Human Anatomy Exam 4

Axial Skeleton Myology

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Levatores Costarum

12 in number on each side Extend from tips of TPs of C7-T11 to subjacent ribs between the tubercles and the angles [Posterior rami of C8 - T11 spinal nerves Action is to eleveat eht ribs and assist with inspiration]

Atypical Ribs

1st 2nd 10th 11th and 12th

Depressor Labii Inferioris

Draws lower lip downward and outward [(depresses inferior lip)]

Nasal Bones

Form the nose

Accessory Muscles

Scalenes Sternocleidomastoid Abdominal muscles Intercostals [Accessory Muscle breathing]

Osteology - Vertebral Canal

The circular opening made by the posterior body of the vertebrae, the pedicles, the lamina and spinous process is the vertebral canal The vertebral canal houses the spinal cord and associated meningeal coverings (opening that posterior arch forms with body)

extra

Transitional Vertebrae: cervicothoracic, thoracolumbar, lumbosacral Lumbarization?

Platysma

Wrinkles skin under neck (lizard face) [Say and draw out platysma (Hulk face]

The Thoracic Cage - Osteology

.[goal - protect heart and lungs; skeleton and muscle structures; vertebrae = posterior wall; sternum = anterior wall; provide anterior attachment for ribs]

Each lung has:

An apex Three surfaces Three borders [Hard to differentiate between anterior and posterior surfaces of lungs Apex: superior ]

The Lungs - Borders

Anterior Inferior Posterior

Diaphragmatic

Concave (deeper concavity on right lung) Forms the base of the lung Rests on the dome of the diaphragm

Mediastinal surface

Concave because it is related to the middle mediastinum containing the pericardium of the heart Concavity is deeper on left because 2/3 of the heart is on the left [Heart is left of midline with the base at the sternal angle]

Intertransverse

Connect consecutive transverse processes for sidebending Best developed in cervical and lumbar regions Rectus capitis anterior and lateralis are homologues of intertransversarii Aid in lateral flexion Acting bilaterally, stabilize the spine

Sternocostal Joints

Connections between costal cartilages and sternum [1st is primarily a cartilaginous joint]

Cervical Pleura

Extends through the superior thoracic aperture into the root of the neck Forms a cup-shaped pleural dome over the apex of the lung

Muscles of the Thorax

External intercostals Internal intercostals Innermost intercostals Transversus thoracis Levatores costarum Serratus posterior Serratus posterior superior Serratus posterior inferior Diaphragm (muscles below occur in other regions) Spinalis thoracis Longissmus thoracis Iliocostalis thoracis Multifidus Semispinalis thoracis

The Head - Myology

Facial Muscles - The majority are weak with fewer muscle fibers than other skeletal muscles - In some instances arise from muscle or fascia and lack bony attachments - Muscles of facial expression help convey emotion and non-verbal expression during communication

Lateral/Midclavicular Planes

Lines drawn vertically through points midway between ASIS and pubic tubercles

Parietal Pleura

Lines the pulmonary cavities and adheres to the thoracic wall, the mediastinum and the diaphragm Contains nerve fibers (pain sensitive- feel pinching with rib fracture) [More substantial and easily dissected 4 parts to Parietal Pleura: Diaphragmatic (inferior) Costal Mediastinal Cervical Recess: gaps between sections. Allow for expansion Diaphragmatic- Costal recess ]

Appendix

Located at McBurney's point about midway between right ASIS and umbilicus [Extends from cecal (sp?) of LI = ilialcecal junction Function: helps increase healthcare cost]

Parietal Lobes

Posterior to frontal lobe and is separated from it by central sulcus Sensory Areas: Primary and Association SENSORY areas. [somatosensation]

Occipital Lobe

Posterior to parietal lobes Houses Primary and Association VISUAL Areas

Lumbar Region

Posterior to the abdominal cavity Allows mobility between the thorax and the pelvis 5 lumbar vertebrae in human [Large bodies...no costal facets] Distinctive feature is mamillary process

Pleural Cavity

Potential space between layers of pleura Contains layer of serous pleural fluid which provides lubrication Becomes a real space when lungs collapse [Laceration or rupture of the surface of a lung (and its visceral pleura) or penetration of the thoracic wall (and its parietal pleura) results in hemorrhage and the entrance of air into the pleural cavity. Changes in pressure cause the lung to collapse]

Sympathetic Division

Prepares body for emergency situations (expenditure of energy) "Flight or Fight" response Counteracts parasympathetic effects Can visualize body changes that occur: - embarrassment - fright - exertion

Buccinator

Presses cheeks back against teeth, pulling angle of mouth backward as if blowing a trumpet [The cheek muscle (important for control with wind instruments)]

Nasalis

Widens or flares the nostrils. Two portions - Transverse - Alar [Transverse =central; bridge of nose; bony part into cartilaginous Alar = wings of nasalis muscle]

The Lungs: Bronchioles

Terminal Bronchioles - Beyond the segmental bronchi - Leads to 20-25 generations of branches that end in terminal bronchioles Respiratory Bronchioles - Each terminal bronchiole divides into respiratory bronchioles Alveolar Ducts - Each respiratory bronchiole gives rise to 2-11 alveolar ducts - Each duct give rise to 5-6 alveolar sacs lined by alveoli Alveolar Sacs - Alveolar ducts terminate in the alveolar sacs or alveoli. - Estimated 300 million alveoli in each lung - Alveoli are smallest functional unit of respiratory system

Unisegmental Muscles(Minor Deep Intrinsic Back Musculature)

The Spine - Myology Interspinales and Intertransversarii [Innervation is the posterior rami of the spinal nerves...except anterior transverse are anterior rami Interspinal aid in extension and rotation of the vertebral column Intertransverse aid in lateral flexion of the vertebral column] (-Extension bilaterally but mostly to strengthen vertebral column -> When people strengthen spinal stabilizers = these)

Subthalamus

small area immediately inferior to thalamus helps control body movements [Controls how much on impulse is activating neurons or how many neurons are activating ]

Gross Anatomy:Telencephalon (Cerebral Hemispheres)

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Human Nervous System

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Lungs and the Respiratory System

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Postvertebral Muscles

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The Cervical Spine - Lateral Muscles

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The Lungs - Pleura

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Viscera in Relation to Regions

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The Abdominal wall and Viscera

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Neuron

"Nerve Cell" 3 Components - dendrites - axon - cell body (soma) [Needed to transport impulse Axon terminates and connects to dendrites of next nerve cell Axon = away from cell body ; dendrities = toward cell body]

Cell Body

"Soma" Contains nucleus surrounded by cytoplasm that includes typical organelles (i.e. golgi complex, lysosomes, mitochondria)

more extra

(Vertebral column has 3 degress of freedom?) (most of movement in facet joints) (lumbar spine has more nucleus bobolsis than upper regions; varies as you go down spine) (capsule = facet joints; synovial plane gliding joints) Flexion = opening of facet joints Extension = closing of facet joints Closes down on same side as rotation; and opens contralaterally - Sidebending and rotation Muscles contracting causes movement in vertebral column

Prevertebral Muscles

******* [Cervical into prevertebral and postvertebral Prevertebral into anterior and lateral Lateral into scalenes, SCM, rectus cap lat Anterior into Longus (capitus and coil), RCA Postvertebral into intertransverse, interspinal, transversospinal, erector spinae, splenius, suboccipitalis Transversospinal into servospinalis (capitus and cervices), multidus, rotatores Errector spinae: iliocosatlis cervices, longissimus (capitus and cervices), spinalis (capitus and cervices) ]

Thalamus

-Thalamus is central relay station for sensory input reaching cerebral cortex

Gross Anatomy:Supporting SystemsCerebrovascular System

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Visceral Pleura:

- Covers the lungs - Adherent to the lung's surface and cannot be dissected away - Does not contain nerve fibers [Shiny outer surface Includes the surfaces within the fissures Gives lungs smooth and slippery surface allowing movement within the cavity]

diaphragm notes

- Dome shaped, inferior aspect of thor cage - Lots of attachments o Lower ribs = costal part of diaphragm o Xiphoid process = sternal part o Lumbar with vertebrae? (anterior aspect of diaphragm) Crural ligaments support abdominal viscera Expand from crural ligaments = crura of diaphragm; Right one is larger - Outside is muscular and inside is tendinous - Contracts - pulls central tendinous part down - flattens out: Creates suction pressure pulling thoracic cavity down and allowing breath in; Helps increase in superior-inferior fashion - Relaxes = in dome shape - Central diaphragm has 3 openings: Esophagus , blood vessels (have heart inside) - one for abdominal aorta (from thoracic aorta (central)) and one for inferior vena cava (right); Called hiatus - Phrenic nerve supplies diaphragm (from C3-5) (nerves from C3, 4 & 5 keeps the diaphragm alive; why some need ventilators); Phrenic nerve block; can be done purposefully and accidentally ]

Hypothalamus

- Hypothalamus controls many body activities - Regulator of homeostasis Controls: - ANS - contraction of smooth and cardiac muscles effecting movement of food, contraction of urinary bladder and heart rate - Pituitary gland - responsible for many functions of growth and development Hypothalamus also plays a role with: - Emotions - rage, aggression, pain, pleasure - Hunger - Body temperature - Circadian rhythm - sleep patterns

Posterior Longitudinal Ligament

- Runs from the body of axis (C2) to S1 along the posterior aspect of the vertebral bodies - Lies within the vertebral canal and expands cranially to form the tectorial membrane - Forms a protective barrier between the spinal cord, vertebrae and discs - Attaches to discs and margins of vertebral bodies [Broadest superiorly where it continues as the tectorial membrane] - Does not attach to discs in the cervical region - Narrow in lumbar region - Implications for posterolateral disc herniations [Helps to prevent hyperflexion of the spine and posterior displacement of the disc] (o (picture is of cut between pedicles); Does not extend all the way to occiput?; Does not attach to discs but to vertebral bodies; Flex more; has to allow for some movement; Can't attach to discs because that's what opens up for flexion)

Ligamentum Flavum

-Connects laminae of adjacent vertebrae from C1-Sacrum -Thickest in the lumbar spine -Extends ventrally from facet joint capsules -Composed of yellow elastic tissue (elastin) -Springlike properties that permits control of flexion of the spine as assists in restoring the force required for extension -Loses elasticity with age [Helps to maintain normal spinal curvature] (more elastic/has recoil to get back into extension)

Interspinous Ligament

-Extends between adjacent spinous processes -Attaches along the length of the spinous process -Thin compared to the supraspinous ligament -Thickest in the lumbar spine -Definitive interspinous ligament is lacking in the cervical spine (Between spinous processes)

Supraspinous Ligament

-Extends from C7 to sacrum -Connects the tips of spinous processes -Relatively thick in the lumbar spine (On top of spinous process)

Nuchal Ligament

-Runs from C7-Occiput -Merges with the supraspinous ligaments -From the external occipital protuberance and the foramen magnum to the spinous processes cervical vertebra [Actually a continuation of superspinous and interspinous] (o Supraspinous and interspinous in cervical spine)

Cerebellum

-Second largest portion of brain -Lies inferior to cerebrum and posterior to brain stem -Consists of two hemispheres united by middle vermis (a white matter structure) Responsible for coordinated movements and posture -maintains equilibrium -muscle tone -coordination --- by integrating sensory information received from receptors in muscles, tendons, and joints (proprioceptors) and from special sense organs (eyes and ears) [Finger to nose test; flipping hands test; cross arms and stand still; walk in straight line Flaccid = absence of muscle tone; can also have too much muscle tone] Cerebellum Functions: -Maintains posture and balance -Maintains muscle tone -Coordinates voluntary movements -Plays a role in learning

The Back Includes:

1.) The Skin and Subcutaneous Tissue 2.) Muscles: a.) Superficial layer- Extrinsic Back Muscles b.) Deep Layer- Intrinsic Back Muscles 3.) Vertebral Column a.) Vertebrae b.) Intervertebral Discs c.) Joints and Ligaments 4.) Vertebral Canal a.) Spinal cord b.) Meninges and related spaces

External Intercostals

11 in number in each side Extend between ribs from tubercles Fibers are oriented obliquely downwards and laterally behind; downwards and medially in front Action: Elevate the ribs for inspiration Greater activity with forced inspiration Active during speech Innervation is the intercostal nerve to that segment - Anterior rami of T1-T11 form the inetrcostal nerves that run trough the intercostal spaces (Wrap around entire cavity between two ribs -> 11 pairs of these while 12 ribs; Front: inferior/medial (like putting hands in pockets; most are like this); Back: inferior and lateral)

Internal Intercostals

11 in number on each side Deep to external intercostals Extend between ribs from sternum back to the posterior angles where each is replaced by internal intercostal membrane [Looking posterior to anterior in this view] Fibers are oriented at right angles to those of external intercostals Action is debatable: Act in depression of ribs for expiration Act in elevation of ribs for inspiration Active during speech (- Anterior: Superior medial to inferior lateral fibers; Posterior: to inferior medial)

Peripheral Nervous System !

12 pairs of cranial nerves arising from brain - Somatic fibers connecting to the skin and skeletal muscle - Autonomic fibers connecting to viscera 31 pairs of spinal nerves arising from spinal cord - Somatic fibers connecting to the skin and skeletal muscles - Autonomic fibers connecting to viscera

Thoracic Region

12 thoracic vertebrae in humans Suspends the ribs Less flexible and more stable than cervical because of rib articulations Supports the thoracic (respiratory) cavity [Distinct chracteristics are the costal facets for articulation with the ribs] [- Connected to ribs - smoother facets articulate with rib o Costal facets? o Costal vertebral joints o Costal transverse joints - Spinous process of vertebral segments -> sticking straight out - (Thoracic spinous process sticks downward -> Rule of 3s) o Extends to midpoint between T1 and T2 In same plane as transverse processes o T4 - T6 extends more inferiorly than others Starts on plane midway between processes o T7-T9 - starts at almost same high as next spinous process o T10-T12: same thing but backwards - Relation between transverse and spinous processes o Known which one is being palpated - Ex: at T7 spinous process; goes straight lateral -> would be on T8 transverse process o Coming off on same level]

Cerebral Lobes

2 Frontal lobes 2 Parietal lobes 2 Temporal lobes 2 Occipital lobes [Frontal and parietal separated by central sulcus Temporal from parietal and frontal = lateral sulcus Parietal and temporal from occipital = parietal-occipital sulcus ]

Head of Rib

2 facets with a transverse crest between Upper facet articulates with the body of the vertebra above Lower facet articulates with the body of the numerically corresponding vertebrae

Spinal Nerves !

