneum reflects to the posterior vagina and cervix,
forming the rectouterine pouch (pouch of Douglas). See more about the peritoneal cavity here.
The rectum receives arterial supply through three main arteries:
• Superior rectal artery – terminal continuation of the inferior mesenteric artery.

• Middle rectal artery – branch of the internal iliac artery.
• Inferior rectal artery – branch of the internal pudendal artery.
Innervation
• The rectum receives sensory and autonomic innervation.

• Sympathetic nervous supply to the rectum is from the lumbar splanchnic nerves and
superior and inferior hypogastric plexuses. Parasympathetic supply is from S2-4 via
the pelvic splanchnic nerves and inferior hypogastric plexuses. Visceral afferent
(sensory) fibres follow the parasympathetic supply.
61. Development of the alimentary tract. General structure of the digestive system,
characteristic of the layers of the oesophagus, stomach, intestine.
The gastrointestinal tract (GIT) arises initially during the process of gastrulation from
the endoderm of the trilaminar embryo (week 3) and extends from the buccopharyngeal
membrane to the cloacal membrane. The tract and associated organs later have contributions
from all the germ cell layers.
The wall of the digestive tract has four layers or tunics:
• Mucosa
• Submucosa
• Muscular layer
• Serous layer or serosa
The mucosa, or mucous membrane layer, is the innermost tunic of the wall. It lines
the lumen of the digestive tract. The mucosa consists of epithelium, an underlying
loose connective tissue layer called lamina propria, and a thin layer of smooth
muscle called the muscularis mucosa. In certain regions, the mucosa develops folds
that increase the surface area. Certain cells in the mucosa secrete mucus, digestive
enzymes, and hormones. Ducts from other glands pass through the mucosa to the
lumen. In the mouth and anus, where thickness for protection against abrasion is
needed, the epithelium is stratified squamous tissue. The stomach and intestines
have a thin simple columnar epithelial layer for secretion and absorption.
The submucosa is a thick layer of loose connective tissue that surrounds the
mucosa. This layer also contains blood vessels, lymphatic vessels, and nerves.
Glands may be embedded in this layer.
The smooth muscle responsible for movements of the digestive tract is arranged in
two layers, an inner circular layer and an outer longitudinal layer. The
myenteric plexus is between the two muscle layers.
Above the diaphragm, the outermost layer of the digestive tract is a connective
tissue called adventitia. Below the diaphragm, it is called serosa.
62. Liver, its development, structure, topography, gallbladder. Bile tracts, innervation and
blood supply of the liver.
The liver is predominantly located in the right hypochondrium and epigastric areas, and extends
into the left hypochondrium.
When discussing the anatomical position of the liver, it is useful to consider its external surfaces,
associated ligaments, and the anatomical spaces (recesses) that surround it.
The liver has a unique dual blood supply:
• Hepatic artery proper (25%) – supplies the non-parenchymal structures of the liver with
arterial blood. It is derived from the coeliac trunk.
• Hepatic portal vein (75%) – supplies the liver with partially deoxygenated blood, carrying
nutrients absorbed from the small intestine. This is the dominant blood supply to the liver
parenchyma, and allows the liver to perform its gut-related functions, such as detoxification.
Venous drainage of the liver is achieved through hepatic veins. The central veins of the hepatic
lobule form collecting veins which then combine to form multiple hepatic veins. These hepatic veins
then open into the inferior vena cava.
The gallbladder is a gastrointestinal organ located within the right hypochondrial region of the
abdomen. This intraperitoneal, pear-shaped sac lies within a fossa formed between the inferior
aspects of the right and quadrate lobes of the liver.
The primary function of the gallbladder is to concentrate and store bile which is produced by the
liver. As part of the gustatory response, the stored bile is then released from the gallbladder in
response to cholecystokinin.
63. Pancreas: development, structure, topography, innervation and blood supply.

Anatomical Position
The pancreas is an oblong-shaped organ positioned at the level of the transpyloric plane (L1).
With the exception of the tail of the pancreas, it is a retroperitoneal organ, located deep within the
upper abdomen in the epigastrium and left hypochondrium regions.
Within the abdomen, the pancreas has direct anatomical relations to several structures
Organs:
• Stomach – Separated from the pancreas by the lesser sac, the stomach and pylorus lie
anterior and to the pancreas.
• Duodenum – The “C” shaped duodenum curves around and outlines the head of the
pancreas. The first part of the duodenum lies anteriorly whereas the second part of the
duodenum including the ampulla of Vater lies laterally to the right of the pancreatic head
• Transverse mesocolon – Attaches to the anterior surface of the pancreas
• Common bile duct – Descends behind the head of the pancreas before opening into the
second part of the duodenum alongside the major pancreatic duct through the major
duodenal papilla
• Spleen – located posteriorly and laterally. The lienorenal ligament is formed from
peritoneum and connects the spleen to the tail of the pancreas.
Vessels
The pancreas lies near several major vessels and significant landmarks in vascular anatomy:
• The aorta and inferior vena cava pass posteriorly to the head of the pancreas.
• The superior mesenteric artery lies behind the neck of the pancreas and anterior to the
uncinate process.
• Posterior to the neck of the pancreas, the splenic and superior mesenteric veins unite to
form the hepatic portal vein.
• As it journeys from its origin at the celiac plexus to the splenic hilum, the splenic artery
traverses the superior border of the pancreas.
The pancreas is typically divided into five parts:
• Head – the widest part of the pancreas. It lies within the C-shaped curve created by the
duodenum and is connected to it by connective tissue.
• Uncinate process – a projection arising from the lower part of the head and extending
medially to lie beneath the body of the pancreas. It lies posterior to the superior mesenteric
vessels.
• Neck – located between the head and the body of the pancreas. It overlies the superior
mesenteric vessels which form a groove in its posterior aspect.
• Body – centrally located, crossing the midline of the human body to lie behind the stomach
and to the left of the superior mesenteric vessels.
• Tail – the left end of the pancreas that lies within close proximity to the hilum of the spleen.
It is contained within the splenorenal ligament with the splenic vessels. This is the only part
of the pancreas that is intraperitoneal.
Vasculature
The pancreas is supplied by the pancreatic branches of the splenic artery. The head is
additionally supplied by the superior and inferior pancreaticoduodenal arteries which are branches
of the gastroduodenal (from coeliac trunk) and superior mesenteric arteries, respectively.
Venous drainage of the head of the pancreas is into the superior mesenteric branches of
the hepatic portal vein. The pancreatic veins draining the rest of the pancreas do so via the splenic
vein.
64. Peritoneum: development, anatomic structure, layers, ligaments, mesenteries.

Structure of the Peritoneum
The peritoneum consists of two layers that are continuous with each other: the parietal
peritoneum and the visceral peritoneum. Both types are made up of simple squamous epithelial
cells called mesothelium.
Parietal Peritoneum
The parietal peritoneum lines the internal surface of the abdominopelvic wall. It is derived
from somatic mesoderm in the embryo.
It receives the same somatic nerve supply as the region of the abdominal wall that it lines;
therefore, pain from the parietal peritoneum is well localised. Parietal peritoneum is sensitive to
pressure, pain, laceration and temperature.
Visceral Peritoneum
The visceral peritoneum invaginates to cover the majority of the abdominal viscera. It is derived
from splanchnic mesoderm in the embryo.
The visceral peritoneum has the same autonomic nerve supply as the viscera it covers. Unlike
the parietal peritoneum, pain from the visceral peritoneum is poorly localised and the visceral
peritoneum is only sensitive to stretch and chemical irritation.
Pain from the visceral peritoneum is referred to areas of skin (dermatomes) which are supplied
by the same sensory ganglia and spinal cord segments as the nerve fibres innervating the viscera.
Peritoneal Cavity
The peritoneal cavity is a potential space between the parietal and visceral peritoneum. It
normally contains only a small amount of lubricating fluid.
Mesentery
A mesentery is double layer of visceral peritoneum. It connects an intraperitoneal organ to

(usually) the posterior abdominal wall. It provides a pathway for nerves, blood vessels and
lymphatics to travel from the body wall to the viscera.
The mesentery of the small intestine is simply called ‘the mesentery’. Mesentery related to other
parts of the gastrointestinal system is named according to the viscera it connects to, for example
the transverse and sigmoid mesocolons, the mesoappendix.
65. The peritoneal bags. The lesser omentum, its layers and connections.
Lesser Omentum
The lesser omentum is a double layer of visceral peritoneum, and is considerably smaller than the
greater and attaches from the lesser curvature of the stomach and the proximal part of the
duodenum to the liver.
It consists of two parts: the hepatogastric ligament (the flat, broad sheet) and the hepatoduodenal
ligament (the free edge, containing the portal triad).
66. The nose. Nasal cavity, its development, structure, innervation and blood supply.
Nasal development is instigated by the appearance of raised bumps called nasal placodes on both
sides of the frontonasal prominence. These then invaginate to form nasal pits, with medial and
lateral nasal prominences on either side.
As the maxillary prominences expand medially, the nasal prominences are ‘pushed’ closer to the
midline. The maxillary prominences then fuse with the nasal prominences – and soon after fuse
in the midline to form a continuous central structure.

Draws
down the
medial
angle of
skin of the the
from fascia lower part of buccal eyebrow,
over the the forehead branch of giving
lower of the between the the facial expressions
procerus nasal bone eyebrows nerve of frowning
Compresses
bridge,
depresses
tip of nose,
nasalis maxilla nasal bone elevates
corners of
nostrils
margin of
the nasal
notch of the
maxilla,
greater and skin near the
lesser alar margin of dilation of
dilatator naris cartilages the nostril nostrils
nasal
septum and
back part of
incisive the alar part depression
depressor septi fossa of the of nasalis of nasal
nasi maxilla muscle septum
dilates the
nostril;
elevates
the upper
levator labii superior lip and
superioris nostril and labial wing of the
alaeque nasi maxilla upper lip artery nose
67. Larynx: cartilages, connections, muscles, their functions, innervation and blood supply.
The laryngeal skeleton is nine cartilages: the thyroid cartilage, cricoid cartilage, epiglottis, arytenoid
cartilages, corniculate cartilages, and cuneiform cartilages. The first three are unpaired cartilages, and the
latter three are paired cartilages.
tension and
elongation
inferior of the vocal
anterior and cornu and external folds (has
lateral lamina of laryngeal minor
cricoid the thyroid branch of adductory
cricothyroid cartilage cartilage the vagus effect)
approximate
the
arytenoid recurrent arytenoid
arytenoid cartilage on laryngeal cartilages
cartilage on opposite branch of (close rima
arytenoid one side side the vagus glottidis)
thickens the
vocal folds
inner and
surface of decreases
the thyroid anterior recurrent length; also
cartilage surface of laryngeal helps to
(anterior arytenoid branch of adduct the
thyroarytenoid aspect) cartilage the vagus vocal folds
during
speech
Cricoarytenoid muscles
abducts and
laterally
rotates the
cartilage,
pulling the
vocal
ligaments
away from
the midline
muscular and forward
process of recurrent and so
posterior the laryngeal opening the
part of the arytenoid branch of rima
posterior cricoid cartilage the vagus glottidis
adduct and
medially
rotate the
cartilage,
pulling the
vocal
ligaments
towards the
midline and
muscular backwards
lateral part process of recurrent and so
of the arch the laryngeal closing off
of the arytenoid branch of the rima
lateral cricoid cartilage the vagus glottidis
68. Laryngeal cavity: parts and their walls.

The laryngeal cavity (cavity of the larynx) extends from the laryngeal inlet downwards to the lower
border of the cricoid cartilage where it is continuous with that of the trachea
It is divided into two parts by the projection of the vocal folds, between which is a narrow triangular
opening, the rima glottidis.
The portion of the cavity of the larynx above the vocal folds is called the vestibule; it is wide and
triangular in shape, its base or anterior wall presenting, however, about its center the backward
projection of the tubercle of the epiglottis.
69. Trachea and bronchi: development, topography, structure, innervation and blood supply.
The Trachea
Anatomical Position
The trachea marks the beginning of the tracheobronchial tree. It arises at the lower border
of cricoid cartilage in the neck, as a continuation of the larynx.
It travels inferiorly into the superior mediastinum, bifurcating at the level of the sternal angle
(forming the right and left main bronchi). As it descends, the trachea is located anteriorly to
the oesophagus, and inclines slightly to the right
Structure
The trachea, like all of the larger respiratory airways, is held open by cartilage – here in C-
shaped rings. The free ends of these rings are supported by the trachealis muscle.
The trachea and bronchi are lined by ciliated pseudostratified columnar epithelium, interspersed
by goblet cells, which produce mucus. The combination of sweeping movements by the cilia and
mucus from the goblet cells forms the functional mucociliary escalator. This acts to trap inhaled
particles and pathogens, moving them up out of the airways to be swallowed and destroyed.
At the bifurcation of the primary bronchi, a ridge of cartilage called the carina runs
anteroposteriorly between the openings of the two bronchi. This is the most sensitive area of the
trachea for triggering the cough reflex, and can be seen on bronchoscopy.
The trachea receives sensory innervation from the recurrent laryngeal nerve.
Arterial supply comes from the tracheal branches of the inferior thyroid artery, while venous
drainage is via the brachiocephalic, azygos and accessory hemiazygos veins.
Bronchi
At the level of the sternal angle, the trachea bifurcates into the right and left main bronchi. They
undergo further branching to produce the secondary bronchi. Each secondary bronchi supplies a
lobe of the lung, and gives rise to several segmental bronchi.
Along with branches of the pulmonary artery and veins, the main bronchi make up the roots of the
lungs.
Structure
• Right main bronchus – wider, shorter, and descends more vertically than its left-sided
counterpart. Clinically, this results in a higher incidence of foreign body inhalation. The right
superior lobar bronchus arises before the right main bronchus enters the hilum.
• Left main bronchus – passes inferiorly to the arch of the aorta, and anteriorly to the
thoracic aorta and oesophagus in order to reach the hilum of the left lung.
Within the lungs, the main (primary) bronchi branch into lobar (secondary) bronchi. Each
secondary bronchi supplies a lobe of the lung, thus there are 3 right lobar bronchi and 2 left. The
lobar bronchi then bifurcate into several segmental (tertiary) bronchi, each of which supplies
a bronchopulmonary segment. Bronchopulmonary segments are subdivisions of the lung lobes,
and act as the functional unit of the lungs.
The structure of bronchi are very similar to that of the trachea, though differences are seen in the
shape of their cartilage. In the main bronchi, cartilage rings completely encircle the lumen.
However in the smaller lobar and segmental bronchi cartilage is found only in crescent shapes.
The bronchi derive innervation from pulmonary branches of the vagus nerve (CN X). Blood supply
to the bronchi is from branches of the bronchial arteries, while venous drainage is into
the bronchial veins.
70. Lungs: development, structure, topography, innervation and blood supply.

They are located in the thorax, either side of the mediastinum. The function of the lungs is
to oxygenate blood. They achieve this by bringing inspired air into close contact with oxygen-
poor blood in the pulmonary capillaries.
Lung Structure
The lungs are roughly cone shaped, with an apex, base, three surfaces and three borders. The
left lung is slightly smaller than the right – this is due to the presence of the heart.
Each lung consists of:
• Apex – The blunt superior end of the lung. It projects upwards, above the level of the 1st
rib and into the floor of the neck.
• Base – The inferior surface of the lung, which sits on the diaphragm.
• Lobes (two or three) – These are separated by fissures within the lung.
• Surfaces (three) – These correspond to the area of the thorax that they face. They are
named costal, mediastinal and diaphragmatic.
• Borders (three) – The edges of the lungs, named the anterior, inferior and posterior
borders.
Lobes
The right and left lungs do not have an identical lobular structure.
The right lung has three lobes; superior, middle and inferior. The lobes are divided from each
other by two fissures:
• Oblique fissure – Runs from the inferior border of the lung in a superoposterior direction,
until it meets the posterior lung border.
• Horizontal fissure– Runs horizontally from the sternum, at the level of the 4th rib, to meet
the oblique fissure.
The left lung contains superior and inferior lobes, which are separated by a similar oblique fissure.
Vasculature
The lungs are supplied with deoxygenated blood by the paired pulmonary arteries. Once the
blood has received oxygenation, it leaves the lungs via four pulmonary veins (two for each lung).
The bronchi, lung roots, visceral pleura and supporting lung tissues require an extra nutritive blood
supply. This is delivered by the bronchial arteries, which arise from the descending aorta.
The bronchial veins provide venous drainage. The right bronchial vein drains into the azygos vein,
whilst the left drains into the accessory hemiazygos vein.
Nerve Supply
The nerves of the lungs are derived from the pulmonary plexuses. They feature sympathetic,
parasympathetic and visceral afferent fibres:
• Parasympathetic – derived from the vagus nerve. They stimulate secretion from the
bronchial glands, contraction of the bronchial smooth muscle, and vasodilation of the
pulmonary vessels.
• Sympathetic – derived from the sympathetic trunks. They stimulate relaxation of the
bronchial smooth muscle, and vasoconstriction of the pulmonary vessels.
• Visceral afferent – conduct pain impulses to the sensory ganglion of the vagus nerve.
71. Lobes, segments, lobules, acinus of the lungs, innervation and blood supply.
Lobes
Lobes of the left lung
The inferior lobe is posteroinferior with respect to the oblique fissure.
On the other hand, the superior lobe is anterosuperior to the fissure. The inferior lobe is much
larger than the superior lobe; In contrast, the superior lobe includes the apex, and most of the
costal and medial surfaces, and the entire anterior border. The superior lobe also includes the
cardiac notch and the associated lingula found in that area.
Lobes of the right lung
The superior lobe of the right lung is located above the horizontal fissure and anterosuperior to
the oblique fissure. It contains the apex, majority of the upper part of the costal surface, and the
upper part of the medial surface as well.
The middle lobe is the smallest of the three right lung lobes. It is caudally related to the
horizontal fissure and anterior to the oblique fissure. It is cuneiform in shape and involves the
anterior basal aspect of the lung, the anteroinferior part of the costal surface, and the inferior
region of the anterior border.
The inferior lobe accounts for the majority of the lung surface volume. It is situated behind the
oblique fissure. This lobe includes the posteroinferior parts of the costal and medial surfaces and
the entire lung base that is posterior to the oblique fissure.
Acinus
Pulmonary acinus is commonly defined as the portion of lung distal to a terminal bronchiole and
supplied by a ﬁrst-order respiratory bronchiole or bronchioles 1.
Each secondary pulmonary lobule usually contains 3-12 acini, and adjacent acini are separated
by incomplete intralobular septa.
Blood supply
Pulmonary trunk -> pulmonary arteries (right and left) -> superior and inferior pulmonary
arteries (right and left)
Intercostobronchial trunk and thoracic aorta -> bronchial arteries (right and left)
Innervation
Pulmonary plexus (vagus nerve, cervical cardiac nerves)
72. Lungs: bronchial tree and alveolar structures, functions of the lungs.
The function of the lungs is to oxygenate blood. They achieve this by bringing inspired air into
close contact with oxygen-poor blood in the pulmonary capillaries.
Bronchial Tree
The bronchial tree is a series of passages that supplies air to the alveoli of the lungs. It begins with
the trachea, which divides into a left and right bronchus.
Note: The right bronchus has a higher incidence of foreign body inhalation due to its wider shape
and more vertical course.
Each bronchus enters the root of the lung, passing through the hilum. Inside the lung, they divide
to form lobar bronchi – one supplying each lobe.
Each lobar bronchus then further divides into several tertiary segmental bronchi. Each segmental
bronchus provides air to a bronchopulmonary segment – these are the functional units of the lungs.
The segmental bronchi give rise to many conducting bronchioles, which eventually lead
into terminal bronchioles. Each terminal bronchiole gives off respiratory bronchioles, which
feature thin walled outpocketings that extend from their lumens. These are the alveoli – the site of
gaseous exchange.
73. The root of the lungs, its structures, topography.

Root and Hilum
The lung root is a collection of structures that suspends the lung from the mediastinum. Each root
contains a bronchus, pulmonary artery, two pulmonary veins, bronchial vessels, pulmonary plexus
of nerves and lymphatic vessels.
All these structures enter or leave the lung via the hilum – a wedge shaped area on its mediastinal
surface.
74. Pleura: development, layers, recessus, topography.

Structure of the Pleurae
There are two pleurae in the body: one associated with each lung. They consist of a serous
membrane – a layer of simple squamous cells supported by connective tissue. This simple
squamous epithelial layer is also known as the mesothelium.
Each pleura can be divided into two parts:
• Visceral pleura – covers the lungs.

• Parietal pleura – covers the internal surface of the thoracic cavity.
These two parts are continuous with each other at the hilum of each lung. There is a potential
space between the viscera and parietal pleura, known as the pleural cavity.
We shall now consider the structures of the pleurae in more detail.
Parietal Pleura
The parietal pleura covers the internal surface of the thoracic cavity. It is thicker than the visceral
pleura, and can be subdivided according to the part of the body that it is contact with:
• Mediastinal pleura – Covers the lateral aspect of the mediastinum (the central component
of the thoracic cavity, containing a number of organ).
• Cervical pleura – Lines the extension of the pleural cavity into the neck.
• Costal pleura – Covers the inner aspect of the ribs, costal cartilages, and intercostal
muscles.
• Diaphragmatic pleura – Covers the thoracic (superior) surface of the diaphragm.
Pleural Recesses
Anteriorly and posteroinferiorly, the pleural cavity is not completely filled by the lungs. This gives
rise to recesses – where the opposing surfaces of the parietal pleura touch.
There are two recesses present in each pleural cavity:
• Costodiaphragmatic – located between the costal pleurae and the diaphragmatic pleura.
• Costomediastinal – located between the costal pleurae and the mediastinal pleurae,
behind the sternum.
These recesses are of clinical importance, as they provide a location where fluid can collect (such
as in a pleural effusion).
Fetal differentiation of the lung pleura can be divided in two stages--early (until 17 gestation
week) and late stage--up to birth. The high mesothelial cells appear later than the flat cells, but
the first type predominates in the final covering layer during the period investigated.
75. Mediastinum: borders and regions. Organs of the anterior mediastinum.
The mediastinum is the central compartment of the thoracic cavity, located between the two
pleural sacs. It contains most of the thoracic organs, and acts as a conduit for structures traversing
the thorax on their way into the abdomen.
Anatomically, the mediastinum is divided into two parts by an imaginary line that runs from
the sternal angle (the angle formed by the junction of the sternal body and manubrium) to the T4
vertebrae:
• Superior mediastinum – extends upwards, terminating at the superior thoracic aperture.
• Inferior mediastinum – extends downwards, terminating at the diaphragm. It is further

subdivided into the anterior mediastinum, middle mediastinum and posterior mediastinum.
In this article, we shall look at the anatomy of the anterior mediastinum – its borders, contents
and clinical correlations.
Borders
The anterior mediastinum is bordered by the following thoracic structures:
• Lateral borders: Mediastinal pleura (part of the parietal pleural membrane).

• Anterior border: Body of the sternum and the transversus thoracis muscles.
• Posterior border: Pericardium.
• Roof: Continuous with the superior mediastinum at the level of the sternal angle.
• Floor: Diaphragm.
Contents
The anterior mediastinum contains no major structures. It accommodates loose connective tissue
(including the sternopericardial ligaments, which tether the pericardium to the sternum), fat,
some lymphatic vessels, lymph nodes and branches of the internal thoracic vessels.
In infants and children, the thymus extends inferiorly into the anterior mediastinum. However the
thymus recedes during puberty and is mostly replaced by adipose tissue in the adult.
76. Mediastinum: borders and regions. Organs of the posterior mediastinum, their
topography.
Borders
The posterior mediastinum is bordered by the following thoracic structures:
• Lateral: Mediastinal pleura (part of the parietal pleural membrane).

• Anterior: Pericardium.
• Posterior: T5-T12 vertebrae.
• Roof: Imaginary line extending between the sternal angle (the angle formed by the junction
of the sternal body and manubrium) and the T4 vertebrae.
• Floor: Diaphragm.
Contents
The posterior mediastinum contains a number of major organs, blood vessels and nerves. We
shall now explore the anatomy of these structures in more detail.
Thoracic Aorta
The thoracic (descending) aorta is a continuation of the arch of the aorta, beginning at the lower
edge of the T4 vertebra. It descends through the posterior mediastinum to the left of the vertebrae,
becoming more medially located as it moves. At the inferior border of T12, the thoracic aorta
becomes the abdominal aorta, and passes through the aortic hiatus of the diaphragm.
A number of branches arise from the thoracic aorta in the posterior mediastinum. These tend to
arise in three vascular planes; unpaired branches to viscera extend anteriorly, paired branches to
viscera extend laterally, and paired segmental parietal branches extend
mostly posterolaterally. The major branches are:
• Posterior intercostal arteries – Paired parietal branches. Nine such pairs branch from
the posterior aspect of the aorta, supplying the intercostal spaces (except the first two).
Pass posteriorly and laterally, in parallel with the ribs.
• Bronchial arteries – Paired visceral branches, usually one or two. The left bronchial
arteries always arise directly from the thoracic aorta, while those on the right usually branch
indirectly from a right posterior intercostal artery. They go on to supply the tracheobronchial
tree.
• Oesophageal arteries – Unpaired visceral branches, arising from the anterior aspect of
the aorta. In most individuals there are two, but there can up to five. As the name suggests,
these branches go on to supply the oesophagus.
• Superior phrenic arteries – Arise from the anterior aspect of the thoracic aorta at the
aortic hiatus, varying in number. They supply the superior aspect of the diaphragm.
Oesophagus
The oesophagus is a muscular tube that connects the pharynx to the stomach; allowing swallowed
food to pass into the digestive system. It passes into the posterior mediastinum from the superior
mediastinum, descending posteriorly to the arch of the aorta and the heart. Whilst initially
positioned to the right, the oesophagus deviates to the left as it moves downwards. It leaves the
mediastinum via the oesophageal hiatus of the diaphragm.
The oesophageal plexus is a network of nerves surrounding the oesophagus as it descends,

comprising of branches from the left and right vagus nerves. Immediately above the diaphragm,
the fibres of the plexus converge to form the anterior vagal trunk and posterior vagal trunk, which
travel along the surface of the oesophagus as it exits the thorax.
Thoracic Duct
The thoracic duct is the largest lymphatic vessel in the body, allowing return of lymph from most
of the body (all but the right superior quadrant) into the venous system.
The duct originates from the cisterna chyli in the abdomen, and enters the mediastinum through
the aortic hiatus. It ascends to lie directly anterior to the T6-T12 vertebrae, before deviating left
as it ascends into the superior mediastinum. While located in the posterior mediastinum, the
thoracic duct receives lymphatic drainage from the intercostal spaces and neighbouring anatomical
structures through a number of branches.
Azygos System of Veins
This venous network drains blood from the body walls and mediastinal viscera, and empties into
the superior vena cava. It consists of three major veins:
• Azygos vein – Formed by the union of the right lumbar vein and the right subcostal vein.
It enters the mediastinum via the aortic hiatus and drains into the superior vena cava.
• Hemiazygos vein – Formed by the union of the left lumbar vein and left subcostal vein. It
enters the mediastinum through the left crus of the diaphragm, ascending on the left side.
At the level of T8, it turns to the right and combines with the azygos vein.
• Accessory hemiazygos vein – Formed by the union of the fourth to eighth intercostal
veins. It drains into the azygos vein at T7.
• Sympathetic Trunks
• The sympathetic trunks are paired bundles of nerves that extend from the base of the skull
to the coccyx. In the thoracic region, these nerve bundles are known as the thoracic
sympathetic trunks. As they descend through the thorax, they lie within the posterior
mediastinum.
• Arising from these trunks are the lower thoracic splanchnic nerves – they continue
inferiorly to supply the viscera of the abdomen.
77. Classification of the glands of internal secretion. Suprarenal glands: topography, structure,
The adrenal glands consist of an outer connective tissue capsule, a cortex and a medulla. Veins
and lymphatics leave each gland via the hilum, but arteries and nerves enter the glands at
numerous sites.
The outer cortex and inner medulla are the functional portions of the gland. They are two separate
endocrine glands, with different embryological origins:
• Cortex – derived from the embryonic mesoderm.
• Medulla – derived from the ectodermal neural crest cells.
The cortex and medulla synthesise different hormones.
Cortex
The cortex is yellowish in colour. It secretes two cholesterol derived hormones – corticosteroids
and androgens. Functionally, the cortex can be divided into three regions (superficial to deep):
• Zona glomerulosa – produces and secretes mineralocorticoids such as aldosterone.
• Zona fasciculata – produces and secretes corticosteroids such as cortisol. It also secretes
a small amount of androgens.
• Zona reticularis – produces and secretes androgens such as dehydroepiandrosterone

(DHES). It also secretes a small amount of corticosteroids.
Medulla
The medulla lies in the centre of the gland, and is dark brown in colour. It contains chromaffin
cells, which secrete catecholamines (such as adrenaline) into the bloodstream in response to
stress.
These hormones produce a ‘flight-or-fight‘ response. Chromaffin cells also secrete enkephalins
which function in pain control.
Vasculature
The adrenal glands have a rich blood supply via three main arteries:
• Superior adrenal artery – arises from the inferior phrenic artery

