WHERE AM I?

1. WHERE AM I? Online Anatomy Module 1 INTRO & TERMS CELL EPITHELIUM CONNECTIVE TISSUE MUSCLE NERVOUS SYSTEM AXIAL SKELETON APPENDICULAR SKELETON MUSCLES EMBRYOLOGY

2. PARAMEDICAL ANATOMY W Beresford The topics start with general ideas about body systems, terms used in describing the structures of the body - where they are, how they lie, their subdivisions, their blood and nerve supply, etc;the tissues and cell types making up organs; &the structure and workings of cells. Then, we look at individual systems of the body, e.g., muscular, respiratory, etc. There is another way of looking at the body, namely to take a REGION and describe what structures are present there and closely connected in a physical sense, although they belong to several systems. Thus, the chest wall is musculo-skeletal, and covered with skin. Inside the chest are parts of respiratory, cardiovascular, and digestive SYSTEMS - lungs & trachea, heart and vessels, esophagus Without thinking much about it, you will acquire both understandings of the body - systemic and regional

3. ANATOMY: What is the point? Anatomy is just one way of looking at the living person used by all members of the medical team. What they want to know is what went wrong in this patient, what is still working well, and how to correct the problem without doing more damage. Humans are complex large mammals with several systems for getting their energy and distributing it, getting rid of waste products, moving around and manipulating things in their surroundings, detecting threats and change and adapting to them, keeping the body working at about the same level and temperature, keeping nasties outside the body and dealing with ones that have entered, and reproducing themselves. These systems take the form of connected structures packed in tightly in one body. More than one system can be at a particular place, and some are spread out widely in many places.

4. ANATOMY & SYSTEMS Humans are complex large mammals with several SYSTEMS for: getting their energy and distributing it getting rid of waste products moving around and manipulating things in their surroundings detecting threats and change and adapting to them keeping the body working at about the same level and temperature keeping nasties outside the body and dealing with ones that have entered and reproducing themselves. Alimentary/digestive Vascular Respiratory Urinary RespiratoryDigestive Musculo-skeletal Nervous/Sensory Nervous & Endocrine Skin Blood & Lymphoid Reproductive

5. ANATOMY & SYSTEMS: Book Refs The systems and their organs are shown well on pp. 5,6 of Marieb, and Figs 1-5 through 1-12 (pp. 8-10) of Guy Alimentary/digestive Vascular Respiratory getting their energy and distributing it getting rid of waste products moving around and manipulating things in their surroundings detecting threats and change and adapting to them keeping the body working at about the same level and temperature keeping nasties outside the body and dealing with ones that have entered and reproducing themselves. Urinary RespiratoryDigestive Musculo-skeletal Nervous/Sensory Nervous & Endocrine Skin Blood & Lymphoid Reproductive

6. ANATOMY: What is the point? When things go wrong and the patient probably has signs and symptoms, we think of the primary place & structures involved and the system affected, and then the secondary effects. Physiologists and internists are more concerned with the systems and repercussions; anatomists, pathologists and radiologists pay rather more attention to the place - what was the normal structure, what has changed, how is it causing bad effects. But the two kinds of knowledge interact. Thus, the internal-medicine doc knows the cell behavior and biochemistry of how blood clots, and why this is more likely in some people; while the anatomist can partly explain why clots form in the veins of resting legs, and why any clot dislodged in the leg is likely to block vessels in the lung - a pulmonary embolism. The nurse needs to have an idea of both aspects, and what to recommend to the bed-ridden patient or the long-haul traveller.

7. ANATOMY AS STRUCTURES These systems take the form of connected structures packed in tightly in one body. More than one system can be at a particular place, and some are spread out widely in many places. Skin, for example: helps maintain body temperature; protects against microorganisms and water loss; provides touch, and sensory feedback to control movement; in places, skin acts as a tight jacket to enclose soft tissues, such as muscle. So while we describe what the structures are at particular place, we’ll keep in mind a few aspects of how the structures are participating in the various systems. And while we describe what the structures are of a particular system, we’ll keep in mind aspects of other structures at those sites in the body.

