Contents
Section 1 LOWER LIMB 1 Introduction tO the Lower Limb 3 Attachments and relations 37 Navicular bone 38 Parts of the lower limb 4 Attachments 38 Related terms 4 Cuneiform bones 39 Common features 39 2 Bones of the Lower Limb 5 Medial cuneiform 39 The hip bone 5 Attachments 39 Side determination 5 Intermediate cuneiform 39 Ilium 5 Attachments 39 Attachments on ilium 7 Lateral cuneiform 39 Pubis g Attachments 40 Attachments and relations 13 Cuboid 40 Acetabulum 15 Side determination 40 Ossification 15 Attachments 40 Femur 16 Metatarsus 40 Side determination 16 Identification 41 Anatomical position 16 Important attachments 41 Attachments on the femur 19 Phalanges 41 Clinical anatomy 22 Attachments 41 Patella 22 Sesamoid Bones 42 Side determination 22 <» •- ± 4 TI_- •_ AC Attachments 23 3 Front of Thigh 45 Clinical anatomy 23 Surface landmarks 45 Tibia 23 Procedure for embalming 46 Side determination 23 Dissection 46 Attachments on the tibia 26 Deep fascia 49 Fibula 29 Femoral triangle 50 Side determination 30 Femoral sheath 52 Attachments and relations 30 Clinical anatomy 53 Clinical anatomy 33 Femoral artery 54 Bones of the foot 33 Clinical anatomy 56 Talus 34 Femoral vein 56 Side determination 34 Femoral nerve 56 Attachments on the talus 36 Clinical anatomy 57 Calcaneus 36 Muscles of front of thigh 57 Side determination 36 Test for quadriceps femoris 59
Adductor canal 60 Retinacula 98 Dissection 60 Muscles of the anterior compartment 99 Clinical anatomy 61 Dissection 99 Test for the dorsiflexors 99 4 Medial Side Of Thigh 63 Anterior tibial artery 100 _ „ Deep peroneal nerve 102 Dissection 63 ~ .. 7/no t m. J J r* Dissection 103 Muscles of the adductor compartment 64 n ,. ,. , ? ~. Obturator nerve 66 ^lmlcafanatom/ 105 Clinical anatomy 66 ^^ side Q{ fe w5 Obturator artery 67 Dissection i05 _ ~. , – *n Peroneal retinacula 105 5 Gluteal Region 69 Peroneal muscles 106 Introduction 69 Superficial peroneal nerve 106 Surface landmarks 69 Dissection 107 Dissection 70 Medial side of leg 108 Muscles of the gluteal region 71 Dissection JOS Test for gluteus maximus and gluteus medius 71 9 Back of Leg 709 Dissection 72 Structures under cover of Introduction 109 gluteus maximus 72 Dissection 109 Clinical anatomy 75 Flexor retinaculum 111 Nerves of the gluteal region 76 Dissection 111 Arteries of the gluteal region 77 Superficial muscles J12 Deep muscles 114 6 Popliteal Fossa 81 Dissection 114 Posterior tibial artery 116 Introduction 81 Peroneal artery 117 Surface landmarks 81 Tibial nerve 118 Dissection 81 Boundaries and contents 82 ,n .. ____ . c^^* i ir» Popliteal artery 83 lOSoleOfFOOt 119 Clinical anatomy 84 Introduction 119 Tibial nerve 85 Dissection 119 Common peroneal nerve 86 Plantar aponeurosis 120 Clinical anatomy 86 Muscles of first layer 121 Anastomosis around the knee joint 87 Muscles and tendons of the second layer 122 7 Back Of Thigh 89 Dissection 122 Muscles of the third layer 122 Introduction 89 Dissection 122 Muscles of the back of the thigh 89 Muscles of the fourth layer 122 Dissection 89 Plantar vessels and nerves 123 Test for hamstrings 90 Dissection 124 Sciatic nerve 90 Plantar arch 128 Clinical anatomy 93 ft c,™* i „(o,ni ™H M^Hi«i «iHoc „« u Venous and Lymphatic Drainage, 8 Front, Lateral and Medial Sides of Segmental and Sympathetic Leg and Dorsum of Foot 95 innervation, Embryology and surface landmarks 95 Comparison of Lower and Front of leg and dorsum of foot 96 UDD@r Limb 729 Dissection 96 Deep fascia 97 Venous drainage 129 Dissection 98 Clinical anatomy 132