• Middle adrenal artery – arises from the abdominal aorta.
• Inferior adrenal artery – arises from the renal arteries.
Right and left adrenal veins drain the glands. The right adrenal vein drains into the inferior vena
cava, whereas the left adrenal vein drains into the left renal vein.
Innervation
The adrenal glands are innervated by the coeliac plexus and greater splanchnic nerves.
Sympathetic innervation to the adrenal medulla is via myelinated pre-synaptic fibres, mainly from
the T10 to L1 spinal cord segments.
78. Branchiogenic glands of internal secretion: thyroid, parathyroid and thymus, their
development, topography, structure, functions, innervation and blood supply.
Thyroid
Anatomical Location
The thyroid gland is located in the anterior neck and spans the C5-T1 vertebrae. It consists of
two lobes (left and right), which are connected by a central isthmus anteriorly – this produces a
butterfly-shape appearance.
The lobes of the thyroid gland are wrapped around the cricoid cartilage and superior rings of
the trachea. The gland is located within the visceral compartment of the neck (along with the
trachea, oesophagus and pharynx). This compartment is bound by the pretracheal fascia.
Vasculature
The thyroid gland secretes hormones directly into the circulation and is highly vascularised.
Arterial Supply
The arterial supply to the thyroid gland is via two main arteries:
• Superior thyroid artery – arises as the first branch of the external carotid artery. It lies in
close proximity to the external branch of the superior laryngeal nerve (innervates the
larynx).
• Inferior thyroid artery – arises from the thyrocervical trunk (a branch of the subclavian
artery). It lies in close proximity to the recurrent laryngeal nerve (innervates the larynx).
In a small proportion of people (around 10%) there is an additional artery present – the thyroid
ima artery. It arises from the brachiocephalic trunk and supplies the anterior surface and isthmus
of the thyroid gland.
Innervation
The thyroid gland is innervated by branches derived from the sympathetic trunk.
These nerves do not control the secretory function of the gland – the release of thyroid hormones
is regulated by the pituitary gland.
Parathyroid
Anatomical Location
The parathyroid glands are usually located on the posterior aspect of the thyroid gland. They are
flattened and oval in shape – situated external to the thyroid gland itself but within the pretracheal
fascia.
Most individuals have four parathyroid glands, although variation in number (from two to six) is
common:
• Superior parathyroid glands (x2) – derived from the fourth pharyngeal pouch. They are
located at the middle of the posterior border of each thyroid lobe, approximately 1cm
superior to the entry of the inferior thyroid artery into the thyroid gland.
• Inferior parathyroid glands (x2) – derived from the third pharyngeal pouch. Although
inconsistent in location between individuals, the inferior parathyroid glands are usually
found near the inferior poles of the thyroid gland.
In a small number of people, the inferior parathyroid glands can be found as far inferiorly as
the superior mediastinum.
Vasculature
The vascular supply is similar to that of the thyroid gland.
Arterial supply is chiefly via the inferior thyroid artery (as this artery supplies the posterior aspect
of the thyroid gland – where the parathyroids are located). Collateral arterial supply is from the
superior thyroid artery and thyroid ima artery.
Venous drainage is into the superior, middle, and inferior thyroid veins.
Nerves
The parathyroid glands have an extensive supply of sympathetic nerves derived from thyroid
branches of the cervical ganglia.
Note: these nerves are vasomotor, not secretomotor – endocrine secretion of parathyroid
hormone under hormonal control.
Thymus
Anatomical Structure and Position
The thymus gland has an asymmetrical flat shape, with a lobular structure. The lobules are
comprised of a series of follicles, which have a medullary and cortical component:
• Cortical portion – Located peripherally within each follicle. It is largely composed of

lymphocytes, supported epithelial reticular cells.
• Medullary portion – Located centrally within each follicle. It contains fewer lymphocytes
than the cortex, and an increased number of epithelial cells. Hassall’s corpuscles are also
present – these are concentric arrangements of epithelial reticular cells. Their function is
unclear.
The gland is mainly located within the thoracic superior mediastinum, posterior to the manubrium
of the sternum. However, in some individuals, it can extend superiorly into the neck (reaching
the thyroid gland), and inferiorly into the anterior mediastinum (lying in front of the
fibrous pericardium).
Vasculature
The arterial supply to the thymus gland is via the anterior intercostal arteries and small branches
from the internal thoracic arteries. Venous blood drains into the left brachiocephalic and
internal thoracic veins.
79. Organs of haemopoesis, classifications. Spleen: development, anatomic structure, topography,
ANS-----Hematopoiesis is the production of all of the cellular components of blood and blood
plasma. It occurs within the hematopoietic system, which includes organs and tissues such as the
bone marrow, liver, and spleen. Simply, hematopoiesis is the process through which the body
manufactures blood cells.
DEVELOPMENT OF SPLEEN
The human spleen arises in week 5 within the dorsal mesentery as proliferating mesenchyme
overlying the dorsal pancreatic endoderm. Cells required for its hemopoietic function arise from
the yolk sac wall and near dorsal aorta. The spleen generates both red and white cells in the
second trimester.It receives most of its arterial supply from the splenic artery. This vessel arises
from the coeliac trunk, running laterally along the superior aspect of the pancreas, within the
splenorenal ligament. As the artery reaches the spleen, it branches into five vessels – each
supplying a different part of the organ
80. Kidneys: development, structure, topography, innervation and blood supply.
DEVELOPMENT OF KINDEY
The development of the kidney proceeds through a series of successive phases, each marked by
the development of a more advanced kidney: the archinephros, pronephros, mesonephros, and
metanephros.[1] The pronephros is the most immature form of kidney, while the metanephros is
most developed. The metanephros persists as the definitive adult kidney
BLOOD SUPPLY TO KIDNEY
The renal arteries branch off of the abdominal aorta and supply the kidneys with blood. The
arterial supply of the kidneys varies from person to person, and there may be one or more renal
arteries to supply each kidney. The renal veins are the veins that drain the kidneys and connect
them to the inferior vena cava.
81. UREeter, urinary bladder: development, structure, topography, innervation and blood supply.
ANS---The development of the bladder begins during week four when the urogenital septum
divides the cloaca into two parts, the rectum posteriorly and the urogenital sinus anteriorly. The
urogenital sinus will continue to grow to form the bladder, with the inferior end forming the
urethra
BLOOD SUPPLY
The upper ureter closest to the kidneys receives blood directly from the renal arteries. The middle
part is supplied by the common iliac arteries, branches from the abdominal aorta, and the gonadal
arteries. The most distal part of the ureter receives blood from branches of the internal iliac artery
82. Male and female urethra: development, structure, topography, innervation and blood supply.
ANS---MALE--the urethra is anatomically linked with the reproductive structures, its
characteristics in males are quite different from those in females. The male’s urethra is about 18
to 20 cm (7 to 8 inches) long and passes along the length of the penis before emptying. At its
emergence from the bladder, the urethra passes through the prostate gland, and seminal ducts
from the testes enter the urethra at each side, making it the pathway for the transmission of semen
as well as for the discharge of urine
FEMALE--The female urethra is embedded within the vaginal wall, and its opening is situated
between the labia. The female urethra is much shorter than that of the male, being only 4 cm (1.5
inches) long. It begins at the bladder neck and opens to the outside just after passing through the
urethral sphincter.
83. Testicles, epididymis. Descending of testicles into the scrotum. Abnormalities of the testicles
position, spermatic cord, its parts, topography.
ANS---TESTICLES--Testicle or testis (plural testes) is the male reproductive gland or gonad in
all animals, including humans. It is homologous to the female ovary. The functions of the testes
are to produce both sperm and androgens, primarily testosterone. Testosterone release is
controlled by the anterior pituitary luteinizing hormone; whereas sperm production is controlled
both by the anterior pituitary follicle-stimulating hormone and gonadal testosterone.
EPEDEDYMIS--is a tube that connects a testicle to a vas deferens in the male reproductive
system. It is present in all male reptiles, birds, and mammals. It is a single, narrow, tightly-coiled
tube in adult humans, 6 to 7 meters (20 to 23 ft) in length[1] connecting the efferent ducts from
the rear of each testicle to its vas deferens.
ABMORMALITIES OF TESTICLES
Scrotal abnormalities include various conditions such as varicoceles, hydroceles, and
malpositioning of the testicles (e.g., cryptorchidism, retractile testes). The most common
congenital anomaly is cryptorchidism, which involves the incomplete descent of the testicle into
the scrotum. The testicle may be located within the abdominal cavity, inguinal canal, or at the
external inguinal ring. Cryptorchidism is associated with an increased risk of infertility and/or
testicular cancer
84. Layers of the testicle. Scrotum: its development and structure.

ANS---There are three layers to the tunica, the tunica vasculosa, tunica albuginea and tunica
vaginalis.
Tunica vasculosa
The tunica vasculosa is the inner layer of the tunica and consists of blood vessels and connective
tissue. It is covered by the tunica albuginea and facilitates blood supply to the testes.
Tunica albuginea
Tunica albuginea (Latin for white coat) is a dense layer of tissue which encases the testes and
connects to the layers of fibres which surround the epididymis, the first in a series of ducts which
transport sperm out of the testes and into the penis.
The tunica albuginea also extends into the testis, creating partitions between seminiferous tubules
where sperm is produced.
Tunica vaginalis
There are two layers of the tunica vaginalis: the visceral and the parietal. The visceral layer
overlies the tunica albuginea (middle layer of the tunica) while the parietal layer lines the scrotal
cavity. A thin fluid layer separates the two sections of the tunica vaginalis and reduces friction
between the testes and the scrotum.
85. Seminal vesicles, the prostate gland, bulbo-urethral glands, their position relating to urethra.
ANS--- SEMINAL VESICLES
The seminal glands are a pair of 5cm long tubular glands. They are located between the bladder
fundus and the rectum (separated from the latter by the rectovesicle pouch and the rectoprostatic
fascia).Their most important anatomical relation is with the vas deferens, which combine with the
duct of the seminal vesicles to form the ejaculatory duct, which subsequently drains into the
prostatic urethraThe secretions of the seminal gland have a key role in the normal functioning of
semen, making up 70% of its total volume. It is notable however that the first fractions of
expelled semen contain mainly spermatozoa and prostatic secretions; the fluids from the seminal
vesicles are included in the late ejaculate fractions. These fluids contain:
Alkaline fluid – neutralises the acidity of the male urethra and vagina in order to facilitate the
survival of spermatozoa.
Fructose – provides an energy source for spermatozoa.
Prostaglandins – have a role in suppressing the female immune response to foreign semen.
Clotting factors – designed to keep semen in the female reproductive tract post-ejaculation.
PROSTRATE GLAND
The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is
just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to
the penis, letting urine flow out of the body.The prostate secretes fluid that nourishes and protects
sperm
BULBOURETHRAL GLAND
Bulbourethral gland, also called Cowper’s Gland, either of two pea-shaped glands in the male,
located beneath the prostate gland at the beginning of the internal portion of the penis; they add
fluids to semen during the process of ejaculation The fluid excreted by these glands is clear and
thick and acts as a lubricant; it is also thought to function as a flushing agent that washes out the
urethra before the semen is ejaculated; it may also help to make the semen less watery and to
provide a suitable living environment for the sperm
86. Male genitalia: depelopment, structure, abnormalities of the development.

ANS--DEVELOPMENT
The reproductive organs are developed from the intermediate mesoderm. The permanent organs
of the adult are preceded by a set of structures which are purely embryonic, and which with the
exception of the ducts disappear almost entirely before the end of fetal life. These embryonic
structures are the mesonephric ducts (also known as Wolffian ducts) and the paramesonephric
ducts, (also known as Müllerian ducts). The mesonephric duct remains as the duct in males which
gives rise to seminal vesical, epididymes and vas deferens, and the paramesonephric duct as that
of the female.
ABNORMALITIES IN DEVELOPMENT
Androgens have an extensive influence on brain development in regions of the brain that are
relevant for autism spectrum disorder (ASD), yet their etiological involvement remains unclear.
Hypospadias (abnormal positioning of the urethral opening) and cryptorchidism (undescended
testes) are 2 relatively common male birth defects that are strongly associated with prenatal
androgen deficiencies. Having either disorder is a proxy indicator of atypical gestational androgen
exposure
87. Ovary: topography, structure, relation to peritoneum, innervation, blood supply.

ANS--The ovaries are paired, oval organs attached to the posterior surface of the broad ligament
of the uterus by the mesovarium (a fold of peritoneum, continuous with the outer surface of the
ovaries).
Two peritoneal ligaments attach to the ovary;

Suspensory ligament of ovary – fold of peritoneum extending from the mesovarium to the pelvic
wall. Contains neurovascular structures.
Ligament of ovary – extends from the ovary to the fundus of the uterus. It then continues from the
uterus to the connective tissue of the labium majus, as the round ligament of uterus.
The main arterial supply to the ovary is via the paired ovarian arteries. These arise directly from
the abdominal aorta (inferior the renal arteries). There is also a contribution from the uterine
arteries.
88. Uterus: development, structure, parts, topography, relation to peritoneum, innervation, blood
supply.
ANS---It is within the uterus that the fetus develops during gestation. In the human embryo, the
uterus develops from the paramesonephric ducts which fuse into the single organ known as a
simplex uterus. The uterus has different forms in many other animals and in some it exists as two
separate uteri known as a duplex uterus.
The uterus is located within the pelvic region immediately behind and almost overlying the
bladder, and in front of the sigmoid colon. The human uterus is pear-shaped and about 7.6 cm
(3.0 in) long, 4.5 cm (1.8 in) broad (side to side), and 3.0 cm (1.2 in) thick.[1][2] A typical adult
uterus weighs about 60 grams. The uterus can be divided anatomically into four regions: the
fundus – the uppermost rounded portion of the uterus, the corpus (body), the cervix, and the
cervical canal. The cervix protrudes into the vagina. The uterus is held in position within the
pelvis by ligaments, which are part of the endopelvic fascia. These ligaments include the
pubocervical ligaments, the cardinal ligaments, and the uterosacral ligaments. It is covered by a
sheet-like fold of peritoneum, the broad ligament.[3]
The uterus is supplied by arterial blood both from the uterine artery and the ovarian artery.
Another anastomotic branch may also supply the uterus from anastomosis of these two arteries.
Afferent nerves supplying the uterus are T11 and T12. Sympathetic supply is from the
hypogastric plexus and the ovarian plexus. Parasympathetic supply is from the S2, S3 and S4
nerves
89. Uterine tube: development, parts, structure, relation to peritoneum, innervation, blood supply.
ANS---The fallopian tubes develop from the paramesonephric or Müllerian ducts. These ducts are
derived from the mesoderm, the middle layer of one of the three primary germ layers in the
embryo. The other two layers are the ectoderm and the endoderm.
The Fallopian tube is composed of four parts. These are, described from near the ovaries to
inwards near the uterus, the infundibulum with its associated fimbriae near the ovary, the ampulla
that represents the major portion of the lateral tube, the isthmus, which is the narrower part of the
tube that links to the uterus, and the interstitial (or intramural) part, the narrowest part of the
uterine tube, that crosses the muscles of the uterine. The average length of a fallopian tube is 11-
12 cm.
The fallopian tube allows passage of an egg from the ovary to the uterus. When an oocyte is
developing in an ovary, it is surrounded by a spherical collection of cells known as an ovarian
follicle. Just before ovulation, the primary oocyte completes meiosis I to form the first polar body
and a secondary oocyte which is arrested in metaphase of meiosis II.
90. Female external genitalia: development, structure. Mammary gland: structure, innervation,
blood supply.
ANS---Oestrogens in the female embryo are responsible for external genital development. The
genital tubercle only elongates slightly to form the clitoris.
The urethral folds and genital swellings do not fuse, but instead form the labia minora and labia
majora respectively.
The urogenital groove therefore remains open, forming the vestibule into which the urethra and
vagina open.
MAMMARY GLAND
The basic components of a mature mammary gland are the alveoli (hollow cavities, a few
millimeters large) lined with milk-secreting cuboidal cells and surrounded by myoepithelial cells.
These alveoli join to form groups known as lobules. Each lobule has a lactiferous duct that drains
into openings in the nipple. The myoepithelial cells contract under the stimulation of oxytocin,
excreting the milk secreted by alveolar units into the lobule lumen toward the nipple. As the
infant begins to suck, the oxytocin-mediated "let down reflex" ensues and the mother's milk is
secreted — not sucked from the gland — into the baby's mouth.
The mammary gland is highly vascular and is supplied by branches of the internal thoracic,
axillary, and intercostal arteries.
Somatic innervation is via the ventral rami of the spinal nerves. ... Mammary branches of the
pudendal nerve supply the caudal aspect of the udder. There is sympathetic innervation to the
blood vessels and teat sphincter smooth muscle
91. Perineum: definition, female and male perineal muscles and fasciae, innervation, blood
supply.
ANS--The perineum in humans is the space between the anus and scrotum in the male and
between the anus and the vulva in the female.[2] The perineum is the region of the body between
the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and
surrounding structures. There is some variability in how the boundaries are defined
STRUCTURE
The perineum is generally defined as the surface region in both males and females between the
pubic symphysis and the coccyx. The perineum is below the pelvic diaphragm and between the
legs. It is a diamond-shaped area that includes the anus and, in females, the vagina.[6] Its
definition varies: it can refer to only the superficial structures in this region, or it can be used to
include both superficial and deep structures. The perineum corresponds to the outlet of the pelvis.
A line drawn across the surface connecting the ischial tuberosities divides the space into two
triangles:
The anterior urogenital triangle, contains the penis (males) or vagina (females)
The posterior anal triangle containing the anus
The formal anatomical boundaries of the perineum may be said to be:[7]
in front: the pubic arch and the arcuate ligament of the pubis
behind: the tip of the coccyx
on either side: the inferior rami of the pubis and ischial tuberosity, and the sacrotuberous ligament
superiorly: pelvic floor[8]
inferiorly: skin and fascia
BLOOD SUPPLY
Internal pudendal artery – Moves inferiorly to exit the pelvis via the greater sciatic foramen.
Accompanied by the pudendal nerve, it then enters the perineum via the lesser sciatic foramen. It
is the main artery responsible for the blood supply to the perineum.
92. Heart: development, external structure. The structure of the right atrium.
ANS---The heart is the first functional organ to develop and starts to beat and pump blood at
about three weeks into embryogenesis. This early start is crucial for subsequent embryonic and
prenatal development.
The heart derives from splanchnopleuric mesenchyme in the neural plate which forms the
cardiogenic region. Two endocardial tubes form here that fuse to form a primitive heart tube
known as the tubular heart.[35] Between the third and fourth week, the heart tube lengthens, and
begins to fold to form an S-shape within the pericardium. This places the chambers and major
vessels into the correct alignment for the developed heart. Further development will include the
septa and valves formation and remodelling of the heart chambers. By the end of the fifth week
the septa are complete and the heart valves are completed by the ninth week.[7]
Before the fifth week, there is an opening in the fetal heart known as the foramen ovale. The
foramen ovale allowed blood in the fetal heart to pass directly from the right atrium to the left
atrium, allowing some blood to bypass the lungs. Within seconds after birth, a flap of tissue
known as the septum primum that previously acted as a valve closes the foramen ovale and
establishes the typical cardiac circulation pattern. A depression in the surface of the right atrium
remains where the foramen ovale was, called the fossa ovalis.[7]
The embryonic heart begins beating at around 22 days after conception
STRUCTURE OF RIGHT ATRIUM

The right atrium receives deoxygenated blood from the superior and inferior vena cavae, and from
the coronary veins. It pumps this blood through the right atrioventricular orifice (guarded by the
tricuspid valve) into the right ventricle.
In the anatomical position, the right atrium forms the right border of the heart. Extending from the
antero-medial portion of the chamber is the right auricle (right atrial appendage) – a muscular
pouch that acts to increase the capacity of the atrium.
The interior surface of the right atrium can be divided into two parts, each with a distinct
embryological origin. These two parts are separated by a muscular ridge called the crista
terminalis:
Sinus venarum – located posterior to the crista terminalis. This part receives blood from the
superior and inferior vena cavae. It has smooth walls and is derived from the embryonic sinus
venosus.
Atrium proper – located anterior to the crista terminalis, and includes the right auricle. It is
derived from the primitive atrium, and has rough, muscular walls formed by pectinate muscles.
The coronary sinus receives blood from the coronary veins. It opens into the right atrium between
the inferior vena cava orifice and the right atrioventricular orifice.
93. Heart: topography, projection of its borders on the front thoracic wall. The structure of the left
atrium.
ANS----The heart has five surfaces: base (posterior), diaphragmatic (inferior), sternocostal
(anterior), and left and right pulmonary surfaces. It also has several margins: right, left, superior,
and inferior:
The right margin is the small section of the right atrium that extends between the superior and
inferior vena cava.
The left margin is formed by the left ventricle and left auricle.
The superior margin in the anterior view is formed by both atria and their auricles.
The Inferior margin is marked by the right ventricle.
Inside, the heart is divided into four heart chambers: two atria (right and left) and two ventricles
(right and left).
structure of left atrium
The left atrium consists of three parts: the vestibule, the left atrial appendage, and the pulmonary-
vein component. The left atrium is more or less oval-shaped. Its extension is greater in the
superior-inferior aspect than in the antero-posterior or medial-lateral aspect. The left atrium is
largest at end-systole, shortly before the mitral valve opens. The entrance to left atrial appendage
lies in close proximity to the left upper pulmonary vein, from which it is separated by a rather
prominent ridge. The left atrial appendage has a finger-like appearance and "rests" on the
anterolateral portion of the left ventricle. It is the most common site of thrombi in the left atrium
and sensitive to any rise in left atrial pressure.
94. Heart: arteries and veins.
ANS---The heart is a muscular, four-chambered organ that is responsible for distributing blood
throughout the body. The continuous activity of the heart creates a large demand for nutrients to
be delivered to cardiac tissue and for waste to be removed. However, because the organ is several
layers thick, it is not feasible for the tissue to obtain nutrients from the blood (via any form of
cellular transport mechanism) that passes through its chambers. If that were the case, the inner
layers of the heart (endocardium and deep myocardium) would receive nutrients, but the outer
layers (superficial myocardium, pericardium, and epicardium) would become ischaemic and
necrotic (i.e. die).
Therefore, in order to maintain optimum cardiac performance and homeostasis, the heart has a
network of blood vessels known as the coronary vessels that take nutrient-rich blood to the heart
tissue; as well as coronary veins that removes waste products from the cardiac myocytes. Their
role is similar to that of the vasa nervosa (vessels of the nerves) and vasa vasorum (vessels of the
vessels) that perfuse the outer layers of the larger blood vessels.
95. Heart: structure of wall, myocardium of atria and ventricles. Conducting system of the heart.
ANS-----Covering the outer surface of the heart is the epicardium . It is also referred to as the
visceral pericardium, which is the inner layer of the pericardium.The epicardium is a serous
membrane that consists of an external layer of simple squamous and an inner layer of areolar
tissue (loose connective tissue). The squamous cells secrete lubricating fluids into the pericardial
cavity.
The thick middle layer of the heart wall is called the myocardium. It consists of numerous layers
of cardiac muscles fibers that wrap around the heart wall. Contraction of the myocardium pumps
blood out of the heart into the aorta and pulmonary trunk arteries.
Covering the inner surface of the heart wall is the endocardium . This layer also covers the heart
valves and tendons and is continuous with the endothelium that lines the major blood vessels that
attach to the heart.The endocardium is made up of thin layers of simple squamous cells and
areolar tissue, similar to the epicardium. Secretions from the squamous cells help regulate the
activity of the myocardium.
96. Heart valves: topography, structure.

ANS-----The heart valves and the chambers are lined with endocardium. Heart valves separate the
atria from the ventricles, or the ventricles from a blood vessel. Heart valves are situated around
the fibrous rings of the cardiac skeleton. The valves incorporate flaps called leaflets or cusps,
similar to a duckbill valve or flutter valve, which are pushed open to allow blood flow and which
then close together to seal and prevent backflow. The mitral valve has two cusps, whereas the
others have three. There are nodules at the tips of the cusps that make the seal tighter.
The pulmonary valve has left, right, and anterior cusps.[4] The aortic valve has left, right, and
posterior cusps.[5] The tricuspid valve has anterior, posterior, and septal cusps; and the mitral
valve has just anterior and posterior cusps.
The valves of the human heart can be grouped in two sets:[6]
Two atrioventricular (AV) valves to prevent backflow of blood from the ventricles into the atria
Tricuspid valve, located between the right atrium and right ventricle
Bicuspid or mitral valve, located between the left atrium and left ventricle
Two semilunar valves to prevent the backflow of blood into the ventricle
Pulmonary semilunar valve, located at the opening between the right ventricle and the pulmonary
trunk
Aortic semilunar valve, located at the opening between the left ventricle and the aorta
97. Heart chambers and vessels, which are related to them. The innervation of the heart.
ANS---4 chambers. The 2 upper chambers are the atria. They receive and collect blood. The 2
lower chambers are the ventricles. They pump blood to other parts of your body. Here is the
process:
The right atrium receives blood from the body. This blood is low in oxygen. This is the blood
from the veins.
The right ventricle pumps the blood from the right atrium into the lungs to pick up oxygen and
remove carbon dioxide.
The left atrium receives blood from the lungs. This blood is rich in oxygen.
The left ventricle pumps the blood from the left atrium out to the body, supplying all organs with
oxygen-rich blood.
4 valves. The 4 valves are the aortic, pulmonary, mitral, and tricuspid valves. They let blood flow
forward and prevent the backward flow.
Blood vessels. These bring blood to the lungs, where oxygen enters the bloodstream, and then to
the body:
The inferior and superior vena cava bring oxygen-poor blood from the body into the right atrium.
The pulmonary artery channels oxygen-poor blood from the right ventricle into the lungs, where
oxygen enters the bloodstream.
The pulmonary veins bring oxygen-rich blood to the left atrium.
The aorta channels oxygen-rich blood to the body from the left ventricle.
98. Pericardium: parts, topography, structure.

ANS----The pericardium, also called pericardial sac, is a double-walled sac containing the heart
and the roots of the great vessels.[1] The pericardial sac has two layers, a serous (visceral) layer
and a fibrous (parietal) layer.[2][3] It encloses the pericardial cavity, which contains pericardial
fluid.[2]
The pericardium is a tough double layered fibroelastic sac which covers the heart.[4] The space
between the two layers of serous pericardium (see below), the pericardial cavity, is filled with
serous fluid which protects the heart from any kind of external jerk or shock. There are two layers
to the pericardial sac: the outermost fibrous pericardium and the inner serous pericardium.
99. Aorta: parts, their topography. Aortic arch and its branches.
ANS---In anatomical sources, the aorta is usually divided into sections.
One way of classifying a part of the aorta is by anatomical compartment, where the thoracic aorta
(or thoracic portion of the aorta) runs from the heart to the diaphragm. The aorta then continues
downward as the abdominal aorta (or abdominal portion of the aorta) from the diaphragm to the
aortic bifurcation.
Another system divides the aorta with respect to its course and the direction of blood flow. In this
system, the aorta starts as the ascending aorta, travels superiorly from the heart, and then makes a
hairpin turn known as the aortic arch. Following the aortic arch, the aorta then travels inferiorly as
the descending aorta. The descending aorta has two parts. The aorta begins to descend in the
thoracic cavity and is consequently known as the thoracic aorta. After the aorta passes through the
diaphragm, it is known as the abdominal aorta. The aorta ends by dividing into two major blood
vessels, the common iliac arteries and a smaller midline vessel, the median sacral artery.
aortic arch and its branches

The aortic arch loops over the left pulmonary artery and the bifurcation of the pulmonary trunk, to
which it remains connected by the ligamentum arteriosum, a remnant of the fetal circulation that
is obliterated a few days after birth. In addition to these blood vessels, the aortic arch crosses the
left main bronchus. Between the aortic arch and the pulmonary trunk is a network of autonomic
nerve fibers, the cardiac plexus or aortic plexus. The left vagus nerve, which passes anterior to the
aortic arch, gives off a major branch, the recurrent laryngeal nerve, which loops under the aortic
arch just lateral to the ligamentum arteriosum. It then runs back to the neck.
The aortic arch has three major branches: from proximal to distal, they are the brachiocephalic
trunk, the left common carotid artery, and the left subclavian artery. The brachiocephalic trunk
supplies the right side of the head and neck as well as the right arm and chest wall, while the latter
two together supply the left side of the same regions.
The aortic arch ends, and the descending aorta begins at the level of the intervertebral disc
between the fourth and fifth thoracic vertebrae.
100. Aorta: its parts. Abdominal aorta and its branches.
ANS-----The abdominal aorta begins at the aortic hiatus of the diaphragm at the level of the
twelfth thoracic vertebra.[10] It gives rise to lumbar and musculophrenic arteries, renal and
middle suprarenal arteries, and visceral arteries (the celiac trunk, the superior mesenteric artery
and the inferior mesenteric artery). It ends in a bifurcation into the left and right common iliac
arteries. At the point of the bifurcation, there also springs a smaller branch, the median sacral
artery
101. The common carotid artery. The internal carotid artery. Topography, branches. The blood
supply of the brain and spinal cord.
ANS----Comman carotid artery---In anatomy, the left and right common carotid arteries (carotids)
are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form
the external and internal carotid arterie
The common carotid arteries are present on the left and right sides of the body. These arteries
originate from different arteries but follow symmetrical courses. The right common carotid
originates in the neck from the brachiocephalic trunk; the left from the aortic arch in the thorax.
These split into the external and internal carotid arteries at the upper border of the thyroid
cartilage, at around the level of the fourth cervical vertebra.
The left common carotid artery can be thought of as having two parts: a thoracic (chest) part and a
cervical (neck) part. The right common carotid originates in or close to the neck and contains only
a small thoracic portion.
The average diameters of the common carotids in adult males and females are 6.5 mm and 6.1
mm respectively.
INTERNAL CAROTID ARTERY
The internal carotid artery is located in the inner side of the neck in contrast to the external carotid
artery.[1] In human anatomy, they arise from the common carotid arteries where these bifurcate
into the internal and external carotid arteries at cervical vertebral level 3 or 4; the internal carotid
artery supplies the brain including eyes,[2] while the external carotid nourishes other portions of
the head, such as the face, scalp, skull, and meninges
The internal carotid artery is a terminal branch of the common carotid artery; it arises around the
level of the fourth cervical vertebra when the common carotid bifurcates into this artery and its
more superficial counterpart, the external carotid artery.The following are the branches of the
internal carotid artery, listed by segment:[9]
C1: Branches from the cervical portion - none.

