Download Concise Guide to HUMAN ANATOMY 2

CONCISE GUIDE
TO
HUMAN ANATAMY
EDITER
Liu Zhiyu
SHANDONG UNIVERSITY
FORWORD
This book is for the students, faculty and staff in studying and
teaching of the Medical English Course to produce a study aid for human
anatomy. The succinct text, some summaries of the organs, and the
tabeles in the book are the results of long teaching experience. The
contents of the book are closely connected the Text-Book of Human
Anatomy in China. The chapters and sections are, as well as, the came in
order as the Text-Book of Human Anatomy in Chinese. The book was
written according to the Key Contents of Anatomical Outline of the
country and the primary source for your education, but rather to serve as
an aid in the integration of lecture, text review and examination, and for
futher quick reference.
EDITOR
Liu Zhi-yu（刘执玉）
1996.6.26
CONTENTS
Introduction……………………………………………………………………………………1
PART Ⅰ THE LOCOMOTOR SYSTEM
Chapter 1 Osteology...……………………………………………………………………………3
Section 1 Introduction ……………………………………………………………………...3
Section 2 The Bones of the Trunk ………………………………………………………..4
Section 3 The Skull ………………………………………………………………………...6
Ⅰ. General View………………………………………………………………………6
Ⅱ. The Granial Cavity………………………………………………………………...7
Ⅲ. The External Aspect of the Base of the Skull..……………………………………8
Ⅳ. The Anterior Aspect of the Skull…………………………………………………..9
Ⅴ. The Skull at the Birth……………………………………………………………...9
Section 4 The Bones of The Limbs………………………………………………………..10
Ⅰ. The Bones of the Upper Limb……………………………………………………10
Ⅱ. The Bones of the Lower Limb ...…...……………………………………………12
Chapter 2 Arthrology ......………………………………………………………………………14
Section 1 Introduction……………………………………………………………………..14
Section 2 The Articulations of Axis Skeleton……………………………………………..15
Section 3 The Articulations of the Cranial Bones…………………………………………16
Section 4 The Articulations of the Appendicular Bones…………………………………..17
Ⅰ. The Joints of The Upper Limb…………………………………………………...17
Ⅱ.The Articulations of the Lower Limb…………………………………………….18
Chapter 3 Myology……………………………………………………………………………..21
Section 1 Introduction……………………………………………………………………..21
Section 2 The Muscles of the Trunk………………………………………………………22
Ⅰ. The Muscles of the Back…………………………………………………………22
Ⅱ. The Muscles of the Neck…………………………………………………………23
Ⅲ. The Muscles of the Thorax……………………………………………………….23
Ⅳ. The Diaphragm…………………………………………………………………...24
Ⅴ. The Muscles of the Abdomen.…...………………………………………………24
Section 3 The Muscles of the Head………………………………………………………..25
Section 4 The Muscles of the Upper Limb………………………………………………..26
Section 5 The Muscles of the Lower Limb………………………………………………..29
PART Ⅱ THE SPLANCHNOLOGY
Chapter 1 Introduction………………………………………………………………………….33
Chapter 2 The Digestive System………………………………………………………………..35
Section 1 The Oral Cavity…………………………………………………………………35
Section 2 The Pharynx…………………………………………………………………….36
Section 3 The Esophagus………………………………………………………………….37
Section 4 The Stomach…………………………………………………………………….37
Section 5 The Small Intestine……………………………………………………………..38
Section 6 The Large Intestine……………………………………………………………...39
Section 7 The Liver………………………………………………………………………..40
Section 8 The Gallbladder and The Biliary Duct………………………………………….41
Section 9 The Pancreas……………………………………………………………………42
Chapter 3 The Respiratory System……………………………………………………………..43
Section 1 The Nose………………………………………………………………………..43
Section 2 The Pharyns and Larynx………………………………………………………..44
Section 3 The Trachea and Bronchi……………………………………………………….44
Section 4 The Lungs……………………………………………………………………….45
Section 5 The Pleura………………………………………………………………………45
Chapter 4 The Urinary System………………………………………………………………….47
Section 1 The Kidneys…………………………………………………………………….47
Section 2 The Ureters……………………………………………………………………...48
Section 3 The Urinary Bladder……………………………………………………………48
Section 4 The Urethra……………………………………………………………………..49
Chapter 5 The Male Reproductive System……………………………………………………..50
Chapter 6 The Female Reproductive System…………………………………………………...53
Chapter 7 The Peritoneum……………………………………………………………………...57
PART Ⅲ ANGIOLOGY
Chapter 1 The Cardiovascular System………………………………………………………….60
Section 1 Introduction……………………………………………………………………..60