31 Pairs of spinal nerves Named & numbered by the cord level of their origin - 8 pairs of cervical nerves (C1 to C8) - 12 pairs of thoracic nerves (T1 to T12) - 5 pairs of lumbar nerves (L1 to L5) - 5 pairs of sacral nerves  (S1 to S5) - 1 pair of coccygeal nerves Mixed sensory & motor nerves Dorsal root - Provides sensory info to CNS Ventral root - Conveys motor response Dorsal ramus - Supply skin and back Ventral ramus - Supply limbs and remainder of trunk [Vent root and dor root -> spinal nerve root -> ventral and dorsal rami]

Vomer

A thin and flat unpaired bone that makes a major contribution to the bony nasal septum [(central flat bone with 2 wings - ala of vomer) (inf aspect of nasal septum (ethmoid, vomer, and cartilage = nasal septum)]

Abdominal Regions

Abdomen is divided into 9 regions and 4 imaginary planes (2 sagittal and 2 transverse) for purposes of location of viscera [Regions are important for documentation Lines from clavicle = midclavicular lines Look up names]

Functional Classification of Neurons

Afferent (Sensory) Neurons - transmits nerve impulses from receptors in the skin, sense organs, muscles, joints and viscera toward CNS - most are unipolar Efferent (Somatic/Motor) Neurons - transmits nerve impulses from CNS to effectors (muscle cells) - most are multipolar [SAME = sensory-afferent, motor-efferent ] Interneurons (Association Neurons) - neither sensory nor motor neurons - most neurons are this type (~90%) - forms links between other neurons - carry impulses from sensory neurons to motor neurons - located in CNS only - multipolar Efferent Autonomic/Motor Neurons - involuntary - major function w/ homeostasis - active in digestion, respiration, heart rate, sweat, etc. [Knee hit at doctor = tendon reflex; Golgi tendon organs Tendon reflex like rubber band]

Peripheral Nervous System

Afferent (sensory) neurons: "Input" impulses going to the CNS Efferent (motor) neurons: "Output" impulses going away from the CNS Association (interneurons): "Integrator" neither sensory nor motor forms links between other neurons carries impulses from sensory to motor [Motor = muscle response, visceral response, somatic/autonomic ]

The Lungs - Exchange

Alveolus ("small hollow space") - The basic structural unit of gas exchange in the lung - Alveoli kept open by surfactant (chemical secreted by cells on the alveolar surface) -- decreases surface tension [Surfactant from week 28 to 32]

The Heart - Surfaces

Anterior (sternocostal) surface - Formed mainly by the right ventricle [Heart is tilted ] Diaphragmatic (inferior) surface - Formed mainly of the right ventricle and partly by the left ventricle [Note the intraventricular sulcus and the seperation] Left Pulmonary Surface - Formed mainly by the left ventricle [Dotted line separates the pulmonary surface from the diaphragmatic] Right Pulmonary Surface - Formed mainly by right atrium

Typical Ribs

Anterior end - Small cup-shaped depression for costal cartilages [Head is the vertebral articulation] Shaft: Outward convexity with costal groove on under surface for intercostal arteries and nerves Posterior angle: Bend in shaft about 2 inches from the tubercle Posterior end includes: - Head - Neck - Tubercle [o Costal cartilage anteriorly to sternum; posterior - vert column; Posterior end has more features Costal groove: room for intercostal nerves and vessels; Angle of rib = 2 in. from posterior side has bend • Iliocostalis muscle Very end = head; elevation near end = tubercle; between head and tubercle = neck • Head has crest - divides into 2 articular facets - one articulates with a vertebral body and the other articulates with a different vertebral body (superior and inferior?) o 6th ribs - superior with 5th vertebral body and inferior with 6th vertebral body o Vertebral body also has 2 facets - superior and inferior (Can be called demi or costal facets to make easier o Superior demi costal facet articulates with same rib while inferior articulates with next; So superior of 6th vert body with 6th rib and inferior of 6th vert body with 7th rib • Crest is where intervertebral disks are o Tubercle of rib articulates with transverse processes 6th tubercle of rib articulates with 6th transverse process Nonartciualted = ligament attachment o What bone does that 6th ariculate with? With T5 facet, T7 facet, then 4 vertebral body joints: right 6th rib, left 6th rib, right 7th rib, left 7th rib 6 bones total]

Frontalis

Anterior part of the scalp Raises the eyebrows and wrinkles the forehead as if in surprise [Protracts the scalp indicatiing surprise or curiosity (allows for eyebrow lift)]

Rectus Sheath

Aponeurotic sheath which encloses the rectus abdominus and the pyramidalis Composed of: - Anterior layer - Posterior layer Rectus sheath ends in the midline to form the linea alba, blending with rectus sheath on the opposite side [Anterior lamina and the apeneurosis of the external oblique Posterior lamina and the apeneurosis of the transversus abdominus Lateral borders of the rectus sheath are called the linea semi-lunaris]

The Lungs - Hilum

Area on the medial surface of each lung Point at which the structures forming the root- the bronchus, pulmonary vessels, bronchial vessels, lymphatic vessels and nerves enter and leave the lung [Hilum can help differentiate between left and right lung Left lung has cardiac notch (depression) Right lung has cardiac impression (but left is much more pronounced) for this class, we don't need to differentiate between right and left, but have an idea of what parts differ]

The Heart - Pulmonary Trunk

Arterial communication of the right ventricle and divides into right and left pulmonary arteries Conduct poorly oxygenated blood to the lungs for oxygenation [Pulmonary artery carries deoxygenated blood away from heart Pulmonary vein carries oxygen blood back to heart Opposite of usual (arteries usually carry oxygenated blood away) ] Cannot see seperation here, occurs on the posterior side Entry into the pulmonary trunk is guarded by the pulmonary valve [The cusps are directed into the trunk Ventricular systole the cusps are pressed into the walls of the trunk by the outgoing blood Diastole blood flow backward toward the heart, valves fill and come into apposition in the center of the lumen]

Ribs

Articulate anteriorly with sternum and posteriorly with the thoracic vertebrae Typically 12 pairs of ribs True ribs - 1st 7 pairs of ribs - Connected to sternum by their costal cartilagesFalse ribs Last 5 pairs of ribs Costal cartilages of 8th, 9th and 10th ribs are joined to cartilages of ribs just above Floating ribs: 11th and 12th [Remember the rib articulates with the inferio and the superior demifacet of 2 vert... named by the inferior vert. Sometimes the 10th rib floats] (All ribs have costal cartilage even if they don't attach to sternum; Xiphoid process has muscular attachments ; True/false ribs is different than typical and atypical ribs)

Colon

Ascending- right lumbar region; not normally palpable Transverse- upper umbilical region Descending- left lumbar region; may be palpable Sigmoid- left part of hypogastric region

Neuroglia - in CNS

Astrocytes - Star-Shaped, largest and most numerous of the neuroglia - provide nutrients for neuron - participate in neurotransmitter metabolism - helps in forming blood-brain barrier Ependymal cells - cuboidal/columnar cells - line ventricles of brain and central canal of spinal cord - form CSF [Plant on blood vessels; stop certain things from passing such as medication, infections Finding ways to deliver pharmaceuticals in CNS and getting past blood-brain barrier ie dopamine for Parkinson's Ependymal - help in production of CSF] Oligodendrocytes - most common in CNS - smaller and fewer processes than astrocytes - form and maintain myelin sheaths Microglia - phagocytic cells - protect CNS from disease - migrate to areas of nerve tissue

Tubercle of Rib

At junction of neck with shaft Articular portion- has oval facet for numerically corresponding transverse process Nonarticular portion- roughened for ligamentous attachment [Ligament that attaches here is the costotransverse]

Posterior Layer

Attaches to spinous processes and covers posterior surface of erector spinae Posterior layer has superficial and deep fibers oriented at right angles Serves as attachment for latissimus dorsi and serratus post. inf., and the gleut max. [Covers the back muscles from sacrum through the thoracic region to the ligamentum nuchae]

Axial Skeleton

Axial skeleton is made up of the vertebral column (primary skeleton) along with: - Cranium - Sternum - Ribs [All have a protective function as well as a support function] [No O and I this unit except ones specified]

Cervical Region

Axial skeleton of the neck Supports and moves the head 7 cervical vertebrae in humans Distinctive feature is the foramina transversarium. Transverse diameter of the vertebrae is greater than the A/P Diameter and height [Their distinctive feature is the foramina transversarium...the vertebral arteries pass through these openings in the transverse process C1 has no spinous process or body...referred to as the axis...ring shaped and supports the skull... C2 called the axis b/c C1 rotates on it...distinguishing feature is the dens which projects superiorly...held in place by the transverse ligament of the atlas] [- Superior (C1) to inferior (C7) o T1-T12 o L1-L5 - rib cage has ended o 5 Sacral o 4-5 Coccyx - Vertebral artery: supplies brain o In openings in transverse process: transverse foramen - Body of cervical sign is triangular o Transverse diameter = width; greater diameter than A/P]

Meningitis

Bacterial or viral infection Causes inflammation of meninges More common in infants and children Complications - loss of vision - loss of hearing - mental retardation - death

Costal Cartilages

Bars of hyaline cartilage which extend forwards and medially from anterior rib ends No movement occurs at the costochondral junctions, but the costal cartilages do provide mobility and elasticity to the walls of the thorax [Increases in length over the first 7 and then gradually decreases] 12 Pairs 1st 7 pairs directly connect with sternum Next 3 pairs connect with costal cartilages immediately above Last 2 pairs are small and pointed and end in the muscular wall of the abdomen [11 and 12 actually have costal cartilage caps on the ends] (Costal cartilage: elasticity to allow thoracic cage to move for respiration; all ribs have - can say there are 12 pairs of costal cartilage in the body Thoracic cavity expands laterally (lower ribs), anterior-posteriorly (upper ribs 3-6), and superior-inferiorly (deep breath - moves 1-2, 11-12) - Sternum and 3-6 (upper ribs) moves like pump handle - Moves anterior and superiorly ; Increases anterior/posterior diameter - Bucket handle: 7-10: Increases transverse/lateral diameter - Deep breath: 1-12; moving in opposite directions to expand: Increases space in superior/inferior direction)

The Lungs - Apex

Blunt superior end of the lung Ascends above the level of the first rib [Covered by cervical pleura Apex: clavicular space Tumor on the apex of lung can compress brachial plexus Can cause thoracic outlet syndrome ]

Major Components of NS

Brain Cranial nerves Spinal cord Spinal nerves Peripheral nerves Spinal ganglia Enteric plexuses Sensory receptors

Gross Anatomy:Myelencephalon

Brainstem Structures - Medulla Ventricular Structure: Fourth Ventricle

Gross Anatomy:Mesencephalon

Brainstem Structures - Midbrain Ventricular Structures: Cerebral Acqueduct [Cerebral acqueduct (between 3rd and 4th?)]

General Functional Classification of the Cranial Nerves

CN I Olfactory Nerve : Sensory CN II Optic Nerve : Sensory CN III Oculomotor nerve : Motor CN IV Trochlear nerve : Motor CN V Trigeminal Nerve : Both CN VI Abducent Nerve : Motor CN VII Facial Nerve : Both CN VIII Vestibulocochlear nerve : Sensory CN IX Glossopharyngeal nerve : Both CN X Vagus Nerve : Both CN XI Spinal Accessory nerve : Motor CN XII Hypoglossal nerve : Motor ["Some Say Marry Money But My Brother Says Big Brains Matter More": Mnemonic for Cranial Nerves in order. S - Sensory, M - Motor, B - Both ]

2 Principle Divisions of NS

Central Nervous System (CNS) - Brain - lies above foramen magnum - Spinal Cord - lies below foramen magnum Peripheral Nervous System (PNS) - Cranial nerves - Spinal nerves - Peripheral nerves - Sensory receptors [Input requires sensory receptors External sensory receptors on skin - touch etc; internal sensory receptors - ie on walls of intestines; specialized pressure (blood on artery) and chemical (too much CO2?) receptors]

Gross Anatomy:Metencephalon

Cerebellum (considered hindbrain) Brainstem Structures - Pons Ventricular Structure: Fourth Ventricle

More Cerebral hemisphere

Cerebral Hemispheres Functions: - Integrates sensorimotor information - Integrates complex mental functions Cerebral grey matter - cerebral cortex - unmyelinated Cerebral white matter - myelinated [Grey matter = integrating not transport White matter = transport - so has myelin] [White matter responsible for connections Corpus callosum is important white matter tract; separates hemispheres] [Cerebellum = balance and coordination -> communicates with brain via white matter; relies on basal ganglia for motor effort planning; sensory input - thalamic nuclei of sensory cortex]

Cerebral Hemispheres Structures

Cerebral cortex - Frontal, temporal, parietal, and occipital lobes - Landmarks: gyri, sulci/fissures Corpus striatum (Basal ganglia) - Caudate Nucleus - Lentiform Nucleus: Putamen, Globus pallidus Ventricular Structures: Lateral and Third Ventricles [Basal ganglia = grey matter nucleus; motor planning (how much effort needed to do something); Parkinson's -> planning effort to do event causes tremors Frontal lobe = higher level intelligence, calculations , language; behavioral issues Junction with parietal lobe = primary motor cortex Why do they need folds? - inc surface area; accommodate more neurons = more specific functions Fissure = deeper sulci Controllateral control of motor movemenets due to crossing of axons in brain stem] Hemispheres connected by white matter bridge called corpus callosum Both cerebral hemispheres - receive and analyze sensory information - control skeletal muscle on opposite sides of body - store memory

Brain

Cerebrum - cerebral cortex - principle part of brain - gyri - folds - sulci - grooves - fissures - deep folds - longitudinal fissure separates cerebrum into L & R hemispheres includes - cerebral hemispheres - centers for intelligence - diencephalon - houses thalamus and hypothalamus, epithalamus and subthalamus

Thoracolumbar Fascia

Composed of three layers: Anterior Middle Posterior [-Top/posterior layer blends with latissimus dorsi; most superficial -Middle/lateral layer - gives out muscle/blends/origin of- with transversus abdominus -Bottom/anterior - covers quadratus laborum and between it and psoas major]

Intervertebral Joints

Composed of: - Intervertebral Discs - Ligaments [Considered a symphysis ALL and PLL] (Vertebral Column - Facet joints: plane-gliding; F/E; sidebending; rotation of vert col - IV Body Joints: fibrocartilaginous; not synovial but still F/E, sidebending, rotation of vert col Thoracic Cage - Costochondral o 3-6: Pump handle bc directly connected to sternum o 7-10: Bucket handle bc connected to each other -> Interchondral joints o 11-12 don't connect Costovertebral and costotransverse - Costotransverse = corresponds with same number - Costobverebral: same for T1 and T10-12; ribs 2-9 articulate with 2 vertebral bodies o With same number and one above it o T6 with vert body of T6 and T5 (n(n-1)))

The Abdominal Wall

Composed of: Anterior wall Lateral wall Posterior wall Superior wall Inferior wall [Musculo - Aponeurotic Wall of the Abdomen Diaphragm = roof of abdominal cavity Pelvic floor muscles inferior]

Axon

Connective Tissue Coats (in both myelinated and unmyelinated axons) - endoneurium - wraps individual axons - perineurium - wraps fascicles (bundles of axons with endoneurium) - epineurium - covering over entire nerve Myelin Sheath - multilayered, segmented phospholipid covering axon - electrically insulates the axon of a neuron and increases the speed of nerve impulse conduction - disruption in myelin properties can cause muscular disorder, i.e. MS [MS treatment = energy conservation because common symptoms are tired, slow; overload of NS because moving slowly on axon without myelin Axons are demyelinated during episodes Schwann cells constantly produced myelin ]

Autonomic Nervous System !!

