Introduction to Human Anatomy

Definition of Anatomy:
It is the science dealing with the study of the structure, arrangement and
geography of the human body, which forms the keystone for all other
branches of medical science.
Methods used in the study of anatomy
1-Living anatomy: It is the study of anatomy on living individuals,
using:

Inspection by naked eye & Palpation by hand & Auscultation by

Stethoscope or by using Endoscopes
2-

3- Radiological anatomy: It is the study of the different parts and organs

in the body by using X-ray.
4-Cross-sectional anatomy: It is the study of the structure and
arrangement of the different parts of the body as seen in cross-sections or
slices of the body. It is the essential base in the field of computerized
tomography (CT-scanning) and Magnetic Resonance Image (MRI)
technique.

CT scan
5-

6- Surgical anatomy: It is the study of anatomy in surgical exposures

and incisions.
 Anatomical Terms
Terms of position:-
1-Anatomical position:
-It is the standard position of the human body which is used for the
description of anatomy.
-In the anatomical position, the body is standing erect, the eyes looking
forwards, the upper limbs are straight by the sides of the trunk with the
palms facing forward and the feet are close together.

2- Supine position:
The body lies down on the back, with the face looking upwards.
3- Prone position:
The body lies down with the face looking downwards.
Terms of planes
1-Median plane (Midsagittal plane ):
It is a vertical antero- posterior plane, which divides the body into two
equal parts (right and left halves). It is in the direction of sagittal suture of
the skull.
2-The Paramedian sagittal plane: It is any vertical plane parallel to the
median plane which divides the body into two unequal parts.
3- Coronal plane:
It is side to side vertical plane, which divides the body into anterior and
posterior parts. It lies at right angles to the median sagittal plane, and in the
direction of the coronal suture of the skull.
4- Transverse plane:
It is the plane of cross-sectioning of the body. It lies at right angles to the
vertical planes / or the long axis of the part.

Terms of relations:
1- Right & left
2- Anterior (Ventral): The direction towards the front of the body.
3- Posterior (Dorsal): The direction towards the back of the body.
4- Superior (Cranial): The direction towards the head.
5- Inferior (caudal): The direction towards the feet.
6- Medial: The direction towards the median plane.
7- Lateral: The direction is away from the median plane.
8- Proximal: nearer to the trunk.
9- Distal: away from the trunk.

Terms of movements:
1-Flexion: It is the angular movement (bending) of a joint.
2-Extension: It is the act of bringing the distal portion of a joint in
continuity with the long axis of the proximal portion, i.e. straightening of
joint
3-Adduction: It is the movement towards the median plane.
4-Abduction: It is the movement away from the median plane.
5-Rotation: It is the turning movement of the joint around its long axis.
Rotation can be inward (medial rotation) and outward lateral rotation.
6-Circumduction: It is the movement of the limb, in a circular direction. It
occurs by the succession of flexion, extension, adduction, abduction and
rotation movements.
7-Pronation: It is the medial rotation of the forearm to direct the palm of
the hand backwards.
8-Supination: It is the lateral rotation of the forearm to direct the palm
forwards.
9-Inversion: It is the turning inwards of the foot with elevation of its inner
margin; to direct the sole medially.
10-Eversion: It is the turning outwards of the foot with elevation of its outer
(external) margin, to direct the sole laterally.

Body systems
The human body consists of the following systems:
1-Skeletal system 2-Articulating system (joints)
3-Muscular system 4-Nervous system
5-Circulatory system 6-Lymphatic system
7-Respiratory system 8-Digestive system
9-Urinary system 10-Reproductive system
11-Glands 12-Special sense organs as eye ,ear, nose
 Bones and Cartilages
Functions of the bones:
1-Support the body and give the body its shape.
2- Skeletal muscles attached to the bone for movements.
3- Protect some important organs. For example, the skull protects the
brain, the thoracic cage protects the heart and lungs, and the spine
protects the spinal cord.
4-The bone marrow used for the production of blood cells.
5-The bone is considered as a store house of salt calcium and phosphorus.

Classifications of bones
1-Regional classification:
according to the position of bones (axial bones & appendicular bones)

2-Morphological classification:
A-Long bone:-
* Typical Long Bones: It is the bone having an elongated shaft (body or
diaphysis), which extends between two expanded, smooth and articular
ends (epiphyses).
Examples: femur, tibia, humerus, radius
* Atypical long bones: It is known as the small long bones.
Examples: Metacarpals, Metatarsals and Phalanges & CLAVICLE
B-Short bones:-
The bones which are usually cubical, trapezoidal or scaphoidal in shape.
Examples: carpal bones of hand and tarsal bones of foot.
C-Flat bones:-
They are formed of an outer and inner lamina of compact bone, separated
by a layer of spongy bone in adult.

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 Examples: bones of vault of skull, sternum, ribs
D-Irregular bones:-
The bones which are not long, short or flat
Examples: -1- Vertebrae
E-Pneumatic bones:
the bones containing large air spaces as maxilla in the skull.
F-Sesamoid bones:-
They are bony nodules (SMALL) found embedded in the tendons of some
muscles, ligaments or joint capsules. Examples: Patella
G- accessory bone (supernumerary bone)
Discover by chance and may be mistaken for fractures
As small bone beside 5th metatarsal bone

3-Structural classification
1- Compact bone: It is the hard, ivory like bone, which forms the cortical
covering of all types of bone. It is well developed and thick in long bones,
particularly at the middle of shafts, to resist the bending and twisting by
the compression or tension forces.
2- Cancellous /spongy or trabecular bone: It is formed of a trabecular
meshwork, enclosing the spaces which contain bone marrow. Cancellous
bone forms the ends of long bones and the interior of all other types of

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bone. Cancellous bone is always covered by an outer shell of compact
bone, with a variable thickness in different bones.

4-Developmental classification
A-Membranous bones: It is the bone developed from a connective tissue
membrane, by intramembranous ossification.
Examples: Bones in the skull cap
B-Cartilaginous bones: It is the bone developed from a hyaline cartilage
model by cartilaginous ossification.
Examples: Appendicular bones
C-Bones of mixed ossification:-It is the bones which ossify partly in
membrane and partly in cartilage…. i.e. membrano – cartilaginous bones.
Examples:
-Mandible & Clavicle is the only long bone without a medullary cavity,
because of its membranous ossification.

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 Structure of the living long bones
The long bone consists of a shaft (diaphysis) and two ends called epiphysis.
*The shaft is composed of a cylinder of compact bone enclosing a cavity
called medullary cavity which is filled with bone marrow.
*The epiphysis is composed of spongy (cancellous ) bone and is covered
by a layer of hyaline articular cartilage
*In the growing long bone the epiphysis is separated from the shaft by a
cartilage plate called epiphyseal cartilage which is of hyaline cartilage. The
epiphyseal cartilage plate is the site of increase in length of the bone
*The region of the shaft close to the epiphyseal cartilage plate is called
metaphysis
*The shaft is covered by a fibrous membrane called periosteum.
Bone marrow:
1-Red bone marrow:
Its a fatty, vascular tissue concerned in the formation of blood cells and
found in the flat bones, the vertebrae, the skull and it lasts for life. It is
also found in the medullary cavity of long bones in early age but it is
replaced by the yellow bone marrow after puberty.
2-Yellow bone marrow: It is a fatty tissue has no role in the formation of
red blood cells.

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 Blood supply of bones
Arterial supply of long bones:
Nutrient, periosteal, metaphyseal and epiphyseal arteries.
1- Nutrient artery:
- It arise from the nearby main artery , it enters the shaft obliquely, through
the nutrient foramen (canal), which forms the main passage for the vessels
supplying the interior of long bone.
- As it reaches the medullary cavity, it divides into (ascending and
descending) branches. Each branch subdivides into a number of successive
smaller branches. Then they terminate at both ends of the shaft by
anastomosing with the metaphyseal, periosteal arteries and epiphyseal
arteries in adult bone, after the complete fusion of the epiphysis with the
metaphysis.
- The nutrient artery supplies the:
 medullary cavity with the bone marrow.
 deeper 2/3 of the compact cortex of the shaft.
2- Periosteal arteries:
-They arise from the nearby main artery and from the arteries of the
attached structures to the periosteum. They are numerous and supply
 periosteum
 Penetrate the bone to supply the outer 1/3 of the bone cortex.
3-Metaphyseal arteries:
-They are numerous and arise from the nearby arteries. They enter the
metaphysis.
4-Epiphyseal arteries:
-They are branches from the articular arteries. They enter the epiphysis
through multiple foramina at the ends of the shaft.

Venous drainage:-The veins accompany the arteries, and are relatively

small.
Lymphatic vessels:-They accompany the periosteal vessels to the regional
lymph nodes.