C2: Branches from the petrous portion
Caroticotympanic arteries
Artery of pterygoid canal (vidian artery)
C3: Branches from the lacerum portion - none
C4: Branches from the cavernous portion
Branches of the meningohypophyseal trunk:
Tentorial basal branch
Tentorial marginal branch
Meningeal branch - helps supply blood to the meninges of the anterior cranial fossa
Clivus branches - tiny branches that supply the clivus
Inferior hypophyseal artery
Capsular branches - supplies wall of cavernous sinus
Branches of the inferolateral trunk:
Branches to trigeminal ganglion - provide blood to trigeminal ganglion
Artery of the foramen rotundum
Branches to nerves
C5: Branches from the clinoid portion - none
C6: Branches from the ophthalmic portion
Ophthalmic artery
Superior hypophyseal artery
C7: Branches from the communicating portion
Posterior communicating artery
Anterior choroidal artery
Anterior cerebral artery (a terminal branch)
Middle cerebral artery (a terminal branch)
102. The external carotid artery: its topography, branches, areas of blood supply.
ANS-----The external carotid artery is a major artery of the head and neck. It arises from the
common carotid artery when it splits into the external and internal carotid artery. External carotid
artery supplies blood to the face and neck.The external carotid artery begins at the upper border of
thyroid cartilage, and curves, passing forward and upward, and then inclining backward to the
space behind the neck of the mandible, where it divides into the superficial temporal and
maxillary artery within the parotid gland.
It rapidly diminishes in size as it travels up the neck, owing to the number and large size of its
branches.
At its origin, this artery is closer to the skin and more medial than the internal carotid, and is
situated within the carotid triangle.
As the artery travels upwards, it supplies:
In the carotid triangle:[2]

Superior thyroid artery, arising from its anterior aspect
Ascending pharyngeal artery - arising from medial, or deep, aspect
Lingual artery - arising from its anterior aspect
Facial artery - arise from its anterior aspect
Occipital artery - arising from its posterior aspect
Posterior auricular artery - arising from posterior aspect
The external carotid artery terminates as two branches:
Maxillary artery
Superficial temporal artery
Several mnemonics are commonly used to remember the main branches of the external carotid
artery.
103. Subclavian artery: its topography, branches, areas of blood supply.
ANS---the subclavian arteries are paired major arteries of the upper thorax, below the clavicle.
They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm
and the right subclavian artery supplies blood to the right arm, with some branches supplying the
head and thorax. On the left side of the body, the subclavian comes directly off the aortic arch,
while on the right side it arises from the relatively short brachiocephalic artery when it bifurcates
into the subclavian and the right common carotid artery.
The usual branches of the subclavian on both sides of the body are the vertebral artery, the
internal thoracic artery, the thyrocervical trunk, the costocervical trunk and the dorsal scapular
artery, which may branch off the transverse cervical artery, which is a branch of the thyrocervical
trunk. The subclavian becomes the axillary artery at the lateral border of the first rib.
104. Pulmonary circulation.

ANS---The pulmonary circulation is the portion of the circulatory system which carries
deoxygenated blood away from the right ventricle, to the lungs, and returns oxygenated blood to
the left atrium and ventricle of the heart.[1] The term pulmonary circulation is readily paired and
contrasted with the systemic circulation. The vessels of the pulmonary circulation are the
pulmonary arteries and the pulmonary veins.
Deoxygenated blood leaves the heart, goes to the lungs, and then re-enters the heart;
Deoxygenated blood leaves through the right ventricle through the pulmonary artery. From the
right atrium, the blood is pumped through the tricuspid valve (or right atrioventricular valve), into
the right ventricle. Blood is then pumped from the right ventricle through the pulmonary valve
and into the main pulmonary artery.The pulmonary arteries carry deoxygenated blood to the
lungs, where carbon dioxide is released and oxygen is picked up during respiration. Arteries are
further divided into very fine capillaries which are extremely thin-walled. The pulmonary vein
returns oxygenated blood to the left atrium of the heart.The oxygenated blood then leaves the
lungs through pulmonary veins, which return it to the left part of the heart, completing the
pulmonary cycle. This blood then enters the left atrium, which pumps it through the mitral valve
into the left ventricle. From the left ventricle, the blood passes through the aortic valve to the
aorta. The blood is then distributed to the body through the systemic circulation before returning
again to the pulmonary circulation.From the right ventricle, blood is pumped through the
semilunar pulmonary valve into the left and right main pulmonary arteries (one for each lung),
which branch into smaller pulmonary arteries that spread throughout the lungs.
105. Larger ring of blood circulation.
106. Blood circulation of the fetus
ANS----The fetal (prenatal) circulation differs from normal postnatal circulation, mainly because
the lungs are not in use. Instead, the fetus obtains oxygen and nutrients from the mother through
the placenta and the umbilical cord.
Blood from the placenta is carried to the fetus by the umbilical vein. In humans, less than a third
of this enters the fetal ductus venosus and is carried to the inferior vena cava,[2] while the rest
enters the liver proper from the inferior border of the liver. The branch of the umbilical vein that
supplies the right lobe of the liver first joins with the portal vein. The blood then moves to the
right atrium of the heart. In the fetus, there is an opening between the right and left atrium (the
foramen ovale), and most of the blood flows through this hole directly into the left atrium from
the right atrium, thus bypassing pulmonary circulation. The continuation of this blood flow is into
the left ventricle, and from there it is pumped through the aorta into the body. Some of the blood
moves from the aorta through the internal iliac arteries to the umbilical arteries, and re-enters the
placenta, where carbon dioxide and other waste products from the fetus are taken up and enter the
maternal circulation.[1]
Some of the blood entering the right atrium does not pass directly to the left atrium through the
foramen ovale, but enters the right ventricle and is pumped into the pulmonary artery. In the fetus,
there is a special connection between the pulmonary artery and the aorta, called the ductus
arteriosus, which directs most of this blood away from the lungs (which are not being used for
respiration at this point as the fetus is suspended in amniotic fluid).[1]
107. Axillary and brachial arteries: topography, branches, areas of blood supply.
ANS---- AXILLARY ARTERY
In human anatomy, the axillary artery is a large blood vessel that conveys oxygenated blood to the
lateral aspect of the thorax, the axilla (armpit) and the upper limb. Its origin is at the lateral
margin of the first rib, before which it is called the subclavian artery.The axillary artery is often
referred to as having three parts, with these divisions based on its location relative to the
Pectoralis minor muscle, which is superficial to the artery.
The axillary artery has several smaller branche
First part (1 branch)
Superior thoracic artery (Supreme thoracic artery)
Second part (2 branches)
Thoraco-acromial artery
Lateral thoracic artery. If the lateral thoracic artery is not branching from the axillary artery, will
most likely branch from the following (in order of likelihood): (1) thoracoacromial, (2) third part
of axillary artery, (3) suprascapular artery, (4) subscapular artery
Third part (3 branches)
Subscapular artery
Anterior humeral circumflex artery
Posterior humeral circumflex artery
Continues as the brachial artery past the inferior border of the teres major.
BRACHIAL ARTERY
The brachial artery is the major blood vessel of the (upper) arm. It is the continuation of the
axillary artery beyond the lower margin of teres major muscle. It continues down the ventral
surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and
ulnar arteries which run down the forearm.
The brachial artery gives rise to the following branches:[3]
Profunda brachii artery (deep brachial artery)

Superior ulnar collateral artery
Inferior ulnar collateral artery
Radial artery (a terminal branch)
Ulnar artery (a terminal branch)
Nutrient branches to the humerus
108. The arteries of forearm and hand: topography, branches, areas of blood supply.
ANS--- FOREARM
The forearm region is thus supplied by two major vessels, the radial artery and ulnar artery. These
arteries originate from the brachial artery at the apex of the cubital fossa, with the radial artery
descending through the lateral part of the forearm and the ulnar artery through the medial
part.Both arteries give off their main branches within the forearm; with the radial artery giving the
radial recurrent artery, palmar carpal branch and superficial carpal branch, and the ulnar artery
giving the ulnar recurrent artery, muscular arteries, common interosseous artery, dorsal and
palmar carpal arteries.
Anterior ulnar recurrent
Posterior ulnar recurrent
Common interosseous
Dorsal carpal branch
Deep palmar branch
Palmar carpal branch
HAND
The radial and ulnar arteries both end in the hand, anastomosing with each other. The radial artery
mainly supplies the thumb and the lateral side of the index finger, while the ulnar artery supplies
the medial side of the index finger and the rest of the fingersthese two arteries form two
anastomotic arches in the palm, called the superficial palmar arch and deep palmar arch, from
which minor arteries to the muscles, digits and joints of the hand originate.
109. Arterial plexus of the elbow and wrist joints.
ANS-- ELBOW JOINT
The arterial supply to the elbow joint is from the cubital anastomosis, which includes recurrent
and collateral branches from the brachial and deep brachial arteries. Its nerve supply is provided
by the median, musculocutaneous and radial nerves anteriorly, and the ulnar nerve posteriorly.
wrist joint
The wrist joint receives blood from branches of the dorsal and palmar carpal arches, which are
derived from the ulnar and radial arteries
110. Common iliac artery. Internal iliac artery: areas of blood supply.
ANS-- COMMAN ILIAC ARTERY
The common iliac arteries are two large arteries that originate from the aortic bifurcation at the
level of the fourth lumbar vertebra. They end in front of the sacroiliac joint, one on either side,
and each bifurcates into the external and internal iliac arteries.The distribution of the common
iliac artery is basically the pelvis and lower limb (as the femoral artery) on the corresponding
side.
INTERNAL ILIAC ARTERY
The internal iliac artery supplies the walls and viscera of the pelvis, the buttock, the reproductive
organs, and the medial compartment of the thigh. The vesicular branches of the internal iliac
arteries supply the bladder[1]
It is a short, thick vessel, smaller than the external iliac artery, and about 3 to 4 cm in length.
branches
I: iliolumbar artery
L: lateral sacral artery
G: gluteal (superior and inferior) arteries
P: (internal) pudendal artery
I: inferior vesical (vaginal in females) artery, and superior vesical artery
M: middle rectal artery
V: vaginal artery (females only)
O: obturator artery
U: umbilical artery and uterine artery (females only)
111. Femoral artery. Popliteal artery: topography, branches, areas of blood supply.
ANS--- FEMORAL ARTERY
The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. It
enters the thigh from behind the inguinal ligament as the continuation of the external iliac
artery.Branches arising from the common femoral artery include superficial epigastric artery,
superficial circumflex artery, and external pudendal artery. Distal to these smaller branches, the
common femoral artery bifurcates into the deep femoral (or profunda femoris) and superficial
femoral artery.
POPLITEAL ARTERY
The popliteal artery is a deeply placed continuation of the femoral artery opening in the distal
portion of the adductor magnus muscle. It courses through the popliteal fossa and ends at the
lower border of the popliteus muscle, where it branches into the anterior and posterior tibial
arteries.
The branches of the popliteal artery are:
anterior tibial artery

posterior tibial artery
sural artery
medial superior genicular artery
lateral superior genicular artery
middle genicular artery
lateral inferior genicular artery
medial inferior genicular artery
Five genicular branches of the popliteal artery supply the capsule and ligaments of the knee joint.
The genicular arteries are the superior lateral, superior medial, middle, inferior lateral, and
inferior medial genicular arteries.
112. Blood supply and innervation of the knee and ankle joints.
ANS-- KNEE
The knee joint blood supply is derived from a rich anastomosis of the five major constant arteries,
namely, the superior medial and lateral, the middle (posterior), and the inferior medial and lateral
genicular arteries.
The nerve supply to the knee is derived from:
branches of the femoral nerve to vastus medialis, and also intermedius and lateralis
from the sciatic by genicular branches of the tibial and common peroneal nerves
from the obturator by a branch from the posterior division
ANKLE
The arterial supply to the ankle joint is derived from the malleolar branches of the anterior tibial,
posterior tibial and fibular arteries.
Innervation is provided by tibial, superficial fibular and deep fibular nerves.
113. Calf arteries, topography, branches, regions of their blood supply.
ANS-- At the lower border of the popliteus, the popliteal artery terminates by dividing into the
anterior tibial artery and the tibioperoneal trunk. In turn, the tibioperoneal trunk bifurcates into the
posterior tibial and fibular arteries:
Posterior tibial artery – continues inferiorly, along the surface of the deep posterior leg muscles
(such as tibialis posterior). It enters the sole of the foot via the tarsal tunnel, accompanying the
tibial nerve.
Fibular (peroneal) artery – descends posteriorly to the fibula, within the posterior compartment of
the leg. It gives rise to perforating branches, which penetrate the intermuscular septum to supply
muscles in the lateral compartment of the leg.
The other division of the popliteal artery, the anterior tibial artery, passes anteriorly between the
tibia and fibula, through a gap in the interosseous membrane. It then moves inferiorly down the
leg. It runs down the entire length of the leg, and into the foot, where it becomes the dorsalis pedis
artery.
114. Foot arteries, topography, branches, regions of their blood supply.
ANS---Arterial supply to the foot is delivered via two arteries:
Dorsalis pedis (a continuation of the anterior tibial artery)

Posterior tibial
The dorsalis pedis artery begins as the anterior tibial artery enters the foot. It passes over the
dorsal aspect of the tarsal bones, then moves inferiorly, towards the sole of the foot. It then
anastomoses with the lateral plantar artery to form the deep plantar arch. The dorsalis pedis artery
supplies the tarsal bones and the dorsal aspect of the metatarsals. Via the deep plantar arch, it also
contributes to the supply of the toes.
The posterior tibial artery enters the sole of the foot through the tarsal tunnel. It then splits into the
lateral and medial plantar arteries. These arteries supply the plantar side of the foot, and
contributes to the supply of the toes via the deep plantar arch.
115. General anatomy of blood vessels. Extraorganic and intraorganic vessels,
microcirculation.
ANS---Aside from capillaries, blood vessels are all made of three layers:
The adventitia or outer layer which provides structural support and shape to the vessel
The tunica media or a middle layer composed of elastic and muscular tissue which regulates the
internal diameter of the vessel
Within each layer, the amount of muscle and collagen fibrils varies, depending on the size and
location of the vessel.
Arteries can be classified as extraorganic arteries, which pass outside the organ before entering it,
and their continunations,intraorganic arteries, which branch out inside the organ. Lateral branches
of a single trunk or branches of different trunk can join one another.
116. Microcirculation. Characteristic of links.
ANS---The microcirculation is the circulation of the blood in the smallest blood vessels, the
microvessels of the microvasculature present within organ tissues.[1] The microvessels include
terminal arterioles, metarterioles, capillaries, and venules. Arterioles carry oxygenated blood to
the capillaries, and blood flows out of the capillaries through venules into veins.
Most vessels of the microcirculation are lined by flattened cells of the endothelium and many of
them are surrounded by contractile cells called pericytes. The endothelium provides a smooth
surface for the flow of blood and regulates the movement of water and dissolved materials in the
interstitial plasma between the blood and the tissues. The endothelium also produces molecules
that discourage the blood from clotting unless there is a leak. Pericyte cells can contract and
decrease the size of the arterioles and thereby regulate blood flow and blood pressure.
117. Superior vena cava, formation, topography, tributaries. Azygos and hemiazygos veins.
ANS---- SUPERIOR VENA CAVA
The superior vena cava is classified as a large vein, with a wide diameter of up to 2cm and a
length of approximately 7cm.
It arises from the union of the left and right brachiocephalic veins, posterior to the first right costal
cartilage. It descends vertically through the superior mediastinum, behind the intercostal spaces
and to the right of the aorta and trachea.
The superior vena cava contains venous blood from the head, neck, both upper limbs and from
structures within the thorax
It is formed by the union of the right and left brachiocephalic veins – which provide venous
drainage of the head, neck, and upper limbs. At the level of T4, the superior vena cava receives
the azygous vein, which drains the upper lumbar region and thoracic wall.
The SVC receives tributaries from several minor vein groups:
Mediastinal veins
Oesophageal veins
Pericardial veins
azygous vein
The azygos vein is a vein running up the right side of the thoracic vertebral column draining itself
towards the superior vena cava. It connects the systems of superior vena cava and inferior vena
cava and can provide an alternative path for blood to the right atrium when either of the venae
cavae is blocked.
hemiazygous vein
The hemiazygos vein (vena azygos minor inferior) is a vein running superiorly in the lower
thoracic region, just to the left side of the vertebral column.
hemiazygos vein and the accessory hemiazygos vein drain most of the posterior intercostal veins
on the left side of the body.[2] Specifically, the hemiazygos vein mirrors the bottom part of the
azygos vein.
118. Internal jugular vein, topography, tributaries.
The internal jugular vein is a paired jugular vein that collects blood from the brain and the
superficial parts of the face and neck. This vein runs in the carotid sheath with the common
carotid artery and vagus nerve.
It begins in the posterior compartment of the jugular foramen, at the base of the skull. It is
somewhat dilated at its origin, which is called the superior bulb.
This vein also has a common trunk into which drains the anterior branch of the retromandibular
vein, the facial vein, and the lingual vein.
It runs down the side of the neck in a vertical direction, being at one end lateral to the internal
carotid artery, and then lateral to the common carotid artery, and at the root of the neck, it unites
with the subclavian vein to form the brachiocephalic vein (innominate vein); a little above its
termination is a second dilation, the inferior bulb.
Tributaries
• Inferior petrosal sinus

• Pharyngeal vein
• Common facial vein
• Lingual vein
• Superior thyroid vein
• Middle thyroid vein
• Occipital vein (sometimes)
119. External and anterior jugular veins. topography, tributaries.
The external jugular vein is a vein of the neck that arises from the union of the posterior division
of the retromandibular vein and the posterior auricular vein…The external jugular vein begins
near the mandibular angle, just below or within the substance of the parotid gland. It descends
obliquely along the neck, superficial to the sternocleidomastoid muscle. Upon reaching the
clavicle, it crosses the deep cervical fascia and ends by draining into the subclavian vein. The
main function of the external jugular vein is to drain the superficial structures of the head, i.e. the
scalp and face.Tributaries
anterior jugular vein.
posterior external jugular vein.

suprascapular vein.
transverse cervical vein.
The anterior jugular vein is a vein in the neck. It begins near the hyoid bone by the confluence of
several superficial veins from the submandibular region. Anterior jugular vein. The veins of the
neck, viewed from in front. (anterior jugular visible at center)
Branches~laryngeal, small thyroid and inferior thyroid veins.
120. Inferior vena cava, formation, topography, tributaries.
The inferior vena cava is the lower ("inferior") of the two venae cavae, the two large veins that
carry deoxygenated blood from the body to the right atrium of the heart: the inferior vena cava
carries blood from the lower half of the body whilst the superior vena cava carries blood from the
upper half of the body. Together, the venae cavae (in addition to the coronary sinus, which carries
blood from the muscle of the heart itself) form the venous counterparts of the aorta.It is a large
retroperitoneal vein that lies posterior to the abdominal cavity and runs along the right side of the
vertebral column.[1] It enters the right auricle at the lower right, back side of the heart. The name
derives from Latin: vena, "vein", cavus, "hollow".
Structure
The IVC is formed by the joining of the left and right common iliac veins and brings collected
blood into the right atrium of the heart.[1] It also joins with the azygos vein (which runs on the
right side of the vertebral column) and venous plexuses next to the spinal cord.The inferior vena
cava begins as the left and right common iliac veins behind the abdomen unite, at about the level
of L5.[1][2] It passes through the thoracic diaphragm at the caval opening at the level of T8 -
T9.[1][3] It passes to the right of the descending aorta
Level Vein
T8 hepatic veins, inferior phrenic vein
L1 right suprarenal vein, renal veins
L2 right gonadal vein
L1–L5 lumbar veins
L5 common iliac veins
121. Cava-caval anastomosis.
Porto-systemic anastomosis also known as portocaval anastomosis is the collateral

communication between the portal and the systemic venous system. The portal venous system
transmits deoxygenated blood from most of the gastrointestinal tract and gastrointestinal organs to
the liver.
When there is a blockage of the portal system, portocaval anastomosis enable the blood to still
reach the systemic venous circulation. Even though this is useful, bypassing the liver may be
dangerous, since it is the main organ in charge for detoxication and breaking down of substances
found in the gastrointestinal tract, such as mediactions but the poisons as well.
Key facts about porto-systemic anastomoses
Lower esophagus
Left gastric veins (portal system) -> lower branches of oesophageal veins (systemic veins)
Upper part of anal canal
Superior rectal veins (portal) -> inferior and middle rectal veins (systemic)
Umbilicus
Paraumbilical veins (portal) -> epigastric veins (systemic)
Area of the liver
Intraparenchymal branches of right division of portal vein (portal) -> retroperitoneal veins
(systemic)
Hepatic and splenic flexures
Omental and colonic veins (portal) -> retroperitoneal veins (systemic)
Hepatic and splenic
Ductus venosus (portal) -> inferior vena cava (systemic)
Function of the porto-systemic anastomosis
Provide alternative routes of venous blood circulation when there is a blockage in the liver or
portal vein.
Ensure that venous blood from the gastrointestinal tract still reaches the heart through the inferior
vena cava without going through the liver.
The portal vein is the most important vein in the portal venous system; it starts its formation close
to the level of the second lumbar vertebrae (L2) and it is located in front (anterior) of the inferior
vena cava and at the back (posterior) of the neck of the pancreas. It is about 8cm long.
The portal vein is formed by the joining of the superior mesenteric vein and the splenic vein. It
runs upwards and lies behind the bile duct and hepatic artery and it also lies anterior to the
inferior vena cava. It penetrates in the right border of the lesser omentum and continues upwards
in front (anterior) of the epiploic foramen to reach the porta hepatis (transverse fissure on the
liver). After it reaches the porta hepatis, it bifurcates into a right and left branch which penetrates
the liver.
Various veins drain into the portal vein. These veins are:
superior mesenteric vein: drains blood mainly from small intestine
splenic vein: receives blood from short gastric, left gastroepiploic, inferior mesenteric, and
pancreatic veins
right and left gastric veins: drain blood from the stomach and oesophagus
superior pancreaticoduodenal veins: drain blood from the pancreas and duodenum
cystic veins: drain blood from the gallbladder and the paraumbilical vein
From the portal vein, the blood is drained into the left and right branches of the portal vein into
the left and right side of the liver. Inside the liver it passes through tiny capillary beds called
venous sinusoids of the liver and finally into the hepatic vein which transmits the blood into the
inferior vena cava (carries deoxygenated blood to the heart).
122. Portal vein, formation, topography, tributaries.
The portal vein is not a true vein, because it conducts blood to capillary beds in the liver and not
directly to the heart. It is a major component of the hepatic portal system, one of only two portal
venous systems in the body – with the hypophyseal portal system being the other..The portal vein
is usually formed by the confluence of the superior mesenteric, splenic veins, inferior mesenteric,
left, right gastric veins and the pancreatic vein.Conditions involving the portal vein cause
considerable illness and death. An important example of such a condition is elevated blood
pressure in the portal vein. This condition, called portal hypertension, is a major complication of
cirrhosis.
Structure
Measuring approximately 8 cm (3 inches) in adults,[1] the portal vein is located in the right upper
quadrant of the abdomen, originating behind the neck of the pancreas.[2].In most individuals, the
portal vein is formed by the union of the superior mesenteric vein and the splenic vein.[3] For this
reason, the portal vein is occasionally called the splenic-mesenteric confluence.[2] Occasionally,
the portal vein also directly communicates with the inferior mesenteric vein, although this is
highly variable. Other tributaries of the portal vein include the cystic and the left and right gastric
veins.[4] and also pararumbilical vein and prepyloric vein.
Tributaries of the hepatic portal vein[4]
Splenic vein
Superior mesenteric vein
Inferior mesenteric vein
Left and right gastric veins
Cystic vein
Immediately before reaching the liver, the portal vein divides into right and left. It ramifies
further, forming smaller venous branches and ultimately portal venules. Each portal venule
courses alongside a hepatic arteriole and the two vessels form the vascular components of the
portal triad. These vessels ultimately empty into the hepatic sinusoids to supply blood to the
liver.[4]
Portacaval anastomoses
The portal venous system has several anastomoses with the systemic venous system. In cases of
portal hypertension these anastamoses may become engorged, dilated, or varicosed and
subsequently rupture.
Accessory hepatic portal veins
Accessory hepatic portal veins are those veins that drain directly into the liver without joining the
hepatic portal vein. These include the paraumbilical veins as well as veins of the lesser omentum,
falciform ligament, and those draining the gallbladder wall.[2]
Function
The portal vein and hepatic arteries form the liver's dual blood supply. Approximately 75% of
hepatic blood flow is derived from the portal vein, while the remainder is from the hepatic
arteries.[2].Unlike most veins, the portal vein does not drain into the heart. Rather, it is part of a
portal venous system that delivers venous blood into another capillary system, the hepatic
sinusoids of the liver. In carrying venous blood from the gastrointestinal tract to the liver, the
portal vein accomplishes two tasks: it supplies the liver with metabolic substrates and it ensures
that substances ingested are first processed by the liver before reaching the systemic circulation.
This accomplishes two things. First, possible toxins that may be ingested can be detoxified by the
hepatocytes before they are released into the systemic circulation. Second, the liver is the first
organ to absorb nutrients just taken in by the intestines. After draining into the liver sinusoids,
blood from the liver is drained by the hepatic vein.
123. Pelvic veins, porto-caval anastomosis.
The veins of the pelvis drain deoxygenated blood and return it to the heart. There are three major
vessels involved in the venous drainage of the pelvis – the external iliac vein, internal iliac vein
and common iliac vein (these correspond the major pelvic arteries).
Note: The ovarian/testicular vessels drain directly into the abdominal veins; into the inferior vena
cava on the right and the renal vein on the left.
External Iliac Vein
The external iliac vein is a continuation of the femoral vein (the major vessel draining the lower
limb), arising when the femoral vein crosses underneath the inguinal ligament. It ascends along
the medial aspect of the external iliac artery, before joining with the internal iliac vein to form the
common iliac vein.During its short course, the external iliac vein receives the inferior epigastric
and deep circumflex iliac veins.
Internal Iliac Vein
The internal iliac vein is responsible the majority of pelvic venous drainage, and receives
numerous tributaries from veins that drain the pelvic region. It is formed near the greater sciatic
foramen, ascending anteriorly to the sacroiliac joint, before combining with the external iliac vein
to form the common iliac vein.With the exception of the iliolumbar vein (which drains into the
common iliac), the tributaries of the internal iliac vein correspond with the branches of the
internal iliac artery. It receives venous blood from the:
Superior and inferior gluteal veins – drains the buttock and upper thigh.Internal pudendal vein –
drains the reproductive organs and part of the rectum (via the inferior rectal vein).
Obturator vein
Lateral sacral veins – drains part of the sacrum.