Consists of general visceral sensory (afferent) and visceral motor (efferent) neurons Basically "automatic" type of innervation Association with interoreceptors: - chemoreceptors: monitor blood carbon dioxide levels - mechanoreceptors: that detect degree of stretch or organs or blood vessels Not consciously perceived Regulates actions by either exciting or inhibiting effector site (tissue): involuntary information to smooth muscle in: - digestive system (smooth muscle) - respiratory system (bronchioles) - cardiovascular system (cardiac muscle, heart, blood vessels) - integumentary system (sweat glands) Responses include: - changes in pupil size - accommodation for near vision - dilation of blood vessels - adjust rate and force of heart beat Usually done beyond conscious control "automatic" Divisions of motor portion of ANS: - Sympathetic - "excitation" - Parasympathetic - "inhibition" -- dual innervation - one division stimulates organ to start or increase activity (excitation) while the other causes decrease (inhibition)

The Heart - Function

Contraction - Diastole -- Atria contract in unison superiorly to inferiorly -- Ventricles elongate and fill - Systole -- Ventricles contract in unison inferiorly to superiorly -- Ventricles shorten and empty [Systole: ventricles push blood out Diastole: ventricles receive blood] Heart Sounds LUB DUB LUB (Systole) - Closing of Mitral and Tricuspid Valves DUB (Diastole) - Closing of Aortic and Pulmonic Valves [Systole: ventricles are emptying AV valves are closed, semilunar valves need to be open Sound is closing of AV valves (LUB) ] [Diastole: AV valves open Semilunar valves close]

Tendon Reflex

Controls muscle tension by causing muscle relaxation that prevents tendon damage Golgi tendon organs in tendon - Activated by tension within tendon - Inhibitory neuron is stimulated (polysynaptic) - Motor neuron is hyperpolarized and muscle relaxes Both tendon & muscle are protected Reciprocal innervation (polysynaptic) - Causes contraction of ipsilateral muscle group

Arterial Supply

Coronary Arteries - 1st branches of the aorta - Supply the myocardium and epicardium - Supply the atria and the ventricles [Sternocostal view Coronary Arteries are the only arteries that receive blood during diastole ] Arterial Supply Left Coronary Artery Anterior Descending Artery Circumflex Artery Right Coronary Artery Posterior Descending Artery Marginal Artery Coronary Vessels receive blood during relaxation (diastole) [Need to know right and left coronary arties, but not names of specific branches ]

The Lungs - Surfaces

Costal Mediastinal Diaphragmatic

Costal Pleura

Covers the internal surfaces of the thoracic wall [Costal is the blue]

Mediastinal Pleura

Covers the lateral aspects of the mediastinum [Remember the mediasteinum is the mass of tissue that seperates the organs and their cavaties The med. is also the median partition of the thoracic cavity. Covers all the thoracic viscera except the lungs]

Diaphragmatic Pleura

Covers the superior or thoracic surface of the diaphragm on each side of the mediastinum

Inferior Nasal Conchae

Curvy bony plates on the lateral wall of each nasal cavity [(important function: make air you breathe in have optimal temp and water vapor before lungs)]

Innermost Intercostals

Deep to internal intercostals and run in the same direction Run between the ribs Act together with internal intercostals [Note the VAN and their order in this slide...all travel in this manner through the costal groove] (have same orientation as internal)

Superior Abdominal Wall

Diaphragm [Location and main function?]

Inspiration

Diaphragm contracts, moves downward and outward Intercostal muscles contract, pull ribs up and outward Air pressure in chest cavity decreases below atmospheric pressure and air fills lungs

Expiration

Diaphragm relaxes and moves upward Intercostal muscles relax Air pressure in chest cavity increases above atmospheric pressure and forces air out of lungs

Inferior Border

Diaphragmatic surface of the lung Separates this surface from the costal and mediastinal surfaces

Gross Anatomy:Diencephalon

Diencephalon Structures - Thalamus = mailroom - Hypothalamus, epithalamus, subthalamus - Prominent white matter structure --- Internal capsule - Third ventricle [Thalamus receives sensory info (with thalamic nuclei) - relay centers; decide where information needs to go Hypo etc - important for maintaining homeostasis Associated with 3rd ventricle - bound on either side by thalamic nuclei] -Develops from posterior forebrain -Located between the cerebral hemispheres and above the brain stem -Consists of thalamus, hypothalamus, epithalamus and subthalamus Diencephalon Functions: Relays sensorimotor information between spinal cord/brainstem and cerebral hemispheres Monitors homeostasis

Diaphragm

Dome-shaped musculotendinous sheet separating thoracic from abdominal cavities 3 Parts: Sternal Arises from back of xiphoid process Costal Arises from internal surfaces of costal cartilages Lumbar Medial and lateral arcuate ligaments and crura fibers converge into a central tendon I: phrenic nerve A: essential for inspiration [Chief muscle of inspiration]

Cervical Neurology

Dorsal divisions (rami) of spinal nerves innervate all the intermediate and deep layers of the back muscles Ventral divisions (rami) innervate anterior and lateral neck muscles [This is more specific, but for the time being will do.]

Thoracic Neurology..

Dorsal primary rami of spinal nerves innervate all the intermediate and deep layers of the back muscles Intercostal nerves - Ventral rami of 1st 11 pairs of thoracic nerves Intercostal nerves innervate the levator costarum and external and internal intercostal, and serratus posterior muscles [Post: erector spinae (all), transversospinal (all), unisegmental, serratus posterior (superior and inferior), latissimus dorsi ,trapezius Pre: form thoracic cage: intercostals, diaphragm (separates thoracic cage from abdominal cavity)]

Thoracic Neurology

Dorsal primary rami of spinal nerves innervate all the intermediate and deep layers of the back muscles Intercostal nerves - Ventral rami of 1st 11 pairs of thoracic nerves Intercostal nerves innervate the levator costarum and external and internal intercostal, and serratus posterior muscles.

don't know where to put this

Dorsal rami of spinal cord - Anterior or ventral rami forms plexus - Posterior or dorsal rami supply muscles on back o Cervical dorsal rami o Thoracic dorsal rami o (all we need to know about nerve supply unless specific for singular muscle) o (muscle tagged in practical and asked about nerve supply - if tagged in its cervical area = cervical dorsal rami is answer Superficial/Extrinsic : - Trapezius - Latissimus dorsi o Thoracal lumbar fascia (where lat dorsi enters lumbar) Posterior layer - when prone Anterior and lateral layers - have to move around and look for layers - Serratus anterior? - Serratus posterior o From ribs to vertebral column (lower cervical and upper thoracic)

Depressor Anguli Oris

Draws the angle of the mouth down as if in a frown [Indicate sadness Depresses angle of mouth]

Zygomaticus Major

Draws the angle of the mouth outward and upward as in smiling [Bilateral smile...unilateral sneer (where is minor?]

Risorius

Draws the angle of the mouth posterior [Wides the rima oris when grinning or grimacing (very superficial; moves skin; transverse muscle (trying to smile but not really smiling)]

Levator Anguli Oris

Draws the angle of the mouth straight up as in sneering [Pulls upward but deeper compared to zygomatic]

Corrugator Supercilii

Draws the medial end of the eyebrow downward and wrinkles the forehead vertically demonstrating concern [(deep muscle also responsible for bringing eyebrows together; causes my wrinkles]

Intestines

Duodenum located along transpyloric plane in middle region Jejunum and ileum packs much of the abdomen and pelvis [Duodenum = continues from stomach and most proximal portion of SI]

Meninges (Supporting Membranes)

Dura Mater Arachnoid Pia Mater [Just CNS Superficial -> deep (in order) Dura is outermost, toughest Arachnoid has spiderlike projections] Connective tissue coverings that surround brain and spinal cord - cranial meninges = brain - spinal meninges = spinal cord Dura Mater: Outer most layer: dense, irregular connective tissue Surrounds the brain and spinal cord Dura Mater (Brain) - Cranial dura - Inner dura -- Falx cerebri -- Falx cerebelli -- Tentorium cerebelli Dura Mater (Spine) - Spinal dura -- Periosteal lining (forms spinal canal) - Inner dura -- Loosely covers spinal cord and spinal nerves - Dural sac: (LV2 - SV2) [Spinal cord ends at L1 -> after = dural sac (for epidural)] 3 extensions separate parts of the brain - falx cerebri - separates cerebral hemispheres - falx cerebelli - separates cerebellar hemispheres - tentorium cerebelli - separates cerebrum from cerebellum Thin, spider web-like middle layer Forms projections between dura mater and pia mater Meningeal space below it is the subarachnoid space - contains cerebrospinal fluid (CSF) Pia Mater Thin vascular inferior layer containing many nerves and blood vessels Attached to surfaces of brain and spinal cord - Closely covers brain/spinal cord

Dermatomes

Each spinal nerve contains both sensory & motor nerve fibers Myotome - A myotome is the group of muscles on one side of the body that are enervated by one spinal nerve. A myotome may include parts of muscles. [Myotome = function] (table in pictures doc) Dermatome - Area of skin supplied by one single spinal nerve - Overlap prevents loss of sensation if one damaged - Sensory anesthesia requires 3 spinal nerves to be blocked

Osteology

Each vertebra is made of the following components: - Vertebral body - Vertebral arch - Seven processes [Body becomes progressively larger as we move down the spine...increased weight bearing The arch encloses the vertebral foramen Resembles a short long bone] [- 7 processes: articular pillars/processes; Superior, inferior - Ex: T5, T6 would be right below with superior; Superior of T6 articulates with inferior of T5; Facet joints of vertebral column; 4 different articular pillars with 4 different articular facets forming facet joints of vertebral column; Synovial plane gliding - Intervetebral joints have disk between then (2: one with segment above and one with below) - With one vertebral bodies: 4 articular pillars (2 sup; 2 inf), 2 transverse processes (on sides), and 1 spinous process (sticks out posteriorly) - Lumbar has largest vertebral body (increases in size going down) - Looking at cervical facet joint -> / (oblique plane?) - Thoracic in frontal plane - Lumbar in sagittal plane o Orientation changes - Body is spongy bone (absorb forces) but outer covering is cortical bones (structure) -> Burst fracture (Disk and spongy bone trying to prevent) - Ring apophysis -> ring of cortical around spongy; Annular fibers attach to ends of ring of apophysis; Denser ring of cortical bone - cortical bone still covering around it ->disks in between; growth plates; vertebral endplates - spongy bone has trabeculae ->trabecular bone: has blood vessels that go through them]

Temporalis

Elevates the mandible and closes the jaws. Supplied by CN V³ (Trigeminal) [(Hands on side of forehead and clench Travels deep to zygomatic arch Trigeminal N - C5 We can get tested on pictures from slides; which facial expression is this? Injury to facial nerve = bell's palsy; 2 different types = 1 is permanent - complete paralysis; stroke affecting brainstem; or MS 1 is caused by cold air constantly going in ear = transient bell's palsy Trigeminal N affected is Trigeminal neuralgia Mandibular branch moves mandibular Other 2 branches are sensory; burning sensation all over trigeminal supply when injured - ie MS, Stroke Facial nerve injury = motor; Trigeminal = more sensory but problems chewing food]

Gross Anatomy of the Central Nervous System: Embryology

Embryological Division: Prosencephalon (Forebrain) -> Embryological Sub-Division: Telencephalon -> Gross Anatomy: Cerebral Hemispheres or Embryological Sub-Division: Diencephalon -> Gross Anatomy: Thalamic Nuclei Embryological Division: Mesencephalon (Midbrain) -> Embryological Sub-Division: Mesencephalon -> Gross Anatomy: Brainstem: Mid-Brain Embryological Division: Rhombencephalon (Hindbrain) -> Embryological Sub-Division: Metencephalon -> Gross Anatomy: Cerebellum; Brainstem: Pons or Embryological Sub-Division: Myelencephalon -> Gross Anatomy: Brainstem: Medulla Oblongata [How CNS is formed; forms neural tube (6-7wk); pic from 16wks; almost fully developed by wk 20 Just be familiar with names; what things end up forming] See pictures for next slide -> DEFINITELY KNOW; Know ventricles associated 4th vent is part of hind brain; pons in front; cerebellum in back

The Heart - Tissue Layers

Endocardium - layer, made of connective tissue - Lines the heart's chambers and covers valves Myocardium - Thick middle layer composed of muscle - Conducts electrical impulses [3 Tissue Layers Endocardium Myocardium Pericardium] Pericardium - Protective sac surrounding heart (2 serous layers) - Visceral Pericardium (Epicardium) inner layer - Parietal Pericardium outer, fibrous layer - Between two serous layers contains pericardial fluid. Serves as a lubricant to reduce friction, gives heart protection. [Pericardial cavity with pericardial fluid Pericarditis- inflammation]

Medulla Oblongata (Inferior)

Enlarged continuation of spinal cord extending from foramen magnum to pons Cranial Nerves VIII-XII - conveys motor and sensory impulses between other parts of the brain and spinal cord - regulates heartbeat, breathing and blood vessel diameter [Cardiac and respiratory centers]

Meningeal Spaces

Epidural (potential space) Subdural (potential space) Subarachnoid (filled with cerebrospinal fluid) [Blocked = epidural hematoma, subdural hematoma,] [Hematoma = blood clot]

Epidural vs. Subdural Space

Epidural Space: between skull and dura mater; contains middle meningeal artery - epidural hematoma - rapid onset; medical emergency Subdural Space: between dura mater and arachnoid; contains cerebral artery and vein - subdural hematoma - slower onset; typically venous in origin Hematomas (collection of blood in space) - causes increasing pressure between rigid bones of skull and soft tissue of brain - accumulating blood must be evacuated rapidly [Epidural hematoma usually arterial; medical emergency; rapid; arteries have blood pressure Subdural hematoma = venous; does not need rapid fix; can happen over time]

The Abdominal Regions

Epigastric: Between right and left lateral planes and above transpyloric plane Right and left hypochondriac: Above transpyloric plane to and lateral to right or left lateral planes Umbilical: Between transpyloric and transtubercular planes and between right and left lateral planes Right and left lumbar: Between transpyloric planes and lateral to right or left lateral planes Hypogastric or pubic: Below transtubercular plane and between right and left lateral planes Right and left iliac or inguinal: Below transtubercular plane and lateral to right or left lateral planes

Erector Spinae Muscles(Intermediate Intrinsic Back Musculature)

Erector Spinae Composed of three columns: - Lateral column- Iliocostalis - Middle column- Longissmus - Medial column- Spinalis (o Cause sidebending/rotation if independent)

Intertransverse Ligaments

Extend between adjacent transverse processes Relatively thin in the lumbar spine

Osteology - Lamina

Extend dorsally from the pedicles and fuse in the midline [Function is primarily protection Vertebral notches are indentations in the pedicle] (- Arch comes together posteriorly and forms spinous process that goes behind; Lamina on either side fuse together to form spinous process)

Reticular Formation

Extends into spinal cord and diencephalon Has both sensory and motor functions Sensory - alerts cerebral cortex to incoming sensory signals - Reticular Activating System (RAS) - responsible for maintaining consciousness and awakening from sleep Motor - regulates muscle tone (with cerebellum) [Grey matter from brain stem to spinal cord; Very important for autonomic functions (brain stem is real important for autonomic functions)]

The Lungs - Lobes

Fissures divide the lungs into lobes Right lung has 3 lobes - Superior Lobe - Middle Lobe - Inferior Lobe Left Lung - Superior Lobe - Inferior Lobe Increased space accommodates the heart. [Cardiac notch on left lung Oblique fissure and horizontal fissure on right lung divide into lobes Left lung only has oblique fissure- divides into superior and inferior lobe ]

Palatine Bones

Form the bony palate Inclisive fossa [(Posterior aspect of hard palate; openings = palatine foramen; passage for greater/lesser palatine nerves and vessels) (Inclisive fossa = junction between hard and soft palate ]

Zygomatic Bones

Form the prominences of the cheeks Lie on the inferolateral sides of the orbits and rest on the maxillae [Small foramen pierces the side of the bone - Zygomatical facial nerve (zygomatic arch is important landmark)]