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*Nerve supply of bones:
a- Sensory fibers through the periosteum and articular surfaces.
b- Vasomotor sympathetic fibers, which form most of the bone
innervation. The nerves accompany the blood vessels.

CARTILAGE
Cartilage is a firm, rubber-like part of the skeleton.
General features of cartilage:
1-Cartilage is a non-vascular structure i.e. it has no vessels.
2-It is insensitive, as it contains no nerves.
3-Cartilage is covered on its surface by perichondrium.
4-Calcification of cartilage, occurs when it is replaced by bone.
5-It is a radiolucent i.e. black in colour.
Classification of cartilage:
1- Hyaline cartilage:
-It is homogenous, bluish white in colour and translucent .
-Its distribution in the body is as follows:
 Articular cartilage of synovial joints.
 Epiphyseal cartilage plates, during the growth period only.
 In respiratory system:-Nasal cartilages, Larynx and trachea and
bronchi.

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2- White fibrocartilage:
-It is the cartilage rich in white collagenous fibers, which are responsible
for its white colour and opaque appearance. It is resilient, strong and tough,
and is usually found in places subjected to great pressure.
Examples:- Intervertebral discs (IVD) .

3- Yellow elastic fibrocartilage:

-It is the cartilage rich in yellow elastic fibers which make it more flexible.
- Examples:- External ear ,auditory tube and epiglottis.

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Collection of connective tissue
1. Superficial fascia
2. Deep fascia

SUPERFICIAL FASCIA
defenition
• General coating of the body beneath the skin made up of
loose areolar tissue and fat
ABUNDANCE OF FAT
• Front of thigh and anterior abdominal wall

ABSENCE OF FAT
• Eyelids & external ear in females there is more fat and
it is evenly distributed
IMPORTANT FEATURES c

• Most distinct in lower part of anterior abdominal wall & limbs

• Very thin on dorsal aspect of hands & feet, sides of neck, face.
• Very dense in scalp, palms and soles.

IMPORTANT FEATURES
• IT CONTAINS
1. Cutaneous nerves & vessels
2. Groups of lymph nodes
3. Subcutaneous muscle in neck

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FUNCTIONS
• Helps in movements of skin
• Allows for the passage of the vessels & nerves to the skin
• Conserves body heat as fat is a bad conductor of heat
• Fat fills hollow spaces like axilla & orbits

Deep fascia (Investing fascia)

DISTRIBUTION OF DEEP FASCIA
• Best seen in limbs where it forms tough and tight sleeves
• Well defined in the neck where it
• forms a collar
• Not well formed on the trunk and face
• Blends with periosteum of a subcutaneous bone
MODIFICATIONS OF DEEP FASCIA
A) Extensions
• septa
• Fascial covering c

B) Thickening
• Retinacula
• Aponeurosis
• Ligaments
C) Interruption of deep fascia
D) Internal fascia

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 BLOOD VESSELS
ARTERIES, VEINS, & CAPILLARIES
Artery Vein
• Carry blood from heart to body • Carry blood from body to heart
• Oxygenated blood • Non-Oxygenated blood
• Thick wall • Thin wall
• Narrow lumen • Wide lumen

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How the artery terminates
Vena comitant

Anastomoses
Definition
It is a communication between two vessels by collateral channels
Types of anastomoses
i) Arterial anastomosis
ii) Venous anastomosis
iii) Arteriovenous anastomosis

Proximal

Distal

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 The muscle is a group of contractile fibers, responsible for the movements of the different
parts of the body

Types of muscles: (site, shape, innervation)

1) Skeletal muscles
2) Cardiac muscle
3) Smooth or visceral muscles

Visceral muscle
 They are also named smooth, plain, non-striated and involuntary
 Present in viscera
 Each muscle fiber has a spindle-shaped cell with a large, single centrally placed nucleus.
 They are arranged in thin sheets connected together by areolar tissue not branches.
 It is involuntarily. Innervated by autonomic nerves
 They respond by a slow and sustained contraction, and therefore are not easily fatigued.
c
1-Longitudinal together
 with circular sheets: In the walls of the digestive tube and urogenital tracts.
 This contraction is named "peristalsis".

2-Circular sheets only

 in the walls of blood vessels.

3-Irregular form
 as in the walls of the uterus and urinary bladder.
 This type acts to produce "mass contraction" responsible
for the and expulsion of the visceral contents.

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 Cardiac muscle

 The cardiac muscle forms the myocardium of the heart.

 The muscle fiber is formed by a numerous muscle cells joined
together at the intercalated discs
 Each muscle cell contains a single, centrally placed nucleus, and
shows, less marked longitudinal and transverse striations
 The muscle fiber is branched to form the characteristic network of
the myocardium. It also responsible for mass contraction.
 It is involuntary
 innervated by the autonomic nerves, and is controlled also by a
Special conduction system
 located in the myocardium.
 for this reason, it can act automatically independent from its
innervation.

Skeletal muscles
 Skeletal muscle is attached to the skeleton. c
 They also named somatic, striated and voluntary

Characters of the skeletal muscles:

 Weight: -40-45%
 Muscle fibers: - Each muscle fiber is thick not
branched with marked Longitudinal and cross striation and
peripheral multinucleated cells
 The muscle is voluntary
 innervated by somatic nerves
 It is of rapid contraction, and easily fatigued, while the
visceral muscle not easily fatigued.

Parts of skeletal muscle:

 The skeletal muscle consists of two ends

Origin:
 It is the less mobile end of the muscle during its contraction.
 In limb muscles it is usually the proximal end.

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Insertion:
 It is the more mobile end of the muscle, and is usually the distal end in the limb muscles,
and is mostly tendinous.
 Fleshy part (Muscle belly) Muscle belly is the fleshy, contractile part of the muscle,
between its two ends.

Muscle tendon:
 It is the non-contractile, fibrous, flat or cord- like part of the muscle.
 The muscle tendon is usually found at its two ends, tendon of origin and tendon of
insertion.

Skeletal muscles arranged in functional groups:

- e.g.
 Ventral muscles are flexors, except in lower limb.
 Dorsal muscles are extensors except in the lower limb.
 Lateral muscles are abductors.
 Medial muscles are adductors.
c
Arrangement of muscle fibers:
A- Fibers parallel to the line of pull:
 This type of fibers, extends throughout the length of the
muscle.
 The fibers are relatively longer and fewer in number than
in the other types.
 They provide a greater range of movement, but a less force
of contraction.

-Examples: pronator quadratus, rectus, abdominis, Sartorius ,……..

B- Fibers oblique to the line of pull:

 These muscle fibers are called pennate muscles (feather – Like).
 The muscle fibers are shorter and numerous than in the parallel type.
 Therefore, the fleshy bellies are generally short and of bulky size.
 This arrangement makes the muscle contraction more powerful, but with a reduced range
movement.

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Shape of skeletal muscles
1) parallel

2) Oblique fibers
 Pennate
o unipennate
o Bipennate
o Multipennate
 Circumpennate
 triangular
 twisted

Muscle tone
 it is a characteristic firmness of muscle during rest, it lost after injury
of motor nerve supply of the muscle, the musclec become flaccid

Muscle actions "functions":

 Means contraction of a muscle makes it shorter in length to bring its
attachments closer to each other.

Blood supply:
 The muscle receives muscular branch from the nearby arteries, which
enter at one or more situations.

Nerve supply
 The somatic muscle receives its nerve supply along with its arterial
supply which is usually through its deep surface, to avoid the external nerve injury.
 A synovial bursa is a small fluid-filled sac lined by synovial membrane .
 It provides a cushion between bones and tendons and/or muscles around a joint.
 This helps to reduce friction between the bones and allows free movement.
 Bursae are found around most major joints of the bod
A synovial sheath is one of the two membranes of a tendon sheath which covers a tendon

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 Joints
Joints =Articulation / Arthrology / Articular

➢ Definition : joint Is the Site between two bones or more to allow movement (bone &
bone),Bone and cartilages ,( cartilage to cartilage)

➢ Structural Classification of joints : (composition =connecting tissue )

1) fibrous joints:
• Fibrous tissues
• (short or long)
• Immobile or slightly mobile
• Suture
Only in skull conn. bones of vault & side of skull
narrow space short fibers
Immobile except..?
Considered temporary calcify …30 y up
Ex. coronal suture
• Syndesmoses
Wider space
fibers longer stronger denser than sutures
slightly mobile
Permanent
Ex. Inf. tibio fibular j & interosseous membrane

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 • Gomphosis
between tooth and its socket
Peg & socket
Immobile
• Symphysis menti
• Costochondral joints

2) Cartilaginous joints :
connecting tissue : cartilage
❖ 1ry cartilaginous joint
• Hyaline cartilage joint (synchondrosis)
• Cartilage plate
• fixed strong immobile
• disappear by fusion (ossify) temporary
• May persist …?
• EX.