Middle rectal vein – drains the bladder, prostate (in males only), and part of the rectum.
Vesical veins – drains the urinary bladder via the vesical venous plexus.
Uterine and vaginal veins – drain the female reproductive organs via the vaginal and uterine
venous plexuses.
Common Iliac Vein-The common iliac vein is formed at the upper margin of the pubic symphysis
by the union of the external and internal iliac veins. It receives two additional tributaries:
Iliolumbar vein – drains the L4 and L5 vertebrae, and the iliopsoas muscle.
Middle sacral veins – drain part of the sacrum.The left and right common iliac veins combine at
L5 to become the inferior vena cava, which empties into the inferior aspect of the right atrium.
124. Veins of limbs, general characteristics.
Veins of upper limb
Superficial Veins
The major superficial veins of the upper limb are the cephalic and basilic veins. They are located
within the subcutaneous tissue of the upper limb.
Basilic Vein-The basilic vein originates from the dorsal venous network of the hand and ascends
the medial aspect of the upper limb.At the border of the teres major, the vein moves deep into the
arm. Here, it combines with the brachial veins from the deep venous system to form the axillary
vein.
Cephalic Vein-The cephalic vein also arises from the dorsal venous network of the hand. It
ascends the antero-lateral aspect of the upper limb, passing anteriorly at the elbow.At the
shoulder, the cephalic vein travels between the deltoid and pectoralis major muscles (known as
the deltopectoral groove), and enters the axilla region via the clavipectoral triangle. Within the
axilla, the cephalic vein empties into axillary vein.The cephalic and basilic veins are connected at
the elbow by the median cubital vein.
Key facts about the veins of the upper limb
Hand-
Superficial palmar arch

Deep palmar arch
Forearm-
Cephalic vein
Basilic vein
Median forearm vein
Arm-
Brachial veins
Cephalic vein
Basilic vein
Shoulder
Axillary vein
Subclavian vein
The lower limb consists of two main types of veins:
Superficial veins
Deep veins
The superficial veins are located within the subcutaneous tissue whilst the deep veins are found
deep to the deep fascia. The deep veins accompany the major arteries and their branches and are
usually paired.They are located within a vascular sheath with the corresponding artery, which
helps compress and move blood within the veins. Both types of veins contain venous valves, to
prevent reflux of blood distally, but they are more numerous in the deep veins. They also contain
tributaries, other veins which drain into them.
Key facts about the veins of the lower limb
Superficial veins
Great saphenous vein (long saphenous vein)
Small saphenous vein (short saphenous vein)

Deep veins
Veins of the foot
- plantar veins
- dorsal veins
Veins of the leg
- anterior tibial veins
- posterior tibial veins
- fibular veins
Veins of the knee
- popliteal vein
Veins of the thigh
- femoral vein and its tributaries
.Deep veins of the lower limb
The deep veins of the lower limb can be separated into four main groups, according to their
location:
Veins of the foot
Veins of the leg
Vein of the knee
Veins of the thigh
Veins of the foot
The foot consists of two main types of deep veins:

Plantar veins, which drain the plantar surface or underside of the foot
Dorsal veins, which drain the dorsal or upper surface of the foot
Venous plexuses within the plantar regions of the toes join to form plantar digital veins. These
veins connect with their dorsal counterparts, the dorsal digital veins, to form four plantar
metatarsal veins. These veins run proximally within the intermetatarsal spaces and then continue
on to form the deep plantar venous arch. Medial and lateral plantar veins arise from this arch.A
dorsal venous arch is also present and is formed by the dorsal metatarsal veins, which are also
formed by the dorsal and plantar digital veins.
125. Lymphatic system. General characteristic, links, and their characteristics.
Unlike the cardiovascular system, the lymphatic system is not a closed system. The human
circulatory system processes an average of 20 litres of blood per day through capillary filtration,
which removes plasma from the blood. Roughly 17 litres of the filtered plasma is reabsorbed
directly into the blood vessels, while the remaining three litres remain in the interstitial fluid. One
of the main functions of the lymphatic system is to provide an accessory return route to the blood
for the surplus three litres.[4].The other main function is that of immune defense. Lymph is very
similar to blood plasma, in that it contains waste products and cellular debris, together with
bacteria and proteins. The cells of the lymph are mostly lymphocytes. Associated lymphoid
organs are composed of lymphoid tissue, and are the sites either of lymphocyte production or of
lymphocyte activation. These include the lymph nodes (where the highest lymphocyte
concentration is found), the spleen, the thymus, and the tonsils. Lymphocytes are initially
generated in the bone marrow. The lymphoid organs also contain other types of cells such as
stromal cells for support.[5] Lymphoid tissue is also associated with mucosas such as mucosa-
associated lymphoid tissue (MALT).[6].Fluid from circulating blood leaks into the tissues of the
body by capillary action, carrying nutrients to the cells. The fluid bathes the tissues as interstitial
fluid, collecting waste products, bacteria, and damaged cells, and then drains as lymph into the
lymphatic capillaries and lymphatic vessels. These vessels carry the lymph throughout the body,
passing through numerous lymph nodes which filter out unwanted materials such as bacteria and
damaged cells. Lymph then passes into much larger lymph vessels known as lymph ducts. The
right lymphatic duct drains the right side of the region and the much larger left lymphatic duct,
known as the thoracic duct, drains the left side of the body. The ducts empty into the subclavian
veins to return to the blood circulation. Lymph is moved through the system by muscle
contractions.[7] In some vertebrates, a lymph heart is present that pumps the lymph to the veins.
Function Edit
The lymphatic system has multiple interrelated functions:[33]

It is responsible for the removal of interstitial fluid from tissues
It absorbs and transports fatty acids and fats as chyle from the digestive system
It transports white blood cells to and from the lymph nodes into the bones
The lymph transports antigen-presenting cells, such as dendritic cells, to the lymph nodes where
an immune response is stimulated.
Fat absorption-vessels called lacteals are at the beginning of the gastrointestinal tract,
predominantly in the small intestine. While most other nutrients absorbed by the small intestine
are passed on to the portal venous system to drain via the portal vein into the liver for processing,
fats (lipids) are passed on to the lymphatic system to be transported to the blood circulation via
the thoracic duct. (There are exceptions, for example medium-chain triglycerides are fatty acid
esters of glycerol that passively diffuse from the GI tract to the portal system.) The enriched
lymph originating in the lymphatics of the small intestine is called chyle. The nutrients that are
released into the circulatory system are processed by the liver, having passed through the s
ystemic circulation
126. Thoracic duct, roots, the place where it drains into the circulatory system.
The thoracic duct is the largest lymphatic vessel in the human body. Around 75% of the lymph
from the entire body (aside from the right upper limb, right breast, right lung and right side of the
head and neck) passes through the thoracic duct.The cells of the immune system circulate through
the lymphatic system. Also, large molecular products of digestion, like fats, first need to be
absorbed into the lymphatic system, and then to reach the systemic circulation through the venous
system. The lymphatic system is essential for the drainage of tissue fluid, and the passage of
lymph around the body.
Key facts about the thoracic duct
Anatomy
Location: paravertebral from T12 to the root of the neck
Tributaries
Main tributaries: left and right lumbar lymph trunks, left and right intestinal lymph trunks (their
confluence is called cysterna chyli).Additional tributaries: mediastinal lymph trunks, left jugular
trunk, left bronchomediastinal trunk, left subclavian trunk
Drainage
Drains from: 75% of the body -> all region except for the right arm, right breast, right lung, right
side of the head and neck (which are drained by the right lymphatic duct)
Drains to: venous angle (Pirgoff's angle) between left subclavian vein and left internal jugular
vein
The thoracic duct drains lymph from the right and left descending thoracic lymph trunks,
originating from the lower 6 intercostal spaces (6 to 11). The duct also receives lymph from
intercostal spaces 1 to 5 via the upper intercostal lymph trunks. Additional tributaries include the:
mediastinal lymph trunks
left jugular trunk,
left bronchomediastinal trunk
left subclavia trunk.
In over 95% of cases, the thoracic duct terminates in the internal jugular vein, the subclavian vein,
or the angle between the two. The remaining 5% include termination in the external jugular vein,
vertebral vein, brachiocephalic vein, suprascapular vein, and transverse cervical vein.
127. Lymphatic nodes and vessels of head and neck.
In the lymphatic system a lymph node is a secondary lymphoid organ. A lymph node is enclosed
in a fibrous capsule and is made up of an outer cortex and an inner medulla.Lymph nodes become
inflamed or enlarged in various diseases, which may range from trivial throat infections to life-
threatening cancers. The condition of lymph nodes is very important in cancer staging, which
decides the treatment to be used and determines the prognosis. Lymphadenopathy refers to glands
that are enlarged or swollen. When inflamed or enlarged, lymph nodes can be firm or tender.
Lymph nodes are kidney or oval shaped and range in size from 0.1 to 2.5 cm long.[2] Each lymph
node is surrounded by a fibrous capsule, which extends inside a lymph node to form
trabeculae.[3] The substance of a lymph node is divided into the outer cortex and the inner
medulla.[3] These are rich with cells.[2] The hilum is an indent on the concave surface of the
lymph node where lymphatic vessels leave and blood vessels enter and leave.[2]
Lymph enters the convex side of a lymph node through multiple afferent lymphatic vessels and
from there flows into a series of sinuses.[3] After entering the lymph node from afferent
lymphatic vessels, lymph flows into a space underneath the capsule called the subcapsular sinus,
then into cortical sinuses.[3] After passing through the cortex, lymph then collects in medullary
sinuses.[3] All of these sinuses drain into the efferent lymph
vessels to exit the node at the hilum on