Maxillae

Form the upper jaw Have alveolar processes which include sockets to support the maxillary teeth Infraorbital foramen [Forms the skeleton of the upper jaw which is fixed to the cranial base (Infraorbital foramen - opening on maxillae = passageway for infraorbital nerves and vessels)]

Frontal Lobe

Forms anterior portion of each cerebral hemisphere Bordered posteriorly by central sulcus and inferiorly by lateral sulcus Houses Primary and Association MOTOR Areas [(don't know #s) = Broca's Areas ]

Left Atrium

Forms most of the base of the heart Valveless pairs of right and left pulmonary veins enter the smooth-walled atrium Pulmonary Veins are only veins that carry oxygenated blood [4 pulmonary veins Left superior and inferior, Right superior and inferior ] Auricle Smooth walled except for the auricle Openings - L/R Superior and Inferior Pulmonary Veins - Bicuspid valve [Wall is thicker than the right Auricle: ear-like extension Bicupsid valve opens to left ventricle ]

Sternum

Forms the anterior wall of the thoracic cage Consists of three different parts: 1.) Manubrium 2.)Body 3.)Xyphoid process

Left Ventricle

Forms the apex of the heart Trabaculae Carnae Papillary muscles - Only 2 Openings - Bicuspid Valve (Mitral) - Aortic Valve (semilunar) [Walls 2X as thick as right, cavity is longer than the right Mesh of trabeculae carneae that are finer and more numerous Anterior & posterior papillary muscles that are larger than those in RV Correspond with the # of valves Mitral for a bishops hat Aortic ascultation at the third intercostalspace on left side of sternum (Right ventricle has 3 papillary muscles) Aorta carries blood out of heart to rest of body ]

Right Ventricle

Forms the largest part of the anterior surface of the heart Conus Arteriosis Trabaculae Carne Supraventricular crest [Tapers to conus, entry to the pulmonary trunk Conus Arteriosis: like a funnel to ensure that blood flows through pulmonary atery Smooth wall Trabuculae are irregular muscle elevations increase surface area which allows for more forceful contraction Supra is a muscular wall that separates in from out] Receives blood from the atria Openings Tricuspid Pulmonary valve Chordae Tendinae Papillary Muscle [Tricuspid surrounded by fibrous ring Maintains the diameter of the orifice so there is no leakage Pulmonary valves at the apex of the conus arteriosis Chordae Tendinae Attach to the free edges of the cusps like a parachute Cords arise from the papillary muscles Papillary muscles contract before the ventricle to draw the cusps together and prevent backflow Anterior posterior and septal Papillary muscles via the chordae tendinae control the tricuspid and bicuspid valves]

Right Atria

Forms the right border of the heart Auricle Receives venous blood from the SVC, IVC and coronary sinus Openings - SCV / IVC - Tricuspid - Coronary sinus [Auricle is an addition that increases the available volume of the heart. (small extension) Superior portion of the atria IVC opens at the 3rd and SVC open at 5th rib Coronary sinus is a small venous trunk from the cardiac veins drains into right atrium Tricupsid valve- 3 different leaves (parts) (AV valve) ]

Osteology - Vertebral Arch

Forms the vertebral foramen together with the vertebral body - Formed by the body, lamina and the pedicle Protects neural tissue Composed of less trabecular bone and more cortical bone than vertebral body - Enables vertebral arch to better withstand torsional forces [Spinal cord travels through the foramen] pedicle lamina spinous process zygapophyses pars interarticularis transverse processes [Pars is the area between the superior and the inferior facets See on a later slide during discussion of spondylolysthesis] (behind body (body is most anterior part); arch is posterior; pedicle - one on either side; laminectomy: for spinal stenosis (narrowing); arch/lamina lessens -> presses on nerves -> take out lamina)

Anterior Layer

From the anterior surfaces of TPs of lumbar spine Covers the quadratus lumborum and arises from the associated fascia Blends with the intertransverse ligaments

Middle Layer

From tips of the lumbar spine TPs which gives rise to transversus abdominus Between iliac crest and 12th rib

The Head - Facial Muscles

Frontalis Orbicularis oris Orbicularis oculi Procerus Nasalis Risorius Zygomaticus major Levator anguli oris Depressor anguli oris Levator labii superioris Depressor labii inferioris Platysma Buccinator Masseter Corrugator supercilii Temporalis

Synapse

Functional contact between two neurons or between a neuron and an effector (muscle/gland) - axodendritic junction - between adjacent neurons - neuromuscular junction - between neuron and muscle - neuroglandular junction - between neuron and gland

The Human Heart

Heart- autonomic nervous system In carotiod artery, there are baroreceptors and chemoreceptors Monitor blood pressure, partial pressures of oxygen and carbon dioxide

Spinal Cord

Functions - Transmit input from PNS to brain - Transmit output from brain to PNS Structures: Grey matter (horns, zones) - Posterior (dorsal) horn - Anterior (ventral) horn - Lateral horn - Intermediate zone White matter (funiculi, columns) - Posterior funiculus (dorsal column) - Lateral funiculus (lateral column) - Anterior funiculus (ventral column) Central canal

Intervertebral Discs

General Characteristics - Fibrocartilaginous - Major compression-bearing structures of the spine - Interposed between adjacent vertebrae - Present from C2-C3 to L5-S1 [No C1 / C2 disc] - Together with the vertebral bodies form anterior elements of vertebral column, giving it support - Deeper anteriorly in lumbar and cervical regions contributing to the anterior convexities - Relatively avascular - Nutrition via diffusion from trabecular portions of the vertebral bodies Components: - Nucleus pulposis --Fills 20% to 50% of total disc area depending on the region ---Least in cervical discs and most in lumbar discs -Composition: --Fine fibrous strands within proteogylcan gel --Gel properties provide for viscoelasticity and water imbibement --Gel begins to be replaced by fibrocartilage by end of first decade until eventually gel is not distinguished from annulus fibrosis ---This compromises disc's capacity for water imbibement and viscoelasticity - Annulus fibrosis --Composition: ---Concentric lamellar bands of fibrocartilage and collagenous fibers ---Insert into the epiphyseal rim (-Relatively avascular -> some outer fibers may receive blood supply and heal During flexion: posterior end opens up; Extension: anterior end opens up Rupture of disc when lifting heavy weight -> Nucleus pulposis- fluid will go outside with rupture and form bulge; Puts pressure on spinal cord (if posterior), or intervertebral foramen if goes to either side (spinal nerve compressed)

10th Rib

Head has a single facet for the body of the 10th thoracic vertebra [10th articulates with only one vert]

11th and 12th Ribs

Heads have single facets for bodies of numerically corresponding vertebra No necks or tubercles Anterior ends are pointed and tipped with costal cartilage 12th rib is short and has no angle or no costal groove

The Heart - Chambers

Heart is composed of four chambers Right Atrium Left Atrium Right Ventricle Left Ventricle Chambers are divided by septa that contain fibrous connective tissue and muscle. Interatrial Septum Interventricular Septum [Interatrial septum has fossa ovalis which is a remnant of the oval foramen in the fetus 15-25% OF ADULTS HAVE SMALL ASD that causes no changes in hemodynamic function Atrial septal defect- most of the time left alone to heal on own. Mixing of blood Tissues receive poorly oxygenated blood, fatigue earlier AV valves: tricuspid (right) and bicuspid (left) Semilunar valves: controlled by pressure gradients ]

Ethmoid Bone

Houses the cribiform plate Olfactory nerves pass through the foramina of the cribiform plate to reach the olfactory bulbs of the brain that lie on the plate Makes up most of the medial wall of the orbit [The crista galli is the thick median ridge of bone (right in the middle); posterior to the foramen cecum....on each side of the ridge is the cribiform plate...the olfactory projections pass through the cribiform plate of the ethmoid bone (where glasses sit on is lateral part of cavity; part of ethmoid bone (lateral wall of nasal cavity and medial bone or obit)]

Cranial Nerves

I - Olfactory II - Optic III - Oculomotor IV - Trochlear V - Trigeminal VI - Abducens VII - Facial VIII - Vestibulocochlear IX - Glossopharyngeal X - Vagus XI - Spinal Accessory XII - Hypoglossal [How to test integrity of nerve 3,4, 6 = movement of eye / dilation of pupils 5 - sensory for most of face and mastication 7 - facial expressions 8 - hearing and auditory responses (most imp. Nerve)] [Different ways to remember functions Which part of CNS arise from 1-2 cranium, 3-4, 4-8 pons, 8-12 medulla]

Cranial Vault

In adults is formed by a series of eight bones: - A frontal bone - Paired parietal bones - Paired temporal bones - An occipital bone - A sphenoid bone - An ethmoid bone [Bony covering of the brain...in addition to the brain and the membranous coverings, it also contains the proximal portion of the cranial nerves...bones are considered flat bones and are primarily protective in nature In addition the bones also serve as attachment points for the muscles of mastication (held together by sutures; fibrotic/fibrous joints); these joints are cartilaginous in a baby (occipital bone articulates with 1st C spine; -> spinal cord); base of skull Temporal is also part of bottom; sphenoid is middle part of base; even small part of frontal bone Ethmoid bone - irregular bone; part of nasal septum; roof of nasal cavity; porous - receptors for smell Cranial nerves - 12 pairs that exit cranium 1st cranial nerve responsible for smell; exits ethmoid bone; form bulbs with projections for pores Saggital suture - between parietal down middle Frontal suture - between frontal and parietal? Landoid suture - between occipital and parietal Where sutures meet is weak point Weakest point of cranial vault= side of head - bregma - see in pic where sutures meet]

Neck of Rib

In between head and tubercle

Cerebral Hemisphere Dominance

In most persons - one side acts as a dominant hemisphere 90% of population is left hemisphere dominant for - language-related activities of speech, reading, writing - complex intellectual functions requiring verbal, analytical, and computational skills [Can practice tasks enough to be dominant on both sides ]

Osteology - Verteberal Body

Increase in size from C1 to L5 to accommodate progressively increasing loads Made up of: - Trabeculae - Ring apophyses - Vertebral endplates

Temporal Lobes

Inferior to parietal lobes, separated by lateral sulcus Houses Primary and Association AUDITORY Areas

Semispinalis Capitis / Cervicis

Insertion (SA): Runs superomedial to attach on the occiput and the spinous process in the cervical and throacic regions Origin (IA): Transverse Processes of C4-T12 N: dorsal rami A: extension of the head an neckand contralateral rotation of vertebral column and head Cervical attachment is deep to obliquus capitis inferior [This is the deep layer of the intrinsic back muscles Each semispinalis spans 4-6 segments...looks like on long muscle but really has multiple attachments Origin looks like it's wrong, but the origin is the inferior attachment.]

Respiration

Inspiration - Active process -- Requires energy Expiration - Passive process

Hydrocephalus

Interference of CSF circulation caused by abnormalities in the brain (i.e. tumors, inflammation, developmental malformations - causes increase in CSF pressure - persistent pressure will cause damage to delicate nervous tissue - relieved by inserting a shunt into third ventricle to drain excess CSF into superior vena cava or abdominal cavity - in adults, may be result of head injury, meningitis or subarachnoid hemorrhage [Water retention in skull; anything that blocks flow Symptom not diagnosis Space occupying lesion will cause more; pushes brain farther down -> affects foramen magnum]

Arthrology

Intervertebral Joint - The intervertebral disc forms a bond between two adjacent vertebral bodies - Fibers of annulus attach at cartilaginous endplates and peripheral osseous portions of the vertebral bodies via Sharpey's fibers Ligaments of intervertebral joints: - Anterior longitudinal ligament - Posterior longitudinal ligament (- Work to prevent disc herniation and leaking of fluid from nucleus) Ligaments of the vertebral arch - Ligamentum flavum - Supraspinous ligament - Interspinous ligament - Nuchal ligament - Intertransverse ligaments

Nerve Plexus

Joining of ventral rami of spinal nerves to form nerve networks or plexuses Found in neck, arm, low back & sacral regions No plexus in thoracic region - intercostal nn. innervate intercostal spaces - T7 to T12 supply abdominal wall as well

Costal surface

Large, smooth and convex Separates the costal pleura from the ribs, costal cartilages and innermost intercostal muscles Posteriorly, related to thoracic vertebrae

The Lungs - Bronchopulmonary Segment

Largest subdivision of a lobe Separated from adjacent segments by connective tissue [Named according to the segmental bronchi supplying them] Segmental Bronchi - Lateral and medial views - colors with previous slide [Don't need to know names ]

Thoracolumbar Myology

Latissmus dorsi Erector Spinae Transversospinal Quadratus lumborum Psoas major Diaphragm

Main Bronchi

Left and Right Pass inferolaterally from the bifurcation of the trachea Walls of trachea and bronchi are supported by horseshoe shaped rings of hyaline cartilage [Trachea divides to left and right main bronchus Right: more vertical, left: more horizontal (because of heart) If someone is eating and food goes down wrong pipe, more likely for food particles to go into right ]

Stomach

Left hypochondriac, epigastric and umbilical regions Soft, so difficult to differentiate from other organs when palpating [Where esophagus terminates; initial digestion; produces acids that helps break down food into nutrients]

Blood Flow

Left side receives oxygenated blood (arterial blood) from the lungs through the pulmonary veins and pumps it into the aorta to be distributed throughout the body Right side receives poorly oxygenated blood (venous blood) from the superior and inferior vena cava (SVC, IVC) and pumps it via the Pulmonary Arteries to the lungs for oxygenation Blood Flow: Vena Cava RA through Tricuspid Valve to RV Pulmonary Arteries Lungs Pulmonary Veins LA through Mitral Valve to LV Aorta to body

Body of Sternum

Level with 5th to 9th thoracic vertebrae Articulates superiorly with the manubrium at sternal angle Costal notches- 6 pairs of facets for 2nd through 7th costal cartilages [Sternal angle is the angle of Louis When young there are sternebrae which are initially synchondroses...fusion by 25]

Manubrium

Level with the 3rd and 4th thoracic vertebrae Articulates inferiorly with the body of the sternum Clavicular notches- pair of articular surfaces for clavicles located superiorly Costal notches- pairs of facets for 1st and 2nd costal cartilages [From the Latin handle...as in handle of the sword Widest and the thickest of the three parts Jugular notch is the superior unpaired notch..bordered by the clavicular notches] (articulates with ribs and sternum; Sternoclavicular joint = saddle; articulates at manubrium; Then articulation with 1st rib on manubrium ; Sternalcostal = between ribs and sternum_)

Kidneys

Lie on posterior abdominal wall Right kidney is lower than the left due to the liver

Spleen

Lies above left kidney and behind the stomach Lies between 9th and 11th ribs on left [Left hypochondriac Spleen is important until ages 12-13; now bone marrow is producing blood cells]

Gall Bladder

Lies behind tip of 9th costal cartilage on right in the fossa for the gallbladder on the visceral surface, between the right and left parts of the liver Not normally palpable [Usually 7-10cm Stores bile produced by the liver. Becomes more concentrated after storage. Aids digestion by emulsifying fat. R umbilical and R epigastric Pierces duodenum ]

Pancreas

Lies near transpyloric plane in middle region and to the left [Posterior and inferior to the stomach. Responsible for the production of hormones and insulin and glucagon and aids with digestion with the secretion of pancreatic acid which passes to the small intestine Just a large gland (enzymes produced: endocrine - into blood stream and exocrine) Has head (near duodenum), body, and tail (near spleen)]