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 ❖ 2ry cartilaginous joint
• Fibrocartilage joint (symphysis)
• Cartilage disc +hyaline cartilage on articular surfaces
• Slightly mobile stable
• Permanent don’t ossify
• in Median plane(symphysis)
• Ex: - IVD - Symphysis menti
- Betweens parts of sternum

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 3) Synovial joints (di arthrosis):
• Cavity contain synovial fluid
• Characters / Features :
✓ Regular joint cavity
✓ Hyaline articular cartilage over expanded articular
surfaces firm compact insensitive not seen in X-ray
except …?
✓ Fibrous capsule highly sensitive to stretch during
movement pierced by articular nerves may
communicate with a bursa become thickened in
specific parts forming capsular ligament
✓ Synovial membrane cover all intracapsular
structure except articular surfaces & synovial fluid
(lubrication, nourishment, immunological)
extension to bursa
✓ Accessory ligaments ( intra or extra articular )
✓ Intra articular structures:
- Fibrocartilaginous disc lips , menisci - Ms.
tendon -Ligaments pads of fat
✓ Freely mobile
• Classifications of synovial joints:
✓ Structural type
1-Simple: between 2 bones
2-compound : between more than 2 bones
3- complex : containing intracapsular structure

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 ✓ Functional type: according shapes of articular surfaces & no. of axes
possible movement
1-Uni axial: movement occur around one axis (hinge, pivot)
2-Biaxial joint: 2 axes (ellipsoid, saddle, condyloid)
3-Poly axial joint: multiple axes (ball & socket)
4-Plane gliding joint
plane joint
• Surfaces: flat
• Axis: Transverse
• movement: gliding no angular or rotation
movement
• e.g.: intercarpal joint / intertarsal joint /
carpometacarpal

Uniaxial joint
❖ Hinge joint
• Surfaces : concavo-convex
• Axis: Transverse
• movement: flexion & extension
• e.g.: Elbow, interphalangeal joint, Ankle
• strong collateral lig.
❖ Pivot joint
• Surfaces: central bony pivot surround by
osteo fibrous ring
• Axis: vertical longitudinal
• movement: rotation
• e.g.: Superior & inferior radioulnar joint

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 Biaxial joint
❖ Ellipsoid joint
• Articular surface oval convex with reciprocal oval
concave (elliptical)
• axes Two:
-transverse (flexion & extension)
-anteroposterior ( adduction & abduction /
Circumduction impossible rotation)
• E.g.: wrist & metacarpophalangeal joint
❖ Saddel joint
• Articular surface: concavo-convex with reciprocal
convexo-concave
• axes Two:
-transverse (flexion & extension)
-anteroposterior ( adduction & abduction + some rotation
• E.g.: carpometacarpal joint of thumb joint

❖ condyloid joint
• Articular surface: 2 convex-condyle with reciprocal 2
concave condyle
• axes Two:
-transverse (flexion & extension) –
vertical (little rotation)
• E.g.: knee joint

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 ❖ polyaxial joint
•Ball and socket joint
•Articular surface: hemispherical head with cup
shaped socket
•axes: multiple
-transverse (flexion & extension)
-anteroposterior (adduction & abduction
-vertical (little rotation & circumduction)
•E.g.: shoulder & hip joints
➢ NERVE SUPPLY OF JOINTS
• The capsule and ligaments receive an abundant sensory nerve supply.
• HILTON'S LAW: "A nerve supplying a joint also supplies the muscles moving that joint
and the skin overlying the insertions of these muscles."
• Synovial membrane less innervated contain few nerve endings
• Articular cartilage is not sensitive not innervated and avascular

➢ Blood supply of joint

• Numerous articular branches from main near vessels
• Anastomosis give good collateral circulation
➢ Stability of joints
• Bone factor: Shape & size fitting of articular surfaces
• Ligamentous factor (fibrous or elastic)
• Muscular factor tone of ms. & force of contraction

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 Muscles and Nerves

MUSCLES
-The muscle is a group of contractile fibers, responsible for the movements of the
different parts of the body, and is usually controlled by nervous stimuli.
*Types of muscles :- ( Fig. 34)
-There are three types of muscle tissues:
1- Skeletal or Somatic muscles, which are
striated and of voluntary control.
2- Smooth or visceral muscles, which are
involuntary.
3-Cardiac muscle, which is found only in
the heart and is striated but acts involuntary or automatically.
Visceral muscles
-They are also named smooth, plain, non-striated and involuntary.
-The main features of the visceral muscles are: (Fig. 35 )
a-Each muscle fiber is a Fusiform, spindle-shaped cell with a large, single and
centrally placed nucleus.
b-In the muscle fiber, the myofibrils are only of fine longitudinal striations and do
not show cross-striations, so the name smooth or plain muscle.
c-They are arranged in thin sheets connected together by areolar tissue.
d-Autonomic nerves innervate them, therefore act involuntarily .
e-They respond by a slow and sustained contraction, and therefore are not easily
fatigued.
Examples:
1-Longitudinal together with circular sheets: In the walls of the digestive tube and
urogenital tracts. This contraction is named "peristalsis".
2-Circular sheets only, in the walls of blood vessels.
3-Irregular form, as in the walls of the uterus and urinary bladder. This type acts to
produce "mass contraction" responsible for the evacuation and expulsion of the
visceral contents.

Cardiac muscle
- The cardiac muscle forms the myocardium of the heart.(Fig. 36)
-The muscle fiber is formed by a numerous muscle cells joined together at the
intercalated discs (opposed cell membranes).
- Each muscle cell contains a single, centrally placed nucleus, and shows a fine, less

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 Muscles and Nerves

marked longitudinal and transverse striations, than those of the somatic muscle.
-The muscle fiber gives branches to form the
characteristic network of the myocardium. It
also responsible for mass contraction.
-The cardiac muscle acts involuntarily (as the
visceral muscle), although it is striated (as the
somatic muscle).
- It is innervated by the autonomic nerves, and
is controlled also by a special conduction system
located in the myocardium. For this reason it
can acts automatically independent from its innervation.

Skeletal muscles
-Skeletal muscle is a group of contractile fibers, attached by its ends to bones
separated by one or more joints.
*Characters of the skeletal muscles: (Fig. 37& 38)
1-Weight :-Somatic muscles in the body form about 40-45% of the body weight.
2-Muscle fibers :- Each muscle fiber is a multinucleated
cell column, formed of many cells joined end to- end
without any partitions.
3-The somatic muscle is of rapid contraction, and easily
fatigued, while the visceral muscle does not easily
fatigued.
4- Parts of skeletal muscle :-The skeletal muscle consists
of four parts; two ends;
origin and insertion, and two parts; fleshy part and tendinous (fibrous) part.
Origin:-It is the less mobile end of the muscle during its contraction. In limb muscles
it is usually the proximal end.
Insertion:-It is the more mobile end of the muscle, and is usually the distal end in
the limb muscles, and is mostly tendinous.
Fleshy part "Muscle belly ":-Muscle belly is the fleshy, contractile part of the
muscle, between its two ends.
Muscle tendon :-It is the non-
contractile, fibrous, flat or cord- like
part of the muscle. The muscle
tendon is usually found at its two

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 Muscles and Nerves

ends , tendon of origin and tendon of

insertion.
5-Muscle attachment :-Most of the skeletal muscle is attached to two or more
bones and across one or more joints. It is attached to the periosteal covering of the
bone or the joint capsule.
6-Skeletal muscles arranged in functional groups : - e.g.
- Ventral muscles are flexors, except in lower limb.
- Dorsal muscles are extensors except in the lower limb.
- Lateral muscles are abductors.
- Medial muscles are adductors.
7-Blood supply : - The muscle receives muscular branch from the nearby arteries,
which enter at one or more situations.
8- Nerve supply :-The somatic muscle receives its nerve supply along with its arterial
supply which is usually through its deep surface, to avoid the external nerve injury.
9-Muscle tone : -It is the characteristic firmness of the somatic muscle during the
rest with elastic resistance to pressure. Muscle tone is lost after injury of the motor
nerve supply to the muscle. The muscle
becomes flaccid .
9-Arrangement of muscle fibers:- (Fig.38)
A- Fibers parallel to the line of pull:
-This type of fibers , extends throughout
the length of the muscle. The fibers are
relatively longer and fewer in number
than in the other types. They provide
a greater range of movement, but a less
force of contraction.
-Examples : pronator quadratus ,rectus abdominis , Sartorius ,……..
B- Fibers oblique to the line of pull:
-These muscle fibers are called pennate muscles (feather – Like).
-The muscle fibers are shorter and numerous than in the parallel type. Therefore
the fleshy bellies are generally short and of bulky size.
-This arrangement makes the muscle contraction more powerful, but with a
reduced range movement.
-Forms and shape of muscles with oblique fibers:
a-Pennate muscles:
1-Unipennate "half a feather" e.g.; flexor pollicis longus …

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 Muscles and Nerves

2-Bipennate"complete feather" e.g.; rectus femoris, dorsal interossei …….