Lymphatic drainage 132 Segmental Innervation 133 Myotomes 135 Clinical anatomy 135 Sympathetic innervation 136 Embryology of lower limb 136 Comparison of lower and upper limb 137 12 Joints of Lower Limb 139 The hip joint 139 Dissection 139 Clinical anatomy 142 The knee joint 143 Dissection 146 Movements 148 Clinical anatomy 149 The ankle joint 150 Dissection 150 Clinical anatomy 152 Tibiofibular joints 152 Clinical anatomy 153 Joints of the foot 153 Subtalar joint 154 Inversion and eversion 155 Pronation and supination 156 Smaller joints of forefoot 156 13 Arches of Foot 159 Classification of arches Factors responsible for maintenance of arches 160 Contents xm Functions of the arches 161 Clinical anatomy 162 14 Surface Anatomy and Radiological Anatomy 163 Surface landmarks 163 Surface marking 165 Arteries 165 Veins 166 Nerves 167 Miscellaneous structures 167 Radiological anatomy 168 The hip 168 The knee 168 The foot 169 Appendix 1 171 Nerves of the lower limb 171 Femoral nerve 171 Obturator nerve 171 Superior gluteal nerve 172 Sciatic nerve 172 Tibial nerve 173 Common peroneal nerve 174 Deep peroneal nerve 174 Superficial peroneal nerve 175 The plantar nerves 175 Clininoanatomical Problems 775 Multiple Choice Questions 776
__________ Section 2 _______ ABDOMEN AND PELVIS 15 Introduction and Osteology 181 Intervertebral joints 191 Clinical anatomy 192 Introduction to the abdomen 181 osteology 181 16 Anterior Abdominal Wall 193 Lumbar vertebrae 182 Attachments and some relations 182 Surface landmarks 193 Clinical anatomy 184 The umbilicus 193 The sacrum 184 Clinical importance 195 Attachments on the sacrum 186 Dissection 196 Relations of the sacrum 186 External oblique muscle 198 Sex differences 187 Internal oblique muscle 199 The coccyx 187 Transversus abdominis The bony pelvis 188 muscle 200 Sex differences in the pelvis 189 Rectus abdominis muscle 200 Anatomical position of the pelvis 191 Action of the main muscles 201
xiv Human Anatomy Inguinal ligament 201 Conjoint tendon 202 Cremasteric reflex 202 Rectus sheath 205 Dissection 205 Clinical anatomy 206 Fascia transversalis 207 Inguinal canal 208 Constituents of the spermatic cord 208 Mechanism of inguinal canal 209 Clinical anatomy 210 17 Male External Genital Organs 213 Organs included 213 Penis 213 Scrotum 215 Clinical anatomy 216 Testis 216 Epididymis 218 Development of testis 218 Descent of testis 219 Development of ducts 219 External genitalia 220 18 Abdominal Cavity and Peritoneum 227 Nine regions of the abdomen 221 Peritoneum 222 Peritoneal folds 223 Greater omentum 225 Lesser omentum 226 The mesentery 227 Mesoappendix 227 Transverse mesocolon 228 Sigmoid mesocolon 228 Dissection 228 Reflection of peritoneum on the liver 228 The peritoneal cavity-greater sac 229 Epiploic foramen 231 Clinical anatomy 232 Lesser sac 232 Clinical anatomy 233 Subphrenic spaces 233 Peritoneal fossae (recesses) 235 Development 236 Clinical anatomy 236 19 Abdominal Part of Oesophagus and Stomach 237 Abdominal part of oesophagus 237 Clinical anatomy 237 Histology 237 The stomach 238 Dissection 238 Surface marking 238 External features 238 Histology of stomach 242 Development 243 Clinical anatomy 243 20 The Intestines 245 The small intestine 245 The duodenum 246 Dissection 246 Surface marking 246 Histology 250 Clinical anatomy 251 Jejunum and ileum 251 Histology 252 Meckel’s diverticulum 252 Large intestine 252 Dissection 253 Surface marking 254 Caecum 255 Clinical anatomy 256 Ileocaecal valve 256 Vermiform appendix 256 Histology 258 Histology of colon 259 Development 259 Clinical anatomy 260 21 Large Blood Vessels of the Gut 261 The coeliac trunk 261 Surface marking 261 Branches 263 Superior mesenteric artery 264 Branches 265 Superior mesenteric vein 266 Inferior mesenteric artery 266 Inferior mesenteric vein 267 The marginal artery 267 The portal vein 268 Surface marking 268 Course 269 Portosystemic communications 270 Development 271 Clinical anatomy 271 22 Extrahepatic Biliary Apparatus 273 Introduction 273 Gallbladder 274 Bile duct 275 Histology 277