Ligaments of the Vertebral Arch

Ligamentum flavum Supraspinous ligament Interspinous ligament Nuchal ligament Intertransverse ligaments

Lordotic Curves

Located in the cervical and lumbar regions Found in regions of greatest mobility [Curvature is convex anteriorly Obesity can increase the lordosis and cause back pain 2nd to the change in the center of gravity] [Secondary curvatures, Cervical, lumbar, More mobile, Weight of head, Throw neck or head out ]

Kyphotic Curves

Located in the thoracic and sacral regions Determined by shape of the vertebrae [Kyphotic curves are convex posteriorly An increase in the thoracic kyphosis oftens develops in the elderly, esp. women and is referred to as a Dowager's hump] [Primary curvatures, Fetal position all in kyphotic posture, Develop lordotic curves, Thoracic, sacrum, More stable]

Heart

Located in thoracic cavity between the lungs and above the diaphragm in an area known as the mediastinum. Slightly larger than a clenched fist Self-adjusting muscular pump Parts work in unison to propel blood to all parts of the body [Pressure gradients are the driving force for blood movement Located slightly to the left Muscle- hypertrophy (works overtime, heart enlargement) ] Bottom of the heart is the apex. Sits just above the diaphragm, left of the midline. Top of the heart is the base. Lies at approximately level of the second rib. The great vessels connect to the heart at the base. [Note that anteriorly we can see the right auricle, atria, ventricle and the left ventricle. Apex kicks off to the left. Base to the right 4 chambers separated by valves. All chambers contract together Valves prevent backflow and mixing of oxygenated and deoxygenated blood Right side- receives deoxygenated blood through superior and inferior vena cava Superior vena cava carries blood from body superior to heart, inferior from below heart Right atria receives blood, right ventricle pushes blood out through pulmonary artery Left side- oxygenated Left atrium receives oxygenated blood, left ventricle pumps out ]

Osteology - Inferior Articular Process

Located on the inferior part of the vertebrae Articulates with the superior articular process of the vertebrae below Together with the superior process forms the zygapophyseal joints

Transversus Thoracis (Sternocostalis)

Located on the internal surface of anterior thoracic wall Extends from the posterior surface of lower sternum, xiphoid process and costal cartilages of lower ribs Attach to inner surfaces of costal cartilages ribs 2-6 Action- pull down costal cartilages [Essentially rib depression] (-Expiratory muscle (sneeze, cough - needs to quickly pull down ribs); Forced expiration)

Osteology - Superior Articular Process

Located on the superior part of the vertebrae Articulates with inferior articular process of the vertebrae above (: 2 superior and 2 posterior - Facets are called: zygapophyses (we can call articular facets and facet joints) - Superior articulates with inferior above - Inferior articulates with superior below - 4 articulations = 4 joints)

Osteology - Ring Apophysis (Epiphysis)

Located over the superior and inferior portions of the cortical bone A ring of smooth bone that surrounds the trabecular bone Represent secondary areas of ossification [Ring at the top of the body]

Axon

Long, thin cylindrical process (usually myelinated) Joins the cell body at cone-shaped elevation called "axon-hillock" (A) Function - transmits nerve impulses "away" from cell body to synapse [MYELIN; travels longer distances ]

2nd Rib

Longer than 1st rib but similar curvature Thinner 2 facets on head to articulate with T1 and T2 vertebral bodies [Main atypical feature is rough area on the superior surface for the origin of the serratus anterior]

Transtubercular Plane

Lower transverse plane Level with the iliac tubercles Passes through L5 vertebral body

The Lungs - Bronchial Tree

Main bronchi enter the hilum of the lungs and branch to form the bronchial tree Lobar Bronchi - Each main bronchus divides to form lobar bronchi (2 left and 3 right) to form a lobe of each lung [Main bronchus divides into Lobar Bronchi (lobar bronchi for different lobes)] Segmental Bronchi - Each lobar bronchus divides into several segmental bronchi that supply the bronchopulmonary segments [Ex. Right Superior Lobar Bronchus, Left Inferior Lobar Bronchus Bronchopulmonary segment: area of lung supplied by 1 segmental bronchi If there's an infection or disease of 1 segmental bronchi, they usually don't spread across segments ]

Parietal Bones

Makes up a part of the superior, lateral and posterior aspect of the skull (a pair)

Temporal Bones

Makes up a portion of the lateral aspect of the cranium (a pair)

Lacrimal Bones

Makes up part of the medial wall of the orbit along with the ethmoid bone, frontal and sphenoid bones [Considered part of the visocranium that surrounds the eyes and the mouth]

Respiratory Control

Medulla controls ventilation Medullary signal transmitted through Phrenic and Intercostal Nerves to primary muscles of ventilation...diaphragm and intercostal muscles Phrenic Nerve originates in cervical portion of spinal cord (C3, C4, C5) C3, C4, C5 keep the diaphragm alive!

Brain Stem

Mid Brain (Superior) - short section between diencephelon and brain (~2.5 cm long) - provides main motor pathways between cerebral cortex and pons - conveys sensory impulses from spinal cord to thalamus - origin for cranial nerves III and IV [Sensory info highway 1st CN from brain; 2nd CN from occipital ]

The Spine - Myology

Minor Deep Intrinsics - Unisegmental Muscles -- Interspinal, Intertransverse, Levatores Costarum Deep Intrinsics - Rotatores, Multifidus, Semispinalis Intrinsic Back - Intermediate Layer - Spinalis- medial group(spinalis thoracis, cervicis and capitis) - Longissmus (medial to spinalis) (thoracis, cervicis and capitis) - Iliocostalis- lateral group (lumborum, thoracis and cervisis)

The Cervical Spine

Minor Deep Intrinsics - Unisegmental Muscles -- Interspinal, Intertransverse, Levatores Costarum Deep Intrinsics - Rotatores, Multifidus, Semispinalis Intrinsic Back - Intermediate Layer - Spinalis- medial group(spinalis thoracis, cervicis and capitis) - Longissmus (medial to spinalis) (thoracis, cervicis and capitis) - Iliocostalis- lateral group (lumborum, thoracis and cervisis) Prevertebral Muscles - Anterior -- Longus capitis: from base of skull to transverse processes of middle cervical spine; Flex head on neck; nodding -- Longus colli: from vertebral segments(eh) to anterior _; Flex neck on trunk: chin to chest -- Rectus capitis anterior: from base of skull to C1 -- Anterior Scalene: from transverse process of cervical spine to first rib; Contraction: elevates ribs; taking a deep breath; Accessory muscles of respiration (N: ventral rami) Sternocleidomastoid - Divides the anterior and the lateral musculature Lateral muscles - Rectus Capitis lateralis - Splenius Capitis - Levator Scapula - Middle and Posterior Scalenes Postvertebral Muscles - Splenius capitis - Splenius cervicis Suboccipital Muscles - Rectus capitis posterior major - Rectus capitis posterior minor - Obliquus capitis inferior - Obliquus capitis superior (-Iliocstalis capitus and cervicis, longismus capitsu and servicus, spinalis capitus and cervicis -Semi spinalis capitus and cervicis, multi, rotat, inerspinous and intertransverse in cervical region -Some are strictly only in cervical spine -Postvertebral (behind neck/laterally) and prevertebral (in front of neck/anterior) -Sternocleidomastoid - divides post and prevertebral )

The Heart - AtrioventricularValves

Mitral Valve - Separates LA from LV - Has 2 leaflets -Bicuspid Valve Tricuspid Valve - Has 3 leaflets - Separates RA from RV [Heart in diastole]

Stretch Reflex (patellar reflex)

Monosynaptic, ipsilateral reflex arc Prevents injury from over stretching because muscle contracts when it is stretched Events of stretch reflex - Muscle spindle signals stretch of muscle - Motor neuron activated & muscle contracts Brain sets muscle spindle sensitivity as it sets muscle tone (degree of muscle contraction at rest) Reciprocal innervation (polysynaptic - interneuron) - Antagonistic muscles relax as part of reflex Illustration: Blue = monosynaptic = quads contract Purple = polysynaptic = hamstrings relax and leg kicks out (inhibitive reflex)

Central Nervous System

Most impulses that stimulate muscles or glands originate in the CNS Connected to sensory receptors, muscles, and glands in the peripheral parts of the body by the PNS [Somatic and autonomical functionally Central and peripheral structurally]

The Thoracic Cage

Movement of Ribs Sternocostal joints - Slight gliding movements occur to provide some "give" for respiratory movements - Ribs move as a unit with the sternum Costovertebral and Costotransverse Joints - Strong ligamentous support and therefore movement is minimal [Sternocostal 1 is primary cartilagiinous joint...2-7 are plane synovial joints] Movement of Ribs 1 and 2 - Movement is minimal in quiet respiration - With inspiration, ribs move upward and laterally Movement of Ribs 3-6 Elevation occurs as ribs move upward and forward thereby increasing the anteroposterior diameter of the thorax Described as a pump handle movement Movement of Ribs 7-10 - Elevation occurs as ribs move upward, backward and laterally thereby increasing the transverse diameter of the thorax - Described as a bucket handle movement Movement of Ribs 11 and 12 - Articulate only at costovertebral joints which permits slight movement in all directions - When other ribs are elevated with inspiration, ribs 11 and 12 are depressed by quadratus lumborum to form a fixed point of action for the diaphragm

Structural Classification of Neurons

Multipolar neurons -Three or more processes -One axon and the rest dendrites -Most common neuron type (motor and interneurons) -Major neuron type in CNS Bipolar neurons -Two processes -An axon and a dendrite from opposite sides of the cell body -Rare, found in special sensory organs Unipolar neurons - Have a short single process leaving the cell body -Mainly found in ganglia of PNS (sensory neurons)

The Thoracic and Lumbar Spine

Muscles of the Thorax External intercostals Internal intercostals Innermost intercostals Transversus thoracis Levatores costarum Serratus posterior - Serratus posterior superior - Serratus posterior inferior Diaphragm (below also occur in other regions) Spinalis thoracis Longissmus thoracis Iliocostalis thoracis Multifidus Semispinalis thoracis

Inferior Abdominal Wall

Muscles of the pelvic floor [Helpful for reproduction]

The Axial Skeleton - Myology

Musculature of the Vertebral Column: - Unisegemental muscles - Lateral muscles - Prevertebral muscles (anterior) - Postvertebral muscles (posterior) - may be characterized by topographic location and size - small unisegmental muscles, which connect consecutive vertebrae, are covered by muscles of various lengths lying anteriorly, laterally or posteriorly depending on the region - Entire vertebral column has postvertebral muscles - Thoracic region lacks any lateral and prevertebral muscles - Cervical and lumbar regions have both lateral and prevertebral muscles

Schwann Cells

Myelin sheath formation begins around axons during fetal development Each Schwann cell only mylenates a single axon or can enclose as many as 20 unmylenated axons

Node of Ranvier

Narrow gaps in myelin sheaths between adjacent Schwann cells Present between adjacent oligodendrocytes as well, but in lesser numbers [Devoid of myelin covering on axon]

Nerve Terms

Nerve Fiber: General term for any neuronal process (i.e. axon or dendrite) Nerve: Bundle of many nerve fibers that course along the same path in PNS (i.e. ulnar nerve in forearm) Ganglia: Clustered nerve cell bodies in PNS Tract: Bundle of nerve fibers, without connective tissue, in CNS Nucleus: Collection of nerve cell bodies in CNS [Nerve fiber = 1 axon Fascicle formed by a number of axons Tract not in PNS because you have nerves Spinal cord has grey matter in middle - interneurons and then white matter around = tract - carries info to brain]

Gray Matter

Nerve cell bodies and unmyelinated ("gray") axons and dendrites of association motor neurons - posterior horns - anterior horns - lateral horns (only thoracic, upper lumbar, sacral) - Gray Commisure: Cross bar of H [Lateral gray horn not in every part of spinal cord Sensory coming in - processed in grey matter- goes out as motor]

Synapse

Neuromuscular Junction - between neuron and muscle Neuroglandular Junction - between neuron and gland [Membrane has resting membrane potential which is altered at junctions and causes influx of electrically charged ions Sliding filament theory]

Structural Units / Histology

Neurons - Have capacity to produce action potentials -- electrical excitability Neuroglia - Half of the volume of the CNS - Smaller cells than neurons - 50X more numerous - Cells can divide -- rapid mitosis in tumor formation (gliomas) [2 broad classifications of cells Neurons are most abundant - transmission of information - VERY IMPORTANT; from CNS to PNS or PNS to CNS; react to electrical impulse and can transmit/transport electrical impulse; but can't tell what it is Neuroglia - can't transport; 4 types in CNS; 2 types in PNS; much smaller; more # but neurons prob have more volume]

Bladder

Not normally palpable Lies behind and a little above the pubis [Behind symphysis pubis]

Internal Oblique

O: arises from inguinal ligament, iliac crest and lateral raphe of thoracolumbar fascia I: Inferior borders of ribs 10-12, linea alba A: Compress and support the viscera. Flex and Laterally rotate the trunk. - Plays a role in lumbar stabilization -Support and compress abdominal viscera -Assist in forced expiration -Acting bilaterally, flex vertebral column -Acting unilaterally, laterally flex and rotate the vertebral column to the same side (ipsilateral rotation as bringing origin and insertion closer together) -Plays a role in lumbar stabilization [Inferior and lateral in front; inferior and medial in back Causes ipsilateral rotation; causes trunk flexion because anterior side]

Transversus Abdominis

O: arises from inguinal ligament, iliac crest, thoracolumbar fascia and costal cartilages 7-12 I: linea alba with the posterior lamina of the internal oblique A: support and compress the abdominal viscera assist in forced expiration plays a role in lumbar spine stabilization [Innermost of the three abdominals; Important for viscera stabilization Arcuate line = no longer have posterior layer ] [Above = Ant -int and ext; Post - int and TA Below = Ant - EO, IO, TA]

Iliacus

O: iliac fossa, ala of sacrum and anterior sacroiliac ligaments I: lesser trochanter of femur N: femoral nerve A: flexion of the thigh / hip, stabilization of the hip during abdominal movements [Hip flexor but part of lateral wall due to its position]

Rectus Abdominis

O: pubic crest and symphysis I: costal cartilages of ribs 5-7 and xiphoid process A: flexes vertebral column (flexes trunk) N: Anterior rami of the inferior 6 thoracic nerves [Rectus abdominis has zigzag intersections? For tension reasons One muscle on each side] Linea alba - Tendinous structure, extending from xiphoid process to pubic symphysis separating rectus abdominus Tendinous intersections - Three zig-zag intersections interrupt rectus abdominus - Adherent to anterior layer of rectus sheath [Linea alba runs through entire rectus sheath separating 2 parts; serves as point of attachment for muscles]

External Oblique

O: ribs 5-12 I: linea alba with aponeurosis of internal oblique , pubic tubercle, and enterior ½ of iliac crest A: Works together with the contralateral internal oblique during torsional movement of the trunk; (rotation to opposite side - contralateral) [Largest and the most superficial of the abdominals] Action: - Support and compress abdominal viscera - Assist in forced expiration - Acting bilaterally flex the vertebral column -- Lateral fibers --- Acting bilaterally, posteriorly rotate the pelvis --- Acting unilaterally, laterally flex the vertebral column -- Anterior fibers --- Acting unilaterally, flex and rotate the vertebral column to the opposite side [Trunk flexion but rotation individually; cause contralateral rotation]