3-Multipennate muscles, formed of multiples of bipennate units close together,
e.g. middle part of deltoid, subscapularis, infraspinatus,…..
4-Circumpennate muscles, in which the tendinous bundle lies centrally with the
muscle fibers radiating in all directions e.g. tibialis anterior muscle and soleus m.
b-Triangular muscles:As temporalis and adductor longus ….. etc.
c-Twisted,spiral or cruciate fibers:
-Examples:1-Spiral or twisted fibers as in trapezius, pectoralis major and supinator.
2- Cruciate fibers as in masseter, sternocleidomastoid and adductor magnus.
10-Muscle actions "functions":
- Means contraction of a muscle makes it shorter in length to bring its attachments
closer to each other.

PARTS OF THE NERVOUS SYSTEM

-It comprises: ( Fig. 39)
1-C.N.S.: Brain and Spinal cord in the skull and vertebral canal.
2-P.N.S: Peripheral nervous system: it includes:
- 12 pairs of cranial nerves.
- 31 pairs of spinal nerves.
- Nerve Ganglia-either somatic or autonomic.
*Peripheral nervous system "P.N.S.":
A-Nerves:-
Nerve: A bundle of fibers that uses electrical and chemical signals to transmit
sensory and motor information from one body part to another

I-Cranial nerves:
-They are the twelve pairs of nerves arising from the brain and get out from the
cranial cavity through foramina in the skull.
-They are classified into :
1-Sensory cranial nerves (3 ) as olfactory nerve(I), optic nerve(II) and auditory
nerves (VIII).
2-Motor cranial nerves ( 5 ) as occulomotor (III) , trochlear nerve(IV) , abducent
nerve(VI) , accessory nerve ( XI )and hypoglossal nerve (XII).
3-Mixed cranial nerve ( 4 ) as trigeminal nerve (V)facial nerve (VII) , glossopharyngeal
nerve (IX) and vagus nerve ( X) .
II-Spinal nerves:
23
 Muscles and Nerves

-They are the nerves attached to the spinal cord inside the vertebral canal, which
get out through the intervertebral foramina .
-All spinal nerves are functionally mixed.
-They are thirty-one pairs, subdivided into:
- 8 cervical , 12 thoracic , 5 lumbar , 5 sacral, and one coccygeal.
*Parts of a typical spinal nerve: (Fig. 40)
1-Two roots: They connect the nerve to the spinal cord:
a-Sensory posterior root:
-Its fibers arise from the nerve cells in
the posterior root ganglion. It is
completely afferents. The nerve cells in
this ganglion have two processes. A
peripheral process
comes from the sensory components of
the spinal nerve. Its central process
forms the posterior root.
b-Motor anterior root:
- Its fibers arise from:
1-Anterior horn cells-the lower Motor Neurons.
2-Lateral horn cells- the Preganglionic autonomic neurons (T1-T12) and (S2,3,4).
-It is completely efferents .
2-Mixed nerve trunk:
-The two roots join together to form the mixed nerve trunk.
-The mixed nerve trunk ends by giving two branches (rami).
3-Small dorsal ramus "D.R":
-It runs backwards, to supply the skin and muscles of the back .
- Dorsal rami do not form plexuses.
4-Large ventral ramus "V.R"
-It runs ventro-laterally, to supply the anterolateral body wall and limbs.
-The ventral rami divide and join together to form nerve plexuses , for the
innervation of limbs as the brachial, lumbar and sacral plexuses.
B-Nerve ganglia:-
-They are collections of nerve cells outside the CNS.
-They are classified into :
A-Sensory ganglia :
1-Posterior root ganglia of spinal nerves.

24
 Muscles and Nerves

2-Sensory ganglia of cranial nerves.

B-Autonomic ganglia :
1-Sympathetic ganglia.
2-Parasympathetic ganglia.

---------------------------------------------------------------------------------------------------------------

*References :-
1-Gray' Anatomy for students (2007 )
2-Clinical Anatomy by regions 8th Ed. (2008) . R. Snell
3-Grant's Anatomy 12th Ed . (2009)
4-Clinically oriented Anatomy . 6th Ed. (2010). K .Moore
5-Last Anatomy (2011)
--------------------------------------------------------------------------------------------
) ‫(تم بحمد هللا تعالى‬

25
 EAMBRYOLOGY
Eambryology: It is the science concerned with development of an organism from zygote
stage to full establishment of the definitive organ systems in prenatal life.

Prenatal life
It can be divided into:
• Pre-embryonic period: The 1St two weeks of pregnancy
• Embryonic period: From beginning of 3rd week to the end of 8th week.
• Fetal period: From beginning of 3rd month to the time of delivery.

Gametogenesis
Gametogenesis is the process of production of mature germ cells whether sperms or ova
from primitive sex cells (gametes ).

Gametogenesis is divided into:

A-Spermatogenesis (production of the sperms).c
B-Oogenesis (production of the ovum).

Spermatogenesis
• Spermatogenesis includes all of the events by which spermatogonia (primitive sex
cells) are transformed into spermatozoa (sperms).

• Differentiation Onset at puberty- End endless-testis

• Phases of Spermatogenesis:-
Spermatogenesis includes two phases:
A-Spermatocytogenesis

1|Page
 B-Spermiogenesis
-It means the series of changes resulting in the transformation of spermatids into spermatozoa
(sperms)
-64 days
-Motility

Spermiogenesis:
c
Def: metamorphic changes in the spermatid transforming it into sperm.
These Changes include:
l- Formation of the sperm head from the nucleus.
2- Formation of the acrosomal cap from Golgi apparatus.
This cap covers anterior 2/3 of sperm head & Contains enzymes needed
in penetration of ovum during fertilization.
3- Formation of the axial filament through elongation of one of the two centrioles. The
proximal part of this filament is called middle piece while its distal pan is called the sperm tail.
4- Formation of mitochondrial sheath through spiral condensation of mitochondria around the
middle piece.
Duration: Two months (64 days). (From spermatogonia till mature sperm).
The motility of sperms begins after ejaculation (tail of epididymis) & in female
genital tract.

2|Page
 Structure of the sperm
Sperm
Types: either carry X or Y chromosome
Parts:
1-Head: formed of nucleus & acrosomal cap
2-Neck: constriction between the head and middle
piece
3-Middle piece: proximal part of axial filament +
mitochondrial sheath
4-Tail: distal part of axial filament
Abnormal sperms
➢ Abnormalities in shape:
✓ Giant sperm
✓ Dwarf sperm
✓ Sperm with 2 heads or 2 tails
✓ 2 joined sperms c

➢ Abnormalities in shape:
✓ Oligospermia: Decreased number.
✓ Aspermia: No sperms.
✓ Necrospermia: Sperms are dead.
✓ Athenospermia: Non-motile

3|Page
 Seminal fluid
Composition:
1- Sperms: 100 million per 1 ml.
2- Seminal Secretions:
✓ From prostate (milky), seminal vesicles (main bulk, make semen mucoid) & bubo
urethral glands.
✓ Contains: vitamin C, fructose .
Volume: 3-4 cc (normal ejaculate)
Reaction: alkaline.

Viability of sperms
Def: period during which sperms are able to fertilize the ovum.
Duration: 1-2 days.

Oogenesis
❖ Oogenesis includes all of the events by which oogonia ( primitive sex cells) are
transformed into mature ova. It is a cycliccprocess, occurring once every month.
❖ Onset: prenatal
❖ End: menapuse (ovary)
❖ Purpose of oogenesis:
1-To reduce the number of chromosomes from 46 to 23.
2-To increase the size of the ovum from 30 micrones to 120 micrones.
❖ t is divided into two phases:
A) Prenatal Maturation Phase
A. At 4 months, the oogonia are grouped in clusters in the cortex of the ovary. Some show
mitosis, others have already differentiated into primary oocytes.
B. At 7 months, almost all the
oogonia are transformed
into primary oocytes.
C. At birth, oogonia are absent
and each primary oocyte is
surrounded by a single layer
of follicular cells, thus
forming primordial follicle.