the concave side.[
The lymphatic vessels of the head and neck can be divided into two major groups; superficial
vessels and deep vessels.
Superficial Vessels-The superficial vessels drain lymph from the scalp, face and neck into the
superficial ring of lymph nodes at the junction of the neck and head.
Deep Vessels-The deep lymphatic vessels of the head and neck arise from the deep cervical
lymph nodes. They converge to form the left and right jugular lymphatic trunks:
Left jugular lymphatic trunk – combines with the thoracic duct at the root of the neck. This
empties into the venous system via the left subclavian vein.
Right jugular lymphatic trunk – forms the right lymphatic duct at the root of the neck. This
empties into the venous system via the right subclavian vein.
The lymph nodes of the head and neck can be divided into two groups; a superficial ring of lymph
nodes, and a vertical group of deep lymph nodes.
Superficial Lymph Nodes
The superficial lymph nodes of the head and neck receive lymph from the scalp, face and neck.
They are arranged in a ring shape; extending from underneath the chin, to the posterior aspect of
the head. They ultimately drain into the deep lymph nodes.
Occipital: There are usually between 1-3 occipital lymph nodes. They are located in the back of
the head at the lateral border of the trapezius muscle and collect lymph from the occipital area of
the scalp.
Mastoid: There are usually 2 mastoid lymph nodes, which are also called the post-auricular lymph
nodes. They are located posterior to the ear and lie on the insertion of the sternocleidomastoid
muscle into the mastoid process. They collect lymph from the posterior neck, upper ear and the
back of the external auditory meatus (the ear canal).
Pre-auricular: There are usually between 1-3 pre-auricular lymph nodes. They are located anterior
to the auricle of the ear, and collect lymph from the superficial areas of the face and temporal
region.
Parotid: The parotid lymph nodes are a small group of nodes located superficially to the parotid
gland. They collect lymph from the nose, the nasal cavity, the external acoustic meatus, the
tympanic cavity and the lateral borders of the orbit. There are also parotid lymph nodes deep to
the parotid gland that drain the nasal cavities and the nasopharynx.
Submental: These lymph nodes are located superficially to the mylohoid muscle. They collect
lymph from the central lower lip, the floor of the mouth and the apex of the tongue.
Submandibular: There are usually between 3-6 submandibular nodes. They are located below the
mandible in the submandibular triangle and collect lymph from the cheeks, the lateral aspects of
the nose, upper lip, lateral parts of the lower lip, gums and the anterior tongue. They also receive
lymph from the submental and facial lymph nodes.
Facial: This group comprises the maxillary/infraorbital, buccinator and supramandibular lymph
nodes. They collect lymph from the mucous membranes of the nose and cheek, eyelids and
conjunctiva.
Superficial Cervical: The superficial cervical lymph nodes can be divided into the superficial
anterior cervical nodes and the posterior lateral superficial cervical lymph nodes. The anterior
nodes lie close to the anterior jugular vein and collect lymph from the superficial surfaces of the
anterior neck. The posterior lateral nodes lie close to the external jugular vein and collect lymph
from superficial surfaces of the neck.
128. Spinal cord. Functions and morphology of gray matter.
The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from
the medulla oblongata in the brainstem to the lumbar region of the vertebral column. It encloses
the central canal of the spinal cord, which contains cerebrospinal fluid. The brain and spinal cord
together make up the central nervous system (CNS). In humans, the spinal cord begins at the
occipital bone, passing through the foramen magnum and entering the spinal canal at the
beginning of the cervical vertebrae. The spinal cord extends down to between the first and second
lumbar vertebrae, where it ends. The enclosing bony vertebral column protects the relatively
shorter spinal cord. It is around 45 cm (18 in) in men and around 43 cm (17 in) long in women.
The diameter of the spinal cord ranges from 13 mm (1⁄2 in) in the cervical and lumbar regions to
6.4 mm (1⁄4 in) in the thoracic area.The spinal cord functions primarily in the transmission of
nerve signals from the motor cortex to the body, and from the afferent fibers of the sensory
neurons to the sensory cortex. It is also a center for coordinating many reflexes and contains
reflex arcs that can independently control reflexes.[1] It is also the location of groups of spinal
interneurons that make up the neural circuits known as central pattern generators. These circuits
are responsible for controlling motor instructions for rhythmic movements such as walking.[2]
Structure-The grey column, (as three regions of grey columns) in the center of the cord, is shaped
like a butterfly and consists of cell bodies of interneurons, motor neurons, neuroglia cells and
unmyelinated axons. The anterior and posterior grey column present as projections of the grey
matter and are also known as the horns of the spinal cord. Together, the grey columns and the
gray commissure form the "grey H."
The white matter is located outside of the grey matter and consists almost totally of myelinated
motor and sensory axons. "Columns" of white matter carry information either up or down the
spinal cord.
The spinal cord proper terminates in a region called the conus medullaris, while the pia mater
continues as an extension called the filum terminale, which anchors the spinal cord to the coccyx.
The cauda equina ("horse's tail") is a collection of nerves inferior to the conus medullaris that
continue to travel through the vertebral column to the coccyx. The cauda equina forms because
the spinal cord stops growing in length at about age four, even though the vertebral column
continues to lengthen until adulthood. This results in sacral spinal nerves originating in the upper
lumbar region. For that reason, the spinal cord occupies only two-thirds of the vertebral canal.
The inferior part of the vertebral canal is filled with cerebrospinal fluid (CSF) and the space is
called the lumbar cistern[5].
129. Spinal cord. Topography of tracts on the transverse section of spinal cord.
In the dorsal column-medial leminiscus tract, a primary neuron's axon enters the spinal cord and
then enters the dorsal column. If the primary axon enters below spinal level T6, the axon travels
in the fasciculus gracilis, the medial part of the column. If the axon enters above level T6, then it
travels in the fasciculus cuneatus, which is lateral to the fasciculus gracilis. Either way, the
primary axon ascends to the lower medulla, where it leaves its fasciculus and synapses with a
secondary neuron in one of the dorsal column nuclei: either the nucleus gracilis or the nucleus
cuneatus, depending on the pathway it took. At this point, the secondary axon leaves its nucleus
and passes anteriorly and medially. The collection of secondary axons that do this are known as
internal arcuate fibers. The internal arcuate fibers decussate and continue ascending as the
contralateral medial lemniscus. Secondary axons from the medial lemniscus finally terminate in
the ventral posterolateral nucleus (VPLN) of the thalamus, where they synapse with tertiary
neurons. From there, tertiary neurons ascend via the posterior limb of the internal capsule and end
in the primary sensory cortex.
The proprioception of the lower limbs differs from the upper limbs and upper trunk. There is a
four-neuron pathway for lower limb proprioception. This pathway initially follows the dorsal
spino-cerebellar pathway. It is arranged as follows: proprioceptive receptors of lower limb →
peripheral process → dorsal root ganglion → central process → Clarke's column → 2nd order
neuron → medulla oblongata (Caudate nucleus) → 3rd order neuron → VPLN of thalamus → 4th
order neuron → posterior limb of internal capsule → corona radiata → sensory area of
cerebrum.The anterolateral system works somewhat differently. Its primary neurons axons
enter the spinal cord and then ascend one to two levels before synapsing in the substantia
gelatinosa. The tract that ascends before synapsing is known as Lissauer's tract. After synapsing,
secondary axons decussate and ascend in the anterior lateral portion of the spinal cord as the
spinothalamic tract. This tract ascends all the way to the VPLN, where it synapses on tertiary
neurons. Tertiary neuronal axons then travel to the primary sensory cortex via the posterior limb
of the internal capsule.Some of the "pain fibers" in the ALS deviate from their pathway towards
the VPLN. In one such deviation, axons travel towards the reticular formation in the midbrain.
The reticular formation then projects to a number of places including the hippocampus (to
create memories about the pain), the centromedian nucleus (to cause diffuse, non-specific pain)
and various parts of the cortex. Additionally, some ALS axons project to the periaqueductal gray
in the pons, and the axons forming the periaqueductal gray then project to the nucleus raphes
magnus, which projects back down to where the pain signal is coming from and inhibits it. This
helps control the sensation of pain to some degree.
130. Spinal cord. Development, external view, topography, meninges of spinal cord.
Development-The spinal cord is made from part of the neural tube during development. There are
four stages of the spinal cord that arises from the neural tube: The neural plate, neural fold, neural
tube, and the spinal cord. Neural differentiation occurs within the spinal cord portion of the
tube.[8] As the neural tube begins to develop, the notochord begins to secrete a factor known as
Sonic hedgehog or SHH. As a result, the floor plate then also begins to secrete SHH, and this will
induce the basal plate to develop motor neurons. During the maturation of the neural tube, its
lateral walls thicken and form a longtitudinal groove called the sulcus limitans. This extends the
length of the spinal cord into dorsal and ventral portions as well.[9] Meanwhile, the overlying
ectoderm secretes bone morphogenetic protein (BMP). This induces the roof plate to begin to
secrete BMP, which will induce the alar plate to develop sensory neurons. Opposing gradients of
such morphogens as BMP and SHH form different domains of dividing cells along the dorsal
ventral axis.[10] Dorsal root ganglion neurons differentiate from neural crest progenitors. As the
dorsal and ventral column cells proliferate, the lumen of the neural tube narrows to form the small
central canal of the spinal cord.[11] The alar plate and the basal plate are separated by the sulcus
limitans. Additionally, the floor plate also secretes netrins. The netrins act as chemoattractants to
decussation of pain and temperature sensory neurons in the alar plate across the anterior white
commissure, where they then ascend towards the thalamus. Following the closure of the caudal
neuropore and formation of the brain's ventricles that contain the choroid plexus tissue, the central
canal of the caudal spinal cord is filled with cerebrospinal fluid.Overall, spontaneous embryonic
activity has been shown to play a role in neuron and muscle development but is probably not
involved in the initial formation of connections between spinal neurons.
Dura mater.
The spinal cord, like the brain, is surrounded by the three meninges. The dura mater extends from
the foramen magnum to the sacrum and coccyx (see fig. 41-1). The dura is attached to the
foramen magnum and the periosteium covering the uppemost cervical vertebrae and their
ligaments. Through the remainder of the vertebral canal, the dura is not attached to the vertebrae,
being separated by the epidural (or peridural or extradural) space, which contains fat and the
internal vertebral venous plexus. In caudal analgesia, an anesthetic solution injected into the
sacral hiatus diffuses upward into the epidural space (see fig. 41-1). This may be used in surgical
procedures relating to pelvic and perineal regions. Extensions of dura (dural sheaths) surround the
nerve roots and spinal ganglia, and continue into the connective tissue coverings (epineurium) of
the spinal nerves.
Arachnoid mater.
The arachnoid invests the spinal cord loosely. Continuous with the cerebral arachnoid above, it
traverses the foramen magnum and descends to about the S2 vertebral level. The subarachnoid
space, which contains cerebrospinal fluid (C.S.F.), is a wide interval between the arachnoid and
pia. Because the spinal cord ends at about the level of the L2 vertebra, whereas the subarachnoid
space continues to S2, access can be gained to the C.S.F. by inserting a needle between the
vertebral lamina below the end of the cord, a procedure termed lumbar puncture (see fig. 41-1).
By this means, the pressure of C.S.F. can be measured, the fluid can be analyzed, a spinal
anesthetic can be introduced, or fluid can be replaced by a contrast medium for radiography
(myelography).
Pia mater.
The pia mater invests the spinal cord closely, ensheathes the anterior spinal artery (as the linea
splendens), and enters the anterior median fissure. Laterally, the pia forms a discontinuous
longitudinal septum, the denticulate ligament (see fig. 41-3), which sends about 21 tooth-like
processes laterally to fuse with the arachnoid and dura on each side. The ligament is a surgical
landmark in that it is attached to the spinal cord about midway between the attachments of dorsal
and ventral roots.
131. Development of central nervous system (brain vesicles and their derivatives). Main stages of
nervous system development.
During early embryonic development the ectoderm becomes specified to give rise to the
epidermis (skin) and the neural plate. The conversion of undifferentiated ectoderm to neuro-
ectoderm requires signals from the mesoderm. At the onset of gastrulation presumptive
mesodermal cells move through the dorsal blastopore lip and form a layer in between the
endoderm and the ectoderm. These mesodermal cells that migrate along the dorsal midline give
rise to a structure called the notochord. Ectodermal cells overlying the notochord develop into the
neural plate in response to a diffusible signal produced by the notochord. The remainder of the
ectoderm gives rise to the epidermis (skin). The ability of the mesoderm to convert the overlying
ectoderm into neural tissue is called neural induction.The neural plate folds outwards during the
third week of gestation to form the neural groove. Beginning in the future neck region, the neural
folds of this groove close to create the neural tube. The formation of the neural tube from the
ectoderm is called neurulation. The ventral part of the neural tube is called the basal plate; the
dorsal part is called the alar plate. The hollow interior is called the neural canal. By the end of the
fourth week of gestation, the open ends of the neural tube, called the neuropores, close off.[4].A
transplanted blastopore lip can convert ectoderm into neural tissue and is said to have an inductive
effect. Neural inducers are molecules that can induce the expression of neural genes in ectoderm
explants without inducing mesodermal genes as well. Neural induction is often studied in xenopus
embryos since they have a simple body pattern and there are good markers to distinguish between
neural and non-neural tissue. Examples of neural inducers are the molecules noggin and
chordin.When embryonic ectodermal cells are cultured at low density in the absence of
mesodermal cells they undergo neural differentiation (express neural genes), suggesting that
neural differentiation is the default fate of ectodermal cells. In explant cultures (which allow
direct cell-cell interactions) the same cells differentiate into epidermis. This is due to the action of
BMP4 (a TGF-β family protein) that induces ectodermal cultures to differentiate into epidermis.
During neural induction, noggin and chordin are produced by the dorsal mesoderm (notochord)
and diffuse into the overlying ectoderm to inhibit the activity of BMP4. This inhibition of BMP4
causes the cells to differentiate into neural cells. Inhibition of TGF-β and BMP (bone
morphogenetic protein) signaling can efficiently induce neural tissue from human pluripotent
stem cells,[5] a model of early human development.
The early brain -Late in the fourth week, the superior part of the neural tube flexes at the
level of the future midbrain—the mesencephalon. Above the mesencephalon is the
prosencephalon (future forebrain) and beneath it is the rhombencephalon (future hindbrain). The
optical vesicle (which will eventually become the optic nerve, retina and iris) forms at the basal
plate of the prosencephalon.The spinal cord forms from the lower part of the neural tube. The
wall of the neural tube consists of neuroepithelial cells, which differentiate into neuroblasts,
forming the mantle layer (the gray matter). Nerve fibers emerge from these neuroblasts to form
the marginal layer (the white matter). The ventral part of the mantle layer (the basal plates) forms
the motor areas of the spinal cord, whilst the dorsal part (the alar plates) forms the sensory areas.
Between the basal and alar plates is an intermediate layer that contains neurons of the autonomic
nervous system.[6].In the fifth week, the alar plate of the prosencephalon expands to form the
cerebral hemispheres (the telencephalon). The basal plate becomes the diencephalon.The
diencephalon, mesencephalon and rhombencephalon constitute the brain stem of the embryo. It
continues to flex at the mesencephalon. The rhombencephalon folds posteriorly, which causes its
alar plate to flare and form the fourth ventricle of the brain. The pons and the cerebellum form in
the upper part of the rhombencephalon, whilst the medulla oblongata forms in the lower part.
132. Medulla oblongata. Development, structure, connections.
Medulla oblongata is the terminal part of the brainstem. It sits in the posterior cranial fossa, below
the tentorium cerebelli. The rostral medulla is continuous with the pons superiorly, with which it
forms the pontomedullary junction. The caudal medulla continues onto the spinal cord inferiorly,
just above the origin of the first pair of the cervical spinal nerves.
The medulla oblongata has many important features and functions.
It is a conduit for many ascending and descending nerve tracts that carry the information between
the brain and spinal cord.
It houses the centers for vital functions of the body, such as those for the heart rate, blood
pressure, and breathing.
It contains the nuclei of the four inferiormost cranial nerves: the glossopharyngeal nerve (CN IX),
vagus nerve (CN X), accessory nerve (CN XI), and the hypoglossal nerve (CN XII).
Structure-Along the midline of the ventral surface of the medulla is the anterior median fissure.
This is a continuation of the anterior median fissure of the spinal cord. On either side of the
fissure is a vertical protuberance known as the medullary pyramid, formed by the fibers of the
corticospinal tract. Below the base of the pyramids, the median fissure is interrupted by the
fascicles of the corticospinal tract that decussate and form the pyramidal decussation in the
midline.
Each half of the ventral medullary surface shows two sulci: anterolateral sulcus and posterolateral
sulcus. Between the sulci, and just lateral and posterior to each pyramid is another oval structure
known as the olive. The olive is formed by the presence of the inferior olivary nucleus in the
medulla. The sulci themselves serve as exit points of certain cranial nerves:
The hypoglossal nerve (CN XII) exits the medulla through the anterolateral sulcus, just medial to
the olive.
Going from rostral to caudal, the glossopharyngeal (CN IX), vagus (CN X) and accessory nerve
(CN XI) exit the medulla through the posterolateral sulcus, lateral to the olive
The medulla or medulla oblongata develops from the secondary brain vesicle the
myelencephalon, that in turn formed from the earlier primary brain vesicle rhombencephalon. The
neural tube lateral walls have 2 halves (alar and a basal lamina) and are connected by a floor plate
and roof-plate region.
133. Cerebellum. Structure, connections, blood supply.
The cerebellum (Latin for "little brain") is a major feature of the hindbrain of all vertebrates.
Although usually smaller than the cerebrum, in some animals such as the mormyrid fishes it may
be as large as or even larger.[1] In humans, the cerebellum plays an important role in motor
control. It may also be involved in some cognitive functions such as attention and language as
well as emotional control such as regulating fear and pleasure responses, but its movement-related
functions are the most solidly established. The human cerebellum does not initiate movement, but
contributes to coordination, precision, and accurate timing: it receives input from sensory systems
of the spinal cord and from other parts of the brain, and integrates these inputs to fine-tune motor
activity.[4] Cerebellar damage produces disorders in fine movement, equilibrium, posture, and
motor learning in humans.
The cerebellum is located in the posterior cranial fossa. The fourth ventricle, pons and medulla
are in front of the cerebellum.[8] It is separated from the overlying cerebrum by a layer of
leathery dura mater, the tentorium cerebelli; all of its connections with other parts of the brain
travel through the pons. Anatomists classify the cerebellum as part of the metencephalon, which
also includes the pons; the metencephalon is the upper part of the rhombencephalon or
"hindbrain". Like the cerebral cortex, the cerebellum is divided into two cerebellar hemispheres; it
also contains a narrow midline zone (the vermis). A set of large folds is, by convention, used to
divide the overall structure into 10 smaller "lobules". Because of its large number of tiny granule
cells, the cerebellum contains more neurons than the total from the rest of the brain, but takes up
only 10% of the total brain volume.[9] The number of neurons in the cerebellum is related to the
number of neurons in the neocortex. There are about 3.6 times as many neurons in the cerebellum
as in the neocortex, a ratio that is conserved across many different mammalian species.[10].The
unusual surface appearance of the cerebellum conceals the fact that most of its volume is made up
of a very tightly folded layer of gray matter: the cerebellar cortex. Each ridge or gyrus in this
layer is called a folium. It is estimated that, if the human cerebellar cortex were completely
unfolded, it would give rise to a layer of neural tissue about 1 meter long and averaging 5
centimeters wide—a total surface area of about 500 square cm, packed within a volume of
dimensions 6 cm × 5 cm × 10 cm.[9] Underneath the gray matter of the cortex lies white matter,
made up largely of myelinated nerve fibers running to and from the cortex. Embedded within the
white matter—which is sometimes called the arbor vitae (tree of life) because of its branched,
tree-like appearance in cross-section—are four deep cerebellar nuclei, composed of gray
matter.[11].Connecting the cerebellum to different parts of the nervous system are three paired
cerebellar peduncles. These are the superior cerebellar peduncle, the middle cerebellar peduncle
and the inferior cerebellar peduncle, named by their position relative to the vermis. The superior
cerebellar peduncle is mainly an output to the cerebral cortex, carrying efferent fibers via thalamic
nuclei to upper motor neurons in the cerebral cortex. The fibers arise from the deep cerebellar
nuclei. The middle cerebellar peduncle is connected to the pons and receives all of its input from
the pons mainly from the pontine nuclei. The input to the pons is from the cerebral cortex and is
relayed from the pontine nuclei via transverse pontine fibers to the cerebellum. The middle
peduncle is the largest of the three and its afferent fibers are grouped into three separate fascicles
taking their inputs to different parts of the cerebellum. The inferior cerebellar peduncle receives
input from afferent fibers from the vestibular nuclei, spinal cord and the tegmentum. Output from
the inferior peduncle is via efferent fibers to the vestibular nuclei and the reticular formation. The
whole of the cerebellum receives modulatory input from the inferior olivary nucleus via the
inferior cerebellar peduncle
Function-The strongest clues to the function of the cerebellum have come from examining the
consequences of damage to it. Animals and humans with cerebellar dysfunction show, above all,
problems with motor control, on the same side of the body as the damaged part of the cerebellum.
They continue to be able to generate motor activity but lose precision, producing erratic,
uncoordinated, or incorrectly timed movements. A standard test of cerebellar function is to reach
with the tip of the finger for a target at arm's length: A healthy person will move the fingertip in a
rapid straight trajectory, whereas a person with cerebellar damage will reach slowly and
erratically, with many mid-course corrections. Deficits in non-motor functions are more difficult
to detect. Thus, the general conclusion reached decades ago is that the basic function of the
cerebellum is to calibrate the detailed form of a movement, not to initiate movements or to decide
which movements to execute.[11]
134. Rhomboid fossa, limits, topography, projection of cranial nerves nuclei.
The rhomboid fossa forms the floor of the fourth ventricle. Its caudal portion is located in the
medulla, and its larger, more rostral area is in the pons. The posterior surface of the pontine
tegmentum, which forms the floor of the fourth ventricle, is visible only when the cerebellum is
detached from the brainstem (Fig. 12.5). This part of the ventricular floor is characterized by the
facial colliculus located between the median fissure and the superior fovea of the sulcus limitans
and by the vestibular area located lateral to the sulcus limitans. The facial colliculus is formed by
the underlying abducens nucleus and internal genu of the facial nerve, and the vestibular area
marks the location of the vestibular nuclei. The brachium pontis and the brachium conjunctivum
form the lateral walls of the fourth ventricle in the pons; the roof is formed by the anterior
medullary velum, by a small part of the cerebellum, and by a portion of the tela choroidea
Walls
Lateral walls - formed by cerebellar peduncles
Roof - formed by cerebellar peduncles, superior and inferior medullary velum
Floor - formed by rhomboid fossa
Features
Lateral apertures of Luschka
Median aperture of Magendie
Functions
Production of cerebrospinal fluid (CSF) by choroid plexus
Circulation of CSF
The roof of the fourth ventricle has presents a 'tent-like' apex at the intersection of it's superior and
inferior parts. This apex, also known as the fastigium, extends into the white core of the
cerebellum.
The superior part of the roof is formed by the superior cerebellar peduncles and the superior
medullary velum (thin sheet of white matter). The inferior part of the roof is made of non-nervous
tissue, the inferior medullary velum. However, like other parts of the ventricle, it is lined by a
membrane consisting of ependyma and a double fold of pia mater which constitutes the tela
choroidea of the fourth ventricle. Laterally on each side of the midline, this membrane extends
and joins the inferior cerebellar peduncles. The lower part of the membrane has a large aperture,
the foramen of Magendie. This is the median aperture of the fourth ventricle, through which the
entire ventricular system communicates.
135. IV ventricle, walls and connections, cerebellar peduncles.
The fourth ventricle is one of the interconnected fluid-filled cavities within the human brain.
There are four of these cavities in the brain, three of which are located within the cerebrum
(lateral ventricles and the third ventricle). These cavities and their content constitute the
ventricular system of the brain.
The fourth ventricle lies posterior/dorsal to the pons and medulla (of the brainstem) and
anterior/ventral to the cerebellum. It extends from the cerebral aqueduct (aqueduct of Sylvius)
superiorly, extending inferiorly into the central canal of brainstem and spinal cord. Its surface is
lined by an epithelial layer called the ependyma, and is bathed with cerebrospinal fluid (CSF).
The fourth ventricle has an anterior/ventral floor with a characteristic diamond shape, named the
rhomboid fossa, and a posterior/dorsal tent-shaped roof. CSF produced and/or flowing into the
fourth ventricle can exit to the subarachnoid space through lateral apertures and a single median
aperture located in the inferiorportion of the roof.
Key facts about the fourth ventricle
Walls
Lateral walls - formed by cerebellar peduncles
Roof - formed by cerebellar peduncles, superior and inferior medullary velum
Floor - formed by rhomboid fossa
Features
Lateral apertures of Luschka
Median aperture of Magendie
Functions
Production of cerebrospinal fluid (CSF) by choroid plexus
Circulation of CSF
The lateral walls of the fourth ventricle are formed by the cerebellar peduncles. The superior part
of these walls is formed by the superior cerebellar peduncle. The inferior part is formed by the
inferior cerebellar peduncle and by the gracile and cuneate tubercles of the brainstem.
It has two major extensions, known as the lateral recesses, one on either side of the midline. These
recesses extend laterally between the inferior cerebellar peduncle and the peduncle of the
flocculus of the cerebellum, to open into the subarachnoid space as the lateral apertures (foramina
of Luschka).
Roof
The roof of the fourth ventricle has a 'tent-like' apex at the intersection of it's superior and inferior
parts. This apex, also known as the fastigium, extends into the white core of the cerebellum.The
superior part of the roof is formed by the superior cerebellar peduncles and the superior medullary
velum (thin sheet of white matter). The inferior part of the roof is made of non-nervous tissue, the
inferior medullary velum. However, like other parts of the ventricle, it is lined by a membrane
consisting of ependyma and a double fold of pia mater which constitutes the tela choroidea of the
fourth ventricle. Laterally on each side of the midline, this membrane extends and joins the
inferior cerebellar peduncles. The lower part of the membrane has a large aperture, the foramen of
Magendie. This is the median aperture of the fourth ventricle, through which the entire ventricular
system communicates.
The cerebral peduncles are the two stalks that attach the cerebrum to the brainstem.[1] They are
structures at the front of the midbrain which arise from the front of the pons and contain the large
ascending (sensory) and descending (motor) nerve tracts that run to and from the cerebrum from
the pons. Mainly, the three common areas that give rise to the cerebral peduncles are the cerebral
cortex, the spinal cord and the cerebellum.[2] The cerebral peduncle, by most classifications, is
everything in the midbrain except the tectum.[citation needed] The region includes the
tegmentum, crus cerebri and pretectum. By this definition, the cerebral peduncles are also known
as the basis pedunculi, while the large ventral bundle of efferent fibers is referred to as the
cerebral crus or the pes pedunculi.
136. Pons. Development, structure, connections.
The pons is the largest part of the brainstem, located above the medulla and below the midbrain. It
is a group of nerves that function as a connection between the cerebrum and cerebellum (pons is
Latin for bridge).The pons develops from the embryonic metencephalon (part of the hindbrain,
developed from the rhombencephalon), alongside the cerebellum.
Anatomical Position
The pons is a horseshoe-shaped collection of nerve fibres located in the anterior part of the
posterior cranial fossa.
Its anatomical relations are as follows:
Posteriorly – the cerebellum, separated by the fourth ventricle.
Inferiorly – the medulla oblongata.
Superiorly – the midbrain lies immediately above the pons.
External Anatomy
Anterior Surface
The anterior or ventral surface of the pons is marked by a bulging formed by the transverse
pontocerebellar fibres. These fibres wrap around the otherwise vertically oriented brainstem. It
measures around 2.5 cm in adults.
The basilar groove demarcates the midline of the ventral surface and is where the basilar artery is
located.
The pontomedullary junction is an important anatomical landmark defined by the angle between
the lower border of the pons and the superior border of the medulla.
Several cranial nerves originate from the ventral surface of the pons:
Cranial nerve V: trigeminal – originates from the lateral aspect of mid pons
Cranial nerve VI: abducens – originates from the pontomedullary junction, close to the midline
Cranial nerve VII: facial – originates from the cerebellopontine angle, the more lateral aspect of
the pontomedullary junction.
Cranial nerve VIII: vestibulocochlear – originates laterally to the facial nerve.
Internal Anatomy
The pons is comprised of two major components – the ventral pons and the tegmentum.
The ventral pons contains the pontine nuclei, which are responsible for coordinating movement.
Fibres from the pontine nuclei cross the midline and form the middle cerebellar peduncles on their
way to the cerebellum.
The tegmentum is the evolutionarily older part of the pons which forms part of the reticular
formation – a set of nuclei found throughout the brainstem that are responsible for arousal and
attentiveness. Damage to this part of the pons may result in anosognosia for hemiplegia, where
patients are unaware of their paralysis.
The rest of the pons is made up of tracts passing through the pons including:
Descending corticospinal tracts – responsible for voluntary motor control of the body.
Descending corticobulbar tracts – responsible for voluntary motor control of face, head and neck.
Ascending medial lemniscus tracts – responsible for fine touch, vibration and proprioception.
Ascending spinothalamic tracts – responsible for pain and temperature sensation
137. Mesencephalon. Development, structure, connections.
The midbrain, or mesencephalon, is the most rostral part of the brainstem that connects the pons
and cerebellum with the forebrain. For most of its part, the midbrain sits in the posterior cranial
fossa, traversing the hiatus of the tentorium cerebelli.
The midbrain is the shortest part of the brainstem. However, it contains many important structures
that make it essential for the proper functioning of the body:
It contains the relay nuclei involved in the processing of auditory and visual information
It houses the nuclei of three cranial nerves: oculomotor nerve (CN III), trochlear nerve (CN IV),
and one of the nuclei of the trigeminal nerve (CN V) via which it controls the movements of the
eye and sensation of the face
It provides the passageway for the pathways traveling between the cerebral cortex and spinal cord
Structure-The principal regions of the midbrain are the tectum, the cerebral aqueduct, tegmentum,
and the cerebral peduncles. Rostrally the midbrain adjoins the diencephalon (thalamus,
hypothalamus, etc.), while caudally it adjoins the hindbrain (pons, medulla and cerebellum).[4] In
the rostral direction, the midbrain noticeably splays laterally.Sectioning of the midbrain is usually
performed axially, at one of two levels – that of the superior colliculi, or that of the inferior
colliculi. One common technique for remembering the structures of the midbrain involves
visualizing these cross-sections (especially at the level of the superior colliculi) as the upside-
down face of a bear, with the cerebral peduncles forming the ears, the cerebral aqueduct the
mouth, and the tectum the chin; prominent features of the tegmentum form the eyes and certain
sculptural shadows of the face.
The tectum (Latin for roof) is the dorsal side of the midbrain. The position of the tectum is
contrasted with the tegmentum, which refers to the region in front of the ventricular system, or
floor of the midbrain.
It is involved in certain reflexes in response to visual or auditory stimuli. The reticulospinal tract,
which exerts some control over alertness, takes input from the tectum,[5] and travels both
rostrally and caudally from it.
The corpora quadrigemina are four mounds, called colliculi, in two pairs – a superior and an
inferior pair, on the surface of the tectum. The superior colliculi process some visual information,
aid the decussation of several fibres of the optic nerve (some fibres remain ipsilateral), and are
involved with saccadic eye movements. The tectospinal tract connects the superior colliculi to the
cervical nerves of the neck, and co-ordinates head and eye movements. Each superior colliculi
also sends information to the corresponding lateral geniculate nucleus, with which it is directly
connected. The homologous structure to the superior colliculus in non mammalian vertebrates
including fish and amphibians, is called the optic tectum; in those animals, the optic tectum
integrates sensory information from the eyes and certain auditory reflexes.[6][7]The inferior
colliculi – located just above the trochlear nerve – process certain auditory information. Each
inferior colliculus sends information to the corresponding medial geniculate nucleus, with which
it is directly connected.
The midbrain tegmentum is the portion of the midbrain ventral to the cerebral aqueduct, and is
much larger in size than the tectum. It communicates with the cerebellum by the superior
cerebellar peduncles, which enter at the caudal end, medially, on the ventral side; the cerebellar
peduncles are distinctive at the level of the inferior colliculus, where they decussate, but they
dissipate more rostrally.[8] Between these peduncles, on the ventral side, is the median raphe
nucleus, which is involved in memory consolidation.
The main bulk of the tegmentum contains a complex synaptic network of neurons, primarily
involved in homeostasis and reflex actions. It includes portions of the reticular formation. A
number of distinct nerve tracts between other parts of the brain pass through it. The medial
lemniscus – a narrow ribbon of fibres – passes through in a relatively constant axial position; at
the level of the inferior colliculus it is near the lateral edge, on the ventral side, and retains a
similar position rostrally (due to widening of the tegmentum towards the rostral end, the position
can appears more medial). The spinothalamic tract – another ribbon-like region of fibres – are
located at the lateral edge of the tegmentum; at the level of the inferior colliculus it is immediately
dorsal to the medial lemiscus, but due to the rostral widening of the tegmentum, is lateral of the
medial lemiscus at the level of the superior colliculus.
138. Brainstem, parts, characteristics of cranial nerves nuclei of brainstem.
The brainstem (brain stem) is the distal part of the brain that is made up of the midbrain, pons,
and medulla oblongata. Each of the three components has its own unique structure and function.
Together, they help to regulate breathing, heart rate, blood pressure, and several other important
functions
Parts The parts of the brainstem are the midbrain, the pons, and the medulla oblongata, and
sometimes the diencephalon
The midbrain is further subdivided into three parts: tectum, tegmentum, and the ventral tegmental
area. The tectum forms the ceiling. The tectum comprises the paired structure of the superior and
inferior colliculi and is the dorsal covering of the cerebral aqueduct. The inferior colliculus is the
principal midbrain nucleus of the auditory pathway and receives input from several peripheral
brainstem nuclei, as well as inputs from the auditory cortex. Its inferior brachium (arm-like
process) reaches to the medial geniculate nucleus of the diencephalon. The superior colliculus is
positioned above the inferior colliculus, and marks the rostral midbrain. It is involved in the
special sense of vision and sends its superior brachium to the lateral geniculate body of the
diencephalon.
The pons lies between the medulla oblongata and the midbrain. The pons is separated from the
midbrain by the superior pontine sulcus, and from the medulla by the inferior pontine sulcus.[7] It
contains tracts that carry signals from the cerebrum to the medulla and to the cerebellum and also
tracts that carry sensory signals to the thalamus. The pons is connected to the cerebellum by the
cerebellar peduncles. The pons houses the respiratory pneumotaxic center and apneustic center
that make up the pontine respiratory group in the respiratory center. The pons co-ordinates
activities of the cerebellar hemispheres
The medulla oblongata, often just referred to as the medulla, is the lower half of the brainstem
continuous with the spinal cord. Its upper part is continuous with the pons.[5]:1121 The medulla
contains the cardiac, dorsal and ventral respiratory groups, and vasomotor centres, dealing with
heart rate, breathing and blood pressure. Another important medullary structure is the area
postrema whose functions include the control of vomiting.
The midbrain of the brainstem has the nuclei of the oculomotor nerve (III) and trochlear nerve
(IV); the pons has the nuclei of the trigeminal nerve (V), abducens nerve (VI), facial nerve (VII)
and vestibulocochlear nerve (VIII); and the medulla has the nuclei of the glossopharyngeal nerve
(IX), vagus nerve (X), ...
139. Medial lemniscus, formation, composition of fibers, location on the transverse section.
The dorsal column-medial lemniscus pathway (DCML) is a sensory pathway of the central
nervous system. It conveys sensation of fine touch, vibration, pressure, two-point discrimination
and proprioception (position) from the skin and joints.Also known as the posterior column -
medial lemniscus pathway, it consists of two parts. The dorsal (posterior) column, which runs
from the spinal cord to the medulla, and the medial lemniscus which runs as a continuation of the
dorsal column, from the medulla to the cortex. In the cortex the DCML pathway projects onto the
primary somatosensory cortex of the postcentral gyrus. Here sensation location is 'mapped' using
a somatotopic arrangement, represented as a homunculus.
The dorsal column is formed by two large fasciculi (bundles of nerve fibers) running through the
posterior spinal cord: fasciculus gracilis and fasciculus cuneatus. These fasciculi gather sensory
information from our body's periphery via skin and joint receptors, and send this information to
superior cerebral structures.
The most important conscious cutaneous receptors for the DCML system are:Ruffini endings
(bulbous corpuscles); detect tension deep in the skin and connective tissue or fascia.Merkel nerve
endings (Merkel discs); detect sustained pressureLamellar corpuscles (Pacinian corpuscles);
detect rapid vibrations (200-300Hz).
The fasciculus cuneatus, also known as the “column of Burdach”, represents the lateral portion of
the dorsal column. It carries input from C1 and T6 spinal cord levels. This part of the DCML is
responsible for transmitting vibration, conscious proprioception and fine (discriminative) touch
sensations from the upper body.
Similar to the fasciculus gracilis, the first-order neurons in the cuneate fasciculus ascend the
spinal cord without decussation. This is unlike other ascending tracts (e.g. the spinothalamic tract)
which cross at some point within the spinal cord. The fibers of fasciculus gracilis reach the
ipsilateral cuneatus nucleus in the caudal medulla, where they synapse with second-order neurons.
These second-order neurons then cross over as internal arcuate fibers and form the medial
lemniscus on the contralateral side.
Function
Our skin and joints contains many various receptors, each of which are specific for different types
of mechanical action (vibration, slight touch, skin stretch, proprioception, temperature, changes in
texture, discrimination, pressure). When these receptors are stimulated, an action potential is
generated and transmitted by the DCML pathway to the primary somatosensory area of the
cerebral cortex.Discriminative sensation/touch is well developed in the fingers of humans. This
capability is given to us by the DCML pathway. It provides us with the ability to detect fine
textures and to determine an unknown object by its shape, using our hands without visual or audio
input (stereognosis).
140. Diencephalon. Development, parts, III ventricle.
The human brain can be subdivided by many classification systems. One particular nomenclature
that refers to the duality of the brain is the diencephalon. It is the caudal part of the forebrain
(prosencephalon) that occupies the central region of the brain. The diencephalon is comprised of
the:Epithalamus
Thalamus
Subthalamus
Metathalamus
Hypothalamus
Function-Each of the components of the diencephalon has specialized functions that are integral
to life. The diencephalon acts as a primary relay and processing center for sensory information
and autonomic control. The plethora of communicating pathways between these structures and
other parts of the body makes the diencephalon a functionally diverse area. Some of these
connections include pathways to the limbic system (seat of memory and emotion), basal ganglia
(motor coordination), as well as primary sensory areas, such as auditory or visual.
Gross anatomy-There are several structures between the brainstem and the cerebral cortex that
make up the diencephalon. These include the epithalamus, thalamus, subthalamus, metathalamus,
hypothalamus, hypophysis cerebri and the third ventricle as its cavity. The medial and lateral
geniculate bodies, which are collectively called the metathalamus, along with the pulvinar, are
frequently regarded as an integral part of the dorsal thalamus.
Borders-The third ventricle is a narrow vertical midline cleft between and below the two lateral
ventricles and in between left and right thalami. The lateral ventricles communicate with the third
ventricle via the interventricular foramen of Monro. It also communicates with the fourth
ventricle posteroinferiorly via the cerebral aqueduct of Sylvius.
It possesses a roof, a floor and four walls: anterior, posterior and two lateral.
The roof is formed by the thin tela choroidea, which is a combination of two membranes, the
ependyma and pia mater. Within the tela choroidea are two plexuses of blood vessels (one on
either side of the middle line) that bulge downwards into the cavity of the third ventricle. These
are the choroid plexuses of the third ventricle which functions as a point of production of the
cerebrospinal fluid (CSF).
The floor is made up of the optic chiasm, the tuber cinereum and infundibulum, the mammillary
bodies, the posterior perforated substance and the uppermost part of the mesencephalic
tegmentum.The anterior wall is the delicate lamina terminalis, as well as the anterior commissure
and anterior column of the fornix..The short posterior wall is formed by the stalk of the pineal
gland, posterior commissure and the Habenular commissures.The lateral walls are of the cavity
are formed by the medial walls of each thalami. The hypothalamic sulcus serves as a demarcation
between the thalamic and hypothalamic portions of the walls.
Blood supply-The diencephalon is richly supplied by several blood vessels, notably the
thalamogeniculate branches of the posterior cerebral artery and thalamoperforating branches of
the posterior cerebral artery and posterior communicating artery.
Third ventricle-The third ventricle is a narrow, laterally flattened, vaguely rectangular region,
filled with cerebrospinal fluid, and lined by ependyma. It is connected at the superior anterior
corner to the lateral ventricles, by the interventricular foramina, and becomes the cerebral
aqueduct (... of Silvius) at the posterior caudal corner. Since the interventricular foramina are on
the lateral edge, the corner of the third ventricle itself forms a bulb, known as the anterior recess
(it is also known as the bulb of the ventricle). The roof of the ventricle comprises choroid plexus,
forming the inferior central portion of the tela choroidea; immediately above the superior central
portion of the tela choroidea is the fornix.The lateral side of the ventricle is marked by a sulcus –
the hypothalamic sulcus – from the inferior side of the interventricular foramina to the anterior
side of the cerebral aqueduct. The lateral border posterior/superior of the sulcus constitutes the
thalamus, while anterior/inferior of the sulcus it constitutes the hypothalamus. The interthalamic
adhesion usually tunnels through the thalamic portion of the ventricle, joining together the left
and right halves of the thalamus, although it is sometimes absent, or split into more than one
tunnel through the ventricle; it is currently unknown whether any nerve fibres pass between the
left and right thalamus via the adhesion (it has more resemblance to a herniation than a
commissure).The posterior border of the ventricle primarily constitutes the epithalamus. The
superior part of the posterior border constitutes the habenular commissure, while more centrally it
the pineal gland, which regulates sleep and reacts to light levels. Caudal of the pineal gland is the
posterior commissure; nerve fibres reach the posterior commissure from the adjacent midbrain,
but their onward connection is currently uncertain. The commissures create concavity to the shape
of the posterior ventricle border, causing the suprapineal recess above the habenular, and the
deeper pineal recess between the habenular and posterior commissures; the recesses being so-
named due to the pineal recess being bordered by the pineal gland.
141. Hypothalamic region: departments, connection with the pituitary gland.
The left and right lateral walls of the third ventricle are divided by an anteroposterior depression
known as the hypothalamic sulcus. It runs from the anterior tip of the fornix – between the
interventricular foramen of Monro superiorly and the anterior commissure inferiorly – to the
posterior commissure (superior to the beginning of the cerebral aqueduct of Sylvius). This
depression separates the thalamus (superiorly) from the hypothalamus (inferiorly).The
hypothalamus is composed mainly of different nuclei (discrete masses of grey matter in the
central nervous system) that synthesize different hormones in response to physiological changes.
These nuclei have been grouped into four regions. The preoptic region (at the level of the
subcallosal gyrus) houses the preoptic nucleus. In the supraoptic region, there is the
suprachiasmatic, supraoptic, paraventricular, and anterior nuclei. The dorsomedial, ventromedial,
arcuate, premammillary and lateral tuberal nuclei belong to the tuberal region. Finally, the
mammillary and posterior nuclei are residents of the mammillary regiosregio
The first of several major hypothalamic nuclei to be discussed is the paraventricular nuclei. It is
located anterior to the pathway of the fornix (arching C-shaped collection of nerve fibers) and
posteroinferior to the anterior commissure. The superior part of the lamina terminalis is directly
anterior to it, while the supraoptic and dorsomedial nuclei are at inferiorly and posteriorly related,
respectively.The supraoptic nucleus is directly posterior to the inferior part of the lamina
terminalis and anteroinferior to the dorsomedial and ventromedial nuclei. It also rests directly
above the supraoptic crest, also known as the organum vasculosum laminae terminalis (OVLT),
just above the supraoptic recess and the optic chiasm.The arcuate (infundibular) nucleus rests
along the proximal part of the tuber cinereum. It is inferior to the ventromedial, anterior to the
mammillary, and posteroinferior to the supraoptic nuclei. The dorsomedial and ventromedial
nuclei are found around the mid-medial section of the hypothalamus. The former nucleus is
located inferiorly to the latter nucleus.The posterior nucleus is directly superior to the mammillary
nucleus, which is found in the mammillary bodies. The posterior nucleus also lies between the
fornical nerve fibers (anteriorly) and the mammillothalamic tract (posteriorly).
Relationship-The hypothalamus has an almost geometrically central location in the brain. As a

result, it is structurally related to several other important parts of the forebrain and
midbrain.Immediately anteriorly, there is the anterior commissure and the lamina terminalis. The
subcallosal area with its gyrus is located anteriorly, just beyond the anterior commissure and
lamina terminalis.Posteriorly, the mammillary bodies, posterior perforated substance, cerebral
peduncle and the cerebral aqueduct of Sylvius can be found.Inferiorly (from anterior to posterior),
there is the supraoptic recess and crest, the pituitary stalk and gland, and the tuber
cinereum.Superiorly there is the hypothalamic sulcus, the thalamus, the choroid plexus of the
third ventricle and the fornix.
Unmyelinated axons of the paraventricular and supraoptic nuclei travel together as the
supraopticohypophyseal tract along the anterior region of the hypothalamus caudally, towards the
infundibulum (pituitary stalk). They meet up with the axons of the arcuate nucleus that travels
along the tuber cinereum (tuberohypophyseal tract) and travels through the infundibular stem of
the neurohypophysis to enter the pars nervosa. These two neuronal tracts form the
hypothalamohypophyseal tract. It conveys neurons produced in the cell bodies in the
hypothalamus to the pars nervosa, where they are stored.Two sets of nerve bundles travel to the
mammillary body. One journeys from the fornix, anterior to the posterior nucleus and the other
from the thalamus, posterior to the posterior nucleus. The latter is known as the
mammillothalamic tract.
Connection with pituitary-The hypothalamus is a structure of the diencephalon of the brain