Frontal Bone

On the anterior aspect of the skull Forms the skeleton of the forehead Articulates inferiorly with the nasal and zygomatic bones Supraorbital Foramen / Notch [Just above the orbit is the supra orbital foramen for the supraorbital nerve and vessels]

Latissmus Dorsi

Only superficial muscle in the lumbar region Blends with thoracolumbar fascia Has muscular attachments to the iliac crest [Fascia arises from the transverse processes of the lumbar vert...completely surrounds the musculature of the L-spine] Origin: Spinous processes of T6 through T12, iliac crest and thoracolumbar fascia Insertion: Floor of intertubercular groove Action: Extension, Adduction and Internal Rotation of shoulder Nerve: Thoracodorsal nerve (from Brachial Plexus)

Obliquus Capitis Superior

Origin (IA) : transverse process of C1 Insertion (SA): Occipital bone between inferior and superior nuchal line N: dorsal rami of C1 A: extend head on C1 and rotate C1 on C2

Obliquus Capitis Inferior

Origin (IA): posterior tubercle of posterior arch of C2 Insertion (SA): transverse process of C1 N: dorsal rami of C1 A: extend head on C1 and rotate C1 on C2

Rectus Capitis Posterior Minor

Origin(SA): posterior tubercle of posterior arch of C1 Insertion (IA): occiput along the medial 1/3 of the inferior nuchal line N: dorsal rami of C1 Action: extend head on C1 and assist the major with rotation of C1 on C2 [Insertion point is medial to the major]

The Axial Skeleton

Osteology - Transitional Vertebrae - Vertebrae which has some characteristic features of both adjacent spinal segments - Typically occurs where morphology of vertebrae markedly changes from one level to the next; ie. cervicothoracic, thoracolumbar, lumbosacral [Orientation of the facets changes to promote different movements]

MAKE SURE YOU STUDY

PICTURES IN POWERPOINT

Levator Scapula

Origin: Transverse processes of C1 through C4 Insertion: Superior part of Medial border of Scapula Action: elevates and rotates the scapula as well as tilting (depressing) the glenoid cavity inferiorly Nerve: Dorsal Scapular nerve [Works with the upper trap to elevate Cervical arcs]

Osteology - Zygapophyses

Paired articular processes - Superior - Inferior Extend from junctions of pedicles and laminae [Each process has an articular facet for either the superior or the inferior Sometimes referred to as the facet joint Helps to resist anterior movement of a superior vertebra on an anterior]

Spinal Cord: Gross Anatomy

Part of CNS; connected to brain by brain stem 31 segments, each giving rise to pair of spinal nerves - 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal Functions - conduct nerve impulses - serve as center for spinal reflexes [Cervical nerves through intervertebral foramen C1 between occiput and C1; C2 between C1 and C2 Between C7 and T1 = C8 nerve 7 cervical but 8 nerves] Protected by vertebral column - vertebrae - vertebral ligament Spinal Meninges - same as brain (dura mater, arachnoid, pia mater) Conus medullaris - L1 - L2 interspace where spinal cord tapers off to become "cone-shaped" Cauda equina - roots of spinal nerves (S1 - S5 and coccyx) travel inferiorly to form "horse tail" [Ends at L1-L2; tapering end = conus medullaris Rest are nerves that have not left spinal column - form horse tail] Filum terminale - extension of pia mater; extends inferiorly from conus medullaris and attaches at coccyx (acts as anchor) [Allows for vertebral column movement without moving spinal cord] Cervical enlargement - (C4-T1) - brachial plexus arises from this area Lumbosacral enlargement - (T12-S2) - nerves supplying lower extremity arise from this area [Cervical and lumbar supply upper and lower extremity = need more room (areas are wider)]

Occipital Bone

Posterior aspect of the skull (a pair) External Occipital Protuberance Occipital Condyles Carotid Foramen (Foramen Lacerum) Hypoglossal Canal [(foramen magnum - where brain stem travels through to spinal column) Hypoglossal canal for hypoglossal nerve Carotid foramen - passage for internal carotid artery; supplies entire brain Occipital condyles with 1st C vert to form atlant____ joint]

The Heart - Valves

Prevent valves from prolapsing into atria which prevents backflow of blood Valves connected to papillary muscle Chordae tendineae connect leaflets to papillary muscle [Papillary muscles work eccentricly Contract: valves close ] Atrioventricular Valves - Tricuspid Valve - Mitral Valve Semilunar Valves - Pulmonic Valve (right) - Aortic Valve (left) No valve between Pulmonary Veins and LA [AV valves controlled by papillary muscles, Semilunar valves controlled by pressure gradients ]

Multiple Sclerosis (MS)

Progressive destruction of myelin sheaths of neurons in the CNS into hardened scars or plaques called scleroses Chronic, often disabling disease occurring usually between the ages of 20 and 40 2x more common in ♀ than in ♂ - neuron transmission of nerve impulses is significantly limited or even eliminated - normally fine coordination is severely diminished and gross movements become uncoordinated Possible Cause - genetic susceptibility and exposure to some environmental factor (ie virus)

Osteology - Transverse Processes

Project laterally from the junction between the pedicles and laminae Serve as levers for muscles [Increases leverage on the verteberal column] (Offer leverage for muscles and points of attachment)

Osteology - Spinous Process

Projects dorsally from junction between the two laminae Function as levers for the back extensors [Primarily for movement] (For movement; access points where muscles can attach ; Levers for muscles -> mechanical advantage, 1st, 2nd, and 3rd )

Blood Brain Barrier

Protects brain cells from harmful substances and pathogens by preventing passage of many substances from the blood in to the brain tissue Astrocytes (type of neuroglia) selectively control activity of endothelial cells of capillaries - some H2O-soluble (i.e. glucose) and all lipid-soluble (i.e. O2, CO2, alcohol, most anesthetics) substances pass freely - other H2O-soluble (i.e. creatine, urea, most ions) substance pass more slowly - proteins and most antibiotics are not permitted through the BBB - One consequence of BBB is it prevents passage of some drugs that may be therapeutic for cancers or other CNS disorders - Researchers are finding ways of delivering drugs in a concentrated glucose solution to "trick" the BBB

Posterior Abdominal Wall

Psoas muscles Quadratus Lumborum

Procerus

Pulls the skin over nose upward Forms wrinkles over bridge of nose [Something Smells (bring eyebrows closer together)]

The Heart - Semilunar Valves

Pulmonic Valve - Connects RV to Pulmonary Artery Aortic Valves - Located posterior to the left side of the sternum at the 3rd intercostal space - Connects LV to Aorta - CORONARY ARTERIES [Heart in systole Both Semilunar Valves permit one-way movement of blood and prevent backflow No tendinous cords to connect Openings for the coronary arteries just outside the valves in the aortic sinus right and left Coronary arteries supply the heart itself ]

Abdominal Aorta

Pulse may be palpable just to left of midline in umbilical region above L4 (didn't go over this slide)

Masseter

Quadrangular muscle Elevates the mandible and occludes the teeth for biting and chewing [(mastication muscle; elevates jaw Mandibular branch of trigeminal nerve of C5]

Levator Labii Superioris

Raises or protrudes the upper lip, as if to show gums [Retractrion and elevation of lip (labii has something to do with lips)]

Anterior Scalene

SA: transverse processes of C3-C6 IA: 1st rib N: ventral rami C4-C6 A: elevates 1st rib, laterally flexes and rotates the neck

Polysynaptic Arc

Receptor organ -> Sensory neuron -> Association neuron (integration) -> Motor neuron -> Effector organi.e. stepping on a tack - "withdrawal reflex" (coordination of several muscles) Sensory neuron sends message by way of an interneuron (association neuron) to a motor neuron i.e. Withdrawal reflex - Receptor organ: receptor end of a dendrite or a specialized receptor cell in a sensory organ - Sensory neuron: transmits nerve impulse from receptor into brain or spinal cord

Anterior Abdominal Wall

Rectus abdominis Rectus sheath Pyramidalis [Two main muscles (rectus abdominis and pyramidalis) and fascia that covers (sheath)]

The Cervical Spine Suboccipital Muscles

Rectus capitis posterior minor and major muscles Obliquus capitis superior and superior muscles Longissimus capitis and cervicis muscles Semispinalis capitis and cervicis muscles Iliocostalis cervicis muscle [: 4 posterior muscles: rectus capitus posterior minor and major, obliquus capitis superior and inferior - Form triangle = suboccipital triangle - Extension of head on neck - Working on computer screen - headache o Greater occipital nerve is compressed in suboccipital triangle because these muscles are tight o Ram's horns headaches - N: dorsal rami of cervical spinal nerves (specifically C1)]

Osteology - Pars Inarticularis

Region between the superior and inferior articular processes If defective results in a spondylolysis (defect of the pars) When anterior displacement occurs it is called spondylolisthesis (Most common area to fracture ; Spondylolisthesis: fracture of pars inarticularis ; Oblique x-ray view -> Break in scotty dog's neck; Gap between neck; Pars defects ; Lysis = defect, can sit in class; But once lolisthesis = fracture, surgery to be fused)

Parasympathetic Division

Regulates actions that conserve and restore body energy during times of rest and recovery Energy conservation and restoration Rest and regroup system "rest and digest"

The Lungs - Main Bronchi

Right Bronchus - Wider, shorter and runs more vertically than the left - Passes directly to the hilum of the lung Left Bronchus - Passes inferolaterally, inferior to the arch of the aorta and anterior to the esophagus and thoracic aorta, finally reaching the hilum of the lung

The Heart - Borders

Right border - Slightly convex and formed by the right atrium and extending between the superior and inferior vena cava (SVC and IVC respectively) Inferior border - Oblique and nearly vertical formed by the right ventricle and the left ventricle Left border - formed by the left ventricle and the left auricle Superior border - Formed by the right and left atria and auricles in an anterior view - Ascending aorta and pulmonary trunk emerge from the superior border with the superior vena cava entering the right side The Base - Left and right atria, more left than right - Faces posterior toward the body of the vertebrae - Pulmonary vessels on left IVC / SVC on right Apex - Formed by the inferiolateral portion of the left ventricle - At the fifth intercostal space. [Ascultation of the mitral valve]

Liver

Right hypochondriac and epigastric regions Not normally palpable because it is covered by rib cage [Remember the xyphoid is the superior margin of the liver Produces juices/enzymes for digestion and metabolism (emulsification of fat through bile to SI)]

The Thoracic Cage - Osteology ..

Rule of Threes Relates to the spinous processes in relation to transverse processes T1-T3: spinous processes project posteriorly in the same plane as the transverse processes T4-T6: spinous processes are directed slightly downward; located midway between the transverse process of its own vertebra and that of the vertebra below T7-T9: tips of spinous processes are in the same plane as the transverse processes of the vertebra below T10: same as T7-T9 T11: same as T4-T6 T12: same as T1-T3 [So when you palpate the thoracic spine you have t know what region you are in...can't just palpate the process and move to the corresponding transverse and name the vert / rotation]

Anterior Longitudinal Ligament

Runs from occiput to body of S1 on the anterior aspect of the vertebral column Firmly attached to margins of the vertebral bodies and discs and less firmly to the midparts of the bodies [Thickest portion opposite the discs] - Prominent and thickest in the thoracic region - In cervical region, presents as a thin narrow strip - Broad and thin in the lumbar region [Helps to prevent hyper extension of the vertebral column Maintains the structure of the joints and helps to restrict extention] (C1 to S1; Attachment firmer to where discs are; Checks extension of trunk/hyperextension of vertebral column ; Takes significant force to tear; Rheumatoid arthritis - this ligament is calcified _

Spinalis Cervicis

SA :Spinous processes of C2-C4 IA :Spinous process of C7-T1 and lower part of the ligamentum nuchae I: dorsal primary rami of spinal nerves A: neck extension [Very small, sometimes absent, medial to semispinalis]

Quadratus Lumborum

SA: Inferior border of 12 rib and tips of lumbar TPs IA: Iliac crest I: Ventral rami of spinal nerves A: Ipsilateral side bending and bilateral extension

Quadratus Lumborum ..

SA: Inferior border of 12 rib and tips of lumbar TPs IA: Iliac crest I: Ventral rami of spinal nerves A: Ipsilateral side bending and bilateral extension [Also fixes the 12 rib during inspiration to provide a fixed attachment for the diaphragm] [Ex: standing on one leg and pulling up hip on other leg = this muscle]

Psoas Minor /

SA: Lateral Bodies T12 - L1 IA: Pectineal line and ililpectineal eminence via the ililpectineal arch I: ventral ramus of L1 A: very weak trunk flexor [Has attachments to the disk as well; 10-11% don't have this muscle; doesn't cross hip joint; WEAK trunk flexor]

Psoas Minor

SA: Lateral Bodies T12 - L1 IA: Pectineal line and ililpectineal eminence via the ililpectineal arch I: ventral ramus of L1 A: very weak trunk flexor [Has attachments to the disk as well]

Iliocostalis Thoracis

SA: Rib angles of ribs 1-6 and C7 Spinous process IA: Superior rib angles of ribs 7-12 I: dorsal primary rami of spinal nerves A: trunk extension and ipsilateral side bending Arises medial to the Iliocostalis Lumborum

Spinalis Thoracis

SA: Separate tendons to T2 - T6 (sometimes as low as T8 IA: s.p. T11-L2 I: dorsal primary rami of spinal nerves A: trunk extension [Blends with longissimus thoracis in the inferior part]

Semispinalis Cervicis

SA: Spinous process 4-6 segments above IA: upper thoracic and cervical transverse processes spanning 4-6 segments below I: dorsal rami A: extension and contralateral rotation of vertebral column and head The fasicle from the axis is the most easily identified in the lab

Psoas Major

SA: TPs of lumbar vertebrae T12-L5 IA: lesser trochanter of femur by a common tendon with the illiacus I: ventral rami of spinal nerves L2-L4 (from the lumbar plexus) A: flexes thigh when distal insertion is moving; ipsilateral lateral flexion when the distal extremity is fixed

Psoas Major .

SA: TPs of lumbar vertebrae T12-L5 IA: lesser trochanter of femur by a common tendon with the illiacus I: ventral rami of spinal nerves L2-L4 (from the lumbar plexus) A: flexes thigh when distal insertion is moving; ipsilateral lateral flexion when the distal extremity is fixed [Transverse processes! Travels under inguinal ligament Action in trunk only when feet are planted on the ground]

Iliocostalis Cervicis

SA: Transverse process of C4-C6 IA: Angles of ribs 3-6 I: dorsal primary rami of spinal nerves A: neck extension and ipsilateral side bending

Iliocostalis

SA: angle of ribs IA: erector spinae aponeurosis into posterior ilium and sacrum I: dorsal primary rami of spinal nerves A: trunk extension and ipsilateral side bending [Lateral column...lumbar, thoracic, cervical] (• Then more specific to region • Costal = ribs • Angle of ribs to angle of ribs; Angle of rib = bending forward • Lumbar connects with erector spinal • Cervicis o From transverse processes of cervical spine to transverse processes of upper thoracic and angle of uppers ribs (wording may be wrong but less specific than notes) • Thoracis: angle of upper ribs to angle of lower ribs • Lumborum: angle of lower ribs to sacrum? • N: dorsal rami of ____ spine (depends on area - thoracic, cervical, lumbar)-

Longus Colli

SA: anterior bodies of C1-C3, and transverse process of C3-C6 IA: Body of C5-T3; transverse processes of C3-C6 N: ventral rami of C2-C6 spinal nerves Action: flexion of neck, Contralateral rotation if acting unilaterally

Rectus Capitus Anterior

SA: base of skull, just anterior to occipital condyle IA: anterior surface of the lateral mass of C1 N: ventral rami of C1 and C2 spinal nerves A: flexes head [Considered prevertebral or deep neck musculature]

Longus Capitis

SA: base of the occiput, anterior to foramen magnum IA: anterior tubercles of C3-C6 transverse process N: ventral rami of C2-C3 Action: flexion of occiput [Rarely do these muscles work alone. They are usually working in conjunction with others]

Serratus Posterior Inferior

SA: from SPs of T11-L2, supraspinous ligament and thoracolumbar fascia IA: inferior borders of 8th to 12th ribs lateral to the posterior angles N: anterior rami of T9 - T12 of thoracic spinal nerves A: draw ribs downwards and backwards

Iliocostalis Lumborum

SA: inferior border of angle of ribs 7-12 IA: erector spinae aponeurosis into posterior ilium and sacrum I: dorsal primary rami of spinal nerves A: trunk extension and ipsilateral side bending Attaches by a series of flattened tendons to the rib angles and to the transverse process in the c-spine.