4|Page
 (B) Postnatal Maturation Phase

After birth: (most of primordial follicles) become atretic so at puberty there are only 400,000
primordial follicles.
IN THE OVARIAN CYCLE: - the following changes occur.
The primordial follicles start maturation to be primary follicle as follows:
1- Flat follicular cells become cuboidal & by mitosis they in number to be stratified epithelium
called granulose cells.
c
2- Zona pellucida is secreted between the oocyte and granulose cells. Formed by 1ry oocyte
and granulose cells.
Now the structure of primary follicle is:
l- Primary oocyte (in the prophase of 1St meiotic division):
2- Granulosa cells: stratified cuboidal epithelium arises from follicular cells.
3- Zona pellucida.
Then maturation of 1ry follicles starts to be 2ry follicle as follows:
-Stroma cells of ovary form theca folliculi
➢ Theca interna cells secretes estrogen
➢ Theca externa formed of connective tissue
-Crescentic shaped cavity (called antrum) filled with fluid (called liquor folliculi) appear
between granulose cells.

5|Page
Now the secondary follicle consists of:
l- Primary oocyte (in the prophase of 1st meiotic division).
2- Zona pellucida.
3- Granulose cells.
4- Cumulus oophorus.
5- Antrum filled with liquor folliculi.
6- Theca interna.
7- Theca externa.

Ovulation
It is the release of the ovum from mature Graafian follicle at about the middle of the ovarian
cycle.
Structure of ovum: zona + corona radiata + 2nd oocyte
Time of ovulation: It occurs at about 14±1 days of ovarian cycle.
Mechanism of ovulation:
The stimulus for ovulation is the luteinizing hormone (LH) which is secreted from the anterior
lobe of pituitary gland.

6|Page
Viability and fate of ovum:
The human ovum has life span which may not exceed 24 hours after ovulation.
✓ If the ovum is fertilized, it completes its second meiotic division and will form the
zygote.
✓ If the ovum is not fertilized within24 hours after ovulation, it degenerates and
phagocytosed.
Luteinization: (Under LH hormone effect)
Following ovulation the ruptured Graafian follicle undergoes Luteinization (deposition of
yellow pigment in the cells of the follicle) and formation of Corpus luteum that secrete
progesterone
Fate of corpus luteum:
If fertilization occurs If no fertilization
-Corpus luteum or pregnancy -Corpus luteum of menstruation
-Corpus luteum enlarges & -Corpus luteum continues to secrete progesterone for
continues to secrete 14 days for endodermal
progesterone till 4th month when
Growth. Then the corpus begins to degenerate &
placenta is full formed c
decrease in size & transformed into functionless corpus
albicans progesterone menstruation

Fertilization
Fertilization is the act of fusion of the male and female gametes (sperm
and ovum) to form the zygote.
Site: Fertilization usually occurs in the ampullary part of the uterine tube.
After insemination, the sperms pass rapidly from the vagina into the
uterus and from it into the uterine tubes.
They must undergo two processes; capacitation and acrosome
reaction.
a-Capacitation:
-It occurs within the female genital tract, and takes about 7 hours
during which the glycoprotein coat and seminal plasma proteins are

7|Page
removed from the plasma membrane that overlies the acrosomal region of the sperm.
Completion of capacitation permits the acrosome reaction to occur.
b-Acrosome reaction:
-It occurs very close to the secondary oocyte. During this reaction the
following substances are released from the acrosomal cap:
• 1)Hyaluronidase, needed to assist in penetration of the corona
radiata,
• 2)Trypsin-like substances, needed to digest the zona pellucida, and
• 3)Acrosin, needed to help the sperm to penetrate the zona pellucida.

Phases of Fertilization:
I-Penetration of the corona radiata
II-Penetration of the zona pellucida
III-Fusion of the sperm with the ovum to form the zygote
Results of fertilization are the following:
c
a-Formation of the zygote with restoration of the diploid
number of chromosomes, half from the father and half from the
mother.
b-Determination of the sex of the new individual.
c-Initiation of cleavage.

In Vitro Fertilization (IVF) of Human Ova:

-In vitro fertilization of human ova and embryo transfer is a frequent practice done by
laboratories throughout the world.
-In this technique, oocytes are collected with an aspirator from the ovarian follicles by
laporoscopy.

8|Page
 EAMBRYOLOGY
It is the science concerned with development of an organism from zygote
stage to full establishment of the definitive organ systems in prenatal life.

Prenatal life
It can be divided into:
• Pre-embryonic period: The 1st two weeks of pregnancy
• Embryonic period: From beginning of 3rd week to the end of 8th week.
• Fetal period: From beginning of 3rd month to the time of delivery.

Gametogenesis
Def: All events by which primitive sex cells which called primordial germ cells
transformed into the mature gametes (sperms or ova)

What are the primitive sex cells?

The cells that appear in the wall of yolk sac at end of 3rd week of
pregnancy then migrate to gonads (ovary or testis) where they arrive at the end
of 5th week of pregnancy.

Gametogenesis is classified into 2 processes:

Spermatogenesis: production of mature sperms from primitive sex cells in
the testis.
Oogenesis: production of mature ova from primitive sex cells in the ovaries.

Spermatogenesis
1-Spermatocytogenesis
• Def: All events by which primitive sex cells(spermatogonia)
transformed into mature sperms.
• Site: testis
• The time of spermatogenesis: From puberty and continues for life

Steps of spermatocytogenesis:
primitive sex cells (46 XY)→ mitosis → dark A spermatogonia (46 XY) →
mitosis (4-5 times for continuous supply) → daughter Dark A spermatogonia
(46 XY) some of them differentiate → pale A spermatogonia (46 XY) →

1
mitosis some of them differentiate → type B Spermatogonia (46 XY) →
mitosis and be pushed towards the lumen → primary spermatocytes (46
XY)→ 1st meiotic division (1st maturation division) → 2 secondary
spermatocytes (23X or Y) → 2nd meiotic division (2nd maturation division) →
4 spermatids (23 X or Y). The spermatids contact sertoli cells for
spermiogenesis.

2- Spermiogenesis:
Def: metamorphic changes in the spermatid transforming it into sperm.
These Changes include:
1- Formation of the sperm head from the nucleus.
2- Formation of the acrosomal cap from Golgi apparatus.
This cap covers anterior 2/3 of sperm head & Contains enzymes needed
in penetration of ovum during fertilization.
3- Formation of the axial filament through elongation of one of the two
centrioles. The proximal part of this filament is called middle piece
while its distal part is called the sperm tail.
4- Formation of mitochondrial sheath through spiral condensation of
mitochondria around the middle piece.
Duration: Two months (64 days). (From spermatogonia till mature sperm).
The motility of sperms begins after ejaculation (tail of epididymis) & in
female genital tract.

SPERM
Types: either carry X or Y chromosome.
Parts:
1- Head: formed of nucleus & acrosomal
cap.
2- Neck: constriction between the head
and middle piece.
3- Middle piece: proximal part of axial
filament + mitochondrial sheath.
4- Tail: distal part of axial filament.

Abnormal sperms:
1- Abnormality in shape: 2- Abnormality in number:
- Giant sperm • Oligospermia: Decrease
- Dwarf sperm number of sperms less than
- Sperm with 2 heads or 2 tails 25% of normal number.
- 2 joined sperms • Aspermia: no sperms.

2
 • Necrospermia: dead sperms.
• Athenospermia:non-motile

Seminal fluid:
Composition:
1- Sperms: -100 million per 1
ml.
2- Seminal Secretions:
- From: prostate (milky),
seminal vesicles (main
bulk, make semen mucoid)
& bubo urethral glands.
- Contains: vitamin C,
fructose .
Volume: 3-4 cc (normal ejaculate)
Reaction:- alkaline.

Viability of sperms:
DEF: period during which sperms are able to fertilize the ovum.
Duration: 1-2 days.
N.b: Spermatogenesis need temperature lower than body temperature.
OOGENESIS
Def: production of mature ova from primitive sex cells
Site: Ovary.
The time of oogenesis: From intrauterine to menopause

Purpose of oogonesis :-
1-To reduce the number of chromosomes from 46 to 23.
2-To increase the size of the ovum from 30 micrones to 120 micrones.

PHASES (STEPS):
A- Prenatal maturation phase.
- At 4 months: the oogonia are grouped in clusters in the cortex of the
ovary. Some show mitosis, others have already differentiated into
primary oocytes.
- During the 5th month: the germ cells (oogonia and 1ry oocyte) reach its
7 millions, and then degeneration (atresia) occurs.
- At 7 months: almost all the oogonia are transformed into primary
oocytes.
3
 - At birth: oogonia are absent and each primary oocyte is surrounded by
a single layer of follicular cells, thus forming primordial follicle. About
one million at birth.

B- Postnatal maturation phase:

- After birth: (most of primordial follicles) become atretic so at puberty
there are only 400,000 primordial follicles.

IN THE OVARIAN CYCLE: - the following changes occur.