located anterior and inferior to the thalamus (Figure 1). It has both neural and endocrine
functions, producing and secreting many hormones. In addition, the hypothalamus is anatomically
and functionally related to the pituitary gland (or hypophysis), a bean-sized organ suspended from
it by a stem called the infundibulum (or pituitary stalk). The pituitary gland is cradled within the
sellaturcica of the sphenoid bone of the skull. It consists of two lobes that arise from distinct parts
of embryonic tissue: the posterior pituitary (neurohypophysis) is neural tissue, whereas the
anterior pituitary (also known as the adenohypophysis) is glandular tissue that develops from the
primitive digestive tract. The hormones secreted by the posterior and anterior pituitary, and the
intermediate zone between the lobes
The posterior pituitary is actually an extension of the neurons of the paraventricular and
supraoptic nuclei of the hypothalamus. The cell bodies of these regions rest in the hypothalamus,
but their axons descend as the hypothalamic–hypophyseal tract within the infundibulum, and end
in axon terminals that comprise the posterior pituitary (Figure 2).
142. III ventricle. Walls, connection.t
The third ventricle is a narrow funnel-shaped cavity of the brain. It is located in the midline,
comprising the central part of the ventricular system of the brain. As such, the third ventricle
directly communicates with other ventricles:
It communicates with each lateral ventricle via the foramen of Monro,
It communicates with the fourth ventricle via the aqueduct of Sylvius.
The third ventricle can be described as a cuboid structure that has a roof, floor and four walls
(anterior, posterior, and two lateral). Similar to the other brain ventricles, the main function of the
third ventricle is to produce, secrete and convey cerebrospinal fluid
Floor-The floor of the third ventricle extends from the optic chiasm anteriorly to the aqueduct of
Sylvius posteriorly. The anterior portion of the floor is formed by the hypothalamus, while the
posterior portion is formed by the midbrain (mesencephalon). Going from the anterior to
posterior, the structures that comprise the floor of the third ventricle are the:
Optic chiasm
Infundibulum of hypothalamus
Tuber cinereum
Mammillary bodies
Posterior perforated substance
The anterior part of the tegmentum of the midbrain
When the floor of the third ventricle is viewed from above, there is a noticeable prominence in the
anteriormost part of the ventricle, formed by the optic chiasm. Note that the optic chiasm is
located at the junction of the floor and anterior wall of the ventricle. Posterior to the optic chiasm,
there is a prominence formed by the mamillary bodies. Between these two prominences, the
cavity of the third ventricle extends into the pituitary stalk, forming the infundibular recess. The
posterior half of the floor (posterior to the mammillary bodies) lies above the posterior perforated
substance and tegmentum and it is generally smooth and unremarkable.
Roof -The roof of the third ventricle extends from the foramen of Monro anteriorly to the
suprapineal recess posteriorly. The roof lies immediately below the body of fornix.
The roof has for separate layers which include:
Neural layer
Tela choroidea (two layers)
Vascular layer
The most superficial layer is the neural layer, formed by the body and the crura of the fornix.
Below this layer, there are two thin membranous layers of tela choroidea. The tela choroidea is
semi-transparent double-layered structure derived from the pia mater and we’ll speak about its
function further in the text.
In between the layers of the tela choroidea, there is a vascular layer that mainly consists of me
The third ventricle has four walls in total; anterior, posterior, and two lateral walls.
Anterior wall
The anterior wall extends from the foramina of Monro superiorly to the optic chiasm inferiorly.
From superior to inferior, the structures that participate in the formation of the anterior wall are as
follows:
Foramina of Monro
Columns of fornix
Anterior commissure
Lamina terminalis
Optic recess
Optic chiasm
Note that the foramen of Monro is located at the junction between the anterior wall and the roof of
the third ventricle. When the brain is viewed from the frontal aspect, only the inferior two-thirds
of the anterior wall are visible. The superiormost portion is covered by the rostrum of the corpus
callosum.
Posterior wall
The posterior wall extends from the suprapineal recess superiorly, to the aqueduct of Sylvius
inferiorly. When viewed from the anterior perspective, the posterior wall is formed by five
structures which are (from superior to inferior):
Suprapineal recess
Habenular commissure
Pineal body and its recess
Posterior commissure
Aqueduct of Sylvius
The only structure visible from the posterior aspect of the brain is the pineal gland. Inferior to the
posterior commissure the ventricle is continuous with the cerebral aqueduct of the midbrain (of
Sylvius).
Lateral walls The lateral walls of the third ventricle are formed by the medial aspects of the
thalamus and hypothalamus, which are separated by the hypothalamic sulcus. When viewed from
the medial perspective, the outlines of lateral walls can be described as the silhouette of the bird's
head with open beaks. The majority of the lateral wall (the head of the bird) is formed by the
medial aspect of the thalamus. The superior beak represents the optic recess, while the inferior
beak is formed by the infundibular recess.
143. White matter of the cerebral hemisphere. Internal capsule. Topography, parts and pathways
of it.
The cerebrum, also known as the forebrain, is the largest part of the brain. It is derived
embryologically from the telencephalon. The cerebrum consists of two cerebral hemispheres
(right and left) separated by a deep longitudinal fissure which contains the corpus callosum. It is
enveloped inside thin but protective membranes called meninges, one of which houses the
subarachnoid space filled with cerebrospinal fluid.
If you’ve ever seen a picture or plastic model of a human brain, you will have noticed that it is not
perfectly smooth. Instead, the cerebrum is full of grooves and ridges running in every direction.
These are called sulci and gyri, respectively. Their role is to increase surface area, and hence the
number of neurons, within the cerebrum. This permits larger processing and cognitive abilities
within the cerebral hemispheres.
Each cerebral hemisphere is composed of five lobes:
Frontal
Parietal
Temporal
Occipital
Insular
Frontal lobe
The frontal lobe is the most anterior part of the cerebrum. It is involved in activities like muscle
control, higher intellect, personality, mood, social behaviour, and language. Posteriorly, the
frontal lobe is separated from the parietal lobe by the central sulcus (of Rolando) and inferiorly
from the temporal lobe by the lateral sulcus (of Sylvius). The most significant convolutions of the
frontal lobe are the precentral, superior, middle, inferior and orbital. The entire frontal lobe is
supplied by the anterior and middle cerebral arteries, which are branches of the internal carotid
artery.
Parietal lobe
The parietal lobe is situated between the frontal and occipital lobes, and separated from them by
the central and parieto-occipital sulci respectively. It is involved in language and calculation, as
well as the perception of various sensations such as touch, pain, and pressure. The lobe consists of
two parts called lobules (superior and inferior) separated by an intraparietal sulcus. Other
important landmarks include the postcentral sulcus together with the postcentral, angular, and
supramarginal gyri. The parietal lobe is supplied by branches of the anterior, middle, and
posterior cerebral arteries. The latter originates from the basilar artery.
Temporal lobe
Continuing down the list, we have another lobe of the cerebrum called the temporal lobe. It is
responsible for memory, language and hearing. It sits underneath the previous two lobes, from
which it is separated by the lateral sulcus. The temporal lobe consists of the superior, middle, and
inferior temporal gyri that are delimited by the superior and inferior sulci. It is supplied by the
middle and posterior cerebral arteries.
Now that we’ve covered the cerebrum, let’s take a look at the cerebral cortex. These two terms
are often used interchangeably but they are actually quite distinct. The cerebrum describes the
whole main part of the brain. It consists of two types of tissues called grey and white matter. Grey
matter is composed of neural cell bodies and forms the outer, surface layer of the cerebral
hemispheres. It is involved in processing and cognition. White matter, on the other hand, is made
up of myelinated axons and forms the bulk of the deeper structures of the cerebrum. Its role is to
join various areas of the cerebrum together. Strictly speaking, only the outer grey matter layer can
be called the cerebral cortex.The cerebral cortex is divided into smaller areas structurally by sulci
and histologically by its cellular organization. The latter results in Brodmann areas, of which
there are 52 in total. Together this information can help us start to form an understanding of the
functional areas of the brain. The most important are the following:
Internal capsule-The internal capsule is a white matter structure situated in the inferomedial part
of each cerebral hemisphere of the brain. It carries information past the basal ganglia, separating
the caudate nucleus and the thalamus from the putamen and the globus pallidus. The internal
capsule contains both ascending and descending axons, going to and coming from the cerebral
cortex. It also separates the caudate nucleus and the putamen in the dorsal striatum, a brain region
involved in motor and reward pathways
Internal capsule-The internal capsule is a white matter structure situated in the inferomedial part
of each cerebral hemisphere of the brain. It carries information past the basal ganglia, separating
the caudate nucleus and the thalamus from the putamen and the globus pallidus. The internal
capsule contains both ascending and descending axons, going to and coming from the cerebral
cortex. It also separates the caudate nucleus and the putamen in the dorsal striat
um, a brain region involved in motor and
reward pathways
Function-The internal capsule provides passage to ascending and descending fibres running to and
from the cerebral cortex.
Working anterior to posterior:
The anterior limb of the internal capsule contains:
1) Frontopontine fibers project from frontal cortex to the pons;
2) Thalamocortical radiations are the fibers that connect the medial and anterior nuclei of the
thalamus to the frontal lobes (these are severed during a prefrontal lobotomy).
The genu contains corticobulbar fibers, which run between the cortex and the brainstem.
The posterior limb of the internal capsule contains corticospinal fibers, sensory fibers (including
the medial lemniscus and the anterolateral system) from the body and a few corticobulbar fibers.
Other fibers within the internal capsule
The retrolenticular part contains fibers from the optic system, coming from the lateral geniculate
nucleus of the thalamus. More posteriorly, this becomes the optic radiation. Some fibers from the
medial geniculate nucleus (which carry auditory information) also pass in the retrolenticular
internal capsule, but most are in the sublenticular part.The sublenticular part contains fibers
connecting with the temporal lobe. These include the auditory radiations and temporopontine
fibers.
144. Olfactory brain. The I pair of cranial nerves. The ascending ways of the olfactory analyzer.
The olfactory nerve (CN I) is the first and shortest cranial nerve. It is a special visceral afferent
nerve, which transmits information relating to smell.Embryologicallly, the olfactory nerve is
derived from the olfactory placode (a thickening of the ectoderm layer), which also give rise to
the glial cells which support the nerve.
Anatomical Course
The anatomical course of the olfactory nerve describes the transmission of special sensory
information from the nasal epithelium to the primary olfactory cortex of the brain.
Nasal Epithelium
The sense of smell is detected by olfactory receptors located within the nasal epithelium. Their
axons (fila olfactoria) assemble into small bundles of true olfactory nerves, which penetrate the
small foramina in the cribriform plate of the ethmoid bone and enter the cranial cavity.
Olfactory Bulb
Once in the cranial cavity, the fibres enter the olfactory bulb, which lies in the olfactory groove
within the anterior cranial fossa.
The olfactory bulb is an ovoid structure which contains specialised neurones, called mitral cells.
The olfactory nerve fibres synapse with the mitral cells, forming collections known as synaptic
glomeruli. From the glomeruli, second order nerves then pass posteriorly into the olfactory tract.
Olfactory Tract
The olfactory tract travels posteriorly on the inferior surface of the frontal lobe. As the tract
reaches the anterior perforated substance (an area at the level of the optic chiasm) it divides into
medial and lateral stria:
Lateral stria – carries the axons to the primary olfactory cortex, located within the uncus of
temporal lobe.
Medial stria – carries the axons across the medial plane of the anterior commissure, where they
meet the olfactory bulb of the opposite side.
The primary olfactory cortex sends nerve fibres to many other areas of the brain, notably the
piriform cortex, the amygdala, olfactory tubercle and the secondary olfactory cortex. These areas
are involved in the memory and appreciation of olfactory sensations.
Sensory Function
The sensory function of the olfactory nerve is achieved via the olfactory mucosa. This mucosal
layer not only senses smell, but it also detects the more advanced aspects of taste.
It is located in the roof of the nasal cavity and is composed of pseudostratified columnar
epithelium which contains a number of cells:
Basal cells – form the new stem cells from which the new olfactory cells can develop.
Sustentacular cells – tall cells for structural support. These are analogous to the glial cells located
in the CNS.
Olfactory receptor cells – bipolar neurons which consist of two processes:
Dendritic process projects to the surface of the epithelium, where they project a number of short
cilia, the olfactory hairs, into the mucous membrane. These cilia react to odors in the air and
stimulate the olfactory cells.
Central process (also known as the axon) projects in the opposite direction through the basement
membrane.
In addition to the epithelium, there are Bowman’s glands present in the mucosa, which secrete
mucus.
145. Lateral ventricles of the brain. Parts, their position. choroid plexus, connection with the third
ventricle.
Ventricular system
The ventricular system is a well organized interconnecting system spanning every region of the
brain. The channels connecting the lateral ventricles to the third (the midline ventricle) are called
the interventricular foramen (or foramen of Monro). The cerebral aqueduct connects the third and
fourth ventricles. The system is then made continuous with the central canal of the spinal cord,
which originates from the floor of the fourth ventricle.
The ventricles produce and contain cerebrospinal fluid (CSF), and the entire surface of the
ventricular system is lined by an epithelial layer called the ependyma. Also, there is a vascular pia
mater in the roofs of the third and fourth ventricles, and in the medial wall of the lateral ventricle
along the line of the choroid fissure.This pia mater is directly opposed to the ependyma and forms
the tela choroidea, which gives rise to the highly vascularised choroid plexuses. However, the
CSF is secreted by the choroid plexuses located within the lateral, third and fourth ventricles
alone, but reaches the entire ventricular system and beyond by flowing from the lateral to the third
ventricle through the foramen of Monro. It then flows through the cerebral aqueduct into the
fourth ventricle, and from there into the central canal starting just inferior to the fourth ventricle.
The CSF finally leaves the fourth ventricle through the foramen of Magendie and the foramina of
Luschka to reach the subarachnoid space surrounding the brain.
Each lateral ventricle lies within a cerebral hemisphere. The lateral ventricle, when viewed from
the lateral aspects of the brain, has a roughly C–shaped profile which follows the arrangement and
shape of each hemisphere. Thus, the lateral ventricles span the cerebrum, including the occipital,
frontal and parietal lobes. The lateral ventricle has a body or central part and three extensions,
namely the anterior, posterior and inferior horns.Master the ventricular system anatomy and
function with our study unit: lateral ventricles-The central part of the lateral ventricle is elongated
anteroposteriorly. Anteriorly, it becomes continuous with the anterior horn at the level of the
interventricular foramen. Posteriorly, the body reaches the splenium of the corpus callosum.
It is triangular in cross section and has a roof, floor, and a medial wall; the roof and floor meeting
on the lateral aspects.
The roof is formed by the trunk of the corpus callosum
The medial wall is formed by the septum pellucidum and by the body of the fornix, which is
common to two lateral ventricles.
The floor is formed mainly by the superior surface of the thalamus, medially, and by the caudate
nucleus laterally. Between these two structures are the stria terminalis and the thalamostriate
veins.
There is a choroid plexus in each of the four ventricles. In the lateral ventricles it is found in the
body, and continued in an enlarged amount in the atrium. There is no choroid plexus in the
anterior horn. In the third ventricle there is a small amount in the roof that is continuous with that
in the body, via the interventricular foramina, the channels that connect the lateral ventricles with
the third ventricle. A choroid plexus is in part of the roof of the fourth ventricle.
Microanatomy Edit
The choroid plexus consists of a layer of cuboidal epithelial cells surrounding a core of capillaries
and loose connective tissue.[3] The epithelium of the choroid plexus is continuous with the
ependymal cell layer (ventricular layer) that lines the ventricular system. Progenitor ependymal
cells are monociliated but they differentiate into multiciliated ependymal cells.[4][5] Unlike the
ependyma, the choroid plexus epithelial layer has tight junctions[6] between the cells on the side
facing the ventricle (apical surface). These tight junctions prevent the majority of substances from
crossing the cell layer into the cerebrospinal fluid (CSF); thus the choroid plexus acts as a blood–
CSF barrier. The choroid plexus folds into many villi around each capillary, creating frond-like
processes that project into the ventricles. The villi, along with a brush border of microvilli, greatly
increase the surface area of the choroid plexus.[citation needed] CSF is formed as plasma is
filtered from the blood through the epithelial cells. Choroid plexus epithelial cells actively
transport sodium ions into the ventricles and water follows the resulting osmotic gradient.[7]
The choroid plexus consists of many capillaries, separated from the ventricles by choroid
epithelial cells. Fluid filters through these cells from blood to become cerebrospinal fluid. There
is also much active transport of substances into, and out of, the CSF as it is made.
Function Edit
CSF circulation
The choroid plexus regulates the production and composition of cerebrospinal fluid (CSF), that
provides the protective buoyancy for the brain.[2][8] CSF acts as a medium for the glymphatic
filtration system that facilitates the removal of metabolic waste from the brain, and the exchange
of biomolecules and xenobiotics into and out of the brain.[8][9] In this way the choroid plexus
has a very important role in helping to maintain the delicate extracellular environment required by
the brain to function optimally.
The choroid plexus is also a major source of transferrin secretion that plays a part in iron
homeostasis in the brain.[10][11]
146. Subcortical nuclei of the cerebral hemispheres.
The basal ganglia consists of a number of subcortical nuclei. The grouping of these nuclei is
related to function rather than anatomy – its components are not part of a single anatomical unit,
and are spread deep within the brain.
It is part of a basic feedback circuit, receiving information from several sources including the
cerebral cortex. The basal ganglia feeds this information back to the cortex, via the thalamus. In
doing so, it acts to modulate and refine cortical activity – such as that controlling descending
motor pathways.
Although widely used, the term basal ganglia is a misnomer, as ganglia are collection of cell
bodies outside of the central nervous system. Since a collection of subcortical cell bodies inside
the nervous system are known as nuclei, the name basal nuclei is more accurate.
Nuclei of the Basal Ganglia
The anatomy of the basal ganglia is complex since it is spread throughout the forebrain.
Its components can be divided into input nuclei, output nuclei and intrinsic nuclei. Input nuclei
receive information, which is then relayed to intrinsic nuclei for processing, and further passed to
output nuclei:
Input Nuclei Intrinsic Nuclei Output Nuclei
Caudate nucleus and putamen (neostriatum)
External globus pallidus
Subthalamic nucleus
Pars compacta of the substantia nigra
Internal globus pallidus
Pars reticulata of the substantia nigra
In the telencephalon, the caudate nucleus (CN) and the putamen (Pu) are collectively called
neostriatum, and their functions are closely related. The most rostral aspect of the neostriatum,
where the caudate nucleus and the putamen join together, is termed nucleus accumbens (Acb),
which is part of a functionally separate domain named ventral striatum.
The globus pallidus is divided in an external (GPe) and an internal (GPi) domains, which are
functionally different
The subthalamic nucleus (StN) lies in the diencephalon. In the mesencephalon, the substantia
nigra is divided into two parts; the pars compacta (SNc) and the pars reticularis (SNr).
Caudate Nucleus
The caudate nucleus forms the lateral wall of the lateral ventricle and follows the telencephalic
expansion during development. It has a characteristic ventricular C-shape when fully developed.
It can be identified as the collection of gray matter on the wall of the lateral ventricles. During
development, the caudate nucleus is separated from the putamen by descending white matter
fibres, which at this level are known as internal capsule.
Adobe Stock, Licensed to TeachMeSeries Ltd
Fig 1 – Coronal section. Note the relationship of the caudate nucleus to the lateral wall of the
lateral ventricle
Lentiform Nucleus (Globus Pallidus and Putamen)

The lentiform nucleus is comprised of globus pallidus and the putamen. Although anatomically
related, they share no functional relationship. It can be identified as a collection of gray matter
laying deep within the hemispheres.
The putamen forms the lateral aspect of the lentiform nucleus. On its concave inner surface lies
the most exterior of the globus pallidus, the GPe, and the most internal structure is the GPi. The
putamen is separated from the GPe by the lateral medullary lamina, and the medial medullary
lamina separates the GPe from the GPi
Note that, laterally to the putamen, there is another collection of white matter fibres known as
external capsule. A thin bundle of grey matter can be seen lateral to the external capsule: this is
the claustrum, once thought to be part of the basal ganglia. More lateral to the claustrum is the
extreme capsule, which are white matter tracts separating the claustrum from the neocortical
insula.
Fig 2 – Components of the basal ganglia and its anatomical relations.
Substantia Nigra
The substantia nigra is conspicuous in gross specimens and can be seen in cuts through the
midbrain, having a dark appearance due to the neuromelanin present in the cells of the SNc.
Subthalamic Nucleus
The subthalamic nucleus, as the name implies, lies inferior to the thalamus, and right above the
substantia nigra.
Function
In simple terms, the basal ganglia provide a feedback mechanism to the cerebral cortex,
modulating and refining cortical activation.
Its main function is related to motor refinement, acting as a tonically active break, preventing
unwanted movements to start. Much of this involves reducing the excitatory input to the cerebral
cortex. This prevents excessive and exaggerated movements.
The basal ganglia also plays an important role in modulating cognitive and emotional responses.
The putamen receives almost exclusive inputs from motor and somatosensory cortices and
projects back to motor areas, and is thus related to the motor loop. The caudate nucleus receives
input from cortical association areas and projects to prefrontal areas. In contrast, the ventral
striatum (including the Acb) receives limbic inputs and is thus related to emotions.
147. Layers of the brain. Sinuses of dura mater of the brain.
The meninges refer to the membranous coverings of the brain and spinal cord. There are three
layers of meninges, known as the dura mater, arachnoid mater and pia mater.
These coverings have two major functions:
Provide a supportive framework for the cerebral and cranial vasculature.
Acting with cerebrospinal fluid to protect the CNS from mechanical damage.
The meninges are often involved cerebral pathology, as a common site of infection (meningitis),
and intracranial bleeds.
In this article, we shall look at the anatomy of the three layers, and their clinical correlations.
Fig 1.0 - Overview of the meninges, and their relationship to the skull and brain.
Fig 1 – Overview of the meninges, and their relationship to the skull and brain.
Dura Mater
The dura mater is the outermost layer of the meninges, lying directly underneath the bones of the
skull and vertebral column. It is thick, tough and inextensible.
Within the cranial cavity, the dura contains two connective tissue sheets:
Periosteal layer – lines the inner surface of the bones of the cranium.
Meningeal layer – deep to the periosteal layer inside the cranial cavity. It is the only layer present
in the vertebral column.
Between these two layers, the dural venous sinuses are located. They are responsible for the
venous vasculature of the cranium, draining into the internal jugular veins.
In some areas within the skull, the meningeal layer of the dura mater folds inwards as dural
reflections. They partition the brain, and divide the cranial cavity into several compartments. For
example, the tentorium cerebelli divides the cranial cavity into supratentorial and infratentorial
compartments.The dura mater receives its own blood supply – primarily from the middle
meningeal artery and vein. It is innervated by the trigeminal nerve (V1, V2 and V3).
Arachnoid Mater
The arachnoid mater is the middle layer of the meninges, lying directly underneath the dura
mater. It consists of layers of connective tissue, is avascular, and does not receive any
innervation.Underneath the arachnoid is a space known as the sub-arachnoid space. It contains
cerebrospinal fluid, which acts to cushion the brain. Small projections of arachnoid mater into the
dura (known as arachnoid granulations) allow CSF to re-enter the circulation via the dural venous
sinuses.
Pia Mater
The pia mater is located underneath the sub-arachnoid space. It is very thin, and tightly adhered to
the surface of the brain and spinal cord. It is the only covering to follow the contours of the brain
(the gyri and fissures).
Like the dura mater, it is highly vascularised, with blood vessels perforating through the
membrane to supply the underlying neural tissue.
Dural sinus-
The central nervous system consists of the cerebrum, cerebellum, brainstem and spinal cord. Their
venous drainage is complex, and rather uniquely, does not follow the arterial supply.
The cerebrum, cerebellum and brainstem are drained by numerous veins, which empty into the
dural venous sinuses. The spinal cord is supplied by anterior and posterior spinal veins, which
drain into the internal and external vertebral plexuses.
In this article, we shall consider the venous drainage of the central nervous system. We will
discuss the dural venous sinuses, cerebral veins, spinal veins, and consider the clinical relevance
of the described anatomy.
Dural Venous Sinuses
The dural venous sinuses lie between the periosteal and meningeal layers of the dura mater. They
are best thought of as collecting pools of blood, which drain the central nervous system, the face,
and the scalp. All the dural venous sinuses ultimately drain into the internal jugular vein. Unlike
most veins of the body, the dural venous sinuses do not have valves.
There are eleven venous sinuses in total. The straight, superior, and inferior sagittal sinuses are
found in the falx cerebri of the dura mater. They converge at the confluence of sinuses (overlying
the internal occipital protuberance). The straight sinus is a continuation of the great cerebral vein
and the inferior sagittal sinus.From the confluence, the transverse sinus continues bi-laterally and
curves into the sigmoid sinus to meet the opening of the internal jugular vein.The cavernous sinus
drains the ophthalmic veins and can be found on either side of the sella turcica. From here, the
blood returns to the internal jugular vein via the superior or inferior petrosal sinuses.Veins of the
Cerebrum
The veins of cerebrum are responsible for carrying blood from the brain tissue, and depositing it
in the dural venous sinuses.
They can be divided into superficial and deep groups, which are flamboyantly arranged around
the gyri and sulci of the brain. Upon exiting the cerebral parenchyma, the veins run in the
subarachnoid space and pierce the meninges to drain into the dural venous sinuses.
Superficial System
The superficial system of veins is largely responsible for draining the cerebral cortex:
Superior cerebral veins: Drain the superior surface, carrying blood to the superior sagittal sinus.
Superficial middle cerebral vein: Drains the lateral surface of each hemisphere, carrying blood to
the cavernous or sphenopalatine sinuses.
Inferior cerebral veins: Drain the inferior aspect of each cerebral hemisphere, depositing blood
into cavernous and transverse sinuses.
Superior anastamotic vein (Trolard): Connects the superficial middle cerebral vein to the superior
sagittal sinus.
Inferior anastamotic vein (Labbé): Connects the superficial middle cerebral vein to the transverse
sinus.
Deep System
Subependymal veins – There are numerous subependymal veins, which will not be described here
in detail. These receive blood from the medullary veins and carry it to the dural venous sinuses.
The great cerebral vein (vein of Galen) is worthy of a mention; it is formed by the union of two of
the deep veins, and drains into the straight sinus.
Medullary veins: Originate 1-2cm below the cortical grey matter, and drain into subependymal
veins. These drain the deep areas of the brain.
148. Relief of the dorso-lateral surface of the cerebral hemispheres. Localization of nuclei of
analyzers in the cortex of the frontal lobe.
The dorsolateral prefrontal cortex (DLPFC or DL-PFC) is an area in the prefrontal cortex of the
brain of humans and other primates. It is one of the most recently derived parts of the human
brain. It undergoes a prolonged period of maturation which lasts until adulthood.[1] The DLPFC
is not an anatomical structure, but rather a functional one. It lies in the middle frontal gyrus of
humans (i.e., lateral part of Brodmann's area (BA) 9 and 46[2]). In macaque monkeys, it is around
the principal sulcus (i.e., in Brodmann's area 46[3][4][5]). Other sources consider that DLPFC is
attributed anatomically to BA 9 and 46[6] and BA 8, 9 and 1The DLPFC has connections with the
orbitofrontal cortex, as well as the thalamus, parts of the basal ganglia (specifically, the dorsal
caudate nucleus), the hippocampus, and primary and secondary association areas of neocortex
(including posterior temporal, parietal, and occipital areas).[7] The DLPFC is also the end point
for the dorsal pathway (stream),[8] which is concerned with how to interact with stimuli.An
important function of the DLPFC is the executive functions, such as working memory, cognitive
flexibility,[9] planning, inhibition, and abstract reasoning.[10] However, the DLPFC is not
exclusively responsible for the executive functions. All complex mental activity requires the
additional cortical and subcortical circuits with which the DLPFC is connected.[11] The DLPFC
is also the highest cortical area that is involved in motor planning, organization and regulation
Structure
As the DLPFC is composed of spatial selective neurons, it has a neural circuitry that encompasses
the entire range of sub-functions necessary to carry out an integrated response, such as: sensory
input, retention in short-term memory, and motor signaling.[12] Historically, the DLPFC was
defined by its connection to: the superior temporal cortex, the posterior parietal cortex, the
anterior and posterior cingulate, the premotor cortex, the retrosplenial cortex, and the
neocerebellum.[1] These connections allow the DLPFC to regulate the activity of those regions,
as well as to receive information from and be regulated by those regions.
Function-Edit
Primary functions
The DLPFC is known for its involvement in the executive functions, which is an umbrella term
for the management of cognitive processes,[13] including working memory, cognitive
flexibility,[14] and planning.[15] A couple of tasks have been very prominent in the research on
the DLPFC, such as the A-not-B task, the delayed response task and object retrieval tasks.[1] The
behavioral task that is most strongly linked to DLPFC is the combined A-not-B/delayed response
task, in which the subject has to find a hidden object after a certain delay. This task requires
holding information in mind (working memory), which is believed to be one of the functions of
DLPFC.[1] The importance of DLPFC for working memory was strengthened by studies with
adult macaques. Lesions that destroyed DLPFC disrupted the macaques’ performance of the A-
not-B/delayed response task, whereas lesions to other brain parts did not impair their performance
on this task.[1].DLPFC is not required for the memory of a single item. Thus, damage to the
dorsolateral prefrontal cortex does not impair recognition memory.[16] Nevertheless, if two items
must be compared from memory, the involvement of DLPFC is required. People with damaged
DLPFC are not able to identify a picture they had seen, after some time, when given the
opportunity to choose from two pictures.[16] Moreover, these subjects also failed in Wisconsin
Card-Sorting Test as they lose track of the currently correct rule and persistently organize their
cards in the previously correct rule.[17] In addition, as DLPFC deals with waking thought and
reality testing, it is not active when one is asleep.[17] Likewise, DLPFC is most frequently related
to the dysfunction of drive, attention and motivation.[18] Patients with minor DLPFC damage
display disinterest in their surroundings and are deprived of spontaneity in language as well as
behavior.[18] Patients may also be less alert than normal to people and events they know.[18]
Damage to this region in a person also leads to the lack of motivation to do things for themselves
and/or for others.[18]
Decision making
The DLPFC is involved in both risky and moral decision making; when individuals have to make
moral decisions like how to distribute limited resources, the DLPFC is activated.[19] This region
is also active when costs and benefits of alternative choices are of interest.[20] Similarly, when
options for choosing alternatives are present, the DLPFC evokes a preference towards the most
equitable option and suppresses the temptation to maximize personal gain.[21]
Working memory
Working memory is the system that actively holds multiple pieces of transitory information in the
mind, where they can be manipulated. The DLPFC is important for working memory;[22]
reduced activity in this area correlates to poor performance on working memory tasks.[23]
However, other areas of the brain are involved in working memory as well.[
149. Relief of the dorso-lateral surface of the cerebral hemispheres. Localization of nuclei
analyzers in the cortex of the parietal lobe.
150. Relief of the medial surface of the cerebral hemispheres. Localization of nuclei of analyzers
in this area of the hemispheres.
The medial surface of each cerebral hemisphere is flat, the inferior surface is irregular and even
slightly concave anteriorly, while the lateral surface is convex. They are all lined by cerebral
cortex. The surface of the cerebral hemisphere is divided by grooves, called sulci, into ridges
called gyri.Sulci and gyri
Inferior to the genu of the corpus callosum and anterior to the lamina terminalis of the
hypothalamus is the subcallosal gyrus. The cingulate gyrus commences just anterior to the
parolfactory area (inferior to the genu of the corpus callosum) and follows the contour of the
commissural body and the callosal sulcus. The cingulate sulcus is superior to the cingulate gyrus
and separates it from the medial frontal gyrus.The medial frontal gyrus is limited posteriorly by
the paracentral sulcus. Posterior to the paracentral lobule (which is behind the paracentral sulcus
and contains a small medial projection of the central sulcus of Rolando), the cingulate sulcus
courses superiorly and becomes the marginal sulcus. The lobule just posterior to the marginal
sulcus is the precuneus. It is separated posteriorly from the cuneus by the parieto-occipital
sulcus.The calcarine sulcus travels horizontally from the occipital pole to meet the parieto-
occipital sulcus just posterior to the venous junction of the great vein of Galen and the straight
sinus. Inferior to the calcarine sulcus is the lingual gyrus of the occipital lobe, which rests on the
cerebral surface of the tentorium cerebelli (roughly horizontal projection of the dura mater).
Medial view
Subcallosal gyrus
Cingulate gyrus
Callosal sulcus
Cingulate sulcus
Medial frontal gyrus
Marginal sulcus
Precuneus
Cuneus
Calcarine sulcus
Lingual sulcus
Diencephalon
151. Relief of the inferior surface of the cerebral hemispheres. The structure of the cortex of the
cerebral hemisphere.
Inferior view
Frontal lobe-The inferior view of the brain reveals more details of the frontal, temporal and
occipital lobes. On the frontal lobe (from medial to lateral), there is a rectus gyrus (straight gyrus)
between the longitudinal cerebral fissure and an olfactory sulcus. The olfactory sulcus, which is
more lateral than the gyrus rectus, provides a pathway for the olfactory tract to course towards its
destination. There are also two orbital sulci and two orbital gyri found on the inferior aspect of the
frontal lobe.
Rectus gyrus-The gyrus rectus is a portion of the brain located at the medial most margin of the
inferior surface of the frontal lobe. While its function is unclear, it may be involved in higher
cognitive function (such as personality).
Olfactory sulcus-The medial orbital gyrus presents a well-marked antero-posterior sulcus, the
olfactory sulcus. Its depth is an indicator of congenital anosmia.[1
Orbital sulci & gyri-Inferior to the genu of the corpus callosum and anterior to the lamina
terminalis of the hypothalamus is the subcallosal gyrus. The cingulate gyrus commences just
anterior to the parolfactory area (inferior to the genu of the corpus callosum) and follows the
contour of the commissural body and the callosal sulcus. The cingulate sulcus is superior to the
cingulate gyrus and separates it from the medial frontal gyrus.The medial frontal gyrus is limited
posteriorly by the paracentral sulcus. Posterior to the paracentral lobule (which is behind the
paracentral sulcus and contains a small medial projection of the central sulcus of Rolando), the
cingulate sulcus courses superiorly and becomes the marginal sulcus. The lobule just posterior to
the marginal sulcus is the precuneus. It is separated posteriorly from the cuneus by the parieto-
occipital sulcus.The calcarine sulcus travels horizontally from the occipital pole to meet the
parieto-occipital sulcus just posterior to the venous junction of the great vein of Galen and the
straight sinus. Inferior to the calcarine sulcus is the lingual gyrus of the occipital lobe, which rests
on the cerebral surface of the tentorium cerebelli (roughly horizontal projection of the dura
mater).
Temporal lobe-The uncus of the temporal lobe is lateral to the hypophysis cerebri, tuber
cinereum, mammillary bodies and posterior perforated substance (in the interpeduncular fossa). It
is also posterior to the anterior perforated substance and anterior to the crus cerebri and lateral
geniculate body of the thalamus. It is adjacent to the parahippocampal gyrus. The
parahippocampal gyrus is laterally limited by the rhinal sulcus anteriorly and the collateral sulcus
posterior. It also continues posteriorly as the medial occipitotemporal gyrus. The collateral sulcus
serves as a medial border for the lateral occipitotemporal gyrus, which is limited laterally by the
occipitotemporal sulcus.
Uncus-The uncus is an anterior extremity of the parahippocampal gyrus. It is separated from the
apex of the temporal lobe by a slight fissure called the incisura temporalis. Although superficially
continuous with the hippocampal gyrus, the uncus forms morphologically a part of the
rhinencephalon.
Parahippocampal gyrus-The parahippocampal gyrus (or hippocampal gyrus) is a grey matter