8. ANATOMICAL NAMES I Descriptions in anatomy aim at a distinctive name for each structure, and one that is precise so that everyone agrees on which thing is under discussion, e.g., to be treated Some names seem to be straightforward - just one word (often derived from the Latin or Greek), e.g., patella for the kneecap. But hold on! There are two, so that we need an adjective specifying right or left. In practice, the adjectives tend to pile up for a precise name. For example, the left, posterior, tibial artery No different from a full address to get your mail to arrive at your door: Apt 4, 326 Marquis Ave, TRENTON, NJ 16235 Also, we need to retain the layman’s name to help in explaining to the patient or a relative.

9. ANATOMICAL NAMES II Some names seem to be straightforward - just one word (often derived from the Latin or Greek), e.g., patella for the kneecap. But hold on! There are two, so that we need an adjective specifying right or left. In practice, the adjectives tend to pile up for a precise name. For example, the left, posterior, tibial artery Another form of anatomical name is to say ‘The something of somewhere’, as for human names, such as Rufus of Ephesus Examples are the muscles Biceps brachii (of the arm) versusBiceps femoris (of the femur bone in the thigh & further specified as Right or Left

10. THE ANATOMICAL POSITION The adjectives in many names fix the structure or part of a structure in relation to an agreed standard orientation of the body, extending to an organ’s relation to adjacent structures Anatomical position - alive The dead (dissecting-table) anatomical position has the person lying flat on her back, arms by the sides, palms facing upwards - think ‘taking the rays’ - which also has the thumbs sticking outwards Anatomical position - dead We’ll now apply anatomical terms and (layman’s equivalents)

11. MEDIAL & LATERAL Thumb points Laterally (Outwards) Little finger lies Medially (Towards the midline) MEDIAN (Midline)

12. MEDIAN (Midline) MEDIAL again MEDIAN can be used for the middle line of other structures than the whole body Thus, the MEDIAN NERVE runs along in the middle of the forearm

13. ARMS & LEGS: Beware The layman’s term is sometimes given a special, more restricted meaning Thus, the ARM is only the section above the elbow From elbow to wrist is the FOREARM The section of the leg above the knee is the THIGH From knee to ankle is the LEG

14. JOINTS BETWEEN BONES SHOULDER The large ones often use the layman’s term, but all joints can be named in terms of the two or more bones involved Thus, the shoulder is also the gleno-humeral joint, from the glenoid fossa (depression) of the scapula and the humerus bone of the arm ELBOW WRIST At the elbow, there is more than one joint because the humerus meets with ulna and radius bones of the forearm KNEE HIP ANKLE

15. SURFACE REGIONS ASSOCIATED WITH JOINTS The adjectives are applied to underlying structures Shoulder Elbow CUBITAL (Front side of elbow) AXILLARY (Armpit) INGUINAL (Groin) POPLITEAL (Behind-the-knee) Hip Knee PERINEAL (Crotch)

16. SPELLING IN ANATOMY MATTERS Even if we have not drawn your attention to it, try yourself to note possible confusions AXILLARY is not auxillary PERINEAL is not the same as peroneal The ILEUM is a part of the gut; the ILIUM is a bone As a bedtime exercise, go over the labeled diagrams and say the names to yourself, noting oddities of the spelling. You will have to come up with the names out of your head in the laboratory exams & to label figures

17. PRONUNCIATION IN ANATOMY MATTERS LESS American and British orthopedic surgeons have operated together for more than 50 years despite several differences, e.g., cervical (neck), which has a long ‘i’ in British English. You can hear the terms spoken in standard American at this site: http://www. An ordinary dictionary gives the pronunciation of most terms. A medical dictionary will fill in the rest. For now, relax about pronunciation: just vocalize the term to yourself in your own way that indicates to you the exact spelling. The ‘correct’ form will come with time.

18. VENTRAL/ ANTERIOR DORSAL/ POSTERIOR VENTRAL & DORSAL Only shows Anterior aspects (Front) (Back) Although there is a choice of terms, convention has usually has settled on a particular pair; and, if ‘dorsal’ is used for one side of a structure, then ‘ventral’ should be applied to the other (ditto for anterior/posterior)

19. RIGHT & LEFT RIGHT LEFT LEFT arm, RIGHT kidney, RIGHT common carotid artery ‘common’ because it will shortly branch into internal & external carotid arteries MEDIAN (Midline)

20. AOR PT Left ATRIUM SVC Right ATRIUM Left VENTRICLE Right VENTRICLE ANTERIOR/FRONT VIEW OF THE HEART Two LEFT chambers of the heart The differences between left and right or laterality are interesting, as is the usage of the terms