The primordial follicles start maturation to be primary follicle as follows:
1- Flat follicular cells become cuboidal & by mitosis they  in number to
be stratified epithelium called granulose cells.
2- Zona pellucida is secreted between the oocyte and granulose cells.
Formed by 1ry oocyte and granulose cells.

Now the structure of primary follicle is:

1- Primary oocyte (in the prophase of 1st. meiotic division):
2- Granulosa cells: stratified cuboidal epithelium arises from follicular
cells.
3- Zona pellucida.

Then maturation of 1ry follicles starts to be 2ry follicle as follows.

- Stroma cells of ovary form theca folliculi
Theca interna cells →secretes
estrogen
Theca externa → formed of
connective tissue
- Crescentic shaped cavity (called antrum) filled with fluid (called liquor
folliculi) appear between granulose cells.

Now the secondary follicle consists of:

1- Primary oocyte (in the prophase of 1st. meiotic division).
2- Zona pellucida.
3- Granulose cells.
4- Cumulus oophorus.
5- Antrum filled with liquor folliculi.
6- Theca interna.
7- Theca externa.

4
Then the 2ry follicles become vesicular or Graafian which is formed due 
liquor folliculi several times so its structure is the same as secondary follicle
but with expanded antrum. One follicle matures & others become atretic.

Just before ovulation: primary oocyte completes 1st meiotic division → 2

daughter cells, each has 23 chromosomes (22+x)

Secondary oocyte 1st polar body

Large in size as it takes all cytoplasm. Small lies between Zona Pellucida
Then at the moment of ovulation it &cell membrane of oocyte. It divides
starts 2nd meiotic division & arrested by 2nd meiotic division into 2 polar
in its metaphase till fertilization. bodies which degenerate

Ovulation:
th
at the 14 day of the ovarian cycle.
Def: Shedding of ovum formed of (secondary oocyte) surrounded by Zona
pellucida & corona radiate (previous cumulus oophorus) from Graafian follicle,
then fimbriae guide ovum to enter the uterine tube.
-:Mechanism of ovulation
The stimulus for ovulation is the luteinizing hormone
(LH) which is secreted from the anterior lobe
of pituitary gland .

5
Viability of ovum:
The 2nd meiotic division is completed if oocyte is fertilized, otherwise if no
fertilization, it degenerates in 24 hours after ovulation.

Luteinization :( Under LH hormone effect)

Following ovulation the ruptured Graafian follicle undergoes Luteinization
(deposition of yellow pigment in the cells of the follicle) and formation of
Corpus luteum that secrete progesterone hormone.

Fate of corpus luteum:

If fertilization occurs If no fertilization
- Corpus luteum of pregnancy. - Corpus luteum of menstruation.
- Corpus luteum enlarges & - Corpus luteum continues to secrete
continues to secrete progesterone progesterone for 14 days for
till 4th month when placenta is full endometrial growth. Then the
formed. corpus luteum begins to
degenerates & decreases in size &
transformed into functionless
corpus albicans →  progesterone
→ menstruation.

RESULTS of oogenesis: - one 1ry Oocyte gives 1 mature ovum and 3 polar
bodies.

6
 1st week of pregnancy
1- Fertilization and zygote formation in 1st day
2- Cleavage & morula formation 1st- 4th day
3- Blastula formation.
4- Implantation in 6th to 7th day.

Fertilization:
Def.: Fusion of sperm(male gamete) & ovum(female gamete) to form zygote.
Site: ampulla of uterine tube.
Steps: from 300-500 million sperms ejaculated in vagina only 500 reach
Fertilization site & they must undergo 2 processes to be able for fertilization.
A-Capacitation:
- Removal of glycoprotein coat & seminal plasma proteins that cover the
acrosomal region to permits acrosomal reaction to occur.
- Site: - In female genital tract (uterine tube).
- Duration: - 7 hours.
B- Acrosomal reaction:

Release of the enzymes from acrosomal cap which are:

1- Hyaluronidase: to penetrate corona radiate.
2- Acrosin & trypsin – like substances: to penetrate zona pellucida.
Site: - (uterine tube) very close to secondary oocyte.

Phases of Fertilization:
1- Penetration of corona radiate by:
- Hyaluronidase enzyme (from 300-500 sperms) reach the fertilization site

7
 - Tubal mucosa enzymes.
2- Penetration of zone pellucida by:
- Acrosin & trypsin like substance released from acrosomal cap of sperms
- The oocyte responds by.
• Formation of fertilization cone to engulf one sperm (once the head of
sperm touches the oocyte membrane).
• Cortical & zona reaction: means
release of cortical oocyte granules
containing lysosomal enzymes from
oocyte. These enzymes change the
properties of zona pellucida to make it
impermeable to other sperms.
3- Fusion of sperm & ovum to form
zygote:
- Immediately after entry of sperm, the
secondary oocyte completes 2nd
meiotic division → formation of
female pronucleus (mature ova) & 2nd
polar body.
- Sperm moves to become close to the female pronucleus.
- Middle piece & tail are then disappear.
- Sperm nucleus swells →form male pronucleus .
- The 2 pronuclei fuse in the center of the ovum forming zygote.
Results of fertilization:
1- Formation of the zygote (46 chromosomes) with restoration of diploid
number of chromosomes.
2- Determination of sex of embryo.
3- Start of cleavage.

In Vitro Fertilization (IVF) of Human Ova:

-In this technique, oocytes are collected with an aspirator from the ovarian
follicles by laparoscopy & sperms added. Then the fertilized ovum placed in
uterus.
Cleavage (segmentation)
Def: Rapid successive mitotic
divisions results in production
of smaller cells called
blastomeres.
Steps: zygote → 2 cell stage in
30 hours → 4 cell stage → 8
cell stage → 16 cell (morula)

8
stage in 3 days → 32 cell stage (morula)& so on.
Site: in uterine tube
Morula:
Def. 16 cell stage, formed & enter uterine cavity at 3rd day after fertilization.
Structure:

Outer cell mass (trophoblast). Inner cell mass.

Outer layer of blastomeres will Centrally placed blastomeres will
form placenta. form tissues of embryo

Blastocyst
Formation:
- In uterine cavity at 5th day after fertilization.
- Fluid pass from uterine cavity through Zona
Pellucida & outer cell mass of morula to
spaces between outer & inner cell mass &
these spaces unite → single cavity called
blastocele.
Structure: a vesicle formed of

9
 1- Outer cell mass (trophoblast):- single layer of flat cells which will form
the placenta.
2- Inner cell mass: at one pole of outer cell mass called embryonic pole.
3- Blastocele (a cavity filled with fluid).

N.B: Functions of zona pellucida.

1- Prevents penetration of ovum by other sperms by zona reaction.
2- Passes nutrients to embryo.
3- Keeps blastomeres together during cleavage.
4- Prevents adhesions of blastomeres to epithelium of uterine tube.

2nd week of pregnancy

1- Implantation is completed.
2- Formation of bilaminar embryonic disc
3- Formation of amniotic cavity,1ry yolk sac& connecting stalk.
4- Formation of chorion & chorionic coelom.

Implantation:
Def: embedding of fertilized ovum (blastocyst) in endometrium.
Normal site: upper part of posterior or anterior wall of uterus near fundus.

10
 Mechanisms of implantation:
3 mechanisms under the effect of progesterone.
1- Muscular: Transport of blastocyst & placed it in the area of
implantation.
2- Adhesive:
By which the blastocyst is attached to localized part of endometrium.
3- Invasive:
By which the blastocyst penetrate the endometrium.

Start of implantation: by the 7th Day after fertilization.

Steps:-
1- Attachment of the blastocyst to the endometrium at embryonic pole).
2- The trophoblastic cells at these projections differentiate into:

• Outer syncytiotrophoblast (has finger like projection) which

erode the Stroma of endometrium
• Inner cytotrophoblast (has intact
cell boundaries) called Langhans
layer.
3- End of implantation: By the 11th. Day
the blastocyst is completely embedded in
the endometrium.