Rectus Capitis Lateralis

SA: jugular process of occipital bone IA: anterior surface of the lateral mass of C1 N: ventral rami from C1 and C2 spinal nerves A: flexes head [Lateral flexion of the head] (from base of skull to C1 o Elevates ribs? But also flexes head (lateral movement? - sidebending?) )

Serratus Posterior Superior

SA: lower part of ligamentum nuchae and SPs of C7-T2 and supraspinous ligament IA: ribs 2-5 lateral to posterior angles N: 2nd - 5th intercostal nerves A: elevate ribs for inspiration [- Exception with nerve - Superior elevates ribs - Inferior - draws ribs downwards and backwards - Both inspiratory??]

Splenius Capitis

SA: mastoid process and lateral third of superior nuchal line IA: nuchal ligament & C7-T5 spinous processes N: dorsal rami of middle cervical spinal nerves A: unilaterally, laterally flex and rotate the head and neck to the same side; bilaterally, extend head and neck [space between transverse and spinous : lateral to midline fibers; Opposite of transversospinal group which went midline to lateral; Causes same side rotation]

Sternocleidomastoid

SA: mastoid process and the lateral half of the superior nuchal line IA: two Heads of attachment - sternal head: anterior surface of manubrium - clavicular head: medial 1/3 of clavicle Nerve: (CN XI)spinal accessory Action: - Alone: ipsilateral side bend of neck, contralateral rotation - Together: neck flexion [There are more motions, but we won't get into them right now] (: same side sidebending but opposite side rotation; Hand on right side of neck, side bend neck to right while rotating left - can feel muscle)

Spinalis Capitis

SA: nuchal line of occiput medial to Semispinalis Capitis IA: s.p and articular process of C6-T1 I: dorsal primary rami of spinal nerves A: occipital extension Usually blended with spinalis cervicis or semispinalis capitis [Thoracic and cervical...thoracic to L2...head attachments blend with the semi spinal in the capital region Fibers are difficult to distinguish from semispinalis esp. in lab.]

Semispinalis Capitis

SA: occiput IA: upper thoracic and cervical transverse processes spanning 4-6 segments each I: dorsal rami A: extension and contralateral rotation of vertebral column and head Largest and strongest posterior neck muscle

Longissmus Capitis

SA: posterior margin of mastoid deep to Splenius Capitis and SCM IA: lower 3-4 cervical and upper 4-5 thoracic transverse processes I: dorsal primary rami of spinal nerves A: occipital extension and ipsilateral side bending

Longissmus Thoracis

SA: posterior surfaces of transverse process of T1 - T12 IA: spinous process of L1 - L5 vertebrae and middle layer of thoracolumbar fascia I: dorsal primary rami of spinal nerves A: trunk extension and ipsilateral side bending

Posterior Scalene

SA: posterior transverse processes of C4-C6 vertebrae IA: External border of the second rib N: ventral rami of cervical spinal nerves C7 and C8 A: elevates the 2nd rib and laterally flexes the neck [Don't forget the levator with the lateral musculature. See past lectures for O&I] (o Middle scalene to 1st rib o Posterior to 2nd ribs o Accessory muscles of respiration)

Middle Scalene

SA: posterior transverse processes of C4-C7 vertebrae IA: superior surface of first rib posterior to groove for subclavian artery N: ventral rami of cervical spinal nerves A: elevates 1st rib and laterally flexes the neck (Roots of brachial plexus = gap between anterior and middle scalenes) (Thoracic outlet syndrome can be caused by elevated ribs - compression on neurovascular subjects in subclavicular space Tight anterior and middle scalene can cause compression in brachial plexus)

Longissmus Cervicis

SA: posterior tubercles of transverse processes of C2-C6 IA: transverse processes of T1-T5 I: dorsal primary rami of spinal nerves A: neck extension and ipsilateral side bending [[Under Iliocostalis Cervicis]

Semispinalis

SA: s.p. lower thoracic vert. 4-6 segments and superior medial to the occipital bone IA: t.p. of C2-T12 I: dorsal primary divisions of spinal nerves A: trunk extension and contralateral rotation Note: not well developed in lumbar area [Arises from the TVP's of C4 - T12, span 4 - 6 segments in the thoracic region...not really in L-spine at all This is the deep layer of the intrinsic back muscles Each semispinalis spans 4-6 segments...looks like on long muscle but really has multiple attachments Origin looks like it's wrong, but the origin is the inferior attachment.] (o Capitis: Extension of head bilaterally; Unilaterally = rotation o Cervicis o Thoracis - hard to find. Not well defined)

Multifidus

SA: s.p. of vertebra 2-4 segments above. IA: t.p. of vertebrae 2-4 levels inferior; mamillary processes and erector spinae apeneurosis in the lumbar spine I: dorsal primary divisions of spinal nerves A: trunk extension and contralateral rotation; stabilization of the vertebrae during bilateral action Best developed in the lumbar spine [Spans 2-4 segments] (o Most defined in lumbar spine; Deeper to erectae spinal; Between transverse process and spinal process; Extends entire spinal column; And contralateral rotation)

Spinalis

SA: s.p. of vertebrae IA: s.p. of vertebrae several levels inferior I: dorsal primary rami of spinal nerves A: trunk extension [Thoracic and cervical...thoracic to L2...head attachments blend with the semi spinal is capitis] (• Extends from spinous process to spinous process •Capitis •Cervicis - cervical spinous processes to •(these 2 tend to blend in with each other; zone of overlap) •Thoracis- thoracic spinous processes to • Insert as individual muscle groups)

Rotatores (Brevis)

SA: s.p. of vertebrae 1 level superior IA: junction of the t.p. and the lamina vertebrae 1 level inferior I: dorsal primary divisions of spinal nerves A: trunk extension and contralateral rotation Best developed in the thoracic region [Spans 1-2 segments] (1!)

Rotatores (Longus)

SA: s.p. of vertebrae 2 levels superior IA: junction of the t.p. and the lamina vertebrae 2 levels inferior I: dorsal primary divisions of spinal nerves A: trunk extension and contralateral rotation Best developed in the thoracic region [Spans 1-2 segments] (2!) - : cross over 1 segment and attaches to next one ; o Cause contralateral rotation o Extension when acting bilaterally - all muscles on back (dorsal primary divisions = dorsal rami)

Longissmus

SA: t.p. of vertebrae IA: s.p. of inferior vertebrae and erector spinae aponeurosis I: dorsal primary rami of spinal nerves A: trunk extension and ipsilateral side bending [Middle column...thoracic and cervical...attachments to the head] (• Extends from transverse process to transverse process o Leave as single fibers but join as one group - (zoom in on app to understand) Capitis: Mastoid process of skull (bone behind ear) to transverse processes of lower cervical and upper thoracic ; (skull has no traverse processes because not part of spine) Cervicis: Transverse process to transverse process Thoracis : Transverse processes of thoracic spine to erector spinal)

Splenius Cervicis

SA: transverse process of C1-C4 IA: nuchal ligament and spinous processes of T3-T6 I: dorsal rami of spinal nerves Action: unilaterally ipsilateral side bend and rotation; bilaterally, extension of head and neck [In lab they are frequently found together and sometimes not separated] [o Superior transverse processes to thoracic spinous process ; Causes same side rotation]

Neuroglia - in PNS

Satellite cells - flat cells that surround and support neuron cell body in ganglia Neurolemmocytes - a.k.a. Schwann cells - produce myelin sheaths in PNS - participate in regeneration of PNS axons [Satellite is protective and gives structure to cell body Schwann produces concentric rings of myelin Schwann cell can engulf about 15-20 axons]

This is the deep layer of the intrinsic back muscles

See pic on slide 25

Functional Classification of the Nervous System

Sensory - senses changes in internal and external environment Integrative - analyzes and stores data - decides which stimuli are important Motor - responds to stimuli through muscular contractions or glandular secretion [Classification for neurons Processing relies on neuroglial cells ]

Functional Aspects of Cerebral Cortex

Sensory - receive, interpret sensory impulses motor - initiate movements association - complex integrative functions (i.e. memory, emotions, reasoning, will, judgment, personality, intelligence [Association is most important aspect of cerb. cortex]

Monosynaptic Arc

Sensory neuron sends message directly to motor neuron (only has one synapse in CNS)i.e. knee-jerk reflex, aka "patellar tendon reflex"

Neurons of Spinal Cord

Sensory: Afferent (ascending) Motor: Efferent (descending) Association: - neurons found in gray matter - neither sensory or motor - assist with organizing and interpreting impulses

Dendrite

Short, thick, tapering, unmyelinated and highly branched processes that emerge from cell body Function - conduct nerve impulses "toward" cell body - relay information from external environment May have several dendrites per neuron [Myelin is to NS as pleura is to the lungs - Protective covering; transmission of info - Dendrites are not myelinated but axons are]

1st Rib

Shortest and most curved Head has single articular facet for body of 1st thoracic vertebra Scalene tubercle for attachment of scalenus anterior No costal groove on under surface [Two transverse grooves across the superior surface for the subclavian vessels...separated by the scalene tubercle Subclavian vein anterior and artery posterior to insertion point of anterior scalene]

The Head

Skull Face Scalp Teeth Brain Cranial nerves Meninges Special sense organs Blood vessels Lymphatics Fat Points of Emphasis - Skull - Facial muscles

Pyramidalis

Small triangular muscle contained within the rectus sheath Anterior to rectus abdominis, running from pubis to linea alba Acts to tense the linea alba [Absent in 20% of the population]

3 Divisions of Peripheral Nervous System

Somatic Nervous System - Voluntary Autonomic Nervous System - Involuntary Enteric Nervous System - Involuntary [Enteric = brain of the gut; closely associated with endocrine and autonomic systems]

Cranial Nerves Functional specialization:

Special Sensory Functions: --Olfactory (CN I) --Visual (CN II) --Vestibular (CN VIII) --Auditory (CN VIII) --Gustatory (CN VII, IX) Somatic Nervous System Functions -Somatosensory -- Sensation of the face (V) -- Sensation of the ear (VII, X) -- Sensation of the tongue and throat (IX) - Somatomotor -- Eye Reflex & Voluntary Movement (III, IV, VI) -- Auditory Reflexes (VIII) -- Chewing Reflex & Voluntary Movement (V, XII) -- Swallowing Reflex & Voluntary Movement (IX, X, XII) -- Speaking Movements (X) -- Facial Movement (VII) -- Head, Neck Reflex & Voluntary Movement (XI) Autonomic Nervous System Functions - Visceral sensory -- Thoracic and abdomen viscera (IX, X) - Visceral motor -- Lens accommodation, -- Pupil dilation (III) -- Lacrimation (VII) -- Salivation (VII, IX) -- Thoracic and abdominal viscera (X)

Reflex Arc

Specific nerve impulse pathway 5 components of reflex arc - Receptor - Sensory neuron - Integrating center - Motor neuron - Effector 4 important somatic spinal reflexes - stretch, tendon, flexor(withdrawal) & crossed extensor reflexes [Step on thumb tack] Monosynaptic Arc Polysynaptic Arc

Orbicularis Oris

Sphincter muscle, closes lips and protrudes lips forward as in whistling Important during articulation (speech), compressing the lips against the teeth and to hold food between the teeth during mastication [Kissing or pursing your lips (surrounds oral cavity)]

Orbicularis Oculi

Sphincter muscle, closes the eyes firmly Consists of: - Orbital part - Palpebral part [Can be moved independently from the contralateral (includes eyelid?)]

Spinal Nerves

Spinal Column (Skeletal Structures) - Cervical vertebrae (7) - Thoracic vertebrae (12) - Lumbar vertebrae(5) - Sacral vertebrae (5) - Coccyx vertebrae (1) Spinal Cord (Nervous Tissue) - Cervical segments (8) - Thoracic segments (12) - Lumbar segments (5) - Sacral segments (5) - Coccygeal segment (1)

Spinal Cord

Spinal Tap Site - L3-L4 or L4-L5 interspace - Cord ends at upper border of L2 vertebrae - Spinal puncture safe below L2 - Performed to sample of CSF [Extract for lap assessment from subarachnoid space - which is close to pia mater; why they use lower L position]

Flexor (withdrawal) Reflex

Step on tack (pain fibers send signal to spinal cord) Interneurons branch to different spinal cord segments Motor fibers in several segments are activated More than one muscle group activated to lift foot off of tack [Polysnaptic - more specifically known as flexor withdrawal reflex]

The Vertebral Column

Structure: The vertebral column is composed of a series of individual bones (vertebrae) articulated in a series of curves bound together by deformable discs [33 bones in all] Function: Provides a rigid but flexible axis for movement Provides a firm base for suspending structures (ie. ribs) that allow body to maintain cavities with relative constant shape and size Creates a link between the upper and lower extremities Provides protection for the spinal cord [Strong and flexible support for the trunk... primary functions are posture, support of body weight, locomotion, and protection of the spinal cord and nerves] The vertebral column is divided into five distinct regions: Each region is unique in structure Different curves and bony articulations Each region meets different functional demands Structure will dictate function [Of the 33 bones only 24 of the actually move / allow movement] Regions - 5 regions Cervical Thoracic Lumbar Sacrum Coccyx [Note the articulation and the possible movement of each vertebrae...this allows a significant amount of flexibility...stability is still maintained by the bony structure, the discs, ligaments and the musculature]

yup

Superificial - Lats - Trapezius - Rhomboids - Serratus posterior (superior and inferior) Intermediate - Erector spinae (all thoracis parts but some cervices) Transversospinal - Semispinalis (thoracis) - multifidus - rotatores (longus and brevis) - (contralateral rotation in addition to normal ___) Minor Intrinsics (superficial has different nerves but rest are Dorsal rami of thoracic spinal nerves; serratus posterior is supplied by intercostal nerves like muscles of respiration) Muscles of Respiration - assist in inspiratory process (normal expiration is passive) Accessory - Scalene (anterior, middle, [both 1st] posterior - 2nd) - Abdominals (wait for abdominal cavity notes) Intercostal - External - Internal - Innermost - (between internal and innermost = intercostal nerves and vessels) Diaphragm - Most important inspiratory muscles - Separates thoracic and abdominal cavities Sternocostalis Levator Costorum (minus diagraphm - all of these are supplied by intercostal nerves)