Development 277 Clinical anatomy 277 23 Spleen, Pancreas and Liver 279 Introduction to spleen 279 Dissection 279 Surface marking 279 External features 280 Histology 283 Development 283 Clinical anatomy 283 The pancreas 283 Dissection 284 Surface marking 284 Histology 287 Development 287 Clinical anatomy 288 The liver 288 Surface marking 288 External features 288 Hepatic segments 291 Histology 292 Development 292 Clinical anatomy 292 24 Kidney and Ureter 295 The kidneys 295 Dissection 295 Surface marking 296 Histology 300 Clinical anatomy 301 The ureters 301 Course 301 Histology 304 Development of kidney and ureter 304 Clinical anatomy 304 25 The Suprarenal Gland and Chromaffin System 305 Suprarenal glands 305 Right suprarenal gland 306 Left suprarenal gland 306 Histology 307 Development 307 Clinical anatomy 307 Chromaffin system 308 26 The Diaphragm 309 Dissection 310 Openings in the diaphragm 310 Actions 311 Development 312 Clinical anatomy 312 Contents xv 27 Posterior Abdominal Wall 313 Introduction 313 Dissection 313 The abdominal aorta 313 Surface marking 313 Inferior vena cava 316 Clinical anatomy 316 Lymph nodes 317 Cisterna chyli 317 Muscles 317 Clinical anatomy 319 Thoracolumbar fascia 319 Lumbar plexus 319 Abdominal part of the autonomic nervous system 320 Coeliac ganglia and plexus 321 Superior hypogastric plexus 322 Inferior hypogastric plexus 322 Clinical anatomy 323 28 The Perineum 325 Divisions of the perineum 325 The anal region 326 Ischiorectal fossa 326 Contents of ischiorectal fossa 328 Clinical anatomy 329 The urogenital region 329 Dissection 329 The perineal membrance 330 Female external genital organs 332 Superficial perineal space 334 Deep perineal space 335 Pudendal nerve 335 Clinical anatomy 337 Internal pudendal artery 338 Histology of body of penis 339 Clinical anatomy 339 29 Preliminary Consideration of the Boundaries and Contents of the Pelvis 341 Lesser pelvis 341 Structures crossing the pelvic Inlet/Brim of the pelvis 343 30 The Urinary Bladder and the Urethra 345 Urinary bladder 345 External features 345 Relations 346 Ligaments of the bladder 347 Clinical anatomy 348
xvi Human Anatomy The male urethra 348 The female urethra 350 Micturition 351 Histology of urinary bladder 351 Development 351 Clinical anatomy 351 31 Female Reproductive Organs 353 Introduction 353 The ovaries 353 Histology 355 Clinical anatomy 356 Uterine tubes 356 Histology 357 Clinical anatomy 357 The uterus 358 Supports of the uterus 361 Histology 363 Clinical anatomy 363 The vagina 364 Histology 365 Development of female reprodutive system 366 Clinical anatomy 367 32 Male Reprodutive Organs 369 The ductus deferens 369 Histology 370 Clinical anatomy 371 Seminal vesicles 371 The prostate 371 Lobes of the prostate 372 Histology 374 Development 374 Clinical anatomy 374 Vertebral system of veins 374 33 The Rectum and Anal Canal 377 The rectum 377 Relations 378 Clinical anatomy 380 The anal canal 381 Interior of the anal canal 381 Musculature of the anal canal 382 Histology 383 Development 384 Clinical anatomy 384 Index 417 34 Walls of the Pelvis 387 Contents 387 Dissection 387 Internal iliac artery 387 Lymph nodes of the pelvis 389 Nerves of the pelvis 389 Dissection 389 Pelvic fascia and muscles 391 Dissection 392 The levator ani 393 Clinical anatomy 394 Joints of the pelvis 394 Dissection 394 Clinical anatomy 397 Mechanism of the pelvis 397 35 Surface Marking of Abdomen and Pelvis 399 Viscera 399 Vessels 401 Miscellaneous 401 36 Imaging Procedures used in the Study of Abdominal and Pelvic Organs 403 Abdominal and Pelvic organs 403 Plain skiagram of abdomen 403 Barium meal examination 404 Barium enema 405 Pyelography 405 Ultrasonography of biliary apparatus, other abdominal and pelvis organs 407 Appendix 2 409 Nerves of the abdomen 409 Lower intercostal 409 Upper lumbar nerves 409 Clinical anatomy 410 Pudendal nerve 411 Abdominal part of sympathetic trunk 411 Collateral plexus 411 Gastrointestinal tract 412 Genitourinary tract 413 Clinicoanatomical Problems 4 73 Multiple Choice Questions 414
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