cortical region of the brain that surrounds the hippocampus and is part of the limbic system. The
region plays an important role in memory encoding and retrieval. It has been involved in some
cases of hippocampal sclerosis
Rhinal sulcus-In the human brain, the entorhinal cortex appears as a longitudinal elevation
anterior to the parahippocampal gyrus, with a corresponding internal furrow, the external rhinal
sulcus (or rhinal fissure), separating it from the inferiolateral surface of the hemisphere close to
the lamina terminalis. It is analogous to the collateral fissure found further caudally in the inferior
part of the temporal lobe.
Medial occipitotemporal gyrus
Collateral sulcus-The collateral fissure (or sulcus) is on the tentorial surface of the hemisphere
and extends from near the occipital pole to within a short distance of the temporal pole
Lateral occipitotemporal gyrus
Occipitotemporal sulcus-The medial occipitotemporal gyrus runs along the medial aspect of the
temporal lobe and occipital lobe. It is formed by two gyri usually referred to separately; temporal
(parahippocampal gyrus) and occipital (lingual gyrus). This is probably preferable to avoid
confusion with the fusiform gyrus (also known as the temporo-occipital gyrus), which runs
parallel and just lateral to the medial occipitotemporal gyrus, separated from it by the collateral
sulcus 1.
152. Ascending pathways: proprioceptive pathways of cerebellar direction.
153. Ascending pathways: proprioceptive pathways of the cortical direction (Goll, Burdach).
154. Ascending pathways of touch and pressure.

155. Ascending pathways of pain and temperature sensitivity.
156. Descending pathways. Classification. Cortickcrospinal pathsways (pyramidal).
The pyramidal tract provides voluntary control of muscular movements. It consists of two distinct
pathways, the corticobulbar tract and the corticospinal tract.The corticospinal tract carries motor
signals from the primary motor cortex in the brain, down the spinal cord, to the muscles of the
trunk and limbs. Thus, this tract is involved in the voluntary movement of muscles of the
body.The corticobulbar tract carries efferent, motor, information from the primary motor cortex to
the muscles of the face, head and neck. It does this by synapsing with motor cranial nerves in the
brainstem. Therefore the corticobulbar tract is responsible for innervating the muscles of the face,
head and neck, as well as the muscles involved in swallowing, phonation and facial expression.
The corticospinal tract is a motor pathway that carries efferent information from the cerebral
cortex to the spinal cord. It is responsible for the voluntary movements of the limbs and trunk.
The path starts in the motor cortex, where the bodies of the first-order neurons lie. These
specialized upper motor neurons are called the pyramidal cells of Betz. Axons of Betz cells
descend and converge to join a white matter sheet within each cerebral hemisphere called the
“corona radiata''. The fibers then pass inferiorly through the anterior two-thirds of the posterior
arm of the internal capsule (a white matter structure, located between the thalamus and the basal
ganglia), through the cerebral peduncles of the midbrain, the pons and into the medulla.
In the anterior aspect of the lower medulla, the majority of corticospinal fibers decussate
(pyramidal decussation). The crossed fibers form the lateral corticospinal tract while the
uncrossed fibers enter the anterior corticospinal tract. The former is responsible for providing
voluntary motor information to the muscles of the limbs while the latter supplies the axial
muscles of the trunk. Both tracts run along the spinal cord, synapsing with lower motor neurons in
the anterior gray horn on the same side. The lower motor neurons leave the spinal cord through
the ventral root and form peripheral nerves which innervate the musculature of the body.
157. Extrapyramidal system. Descending pathsways of the extrapyramidal system.
Extrapyramidal Tracts
The extrapyramidal tracts originate in the brainstem, carrying motor fibres to the spinal cord.
They are responsible for the involuntary and automatic control of all musculature, such as muscle
tone, balance, posture and locomotion.
There are four tracts in total. The vestibulospinal and reticulospinal tracts do not decussate,
providing ipsilateral innervation. The rubrospinal and tectospinal tracts do decussate, and
therefore provide contralateral innervation
Vestibulospinal Tracts
There are two vestibulospinal pathways; medial and lateral. They arise from the vestibular nuclei,
which receive input from the organs of balance. The tracts convey this balance information to the
spinal cord, where it remains ipsilateral.
Fibres in this pathway control balance and posture by innervating the ‘anti-gravity’ muscles
(flexors of the arm, and extensors of the leg), via lower motor neurones.
Reticulospinal Tracts
The two recticulospinal tracts have differing functions:
The medial reticulospinal tract arises from the pons. It facilitates voluntary movements, and
increases muscle tone.
The lateral reticulospinal tract arises from the medulla. It inhibits voluntary movements, and
reduces muscle tone.
Rubrospinal Tracts
The rubrospinal tract originates from the red nucleus, a midbrain structure. As the fibres emerge,
they decussate (cross over to the other side of the CNS), and descend into the spinal cord. Thus,
they have a contralateral innervation.
Its exact function is unclear, but it is thought to play a role in the fine control of hand movements
Tectospinal Tracts
This pathway begins at the superior colliculus of the midbrain. The superior colliculus is a
structure that receives input from the optic nerves. The neurones then quickly decussate, and
enter the spinal cord. They terminate at the cervical levels of the spinal cord.
The tectospinal tract coordinates movements of the head in relation to vision stimuli.
158. External ear, its parts, structure. Timpanic membrane.
The ear can be divided into three parts; external, middle and inner. This article will focus on the
anatomy of the external ear – its structure, neurovascular supply and clinical correlations.The
external ear can be divided functionally and structurally into two parts; the auricle (or pinna), and
the external acoustic meatus – which ends at the tympanic membrane.
Auricle
The auricle is a paired structure found on either side of the head. It functions to capture and direct
sound waves towards the external acoustic meatus.
It is a mostly cartilaginous structure, with the lobule being the only part not supported by
cartilage. The cartilaginous part of the auricle forms an outer curvature, known as the helix. A
second innermost curvature runs in parallel with the helix – the antihelix. The antihelix divides
into two cura; the inferoanterior crus, and the superoposterior crus.In the middle of the auricle is a
hollow depression, called the concha. It continues into the skull as the external acoustic meatus.
The concha acts to direct sound into the external acoustic meatus. Immediately anterior to the
beginning of the external acoustic meatus is an elevation of cartilaginous tissue – the tragus.
Opposite the tragus is the antitragus.
External Acoustic Meatus
The external acoustic meatus is a sigmoid shaped tube that extends from the deep part of the
concha to the tympanic membrane. The walls of the external 1/3 are formed by cartilage, whereas
the inner 2/3 are formed by the temporal bone.
The external acoustic meatus does not have a straight path, and instead travels in an S-shaped
curve as follows:
Initially it travels in a superoanterior direction.
In then turns slightly to move superoposteriorly.
It ends by running in an inferoanterior direction.
Tympanic Membrane
The tympanic membrane lies at the distal end of the external acoustic meatus. It is a connective
tissue structure, covered with skin on the outside and a mucous membrane on the inside. The
membrane is connected to the surrounding temporal bone by a fibrocartilaginous ring.The
translucency of the tympanic membrane allows the structures within the middle ear to be
observed during otoscopy. On the inner surface of the membrane, the handle of malleus attaches
to the tympanic membrane, at a point called the umbo of tympanic membrane.The handle of
malleus continues superiorly, and at its highest point, a small projection called the lateral process
of the malleus can be seen. The parts of the tympanic membrane moving away from the lateral
process are called the anterior and posterior malleolar f
olds.
159. Anatomy of the middle ear: the walls of the tympanic cavity. Auditory bones, auditory tube.
Walls[edit]
The tympanic cavity is bounded by:
• Facing the inner ear, the medial wall (or labyrinthic wall, labyrinthine wall) is vertical, and
has the oval window and round window, the promontory, and the prominence of the facial
canal.
• Facing the outer ear, the lateral wall (or membranous wall), is formed mainly by
the tympanic membrane, partly by the ring of bone into which this membrane is inserted.
• The roof of the cavity (also called the tegmental wall, tegmental roof or tegmentum
tympani) is formed by a thin plate of bone, the tegmen tympani, which separates the
cranial and tympanic cavities. It is situated on the anterior (frontal) surface of the petrous
portion of the temporal bone close to its angle of junction with the squama temporalis; it is
prolonged backward so as to roof in the tympanic antrum, and forward to cover in the
semicanal for the tensor tympani muscle. Its lateral edge corresponds with the remains of
the petrosquamous suture.[1] The Atticus is the part of the tegmentum tympani where the
stapes and incus are attached.
• The floor of the cavity (also called the jugular wall) is narrow, and consists of a thin plate
of bone (fundus tympani) which separates the tympanic cavity from the jugular fossa. It
presents, near the labyrinthic wall, a small aperture for the passage of the tympanic branch
of the glossopharyngeal nerve.
• The posterior wall (or mastoid wall) is wider above than below, and presents for
examination the entrance to the tympanic antrum, the pyramidal eminence, and the fossa
incudis.
• The anterior wall (or carotid wall) is wider above than below; it corresponds with the
carotid canal,
Ear bone, also called Auditory Ossicle, any of the three tiny bones in the middle ear of all
mammals. These are the malleus, or hammer, the incus, or anvil, and the stapes, or stirrup.
Auditory tube: The tube that runs from the middle ear to the pharynx, also known as
the Eustachian tube. The function of this tube is to protect, aerate and drain the middle ear
(and mastoid). Occlusion of the Eustachian tube leads to the development of middle ear
inflammation (otitis media).
160. The inner ear: bony and membranous labyrinths.

Ans:The bony labyrinth (also osseous labyrinth or otic capsule) is the rigid, bony outer wall of the
inner ear in the temporal bone. It consists of three parts: the vestibule, semicircular canals, and
cochlea
The membranous labyrinth is a continuous system of ducts filled with endolymph. It lies within
the bony labyrinth, surrounded by perilymph. It is composed of the cochlear duct, three semi-
circular ducts, saccule and the utricle. The cochlear duct is situated within the cochlea and is the
organ of hearing.
161. Spiral organ. Ascending pathways of the auditory analyzer.

Ans;The organ of Corti, or spiral organ, is the receptor organ for hearing and is located in the
mammalian cochlea. This highly varied strip of epithelial cells allows for transduction of auditory
signals into nerve impulses' action potential
Ascending pathways
This complex chain of nerve cells helps to process and relay auditory information, encoded in the
form of nerve impulses, directly to the highest cerebral levels in the cortex of the brain. To some
extent different properties of the auditory stimulus are conveyed along distinct parallel
pathways.From the cochlea to the brainstem. The auditory pathway begins in the spiral ganglion
of the cochlea, where the axons of the spiral ganglion neurons form the auditory nerve
162. Organ of vision. Eye, layes. The mechanism of accommodation.

Ans:The eye is made up of three coats, which enclose the optically clear aqueous humour,
lens, and vitreous body. The outermost coat consists of the cornea and the sclera; the middle coat
contains the main blood supply to the eye and consists, from the back forward, of the choroid, the
ciliary body, and the iris.The retina is a layer on the inside of the back of the eyeball. It contains
highly specialised nerve cells. These convert the light which is focused there into electrical
signals. These are then passed through the optic nerves to the parts of the brain which process
vision and build up the picture that we see.
Accommodation is the process in which the eyes see objects at different distances and maintain
clear images of the objects by the convergence and divergence of light.According to the classical
view, as described by Helmholtz,9 accommodation occurs by contraction (forward and inward
movement) of the ciliary muscle and relaxation of the zonules that attach the ciliary body to the
lens; as a result, the lens thickens and becomes more steeply curved, increasing the refractive
power
163. Refracting eye environment: cornea, liquid chambers of the eye, lens, vitreum body
Ans :The cornea is the transparent part of the eye that covers the front portion of the eye. It
covers the pupil (the opening at the center of the eye), iris (the colored part of the eye), and
anterior chamber (the fluid-filled inside of the eye.The cornea acts as the eye's outermost lens. It
functions like a window that controls and focuses the entry of light into the eye. The cornea
contributes between 65- 75 percent of the eye's total focusing power. When light strikes the
cornea, it bends--or refracts--the incoming light onto the lens
Fluid fills most of the inside of the eye. The chambers in front of the lens (both the anterior
and posterior chambers) are filled with a clear, watery fluid called aqueous humor. The large
space behind the lens (the vitreous chamber) contains a thick, gel-like fluid called vitreous humor
or vitreous gel
The lens is located in the eye. By changing its shape, the lens changes the focal distance of
the eye. In other words, it focuses the light rays that pass through it (and onto the retina) in order
to create clear images of objects that are positioned at various distances
The vitreous humour (also known simply as the vitreous) is a clear, colourless fluid that fills
the space between the lens and the retina of your eye. 99% of it consists of water and the rest is a
mixture of collagen, proteins, salts and sugars
164. Retina of the eye, its structure and development. Ascending pathways of the visual analyzer.
Ans:The retina is formed from the optic cup. As a consequence of how it arises it is double
layered; the outer layer becoming the retinal pigment epithelium and the inner layer, nearest the
lens vesicle, becoming the neural retina. Both of these layers are continuous with the wall of the
forebrain.The retina is a thin layer of tissue that lines the back of the eye on the inside. It is
located near the optic nerve. The purpose of the retina is to receive light that the lens has focused,
convert the light into neural signals, and send these signals on to the brain for visual recognition.
The optic nerve is the pathway that carries the nerve impulses from each eye to the various
structures in the brain that analyze these visual signals. The optic nerves of the two eyes emerge
from their optics discs and intersect at the optic chiasm just in front of the pituitary gland.
The Visual Pathway. The visual pathway consists of the retina, optic nerves, optic chiasm, optic
tracts, lateral geniculate bodies, optic radiations, and visual cortex.
165. Additional organs of the eye: their innervation, blood supply.
Ans: 6 cranial nerves innervate motor, sensory, and autonomic structures of the eye.
Optic Nerve (CN II): ...
Oculomotor Nerve (CN III): ...
Trochlear Nerve (CN IV): ...
Trigeminal Nerve (CN V): ...
Abducens Nerve (CN VI): ...
Facial Nerve (CN VII): ...
Sympathetic Nervous System. ...
Parasympathetic Nervous System.
The eyeball receives arterial blood primarily via the ophthalmic artery. This is a branch of the
internal carotid artery, arising immediately distal to the cavernous sinus. The ophthalmic artery
gives rise to many branches, which supply different components of the eye
166. The optic nerve. Ascending pathways of the visual analyzer.

Ans ; The optic nerve, also known as cranial nerve II, or simply as CN II, is a paired cranial nerve
that transmits visual information from the retina to the brain. In humans, the optic nerve is derived
from optic stalks during the seventh week of development and is composed of retinal ganglion
cell axons and glial cells; it extends from the optic disc to the optic chiasma and continues as the
optic tract to the lateral geniculate nucleus, pretectal nuclei, and superior colliculus
The optic nerve is the pathway that carries the nerve impulses from each eye to the various
structures in the brain that analyze these visual signals. The optic nerves of the two eyes emerge
from their optics discs and intersect at the optic chiasm just in front of the pituitary gland
167. The concept of the neuron (neyrotcyte). Nerve fibers, bundles, roots, nodes, simple and
compound reflex arches.
Ans; The neuron is the basic working unit of the brain, a specialized cell designed to transmit
information to other nerve cells, muscle, or gland cells. Neurons are cells within the nervous
system that transmit information to other nerve cells, muscle, or gland cells. Most neurons have a
cell body, an axon, and dendrites
An axon (from Greek ἄξων áxōn, axis), or nerve fiber (or nerve fibre: see spelling differences),
is a long, slender projection of a nerve cell, or neuron, in vertebrates, that typically conducts
electrical impulses known as action potentials away from the nerve cell body
In the peripheral nervous system a bundle of axons is called a nerve. In the central nervous
system a bundle of axons is called a tract. Each axon is surrounded by a delicate endoneurium
layer. The course connective tissue layer called perineurium, binds the fibers into bundles called
fascicles.
A dorsal root ganglion (or spinal ganglion; also known as a posterior root ganglion) is a
cluster of neurons (a ganglion) in a dorsal root of a spinal nerve. The cell bodies of sensory
neurons known as first-order neurons are located in the dorsal root ganglia.
Nodes of Ranvier are microscopic gaps found within myelinated axons. Their function is to
speed up propagation of action potentials along the axon via saltatory conduction. The Nodes of
Ranvier are the gaps between the myelin insulation of Schwann cells which insulate the axon of
neuron
The nerve pathway followed by a reflex action is called a reflex arc. For example, a simple
reflex arc happens if we accidentally touch something hot. Receptor in the skin detects a stimulus
(the change in temperature). Sensory neurone sends impulses to relay neurone . Motor neurone
sends impulses to effector.
168. Spinal nerve: formation and its branches.
Ans ;A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals
between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one
on each side of the vertebral column
Each spinal nerve is formed by the combination of nerve fibers from the dorsal and ventral
roots of the spinal cord. The dorsal roots carry afferent sensory axons, while the ventral roots
carry efferent motor axons.
Spinal nerve, in vertebrates, any one of many paired peripheral nerves that arise from the spinal
cord. In humans there are 31 pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal
The spinal nerves branch into the dorsal ramus, ventral ramus, the meningeal branches, and the
rami communicantes
169 Cervical plexus: formation, topography, branches, regions of innervation.
The cervical plexus is a plexus of the anterior rami of the first four cervical spinal nerves
which arise from C1 to C4 cervical segment in the neck. They are located laterally to the
transverse processes between prevertebral muscles from the medial side and vertebral (m.
scalenus, m. levator scapulae, m
The cervical plexus is formed from the anterior primary rami of C1–C4, deep to the
sternocleidomastoid muscle and in front of the scalenus medius and levator scapulae muscles.
Sensory branches include the greater and lesser occipital nerves, great auricular nerve, cutaneous
cervical nerves, and supraclavicular nerves.
The cervical plexus is a network of nerve fibres that supplies innervation to some of the
structures in the neck and trunk. It is located in the posterior triangle of the neck, halfway up the
sternocleidomastoid muscle, and within the prevertebral layer of cervical fascia.
Branches of the Cervical Plexus

Ansa Cervicalis. The ansa cervicalis is a loop of nerves, formed by nerve roots C1-C3. ...
Other Muscular Branches. ...
Greater Auricular Nerve. ...
Transverse Cervical Nerve. ...
Lesser Occipital Nerve. ...
Supraclavicular Nerves.
Branches of the Cervical Plexus

The cervical plexus gives rise to numerous branches which supply structures in the head and neck.
They can broadly be divided into two groups – muscular branches and sensory branches.
We shall now examine these branches in more detail.
Muscular Branches
The muscular branches of the cervical plexus are located deep to the sensory branches. They
supply some of the muscles of the neck, back and the diaphragm.
After arising from the cervical plexus, the muscular branches tend to travel initially in an
anteromedial direction. This is in contrast to the cutaneous branches, which travel posteriorly.
Phrenic Nerve
The phrenic nerve arises from the anterior rami of C3-C5. It provides motor innervation to the
diaphragm.
After arising from the cervical plexus, the nerve travels down the surface of the anterior scalene
muscle and enters the thorax. In the thoracic cavity, the nerve descends anteriorly to the root of
the lung to reach the diaphragm.
A good memory aid for the roots of the phrenic nerve is C3,4,5 keeps the diaphragm alive.
Nerves to Geniohyoid and Thyrohyroid
The C1 spinal nerve gives rise to nerves to the geniohyoid (moves the hyoid bone anteriorly and
upwards, expanding the airway) and the thyrohyoid (which depresses the hyoid bone and elevates
the larynx).
These nerves travel with the hypoglossal nerve to reach their respective muscles.
Ansa Cervicalis
The ansa cervicalis is a loop of nerves, formed by nerve roots C1-C3. It gives off four muscular
branches:
Superior belly of the omohyoid muscle

Inferior belly of omohyoid muscle
Sternohyoid
Sternothyroid
These muscles (the infrahyoids) act to depress the hyoid bone; an important function for
swallowing and speech.
Other Muscular Branches
Several other minor branches arise from the nerve roots to supply muscles of the neck and back:
C1-C2: Rectus capitis anterior and lateralis

C1-C3: Longus capitis
C2-C3: Prevertebral muscles and sternocleidomastoid
C3-C4: Levator scapulae, trapezius and scalenus medius
The middle and anterior scalenus muscles also receive innervation directly from the cervical
plexus.
170. Thoracic nerves: topography, branches, regions of innervation.
Ans; The thoracic nerves refer to the cluster of nerve fibers found in the upper body,
particularly within the chest region. These nerve fibers are considered spinal nerves, which carry
and transmit information between the spinal cord and parts of the body.
The posterior ramus of the thoracic nerve passed through the narrow space between the
bony structures and adjacent fibrous tissue. It is sent to the first branch, which is called "the
descending branch," before bifurcating into medial and lateral branches
The medial branches (ramus medialis; internal branch) of the posterior divisions supply
Semispinalis dorsi and Multifidus, Longissimus dorsi. The lateral branches (ramus lateralis;
external branch) supply Longissimus dorsi, Iliocostales. the skin of the buttock.
The thoracic spine has 12 nerve roots (T1 to T12) on each side of the spine that branch from
the spinal cord and control motor and sensory signals mostly for the upper back, chest, and
abdomen. Each thoracic spinal nerve is named for the vertebra above it.
171. Brachial plexus: formation, topography, short branches, regions of innervation.

Ans: The brachial plexus is a network (plexus) of nerves (formed by the anterior rami of the lower
four cervical nerves and first thoracic nerve (C5, C6, C7, C8, and T1). This plexus extends from
the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the
armpit.
Roots
The ‘roots’ refer the anterior rami of the spinal nerves that comprise the brachial plexus. These
are the anterior rami of spinal nerves C5, C6, C7, C8, and T1.
At each vertebral level, paired spinal nerves arise. They leave the spinal cord via the intervertebral
foramina of the vertebral column.
Each spinal nerve then divides into an anterior and a posterior ramus. The roots of the brachial
plexus are formed by the anterior rami of spinal nerves C5-T1 (the posterior divisions innervate
the skin and musculature of the intrinsic back muscles).
After their formation, these nerves pass between the anterior and medial scalene muscles to enter
the base of the neck.
Trunks
At the base of the neck, the roots of the brachial plexus converge to form three trunks. These
structures are named by their relative anatomical location:
Superior trunk – a combination of C5 and C6 roots.

Middle trunk – continuation of C7.
Inferior trunk – combination of C8 and T1 roots.
Divisions
Each trunk divides into two branches within the posterior triangle of the neck. One division
moves anteriorly (toward the front of the body) and the other posteriorly (towards the back of the
body). Thus, they are known as the anterior and posterior divisions.
We now have three anterior and three posterior nerve fibres. These divisions leave the posterior
triangle and pass into the axilla. They recombine into the cords of the brachial plexus.
Cords
Once the anterior and posterior divisions have entered the axilla, they combine together to form
three cords, named by their position relative to the axillary artery.
The lateral cord is formed by:
The anterior division of the superior trunk

The anterior division of the middle trunk
The posterior cord is formed by:
The posterior division of the superior trunk

The posterior division of the middle trunk
The posterior division of the inferior trunk
The medial cord is formed by:
The anterior division of the inferior trunk.

The cords give rise to the major branches of the brachial plexus.
172 Brachial plexus: formation, topography, long branches, regions of innervation.
Ans: The brachial plexus is a network (plexus) of nerves (formed by the anterior rami of the lower
four cervical nerves and first thoracic nerve (C5, C6, C7, C8, and T1). This plexus extends from
the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the
armpit.
Roots
The ‘roots’ refer the anterior rami of the spinal nerves that comprise the brachial plexus. These
are the anterior rami of spinal nerves C5, C6, C7, C8, and T1.
At each vertebral level, paired spinal nerves arise. They leave the spinal cord via the intervertebral
foramina of the vertebral column.
Each spinal nerve then divides into an anterior and a posterior ramus. The roots of the brachial
plexus are formed by the anterior rami of spinal nerves C5-T1 (the posterior divisions innervate
the skin and musculature of the intrinsic back muscles).
After their formation, these nerves pass between the anterior and medial scalene muscles to enter
the base of the neck.
Trunks
At the base of the neck, the roots of the brachial plexus converge to form three trunks. These
structures are named by their relative anatomical location:
Superior trunk – a combination of C5 and C6 roots.

Middle trunk – continuation of C7.
Inferior trunk – combination of C8 and T1 roots.
Divisions
Each trunk divides into two branches within the posterior triangle of the neck. One division
moves anteriorly (toward the front of the body) and the other posteriorly (towards the back of the
body). Thus, they are known as the anterior and posterior divisions.
We now have three anterior and three posterior nerve fibres. These divisions leave the posterior
triangle and pass into the axilla. They recombine into the cords of the brachial plexus.
Cords
Once the anterior and posterior divisions have entered the axilla, they combine together to form
three cords, named by their position relative to the axillary artery.
The lateral cord is formed by:
The anterior division of the superior trunk

The anterior division of the middle trunk
The posterior cord is formed by:
The posterior division of the superior trunk

The posterior division of the middle trunk
The posterior division of the inferior trunk
The medial cord is formed by:
The anterior division of the inferior trunk.