Osteology - Vertebral Endplates

Superior and inferior surfaces of trabecular bone Covered with hyaline cartilage

Neuroglia

Support, nurture and protect neurons Maintain chemical balance of fluid that bathes neurons Outnumber neurons by 5 to 50 times Often associated with brain tumors 6 types - 1-4 located in CNS; 5-6 in PNS

Gross Anatomy:Supporting Systems of the Human Nervous System

Supporting Structures & Systems - Bony encasement - Meninges - Cerebrospinal fluid system - Cerebrovascular system

Costovertebral Joints

Synovial joints Formed between heads of ribs and thoracic vertebral bodies and interposed intervertebral disc 1st, 10th, 11th and 12th ribs articulate with a single vertebral body (see pic slide 22)

Zygapophyseal (Facet) Joints

Synovial joints formed between the superior and inferior articular processes of adjacent vertebrae Enclosed by a fibrous joint capsule Different characteristics in cervical, thoracic, and lumbar spine [Loose articular capsule] Joint Capsule - Very strong - Fairly loose -- Relatively more taut in the lumbar and thoracic spine [Permits gliding motions between the vertebrae] (all have capsule - is stronger here than in shoulder, etc. In thoracic region, capsule has different characteristics due to mobility - Thinner, but has ribs; doesn't move; Lumbar and cervical -> extremely strong and taut )

Costotransverse Joints

Synovial joints formed between tubercles of ribs and facets on transverse processes Absent at the 11th and 12th ribs

Interchondral Joints

Synovial joints located between: 6th and 7th 7th and 8th 8th and 9th costal cartilages Enclosed in a fibrous capsule and supported by interchondral ligaments [Articulation between the 9th and 10th is fibrous]

Blood Pressure

Systolic/Diastolic Systole - Myocardium is contracting Diastole - Myocardium is relaxed, cardiac filling occurs Pacemakers: Power source placed subcutaneously Electrodes threaded through Subclavian Vein and SVC to RA and/or RV Provide alternate source of electrical power for heart whose intrinsic source of electricity or ability to conduct current is impaired Fixed rate pacemakers (fixed HR) Demand pacemakers (adapts to demands of body) [During Diastole repolarization of the musculature of the atria and the ventricle Systolic number is higher than diastolic (about 120/80 is normal) Ratio more important than actual number SA nodes and AV nodes: receive and transmit impulses that cause contraction These nodes are supplied by coronary arties, they can stop functioning. Pacemakers help this ]

Osteology - Intervertebral Foramina

The inferior vertebral notch of the superior vertebrae in a pair matches with the superior vertebral notch of the inferior member in a pair to form an intervertebral foramina The intervertebral foramen transmit spinal nerves from the spinal cord (between pedicles; openings )

Posterior Border

Where the costal and mediastinal surfaces meet posteriorly It is broad and rounded

The Lungs !

The lungs attach to the heart and trachea by structures that comprise the roots of the lungs Root is formed by structures entering and emerging from the lung at its hilum Function is to oxygenate blood

Osteology - Trabecular Bone

Thick core of trabecular bone in the vertebral body surrounded by a thin shell of cortical bone Function is to support and distribute the weight [Nutrient foramen on the anterior surface of the body and a larger foramen on the posterior for the basivertebral vein] Has canals for basivertebral veins

Respiratory Segments

Trachea Main bronchi Bronchus Lobar bronchi Segmental bronchi Terminal bronchioles Respiratory bronchioles Aveolar ducts Aveolar sacs Alveolus [Different functions: Respiratory and Non-Respiratory ]

Planes

Transpyloric Transtubercular Right and left lateral/midclavicular planes

Fascial Linings of the Abdominal Wall

Transversalis fascia -> Lines transversus abdominus Diaphragmatic fascia -> Lines diaphragm Iliac fascia -> Covers iliacus Anterior layer of thoracolumbar fascia -> Covers quadratus lumborum Pelvic fascia ->Covers pelvic floor muscles [Fascia covering anterior wall Linea alba splits rectus abdominis in two; rectus abdominis is important trunk flexor; gets attachment from 5-7 ribs and xiphoid process; inferior attachment = symphysis pubis; zig-zag tendinous intersections for mechanical advantage - tendons stick to rectus sheath (cover for abdominis) Pyramidalis - Tenses linea alba during trunk flexion N: ventral rami of Lumbar spinal n Venral rami of thoracic spinal N become intercostals 3 layers; Posterior = lat dorsi; Middle = transverse abdominus; Anterior = ]

Transverso-Spinal Muscles(Deep Intrinsic Back Musculature)

Transversospinal Musculature - Occupy area between transverse and spinous process - Composed of three layers: -- Deep outer layer: Semispinalis (not in lumbar) -- Deep mid layer: Multifidus -- Deep inner layer: Rotatores [Contralateral rotation...stabilization during local movements...assist with local extension and rotation of the column] (from transverse process to spinal process or vice versa) (when acting bilaterally: extension because on back of spine (when acting unilaterally: pulls spinous process toward transverse process - if R contracts - causes L rotation (causes contralateral rotation) - Which intermediate/intrinsic muscles cause left rotation? Right Transversospinal? o Also left erector spinae (ipsilateral = same side)

Lateral Abdominal Wall

Transversus abdominis Internal oblique External oblique Iliacus [Can call internal/external abdominals Orientation of fibers matter]

Components of the Thoracic Cavity

Two lateral compartments, the pulmonary cavities that contain the lungs and pleurae (lining membranes) A central compartment, the mediastinum - Contains all other thoracic structures- heart, thoracic part of the trachea, esophagus, etc... Pleura: - Visceral Pleurae - Parietal Pleurae -- Costal Pleura -- Mediastinal Pleura -- Diaphragmatic Pleura -- Cervical Pleura [Covers the lungs Lines the cavaties and adheres to the wall 4 divisions Pleura cavity filled with fluid ]

extra blahhh

Typical considered 3-9 1-2, 10-12 considered atypical - 10-12 Only articulate with one vertebral body; corresponds with its own number o 11-12 also floating, no anterior articulation - 1 only articulates with T1 (not with C7 also) o Body of T1, trans proc of T1, flat - 1 and 2 are flat ribs = have no costal groove inferiorly o Have lateral elevations = serratus anterior muscle origin o Attachments for anterior and middle scalenes - accessory muscles in respiration (deep breath moves them) - 2nd rib articulates with T1 and T2; only because it is flat 10-12: false and atypical 1-2: true and atypical

Mandible

U-shaped bone Alveolar processes that house the mandibular teeth Consists of a horizontal part, the body and a vertical part, the ramus Mental Foramen [Mental Nerves and vessels (lower jaw; only synovial joint - temporalmandibular joint Horizontal part is part of U; body of mandible Vertical part = ramus of mandible Inf alveolar N = supply lower jaw; comes out in mental foramen ]

Sacral Region

Unites vertebral column with the pelvic girdle to which it is strongly bound Primary function is tor support body weight and transmit upper extremity forces to the lower extremities 5 fused sacral vertebrae in humans [SI joints as per previous lectures...may want to review...hint] [- Coccyx articulates with sacrum]

Abdominal Wall - Superficial Fascia

Upper part - Single layer - Characteristic of fatty subcutaneous tissue Lower part - Camper's fascia (superficial layer) - Scarpa's fascia (deep layer) [Camper's = yellow (superficial and fatty - Continuous below with superficial fascia of the thigh Scarpa's = white layer below yellow (membranous) - Membranous layer with some elastic fibers - Medially attached to linea alba and symphysis pubis Function = protection to abdominal cavity; thermoregulation]

Transplyoric Plane

Upper transverse plane Midway between suprasternal notch and pubic symphasis Passes through L1 vertebral body and tips of 9th costal cartilages

Xiphoid Process

Variable in shape: may be pointed, bifid, or deflected to one side Cartilaginous at first but ossifies in adulthood Articulates with the body of the sternum Costal notches- 1 pair of facets for 7th costal cartilages [Important landmark b/c it is the midline marker for the superior limit of the liver, central tendon of the diaphragm, and the inferior border of the heart]

Osteology - Pedicle

Ventral part of vertebral arch Superior and inferior concavities form intervertebral foramen when adjacent vertebrae articulate [Function is primarily protection Vertebral notches are indentations in the pedicle] (connects vertebral body to rest of arch; vertebral notches ; pedicles create openings for nerves -> intervertebral foramen ; throughout entire column ; C1 comes out from above; C2 between C1 and C2; L4 between L4 and L5; C8 between C7 and T1?)

Cerebrospinal Fluid System

Ventricular system - Lateral ventricles - Third ventricle - Cerebral aqueduct - Fourth ventricle - Central canal [CSF produced and stored in ventricles but circulated throughout?] Clear colorless liquid continuosly circulating through sub-arachnoid space Stored and circulates through four ventricles within the brain - lateral (2) -- located in both cerebral hemispheres [Formed on floors of ventricles - choroid plexus ] third - located between hemispheres of the thalamus fourth - located between brain stem and cerebellum [Connects to intraventricular foramen? - connects lateral to third Fourth between cerebellum and pons Cerebral aqueduct connects third and fourth Fourth has 3 openings - 2 lateral (lateral apertures) and 1 medial (median aperture?) Butterfly central canal Median aperture drains into central canal 2 lateral draining into a 3rd which drains into 4th ] Formed in choroid plexus of each ventricle Flows from ventricles into subarachnoid space Drains into venous circulation via arachnoid villi Functions - mechanical protection - shock absorption - chemical protection - maintenance of action potentials - circulation - medium for exchange of nutrients and waste products [Formed and stored in the ventricles and flow through ventricles into subacrachnoid? space; byproduct of blood Maintain AP throughout CNS; maintains potential difference as an insulator ]

Vertebral Curves

Vertebral column exhibits four curves (two types) in humans - Kyphotic curves - Lordotic curves Curves provide additional stability [- Neck moves more than thoracic cage - Lower back moves more than lower region]

The Lungs

Vital organs of respiration Main function is oxygenate blood by bringing inspired air into close relation with the venous blood in the pulmonary capillaries Light, soft and spongy Have elastic properties [Note R lung has 3 lobes the left only 2 Left slightly smaller because heart Autonomic nervous system: respiratory control]

Osteology - Sacrum

Wedge shaped Formed by fusion of five sacral vertebrae Concave ventrally and convex dorsally Concavity serves to increase the pelvic cavity [Strength and stability of the pelvis Inferior ½ is NWB and why it is tapered...Wolff's law]

Sphenoid Bone

Wedged between the frontal, temporal and parietal bones Irregular unpaired bone that consists of a body and three pairs of processes- greater wings, lesser wings and pterygoid processes [Ridge = lesser wings; greater winds look like wings Pituitary gland is on sweedish chair (no clue what he called this - stellatursica??)]

Costal Angle

Where rib turns anterolaterally

Anterior Border

Where the costal and mediastinal surfaces meet anteriorly and overlap the heart The cardiac notch indents this border of the left lung

The Lumbar Spine - Myology

[ Lumbar: can include erector spinae, transverospinal, latissimus dorsi, serratus posterior and inferior (actions all related to ribs/respiration), posterior wall of vertebral/abdominal cavity: quadratus lumborum (12th rib and transverse processes of lumbar to iliac crest; bilaterally: extension; unilaterally: hiking hips; N: ventral rami which form intercostal nerves also ventral rami of lumbar) and psoas major (fibers from transverse processes of lumbar spine and fibers from lateral aspect of body of lumbar spine and combines with iliacus which attaches to lesser trochanter of femur - important hip flexor; flexion of trunk when acting bilaterally; feet on floor and bend over?; causes flexion because anterior of spine; can also cause sidebending of lumbar spine); also psoas minor (doesn't cross hip joint but to superior ramus of hip bone; weak trunk flexor at best) ]

more on these

[All muscles of inspiration (involved in expiration but just these muscles going back to resting position) - Action: can just say respiratory muscle - Also active during speech Intercostal nerves and vessels in costal groove (inner inferior border of every ribs) between internal and innermost intercostals ]

Spondylolisthesis

[Fracture of the articular facet...usually due to a congenital defect or fracture in the pars Note the anterior displacement of L5 on the sacrum]

The Head & Facial Muscles

[Muscles of facial expressions and muscles of mastication (chewing food) are different Facial muscles are superficial - need to express on skin/move skin All facial expressions muscles = facial nerve = C7]

Interspinal

connect consecutive spinous processes for extension Best developed in cervical and lumbar regions Aid in extension

Brain Stem !

connects brain to spinal cord consists of - Midbrain - Pons - Medulla oblongata - Reticular Formation located below cerebral cortex and anterior to cerebellum Brainstem Functions: - Housing for cranial nerves (III - XII) - Highway for ascending and descending pathways - Maintaining sleep/wake cycle and vegetative functions [AUTONOMIC FUNCTIONS Brainstem strokes can be more dangerous than stroke in brain]

White Matter

consists of bundles of myelinated ("white") axons of motor and sensory neurons - forms the sensory and motor tracts of spinal cord

Epithalamus

contains pineal gland contains melatonin, thought to regulate sleepiness sets body's biological clock [Can wake up without alarm]

Facial Skeleton

forms the anterior part of the skull contains orbits, nasal cavities consists of 14 irregular bones Nasal bones (2) Lacrimal bones (2) Zygomatic bones (2) Maxillae (2) Palatine bones (2) Inferior nasal conchae (2) Mandible (1) Vomer (1) [Nasal bones = bridge of nose; lacrimal bone= medial wall of orbit (lacrimal gland on top - produces tears); maxillae = upper jaw, part of medial wall of orbit; mandible = lower jaw; roof of mouth - hard part that is anterior = maxilla; more posterior = palatine bones - openings on bone for nerves for taste etc; vomer = inferior bone in nasal septum ; inferior nasal conchae - lateral in nose - (superior and medial nasal conchae are part of ethmoid bone) - helps reach internal temp before entering lungs 3 bones of medial wall of orbit: Lacrimal (medially), ethmoid (p), maxillae (I), frontal (anteriorly) Nasal: Superior = ethmoid; inferior part of nasal septum = vomer; lateral = conchae Only movable joint - synovial is for mandible; all are synarthrotic ]

Organization of the Human Nervous System

input (afferent) -> processing -> output (efferent) Human Nervous System - Central Nervous System -- Somatic Nervous System -- Autonomic Nervous System -- Neuroendocrine System - is autonomic - Peripheral Nervous System -- Somatic Nervous System -- Autonomic Nervous System [Autonomic sensory = visceral sensory ex: level of oxygen; autonomic motor response = inc heart rate] Central Nervous System - Receives information from the internal and external environment - Interprets and integrates information - Initiates and controls execution of body's systems Peripheral Nervous System - Relays information to/from CNS Central Nervous System - Brain - Spinal cord - Preganglionic nerves (ANS) Peripheral Nervous System - Cranial nerves - Spinal nerves (dorsal roots) - Postganglionic nerves (ANS) [Ganglion is like spinal cord - before it is CNS and after it is PNS] (SEE PICS in powerpt) [AFFERENT Sensory cell body in PNS Dotted line = spinal cord] [EFFERENT Cell bodies in CNS Autonomic can be cell body synapsing with another cell body]

Costal Groove

protects intercostal nerve and vessels [This info was for typical ribs]

Pons (Middle)

rounded bulge on underside of brain stem separating mid brain from medulla oblongata - conveys impulses from one side of cerebellum to the other and between medulla and midbrain - origin for cranial nerves V-VIII - helps control breathing