Abnormal sites of implantation:

A-Uterine implantation(placenta praevia)
In Lateral wall of uterus close to internal OS.
Types:
1- placenta praevia marginalis: partially
covers internal OS.
2- placenta praevia centralis: completely
covers internal OS.
3- placenta praevia lateralis: at margin of
internal OS.
Extra-uterine implantation:
(ectopic pregnancy)
Pregnancy outside the uterus.
Types:
1- (tubal pregnancy)In
uterine tube
2- (ovarian pregnancy) On
ovary
3- (abdominal Pregnancy)

11
 Decidua:
Def.: endometrium after implantation of blastocyst.
Fate: it is shed during delivery.
Formation: - by progesterone through decidual reaction: as follows:
1- Stroma cells become polyhedral cells
& filled with glycogen & lipids and
are called decidua cells.
2- Endometrium become thick &
edematous.
Parts of decidua:
1- Decidua basalis: between implanted
blastocyst & uterine wall.
2- Decidua capsularis: between
implanted blastocyst & uterine
cavity.
3- Decidua parietalis: The remaining decidua, lines wall of uterine cavity.
Formation of germ layers (embryonic disc)
- At 8th day after fertilization amniotic cavity appears within inner cell
mass.
- Inner cell mass differentiate into 2
germ layers.
• Hypoblast: - inner layer of
cuboidal cells close to
blastocele.
• Epiblast: - outer layer of
columnar cells.
- These 2 layers together form
bilaminar embryonic disc.
- Epiblast cells spread to line inner
surface of cytotrophoblast are called amnioblast & together with the rest
of epiblast forming amnion that line amniotic cavity.

12
 - Hypoblast cells spread to line inner
surface of cytotrophoblast at ab.
embryonic pole forming a membrane
called exocoelmic (Heuser's)
membrane. This membrane with
hypoblast form lining of 1ry yolk sac.

Formation of extra embryonic

mesoderm:
- At 11th – 12th day after fertilization. From hypoblast.
- Cells appear between cytotrophoblast externally & exocoelmic
membrane & amnion internally.
Formation of extra embryonic coelom:
Spaces appear in extra embryonic
mesoderm, then unite to form C-shaped
cavity called extra embryonic coelom
that surrounds amniotic cavity & 1ry
yolk sac except at small area called
connecting stalk that connects bilaminar
embryonic disc to trophoblast.

Fate of extra embryonic mesoderm:

- Extra embryonic somato – pleuric mesoderm:
Line cytotrophoblast & covers amniotic cavity.
- Extra embryonic splanchno – pleuric mesoderm: covers 1ry yolk sac.
N.B: At this stage the blastocyst is called chorionic vesicle & extra embryonic
coelom is called chorionic cavity. The membrane formed by extra embryonic
smatopleuric mesoderm & overlying trophoblast is called chorion.

13
 Events in the 3rd week of pregnancy
1- Gastrulation & formation of the 3 germ layers.
2- Notochord formation.
3- Formation of cloacal & buccopharyngeal membrane.
4- Neurulation.
5- Allantois formation and 3 types of chorionic villi.

Gastrulation
Def.: the process by which the epiblast forms the 3 germ layers intra –
embryonic (endoderm, mesoderm & ectoderm).
Time: 3rd week of development.
Steps:
1- Formation of primitive streak & node. (at 15th – 16th day).
Primitive streak
Def.: Narrow groove on the surface of epiblast in
the midline near the caudal end of the embryo.
Primitive node
Def.: rounded elevation at the cephalic end of the
primitive streak.
This elevation has a small pit called primitive
pit

2-Migration: of epiblast cells toward the

primitive streak & node. When the migrating cells
reach the region of primitive streak they become

flask shape & detach from epiblast.

3- Invagination of migrating cells
below the epiblast leading to formation
of the 3 germ layers as follows.
• First invaginated cells that
displace hypoblast form→ intra
embryonic endoderm.
• Next invaginated cells after
formation of endoderm lie
between epiblast & endoderm form → intra – embryonic mesoderm
which spread in.
• Remaining cells in epiblast form → ectoderm.

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 Growth of the embryonic disc
In shape:-
Rounded then oval then pear shape with broad cranial end & narrow
caudal end .
Bilaminar: formed of two layers
• Epiblast: dorsal layer of columnar cells.
• Hypoblast: ventral layer of cuboidal cells.
Trilaminar:
• Ectoderm, mesoderm & endoderm except at buccopharyngeal
membrane cranially & cloacal membrane caudally, there is no
mesoderm & the membranes formed of ectoderm & endoderm only.

Notochord
Def: Solid cord in axis of embryonic disc between ectoderm & endoderm.
Around it vertebral column is formed.
Steps of formation:

1- Notochordal (head) process:

Cells invaginated through primitive pit move in cephalic direction till they
reach prochordal plate (future buccopharyngeal membrane) →forming tube
like process called notochordal (head) process.
2- Notochordal canal:-
Formed by extension of the primitive pit through the process.
3- Notochordal plate:
At 18th day of development the floor of notochordal canal fuses with
underlying endoderm & the 2 layers degenerate

Notochordal plate: Neuro –enteric canal:

Is the roof of notochordal The temporary communication
process between amniotic cavity & yolk sac.
It rapidly closes by regeneration of

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 surrounding endoderm
4- Definitive notochord:
Notochordal plate is folded around its long axis →form definitive notochord.

Differentiation in Germ layer

rd th
Time: between 3 - 8 week of development. It is the period of organogenesis.
Differentiation of Ectoderm (neurulation)
Def: formation of neural tube. Through induction from notochord.
1- Formation of neuroectoderm (neural plate)
The ectoderm overlying the notochord thickened to form neural plate under
induction from notochord. The cells of this plate called neuroectoderm.
2- Formation of neural crest:
Ectodermal cells on sides of neural plate.
3- Formation of neural folds & groove:
- Lateral edges of neural plate are elevated → neural folds & depressed
mid region → neural
groove.
- At end of 3rd week
4- Formation of neural tube:
Neural folds approach each
other in midline then fuse with
each other to form the neural
tube.
5- The neural tube has anterior
(cephalic) & posterior (caudal
end) neuropores that rapidly
Closed at end of 4th wk.

Fate of neural tube : Cephalic broad part → brain

Caudal narrow part→ spinal cord.
N.b.: The remaining part of ectoderm → Form epidermis of skin.

4th week of pregnancy

• Formation of somites-

• folding- primitive heart tube formation-

• Yolk sac is reduced& amniotic cavity increased.

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 Differentiation of intra embryonic (secondary) mesoderm
On each side of notochord, the mesoderm divided by longitudinal groove into:
1- Paraxial mesoderm: medial to groove.
2- Intermediate mesoderm: in floor of groove.
3- Lateral plate mesoderm: lateral to groove.

Paraxial mesoderm
- Two mesodermal mass in each side of notochord.
- Paraxial mesoderm is divided into Paris of cubical masses called
Somites.
- They develop first in cephalic region then proceeds in cephalo-caudal
direction.
- Start at 20th day, 3 pairs/ day & end at end of 5th week to become 42-44
pairs of somites.
Fate of somites:
Divided into 2 parts.
Sclerotome is ventromedial part Dermomyotome is dorsolateral part
It surrounds notochord & spinal cord Dermatome → dermis of skin.
→ form vertebral column Myotome → voluntary muscles.

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 Intermediate mesoderm
- The mesoderm lies lateral to paraxial mesoderm.
- Partly segmented & partly unsegmented:
- The segmented cephalic part is divided into nephrotomes.
- The unsegmented caudal part →form nephrogenic cord that will form
→ Kidneys, gonads & their ducts.

Lateral plate mesoderm

The mesoderm in the lateral part of embryonic disc. Laterally it is
continuous with extra embryonic mesoderm & cranially crosses in front
of buccopharyngeal membrane forming cardiogenic area.

Intraembryonic coelom:
- Spaces appear in lateral plate mesoderm then unite → form inverted U
shaped cavity called intraembryonic coelom.
Fate of intraembryonic coelom → Form 3 serous cavities.
1- Pericardial cavity: from transverse part of coelom that crosses midline of
disc in cardiogenic area.
2- Pleural cavities: from junction between transverse part & 2 caudal limbs
of coelom which is called pericardio-peritoneal canal.
3- Peritoneal cavity: from 2 caudal limbs of the coelom.
-Septum transversum.
- The Part of lateral plate mesoderm between pericardial cavity &
cephalic margin of the embryonic disk.

Differentiation of endoderm Formation of Gastro – intestinal tract.

Folding of the embryonic disc
Def.:- flexion of the trilaminar embryonic disc ventrally towards the yolk sac.
Time: 4th week of development.
The folding occurs around 2 axes:
• An A- P axis (cephalo-caudal folding): →formation of head & tail folds.
• A transverse axis (lateral folding): →formation of 2 lateral folds
Causes of folding:
• Expansion of amniotic cavity (the most important)
• Cephalo – caudal folding by: rapid growth of neural tube
• Lateral folding by: rapid growth of somites.
Head & tail fold is restricted due to the firm notochord & primitive streak.