21. AOR PT Left ATRIUM SVC Right ATRIUM Left VENTRICLE Right VENTRICLE RIGHT & LEFT RIGHT LEFT Although the heart has left and right sides, the best position for the heart turns out to be tipped and rotated in the chest cavity, so that the right chambers face forward/ anteriorly, and are more visible from the front Within the chest, the heart encroaches more on the left lung, so that the left lung is not an exact mirror-image of the right lung - smaller, fewer lobes, etc MEDIAN (Midline)

22. RIGHT & LEFT RIGHT LEFT Having dual structures gives added power, and security in case one is lost, damaged, or diseased, e.g., kidneys, lungs, eyes, ovaries For other structures, having two would complicate matters. Imagine two mouths, or two anuses, or two penises. Not all single structures are on the midline, for example, the spleen & liver MEDIAN (Midline)

23. RIGHT & LEFT RIGHT LEFT Not all single structures are on the midline, for example, the spleen & liver SPLEEN LIVER (Midline)

24. SURFACE ANATOMY A very useful amount of anatomy is available from the surface examination, combined with touch (palpation) But it requires knowing the underlying deep regional anatomy For example, the liver is normally protected up under the right rib-cage. If it is enlarged by disease, it can be felt protruding down into the right upper quadrant of the abdomen Enlargement, Protrusion, Displacement are typical terms in describing such changes

25. RIGHT & LEFT RIGHT LEFT Not all single structures are on the midline, for example, the spleen & liver SPLEEN This lopsidedness affects the stomach and gut which also share the abdominal cavity. LIVER (Midline)

26. RIGHT & LEFT IN CROSS-SECTIONS RIGHT LEFT RIGHT LEFT Beware, the patient’s LEFT, although on your right Because the convention is that you interpret the X-Ray, CT or MR image as looking at the source patient in the anatomical position from the feet upwards MEDIAN (Midline)

27. CROSS-SECTIONAL IMAGES Cross-sectional (transverse) images interpreted as the source patient being in the anatomical position viewed from the feet upwards RIGHT LEFT

28. CROSS-SECTIONAL IMAGES: Horizontal /Transverse ‘Horizontal’ means the same as transverse, but is counterintuitive in the MRI machine RIGHT LEFT Cross-sectional (transverse) images interpreted as the source patient being in the anatomical position viewed from the feet upwards RIGHT LEFT MEDIAN (Midline)

29. OTHER PLANES FOR IMAGING mid-SAGITTAL CORONAL para-SAGITTAL This is the plane used for the common frontal chest X-ray

30. IMAGING mid-SAGITTAL Images are from: X-rays,Computed Tomography (CT) computed from many X-rays,Magnetic Resonance Imaging (MRI), & Ultrasound (US) para-SAGITTAL Actual slices/cross-sections and other ‘preparations’ are made from dead people who have given permission. These are used to check the reliability of the images from the living.

31. ANATOMY OF CROSS-SECTIONS: Wrist Flexor retinaculum - sheet of fibrous tissue roofing in the tunnel Ulnar artery Mediannerve Ulnar nerve Tendons to flex Tendons to extend CARPAL BONES outside tunnel, on dorsal side of wrist Cross-sections of limbs & other structures than the head & trunk help show & explain disorders Carpal-tunnel syndrome & compromised median nerve

32. BODY WALL & CAVITIES: Casing & Contents The body wall is musculo-skeletal and covered with skin The cavities house soft organs: some tubular or bag-like with a space(s) inside (the lumen), others are more solid, e.g., the spleen, kidneys, and liver. These all are the VISCERA. ‘SOMATIC’ is applied to the limbs and body wall, ‘VISCERAL’ to the viscera

33. BODY CAVITIES I Ventral THORACIC (Chest) Further subdivided into PLEURAL CAVITIES (lungs) & PERICARDIAL CAVITY (for the heart) DIAPHRAGM - a moving muscular sheet for separation & breathing ABDOMINAL (Belly) PELVIC Belly button = Umbilicus

34. BODY CAVITIES II Dorsal The bones of the skull are organized to form the face and a cranial cavity for the brain The vertebrae making up the spine have many surfaces for muscle to attach and stabilize and move the spine. But also, they each have a hole. As the holes line up, they create the spinal canal (cavity) for the spinal cord

35. PROXIMAL DISTAL PROXIMAL & DISTAL (Close) (Far) Proximal and distal apply to long structures that have a start somewhere, e.g., a limb, a finger, an artery, a section of the gut

