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

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General Anatomy - sample

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