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 Results of folding:
1- Formation of the Primitive gut: (lined by endoderm)
As a result of folding of the embryonic disc ventrally →Large dorsal part of
yolk sac is enclosed in body of embryo forming primitive gut which is divided
into 3 parts:
- Foregut: in head fold.
- Hindgut: in tail fold.
- Midgut: between foregut and hind gut,
this midgut ventral part of yolk sac by
vitello-intestinal duct.
- Anterior intestinal portal is junction
between foregut & midgut
- Posterior intestinal portal is junction
between midgut & hind gut.
2- Formation of gut mesentery: As a result
of lateral folding of embryonic disc →Forming dorsal &
ventral mesenteries.
3- Formation of umbilical orifice (future umbilicus):
- Lies between the 4 folds that surround umbilical
orifice which contains vitello intestinal duct &
connecting stalk.
4- Reversal of position:
- Due to formation of head fold→
1- Buccopharyngeal membrane becomes the
most cranial structure.
2- Septum transversum becomes caudal to
cardiogenic plate.

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 Foetal membranes
Def: - any tissue or structure developed from zygote & does not form part of
embryo proper. Such as Chorion, umbilical cord, yolk sac, amnion, allantois,
connecting stalk, & placenta.
Chorion
N.B: At the stage of blastocyst transformed into chorionic vesicle. The membrane
formed by extra embryonic mesoderm & overlying Syncytiotrophoblast &
Cytotrophoblast is called chorion.

Chorionic villi:
Def: finger like processes arise from trophoblast into deciduas basalis &
capsularis.
Time: 9th – 25th day of development.

Types of Chorionic villi:

According to structure:
1- Primary villus: formed of two layers .outer syncytiotrophoblast & inner
cytotrophoblast.
2- Secondary villus: as primary but acquire a core of 1ry mesoderm(outer
syncytiotrophoblast , inner cytotrophoblast & core of 1ry mesoderm)
3- Tertiary villus: as secondary but a blood vessel develops in its 1ry
mesoderm. Formed of 4 layers(outer syncytiotrophoblast , inner
cytotrophoblast , core of 1ry mesoderm & a blood vessel)

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 YOLK SAC
Stages of development
Primary yolk sac:
- It is formed in the stage of blastocyst
due to formation of exocoelmic
membrane.

Boundaries: - roof formed by hypoblast.

• Side& floor:- exocoelmic membrane
(Heuser's membrane)

Secondary yolk sac:

- It is formed in the stage of
chorionic vesicle from primary
yolk sac.
- Boundaries:- roofed by
endoderm.
- Side & floor:- endoderm &
extra embryonic mesoderm.

Definitive yolk sac:

- Remaining part of yolk sac outside
embryo after disc folding & formation
of gut.
- Definitive yolk sac temporary
connected with midgut by vitello-
intestinal duct which disappear later.
Functions of yolk sac:
1. Early nutrition.
2. form lining epithelium of gastro
intestinal &respiratory tracts
3. Allantois form part of urinary bladder.
4. Site of formation of primitive sex cells.
5. Blood vessels & cells are formed in surrounding embryonic mesoderm.

AMNION & AMNIOTIC CAVITY

Amniotic fluid = liquor:
It is the fluid that fills amniotic cavity.
Source: at 1st formed by secretion from amnioblast when the fetal kidneys act,
fetal urine is added to the fluid. Also from secretion of mucus cells of lung &
secretion from foetal surface of placenta.

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Amount:  gradually until 7th month of pregnancy, then  & at time of Birth ,
it is about 1,5 liters.
Circulation:- swallowed by the fetus → the gut from which it is absorbed →
the fetal circulation → the placenta to → maternal blood.
Functions of amniotic fluid:
1- Protect embryo from external shocks.
2- Allow Symmetrical growth of embryo.
3- Antiseptic medium (remove bacteria) around embryo.
4- Allow free movement of embryo.
5- Good dilator of cervix of uterus during delivery.
Anomalies:
1- Oligohydramnios: volume <500 cc.
2- Polyhydramnios: volume > 2500 cc.

CONNECTING STALK
Def. mass of extra embryonic mesoderm at caudal end of embryonic disc.
Contains umbilical Vs &allantois.

UMBILICAL CORD
th
Formation: in 5 week of development
by.

Structure of umbilical cord at 5th week:

- Sheath of amnion.
- Wharton's jelly: mesoderm of
connecting stalk.
- Remains of extra – embryonic
coelom.
- Allantois.
- Vitello intestinal duct.
- Umbilical vessels, 2 arteries & 1
vein.
- Vitelline vessels.
Between 6th-10th Week of development
- The abdominal cavity is small to
accommodate rapidly developing
intestinal loops results in herniation
of the loop in umbilical cord forming
physiological umbilical hernia.
th
At 12 Week.
- The intestine returns to the abdomen.

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At birth (full term): features at full term:
1- 50 cm in length.
2- Attached to foetal surface of placenta near center.
3- Twisted as umbilical arteries are longer than vein.
Changes after birth:
1- Obliteration of Urachus → median
umbilical lig.
2- Obliteration of Umbilical arteries →
lateral umbilical ligaments.
3- Obliteration of Umbilical vein →
ligamentum teres of liver.
Functions:
1- Flow of blood ( ) fetus & placenta.
2- Fetus floats freely in amniotic cavity.

Anomalies:
• Double cord.
• Triple cord.
• Very long cord that may turn around neck of
fetus → suffocation.
• Very short → premature separation of placenta.

• true knots:
✓ Due to excessive fetal movements
associated with too long cord.
✓ Obstruction of umbilical vessels →
fetal death.
• false knots:
No obstruction of vessels.
• Abnormal attachment to placenta:
i. Central attachment.
ii. Marginal attachment
(battledore placenta).
iii. Velamentous attachment:
cord attached to foetal membranes
with blood vessels passing
towards placenta.
• Cord with only 1 umbilical artery.
• Omphalocele (umbilical hernia).

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 PLACENTA
It is the organ of exchange between
maternal blood & foetal blood.
Origin of placenta: 2 parts.
o Foetal part: chorion frondosum.
o Maternal part: decidua basalis.
Full term placenta:
▪ Is disc shape of flattened
cake.
▪ 15-20 cm diameter
▪ 3-4 cm thickness "more
thick in center"
▪ 500 grams.
▪ It has two surfaces.

1- maternal surface: 2- foetal surface:

Formed by decidua basalis Formed by chorionic plate
Rough with 15-20 cotyledons & Smooth covered by amnion &
fissures umbilical cord is attached to it near
center.

Placental (foetomaternal) barrier:

- Between maternal blood & fetal blood. In early pregnancy formed of:
• Syncytiotrophoblast.
• Cytotrophoblast.
• Extra embryonic mesoderm.
• Endothelium of fetal blood vessels.
nd
In 2 half of pregnancy, the barrier loses Cytotrophoblast & extra embryonic
mesoderm & becomes thin formed of two layers only 1- Syncytiotrophoblast
2- endothelium of fetal blood vessels , to increase the rate of exchange in late
pregnancy to satisfy growing fetus.

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 Placental functions:
1- Nutritive functions: absorption of nutrients from maternal blood.
2- Excretory functions: fetus gets rid of waste products.
3- Respiratory functions: foetus receive 02& get rid of co2
4- Protective functions: Placenta protects foetus from some diseases as
measles & diphtheria but other diseases affect the foetus as syphilis &
poliomyelitis.
5- Endocrine: syncytiotrophoblast secretes the following hormones:
• Progesterone: start at 5th month, maintain pregnancy.
• Estrogen: at end of pregnancy.
• Human chorionic gonadotropins: pass in mother's urine .Their
presence in urine is an indicator for pregnancy.

Anomalies of placenta:
Anomalies In position: abnormal sites of implantation
Placenta praevia: in lateral wall of uterus close to internal OS:
1- Placenta praevia lateralis: at margin of internal OS.
2- Placenta praevia marginalis: partially covers internal OS.
3- Placenta praevia centralis: completely covers internal OS.

Anomalies In attachment of umbilical cord:

1- Central attachment: Umbilical cord attached to the center of placenta.
2- Marginal attachment (battledore placenta).
3- Velamentous attachment: cord attached to foetal membranes with blood
vessels passing towards placenta.

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 Anomalies In number :
1- Accessory placenta (succenturiata): small placenta near original one.
2- Placenta bipartita: bilobed placenta in twin pregnancy.
3- Placenta tripartita: trilobed placenta in triplet pregnancy.
Anomalies In shape:
Membranous placenta: Placenta occupies more than 1/2 the endometrium.

Types of Twins:
- Dizygotic twins: binovular (twins). Monozygotic twins: monovular.

• Commonest. • Less common

• Results from fertilization of 2 oocytes • Results from fertilization of one oocyte by
by 2sperms → 2 zygots. one sperm → one zygote then the zygote
splits at various stages of development.
• the twins are non- identical • the twins are identical
• may be different sex or the same sex • The twins are the same sex
• Each twin has its "amnion – chorionic
vesicle – placenta".

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