36. INFERIOR SUPERIOR SUPERIOR & INFERIOR SUPERIOR (Upper) Lip (Lower) INFERIOR Lip

37. ROSTRAL CAUDAL SUPERIOR INFERIOR ROSTRAL ROSTRAL & CAUDAL Rostral and Caudal have the same meanings as Superior and Inferior. CAUDAL From Rostrum - the snout or beak of an animal, and Cauda - the tail

38. SUPERFICIAL & DEEP SUPERFICIAL (Outer/surface) DEEP (Inner) SUPERFICIAL Veins The ones used for injections DEEP Veins

39. EXTERNAL & INTERNAL are applied in much the same sense as superficial and deep left common iliac artery left EXTERNAL iliac artery headed for the leg left INTERNAL iliac artery for pelvic structures

40. TRANSVERSE Transverse structures run cross-wise in the body Transverse process of vertebra This could have been named the lateral process, but was not BODY Transverse colon

41. Medially, anteriorly, superiorly, etc As a long structure travels, we speak of its direction or changes in course, in reference to the planes of the body Thus an artery/vein/ureter/ bronchus, etc, can travel inferiorly, superiorly, medially, laterally, ventrally, dorsally, etc

42. PRONE & SUPINE The dead anatomical position has the person lying flat on his back, arms by the sides, palms facing upwards. This is lying SUPINE Lying face-down is PRONE The distinction matters when you translate to a mother/ father that the baby should be laid down supine to sleep

43. PRONATION & SUPINATION I These are movements that refer to the hand, wrist, and forearm bones One reaches for food, a cookie, say, with the fingers stretched out and the palm down Having closed one’s fingers over the food, one rotates the wrist and lower forearm to have the food facing one’s mouth. Then, flexing the elbow joint brings the food to the mouth. Try it for yourself. Turning the wrist so that the palm faces downwards (platewards) is PRONATION. The motion of turning the wrist so that the palm faces upwards (mouthwards) is SUPINATION.

44. PRONATION & SUPINATION II Having closed one’s fingers over the food, one rotates the wrist and lower forearm to have the food facing one’s mouth. Then, flexing the elbow & shoulder joints brings the food to the mouth. Turning the wrist so that the palm faces downwards (platewards) is PRONATION. Note crossing of forearm bones The motion of turning the wrist so that the palm faces upwards (mouthwards) is SUPINATION. Followed by elbow & shoulder flexion

45. PRONATION & SUPINATION III Then, flexing the elbow & shoulder joints brings the food to the mouth. You will notice that this arrangement relies neatly on having a hinge - the elbow - halfway down, with the arm bone - the humerus - of roughly equal length to the forearm radius & ulna bones

46. GROSS ANATOMY This story of getting food to the mouth shows working anatomy as parts of the body, movements around joints, muscle actions, and some underlying actions of bones of the skeleton Other stories of how the body works make sense only in terms of much smaller units seen with the microscope, down to the level of cells and parts of cells - microscopic anatomy or histology, for example in the kidney and the liver.

47. PULMONARY EMBOLISM Another gross story The anatomist can explain why any venous clot dislodged in the leg is likely to block vessels in the lung - a pulmonary embolism. As the clot passes through the venous drainage out of the leg, and up through the abdomen to the heart, it is in progressively wider vessels. The pulmonary arteries are also large. It is only when the clot reaches the narrow arterioles of the lungs that it is likely to be stopped, blocking blood flow. PT Blood clot

48. PT Convention for deoxygenated blood The flow from heart to lung is depicted in blue, although in pulmonary trunk & arteries and no longer in veins, because the blood still is low on oxygen. Blood clot

49. PT PULMONARY EMBOLISM Another gross storycontinued The anatomist can partly explain why clots form in the veins of resting legs The muscular pumping action intermittently squeezing the leg veins has stopped (Marieb’s Fig 11.9, p. 327); and non-moving blood is prone to clot Blood clot

50. ANATOMICAL TERMS SO FAR ROSTRAL SUPERFICIAL DEEP CAUDAL SUPERIOR EXTERNAL INFERIOR INTERNAL DORSAL/ POSTERIOR VENTRAL/ ANTERIOR RIGHT LEFT TRANSVERSE PROXIMAL SUPINE DISTAL PRONE PRONATION & SUPINATION inferiorly, superiorly, medially, laterally, ventrally, dorsally, etc