The cords give rise to the major branches of the brachial plexus.
173. Lumbar plexus: formation, topography, branches, regions of innervation.
is located in the lumbar region, within the substance of the psoas major muscle and anterior to the
transverse processes of the lumbar vertebrae. The plexus is formed by the anterior rami
(divisions) of the lumbar spinal nerves L1, L2, L3 and L4. It also receives contributions from
thoracic spinal nerve 12.
It is created from lumbar spinal nerves L2, L3, and L4. Its principal function is to supply motor
and sensory innervation to the anterior compartment of the thigh. The nerve exits the plexus and
enters the femoral triangle, passing just lateral to the femoral artery
The lumbar plexus passes through the psoas major muscle and innervates the skin and muscles of
the abdominal wall, thigh, and external genitalia. The largest nerve that forms part of the lumbar
plexus is the femoral nerve, which innervates the anterior thigh muscles and some of the skin
distal to the inguinal ligament
174. Sacral plexus: formation, topography, short branches, regions of innervation

The sacral plexus is a network of nerve fibres that supplies the skin and muscles of the pelvis and
lower limb. It is located on the surface of the posterior pelvic wall, anterior to the piriformis
muscle. The plexus is formed by the anterior rami (divisions) of the sacral spinal nerves S1, S2,
S3 and S4.
The sacral plexus is derived from the anterior rami of spinal nerves L4, L5, S1, S2, S3, and S4.
Each of these anterior rami gives rise to anterior and posterior branches. The anterior branches
supply flexor muscles of the lower limb, and posterior branches supply the extensor and abductor
muscles
lower limb. The plexus is formed by the anterior rami (divisions) of the sacral spinal nerves S1,
S2, S3 and S4. ... It also receives contributions from the lumbar spinal nerves L4 and L5.
175. Sacral plexus: formation. Topography, long branches regions of innervation.
lower limb. It is located on the surface of the posterior pelvic wall, anterior to the piriformis
muscle. The plexus is formed by the anterior rami (divisions) of the sacral spinal nerves S1, S2,
S3 and S4.
The sacral plexus is derived from the anterior rami of spinal nerves L4, L5, S1, S2, S3, and S4.
Each of these anterior rami gives rise to anterior and posterior branches. The anterior branches
supply flexor muscles of the lower limb, and posterior branches supply the extensor and abductor
muscles
lower limb. The plexus is formed by the anterior rami (divisions) of the sacral spinal nerves S1,
S2, S3 and S4. ... It also receives contributions from the lumbar spinal nerves L4 and L5.
176. Dorsal branches of the spinal nerves, their characteristics and regions of innervation.
Spinal Nerve Innervation

Outside the vertebral column, the nerve divides into branches. The dorsal ramus contains nerves
that serve the dorsal portions of the trunk; it carries visceral motor, somatic motor, and somatic
sensory information to and from the skin and muscles of the back (epaxial muscles).
Spinal Nerve Innervation

The dorsal ramus contains nerves that serve the dorsal portions of the trunk; it carries visceral
motor, somatic motor, and somatic sensory information to and from the skin and muscles of the
back (epaxial muscles).
177. Cranial nerves: III, IV, VI pairs, formation, topography, branches, regions of innervat
The oculomotor nerve is the third cranial nerve (CN III). It enters the orbit via the superior orbital
fissure and innervates extrinsic eye muscles that enable most movements of the eye and that raise
the eyelid. The nerve also contains fibers that innervate the intrinsic eye muscles that enable
pupillary constriction and accommodation (ability to focus on near objects as in reading). The
oculomotor nerve is derived from the basal plate of the embryonic midbrain. Cranial nerves IV
and VI also participate in control of eye movement.[1]
From
oculomotor nucleus, Edinger-Westphal nucleus
To
superior branch, inferior branch
Innervates
Superior rectus, inferior rectus, medial rectus, inferior oblique, levator palpebrae superioris,
sphincter pupillae (parasympathetics), ciliaris muscle (parasympathetics)
178. Cranial nerves: V pairs. Intracranial part, I branch. Formation, topography, branches, regions
of innervation.
The three major branches of the trigeminal nerve—the ophthalmic nerve (V1), the maxillary
nerve (V2) and the mandibular nerve (V3)—converge on the trigeminal ganglion (also called the
semilunar ganglion or gasserian ganglion), located within Meckel's cave and containing the cell
bodies of incoming sensory-nerve fibers.
Ophthalmic Nerve
After arising from the trigeminal ganglion, the ophthalmic nerve travels laterally to the cavernous
sinus and gives rise to the recurrent tentorial branch (which supplies the tentorium cerebelli).
The nerve then then exits the cranium via the superior orbital fissure, where it divides into its
three main branches:
Frontal nerve
Lacrimal nerve
Nasociliary nerve
These three branches provide sensory innervation to the skin and mucous membranes of the
structures derived from the frontonasal prominence
Sensory Function
The ophthalmic division of trigeminal nerve provides sensory innervation to the following
structures:
Forehead and scalp

Frontal, ethmoid and sphenoid sinuses
Upper eyelid and its conjunctiva
Cornea
Dorsum of the nose
Lacrimal gland
Parts of the meninges and tentorium cerebelli (recurrent tentorial branch)
The table below outlines the structures innervated by branches of CNV1.
Nerve Branches Innervation

Frontal (largest of three terminal branches of CNV1) Supraorbital Upper eyelid and
conjunctiva
Scalp
Supratrochlear Upper eyelid and conjunctiva
Forehead
Lacrimal (smallest of three terminal branches of CNV1) Receives branch from zygomatic
nerve of CNV2 containing parasympathetic fibres Sensory innervation of lacrimal gland, upper
eyelid and conjunctiva
Contains parasympathetic fibres to lacrimal gland.
Nasociliary Anterior ethmoid nerve Sensory innervation of mucous membranes of
frontal, ethmoid and sphenoid sinuses.
Nasal cavity
Posterior ethmoid nerve Absent in approximately 30% of people
Sensory innervation to mucous membranes of sphenoid sinus
Infratrochlear nerve Bridge of nose Upper eyelid and conjunctiva
Long ciliary nerves Sensory innervation to eye (cornea, ciliary bodies, iris)
Contains sympathetic fibres to dilator pupillae muscle.
179. Cranial nerves: V pair - II branch, formation, topography, branches, regions of innervat
The maxillary nerve is the second branch of the trigeminal nerve, which originates
embryologically from the first pharyngeal arch.
Its primary function is sensory supply to the mid-third of the face.
In this article, we shall look at the anatomy of the maxillary nerve – its anatomical course, sensory
and parasympathetic functions.
Anatomical Course
Trigeminal Nerve
The trigeminal nerve originates from four nuclei, which extend from the midbrain to the medulla
(a nucleus refers to a collection of nerve cell bodies within the central nervous system):
Three sensory nuclei:

Mesencephalic nucleus
Principle sensory nucleus
Spinal nucleus
Motor nucleus of the trigeminal nerve
At the level of the pons, the sensory nuclei merge to form a sensory root. The motor nucleus
continues to form a separate motor root. These roots are analogous with the dorsal and ventral
roots of the spinal cord.
Within the middle cranial fossa, the sensory root expands into the trigeminal ganglion (a ganglion
refers to a collection of the nerve cell bodies outside the central nervous system).
The trigeminal ganglion is located lateral to the cavernous sinus, in a depression of the temporal
bone known as the trigeminal cave or Meckel’s cave.
The motor root passes inferiorly to the sensory root, along the floor of the trigeminal cave. Motor
fibres are only distributed to the mandibular division (V3).
From the trigeminal ganglion, the three terminal divisions of the trigeminal nerve arise; the
ophthalmic (V1), maxillary (V2) and mandibular (V3) nerves.
Maxillary Nerve
After arising from the trigeminal ganglion, the maxillary nerve passes through the lateral wall of
the cavernous sinus, before leaving the skull through the foramen rotundum. It gives rise to
numerous sensory branches:
Superior alveolar nerve (anterior, posterior and middle)

Middle meningeal nerve
Infraorbital nerve
Zygomatic nerve
Inferior palpebral nerve
Superior labial nerve
Pharyngeal nerve
Greater and lesser palatine nerves
Nasopalatine nerve
Sensory Function
The maxillary nerve’s terminal branches innervate the skin, mucous membranes and sinuses of
derivatives of the maxillary prominence of the 1st pharyngeal arch:
Lower eyelid and its conjunctiva

Inferior posterior portion of the nasal cavity (superior anterior is CNV1)
Cheeks and maxillary sinus
Lateral nose
Upper lip, teeth and gingiva
Superior palate
180. Cranial nerves: V pair - III branch, formation, topography, branches, regions of innervation.
The mandibular nerve is a terminal branch of the trigeminal nerve (along with the maxillary and
ophthalmic nerves).
It has a sensory role in the head, and is associated with parasympathetic fibres of other cranial
nerves. However unlike the other branches of the trigeminal nerve, the mandibular nerve also has
a motor function.
In this article, we shall look at the anatomy of the mandibular nerve – its anatomical course,
branches, sensory, motor and autonomic functions.
Anatomical Course
The mandibular nerve contains both sensory and motor axons, arising from three sensory nuclei
(mesencephalic, principal sensory and spinal nuclei of trigeminal nerve) and one motor nucleus
(motor nucleus of the trigeminal nerve) respectively.
The motor root runs along the floor or the trigeminal cave, beneath the ganglion, joining the
sensory root before leaving the cranium through the foramen ovale.
Once the mandibular branch has emerged from the cranium, it courses through the infratemporal
fossa, branching into four tributaries which are described below.

Auriculotemporal Nerve
The auriculotemporal branch arises from the trigeminal nerve as two roots:
Superior root – comprises sensory fibers.

Inferior root – carries secretory-motor parasympathetic fibers, originating from CN IX, to the
parotid gland.
The two roots converge in close proximity to the middle meningeal artery. After converging, the
secretory-motor fibers run to synapse in the otic ganglion, while the sensory fibers pass through
the ganglion without synapsing to eventually innervate:
Anterior part of the auricle

Lateral part of the temple
Anterior external meatus
Anterior tympanic membrane
Buccal Nerve
The buccal branch of the mandibular nerve contains sensory fibres. As it emerges from the
mandibular nerve, it passes between the two heads of the lateral pterygoid muscle before heading
to its target sites.
The nerve provides general sensory innervation to the buccal membranes of the mouth (i.e. the
cheek). It also branches to supply the second and third molar teeth, which is important when
performing dental work on those structures.
Inferior Alveolar Nerve
The inferior alveolar nerve carries both sensory and motor axons to and from the respective
trigeminal nuclei.
After branching from its parent nerve it gives rise to the mylohyoid nerve, a motor nerve to the
mylohyoid and anterior digastric muscles.
The remaining sensory axons enter the mandibular canal, a narrow tunnel running through the
mandible bone. Within this canal the nerve provides branches to the mandibular teeth.
The nerve emerges through the mental foramen as the mental nerve. This provides sensory
innervation to the lower lip and chin.
181. Cranial nerves: VII pair, formation, topography, branches, regions of innervation.
The facial nerve (the labyrinthine segment) is the seventh cranial nerve, or simply CN VII. It
emerges from the pons of the brainstem, controls the muscles of facial expression, and functions
in the conveyance of taste sensations from the anterior two-thirds of the tongue.[1][2] The nerves
typically travels from the pons through the facial canal in the temporal bone and exits the skull at
the stylomastoid foramen.[3] It arises from the brainstem from an area posterior to the cranial
nerve VI (abducens nerve) and anterior to cranial nerve VIII (vestibulocochlear nerve).
From
facial nerve nucleus, intermediate nerve
To
greater superficial petrosal nerve,
Innervates
Motor: Muscles of facial expression, posterior belly of digastric, stylohyoid, stapedius
Special sensory: taste to anterior two-thirds of tongue
Parasympathetic: submandibular gland, sublingual gland, lacrimal gl
182. Cranial nerves: VIII pair, formation, topography, branches, regions of innervation.
The vestibulocochlear nerve (auditory vestibular nerve), known as the eighth cranial nerve,
transmits sound and equilibrium (balance) information from the inner ear to the brain. Through
olivocochlear fibers, it also transmits motor and modulatory information from the superior olivary
complex in the brainstem to the cochlea
To
Cochlear nerve, vestibular nerve
Innervates
Hearing, balance
Cranial nerve VIII brings sound and information about one's position and movement in space into
the brain. The auditory and vestibular systems subserve several functions basic to clinical
medicine and to psychiatry
183. Cranial nerves: IX and XI pairs, formation, topography, branches, regions of innervati
The glossopharyngeal nerve (/ˌɡlɒsoʊfəˈrɪn(d)ʒiəl, -ˌfærənˈdʒiːəl/[1]), known as the ninth cranial

nerve (CN IX), is a mixed nerve that carries afferent sensory and efferent motor information. It
exits the brainstem out from the sides of the upper medulla, just anterior (closer to the nose) to the
vagus nerve. The motor division of the glossopharyngeal nerve is derived from the basal plate of
the embryonic medulla oblongata, while the sensory division originates from the cranial neural
crest.
To
tympanic nerve
Innervates
Motor: stylopharyngeus
Sensory: Oropharynx, Eustachian tube, middle ear, posterior third of tongue, carotid sinus, carotid
body
Special sensory: Taste to posterior third of tongue
The accessory nerve is a cranial nerve that supplies the sternocleidomastoid and trapezius
muscles. It is considered as the eleventh of twelve pairs of cranial nerves, or simply cranial nerve
XI, as part of it was formerly believed to originate in the brain. The sternocleidomastoid muscle
tilts and rotates the head, while the trapezius muscle, connecting to the scapula, acts to shrug the
shoulder.
Innervates
sternocleidomastoid muscle, trapezius muscle
184. Cranial nerves: X pair, formation, topography, branches, regions of innervation.

Vagus nerve, also called X cranial nerve or 10th cranial nerve, longest and most complex of the
cranial nerves. The vagus nerve runs from the brain through the face and thorax to the abdomen.
It is a mixed nerve that contains parasympathetic fibres. The vagus nerve has two sensory ganglia
(masses of nerve tissue that transmit sensory impulses): the superior and the inferior ganglia. The
branches of the superior ganglion innervate the skin in the concha of the ear. The inferior
ganglion gives off two branches: the pharyngeal nerve and the superior laryngeal nerve. The
recurrent laryngeal nerve branches from the vagus in the lower neck and upper thorax to innervate
the muscles of the larynx (voice box). The vagus also gives off cardiac, esophageal, and
pulmonary branches. In the abdomen the vagus innervates the greater part of the digestive tract
and other abdominal viscera.
Special Sensory: Provides taste sensation to the epiglottis and root of the tongue. Motor: Provides
motor innervation to the majority of the muscles of the pharynx, soft palate and larynx.
Parasympathetic: Innervates the smooth muscle of the trachea, bronchi and gastro-intestinal tract
and regulates heart rhythm.
185. Cranial nerves: XII pairs, formation, topography, branches, regions of innervation.
The Hypoglossal Nerve is the 12th Cranial Nerve (Cranial Nerve XII). It is mainly an efferent
nerve for the tongue musculature. The nerve originates from the medulla and travels caudally and
dorsally to the tongue
XII.
Your hypoglossal nerve is the 12th cranial nerve which is responsible for the movement of most
of the muscles in your tongue. It starts in the medulla oblongata and moves down into the jaw,
where it reaches the tongue.
contains some sympathetic postganglionic fibers from the cervical ganglia, which innervates
tongue vessels and some small glands in the oral mucosa.
The hypoglossal nerve consists of four branches: the meningeal, descending, thyrothyroid, and
muscular. However, only the muscular branch is considered part of the real hypoglossal nerve
originating from the hypoglossal nucleus. Other branches originate from spinal nerves (mainly
C1/C2) or the cervical ganglia. The meningeal branch arises from C1 and C2 nerves to the
posterior cranial fossa. The descending branch carries information from C1 and then C2/C3 to
innervate the neck muscles (omohyoid, sternohyoid, and sternothyroid). The thyrothyroid
branches innervate the thyrohyoid muscle of the neck. The descending and thyrohyoid branches
mostly originate from the cervical plexus.
186. General scheme of structure and functions of the vegetative nervous system. Central and
peripheral divisions, pre- and post-ganglionic fibers, vegetative nodes, nerves, plexuses.
The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of
the peripheral nervous system that supplies smooth muscle and glands, and thus influences the
function of internal organs.
The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of
the peripheral nervous system that supplies smooth muscle and glands, and thus influences the
function of internal organs.[1] The autonomic nervous system is a control system that acts largely
unconsciously and regulates bodily functions, such as the heart rate, digestion, respiratory rate,
pupillary response, urination, and sexual arousal.[2] This system is the primary mechanism in
control of the fight-or-flight response.
187. Vegetative nodes of the head: topography, roots, branches.

Ans:The superficial lymph nodes of the head and neck receive lymph from the scalp, face and
neck. They are arranged in a ring shape; extending from underneath the chin, to the posterior
aspect of the head. They ultimately drain into the deep lymph nodes. Occipital: There are usually
between 1-3 occipital lymph nodes
The superficial lymph nodes of the head and neck receive lymph from the scalp, face and neck.
They are arranged in a ring shape; extending from underneath the chin, to the posterior aspect of
the head. They ultimately drain into the deep lymph nodes.
Occipital: There are usually between 1-3 occipital lymph nodes. They are located in the back of
the head at the lateral border of the trapezius muscle and collect lymph from the occipital area of
the scalp.
Mastoid: There are usually 2 mastoid lymph nodes, which are also called the post-auricular lymph
nodes. They are located posterior to the ear and lie on the insertion of the sternocleidomastoid
muscle into the mastoid process. They collect lymph from the posterior neck, upper ear and the
back of the external auditory meatus (the ear canal).
Pre-auricular: There are usually between 1-3 pre-auricular lymph nodes. They are located anterior
to the auricle of the ear, and collect lymph from the superficial areas of the face and temporal
region.
Parotid: The parotid lymph nodes are a small group of nodes located superficially to the parotid
gland. They collect lymph from the nose, the nasal cavity, the external acoustic meatus, the
tympanic cavity and the lateral borders of the orbit. There are also parotid lymph nodes deep to
the parotid gland that drain the nasal cavities and the nasopharynx.
Submental: These lymph nodes are located superficially to the mylohoid muscle. They collect
lymph from the central lower lip, the floor of the mouth and the apex of the tongue.
Submandibular: There are usually between 3-6 submandibular nodes. They are located below the
mandible in the submandibular triangle and collect lymph from the cheeks, the lateral aspects of
the nose, upper lip, lateral parts of the lower lip, gums and the anterior tongue. They also receive
lymph from the submental and facial lymph nodes.
Facial: This group comprises the maxillary/infraorbital, buccinator and supramandibular lymph
nodes. They collect lymph from the mucous membranes of the nose and cheek, eyelids and
conjunctiva.
Superficial Cervical: The superficial cervical lymph nodes can be divided into the superficial
anterior cervical nodes and the posterior lateral superficial cervical lymph nodes. The anterior
nodes lie close to the anterior jugular vein and collect lymph from the superficial surfaces of the
anterior neck. The posterior lateral nodes lie close to the external jugular vein and collect lymph
from superficial surfaces of the neck.
188. Cervical part of the sympathetic trunk: topography, nodes, branches.

It runs up the neck on the fascia that lies in front of the longus muscles. This massive thickening
at the top of the sympathetic trunk is the superior cervical ganglion. From its upper end this nerve,
the internal carotid nerve arises, and joins the internal carotid artery as it enters the carotid canal
The sympathetic trunks (sympathetic chain, gangliated cord) are a paired bundle of nerve fibers
that run from the base of the skull to the coccyx. ... Along the length of the sympathetic trunk are
sympathetic ganglia known as paravertebral ganglia.
three interconnected ganglia

The cervical sympathetic trunk contains three interconnected ganglia: the superior, middle, and
inferior cervical ganglia. In 80% of people the lowest cervical ganglion is fused with the first
thoracic ganglion to form the cervicothoracic (stellate) ganglion.
189. Thoracic part of the sympathetic trunk: topography, nodes, branches.

The thoracic part of the sympathetic chain runs downward on head of ribs and leaves the thorax
on the side of the body of the 12th thoracic vertebra behind the medial arcuate ligament. The
thoracic part of the sympathetic chain has rami communicantes, postganglionic fibers to the heart,
aorta, lungs and oesophagus
The thoracic part of the sympathetic chain runs downward and leaves the thorax behind the
medial arcuate ligament. The preganglionic fibers which are grouped together to forms planchnic
nerves and supply the abdominal viscera. Anatomical variations of the thoracic sympathetic trunk
in relation to intercostal nerves may be one of the reasons that cause surgical failures. Therefore,
our present study aimed to investigate the sympathetic variations in the cadavers.
Materials and Methods: In the present study we have investigated 31 embalmed cadavers thoracic
cavities were eviscerated, the posterior thoracic walls were dissected carefully to expose the
sympathetic chain and its branches.
Results: Stellate ganglion was observed bilaterally in 4 cadavers and unilaterally in 15 cadavers.
Greater splanchnic nerve highest origin was 4th ganglion and the lowest origin was 11th
ganglion. Common
190. Abdominal aortic plexus: topography, formation, structure, branches.
The abdominal aortic plexus (not to be confused with the thoracic aortic plexus) is formed by
branches derived, on either side, from the celiac plexus and ganglia, and receives filaments from
some of the lumbar ganglia
From
Celiac plexus, superior mesenteric plexus
To
Superior hypogastric plexus
It is situated upon the sides and front of the aorta, between the origins of the superior and inferior
mesenteric arteries.
From this plexus arise part of the spermatic, the inferior mesenteric, and the hypogastric plexuses;
it also distributes filaments to the inferior vena cava.
191. Lumbar and sacral parts of the sympathetic trunk. Vegetative nerve plexus of the abdominal
cavity.
The sympathetic chain is a ganglionated chain present bilaterally extending from the base of the
skull to the coccyx. It divides into cervical, thoracic, lumbar and sacral segments. ... Lumbar
sympathetic chain lies anterolateral to the bodies of lumbar vertebrae, deep to the medial aspect of
the psoas major muscle
Anatomy, Back, Lumbar Sympathetic Chain
Jetti R, Kadiyala B, Bolla SR.
Publication Details
Introduction
The sympathetic chain is a ganglionated chain present bilaterally extending from the base of the
skull to the coccyx. It divides into cervical, thoracic, lumbar and sacral segments. The two side
chains fuse at the ganglion in front of the sacrococcygeal junction. In this article, the lumbar
sympathetic chain is discussed in detail below.
Location and relations: It presents four interconnected ganglia, on either side. Lumbar
sympathetic chain lies anterolateral to the bodies of lumbar vertebrae, deep to the medial aspect of
the psoas major muscle.
Superiorly it is continuous with the thoracic sympathetic chain passing behind the medial arcuate
ligament of a diaphragm
Inferiorly it passes behind the common iliac vessels over the sacral ala and continuous with the
sacral sympathetic chain
On the right side, it lies posterior to inferior vena cava
On the left, it lies postero-lateral to the aortic lymph nodes
Structure and Function
The lumbar sympathetic chain receives input from the first, second and the third lumbar
sometimes are connected by the white rami communicantes, which contain the preganglionic
neurons from the lateral horn of the spinal cord.
All lumbar spinal nerves close to the beginning of their ventral rami join by grey rami
communicantes from the ganglia that contain postganglionic neurons. They supply the skin and
vessels in the respective territory. Grey rami may leave the sympathetic trunk between the ganglia
to form plexuses around the neighboring arteries to reach the target organs. Sympathetic trunk
branches accompany lumbar, aorta, common, internal and external iliac arteries. The adrenal
medulla is a unique structure in the body that it receives supply from the preganglionic neurons
from T10 to L1 spinal segments.
The non-relayed preganglionic neurons emerge from the medial side of the sympathetic trunk as
lumbar splanchnic nerves. Four lumbar splanchnic nerves arise from sympathetic trunk to join the
coeliac, inferior mesenteric and superior hypogastric
192. Upper and lower hypogastric plexuses. formation, structure, branches.
INTRODUCTION
The hypogastric plexus is the extension of the aortic plexus in the retroperitoneal space, below the
aortic bifurcation. The upper part, the superior hypogastric plexus, is located anterior to the L5
vertebral body and the sacral promontory, whereas the inferior hypogastric plexus lies within the
bilateral presacral tissues on either side of the rectum at S2, S3, and S4 levels. Pain from the
lower abdominal as well as the pelvic and perineal area is transmitted through the hypogastric
plexus.
Chronic noncancer and cancer pain of the pelvic structures are often challenging to treat and
interventional approaches may well be invaluable tools. Plancarte et al described the superior
hypogastric block in 1990, and found that sympathetically mediated pain was significantly
reduced or eliminated in all cases without serious complications. Although this injection was
originally developed for the treatment of pelvic cancer pain, as with many procedures originally
limited to the terminal cancer patient in pain, these techniques are now commonly used in the
nonmalignant pain. Patients have frequently failed to respond to less invasive procedures, such as
lumbar or caudal epidural injections.
INDICATIONS
The indications for performing the two types of blocks have some overlap. A diagnostic block of
the hypogastric plexus with local anesthetic if positive can be followed by a neurolytic procedure,
which could potentially provide long-term relief.
The superior hypogastric plexus block is indicated for chronic intractable lower abdominal and/or
pelvic pain:
Gynecologic disorders like endometriosis, pelvic inflammatory disease, and pelvic adhesions
Nongynecologic disorders like interstitial cystitis, irritable bowel syndrome
Sympathetically maintained pelvic pain (pelvic CRPS)
Pain secondary to neoplasm in the pelvic area
The inferior hypogastric plexus block is indicated for chronic intractable lower abdominal and/or
pelvic pain:
Sacral or perineal pain
Bladder conditions
Penile pain
Prostatitis
Vaginal pain/vulvodynia
Rectal/anal pain
Irradiation-induced tenesmus
Perineal, sacral, and lower pelvic pain caused by malignant causes
Sympathetically maintained pelvic pain (pelvic CRPS)
Lower pelvic endometriosis
Acute herpes zoster
Postherpetic neuralgia of the sacral area
CONTRAINDICATIONS
Infection (systemic or localized)
Coagulopathy
Distorted or complicated anatomy
Patient refusal
Other Considerations
The risks and potential contraindications need to be weighed carefully when performed in patients
with cancer pain and noncancer pain.
Although this injection is performed outside the neuroaxis, there are large blood vessels (iliac
arteries and vein) in close proximity, and therefore an adequate coagulation status is warranted.
In the same way, injections into or through an area of infection should be avoided.
Psychological status in cancer pain patient appears to be less of an issue, as long as the patient or
health care surrogate is capable of providing informed consent.
However, for the nonmalignant pain patient, because of the dramatic psychological overlay often
seen in patients who suffer from chronic pelvic pain, including a ...

Anatomy Final All Questions (New)

Uploaded by

Copyright:

Available Formats

Anatomy Final All Questions (New)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Anatomy Final All Questions (New)

Uploaded by

Copyright:

Available Formats

Anatomy questions final

The history of anatomy is characterized by a progressive understanding of the functions of the

2. The early stages of human embryogenesis. The doctrine of embryonic leayers.

The initial stages of human embryonic development

5. The bones of the facial skull.

6. Cranial base and calvaria. Foramens in skull. Joints of skull bones.

9. The temporal and infratemporal fossa, their borders and contents.

Lateral – condylar process and ramus of the mandible bone

Anterior – posterior border of the maxillary sinus

Posterior – carotid sheath

Roof – greater wing of the sphenoid bone

Floor – medial pterygoid muscle

10. The pterygopalatine fossa, its borders, connection and structure.

Anterior: Posterior wall of the maxillary sinus.

Posterior: Pterygoid process of the sphenoid bone.

Inferior: Palatine bone and palatine canals.

Superior: Inferior orbital fissure of the eye.

Medial: Perpendicular plate of the palatine bone

Lateral: Pterygomaxillary fissure

The Pterygopalatine Fossa contains many important neurovascular structures.

These branches include, but are not limited to:

Sphenopalatine artery (to the nasal cavity).

Infraorbital artery (lacrimal gland, and some muscles of the eye).

Posterior superior alveolar artery (to the teeth and gingiva).

11. Classification of joints

A joint is defined as a connection between two bones in the skeletal system.

Fibrous – bones connected by fibrous tissue.

Cartilaginous – bones connected by cartilage.

Synovial – articulating surfaces enclosed within fluid-filled joint capsule.

Amphiarthrosis – slightly moveable.

Diarthrosis – freely moveable.

contained in the joint capsule (synovium) and are cushioned by cartilage.

The joint seen from the inner surface.

Superficial temporal artery

Auriculotemporal nerve, masseteric nerve

Ans-Structure of vertebral column

The vertebral column has four main functions:

Support – carries the weight of the body above the pelvis.

Axis – forms the central axis of the body.

Movement – has roles in both posture and movement.Functions

The vertebral column has four main functions:

Support – carries the weight of the body above the pelvis.

Axis – forms the central axis of the body.

Twelve in total, containing a body, arch, and costal facets

Typical: head, beck, tubercle, body

Atypical: one or two facets and a tuberosity (1st, 2nd, 10th-12th)

Xiphisternal: xiphoid process and body of sternum

Intervertebral: between vertebrae

Sternochondral: sternum and costal cartilages

Manubriosternal: manubrium and body of sternum

Costochondral: costal cartilage and rib

Costovertebral: formed by the ribs and bodies of the vertebrae.

Interchondral: joining the costal cartilages to one another

EXTENSOR CARPI RADIALIS LONGUS.

EXTENSOR CARPI RADIALIS BREVIS.

EXTENSOR CARPI ULNARIS.

FLEXOR CARPI RADIALIS.

FLEXOR CARPI ULNARIS.

Metacarpals – There are five metacarpals, each one related to a digit