Ⅰ. The Composition…………………………………………………………………60
Ⅱ. The Cardiovascular Circuits……………………………………………………...60
Section 2 The Heart………………………………………………………………………..60
Ⅰ. The Position of the Heart………………………………………………………...60
Ⅱ. The External Morphology of the Heart…………………………………………..61
Ⅲ. The Internal Morphology of the Heart…………………………………………...61
Ⅳ. The Structure of the Heart………………………………………………………..63
Ⅴ. The Conducting System of the Heart…………………………………………….63
Ⅵ. The Vessels of the Heart………………………………………………………….64
Ⅶ. The Pericardium………………………………………………………………….65
Section 3 The Arteries……………………………………………………………………..66
Ⅰ. The Arteries of Pulmonary Circulation…………………………………………..66
Ⅱ. The Arteries of Systemic Circulation…………………………………………….66
Section 4 The Veins………………………………………………………………………..72
Ⅰ. The Veins of Pulmonary Circulation……………………………………………..72
Ⅱ. The Veins of Systemic Circulation……………………………………………….72
Chapter 2 The Lymphatic System………………………………………………………………78
Section 1 Introduction……………………………………………………………………..78
Ⅰ. The Composition…………………………………………………………………78
Ⅱ. The Character…………………………………………………………………….78
Section 2 The Lymphatic Ducts of the Body……………………………………………...79
Ⅰ. The Thoracic Duct………………………………………………………………..79
Ⅱ. The Right Lymphatic Duct……………………………………………………….80
Section 3 The Lymph Vessels an Nodes of the Body……………………………………...80
Ⅰ. The Lymph Vessels and Nodes of the Head and Neck…………………………80
Ⅱ. The Lymph Vessels and Nodes of the Upper Limb…………………………….81
Ⅲ. The Lymph Vessels and Nodes of the Thorax………………………………….81
Ⅳ. The Lymph Vessels and Nodes of the Abdomen……………………………….82
Ⅴ. The Lymph Vessels and Nodes of the Pelvis…………………………………...83
Ⅵ. The Lymph Vessels and Nodes of the Lower Limb……………………………83
Section 4 The Spleen………………………………………………………………………84
Ⅰ. The Position……………………………………………………………………...84
Ⅱ. The Shape………………………………………………………………………...84
Section 5 The Thymus……………………………………………………………………..84
PART Ⅳ THE SENSE ORGANS
Chapter 1 Introduction………………………………………………………………………….85
Chapter 2 The Visual Apparatus………………………………………………………………...86
Section 1 The Eyeball……………………………………………………………………..86
Ⅰ. The Wall of the Eyeball…………………………………………………………..86
Ⅱ. The Contents of the Eyeball……………………………………………………...87
Section 2 The Accessory Apparatus of the Eyeball……………………………………….88
Ⅰ. The Eyelids or Palpebrae………………………………………………………...88
Ⅱ. The Conjunctiva………………………………………………………………….88
Ⅲ. The Lacrimal Apparatus …………………………………………………………89
Ⅳ. The Extraocular Muscles…………………………………………………………89
Section 3 The Blood Vessels of the Eye…………………………………………………...90
Ⅰ. The Arteries of the Eye ………………………………………………………….90
Ⅱ. The Veins of the Eye……………………………………………………………..90
Chapter 3 The Auditory and Vestibular Apparatus……………………………………………...91
Section 1 The External Ear………………………………………………………………..91
Ⅰ. The Auricle……………………………………………………………………….91
Ⅱ. The External Acoustic Meatus…………………………………………………...91
Section 2 The Middle Ear…………………………………………………………………92
Ⅰ. The Tympanic Cavity…………………………………………………………….92
Ⅱ. The Auditory Tube……………………………………………………………….93
Ⅲ. The Mastoid Antrum and Mastoid Air cells……………………………………...93
Section 3 The Internal Ear…………………………………………………………………93
Ⅰ. The Osseous Labyrinth…………………………………………………………..94
Ⅱ. The Membranous Labyrinth……………………………………………………...95
Ⅲ. The Internal Acoustic Meatus……………………………………………………95
PART Ⅴ THE NERVOUS SYSTEM
Chapter 1 Introduction………………………………………………………………………….96
Chapter 2 The Perpheral Nervous System……………………………………………………...98
Section 1 The Spinal Nerves………………………………………………………………98
Ⅰ. The Cervical Plexus……………………………………………………………...99
Ⅱ. The Brachial Plexus…………………………………………………………….100
Ⅲ. The Ventral Rami of the Thoracic Nerves………………………………………102
Ⅳ. The Lumbar Plexus……………………………………………………………..102
Ⅴ. The Sacral Plexus……………………………………………………………….103
Section 2 The Cranial Nerves……………………………………………………………104
Ⅰ. The Olfactory Nerve……………………………………………………………106
Ⅱ. The Optic Nerve………………………………………………………………...106
Ⅲ. The Oculomotor Nerve…………………………………………………………106
Ⅳ. The Trochlear Nerve……………………………………………………………107
Ⅴ. The Trigeminal Nerve…………………………………………………………..107
Ⅵ. The Abducent Nerve……………………………………………………………109
Ⅶ. The Facial Nerve………………………………………………………………..109
Ⅷ. The Vestibulocochlear ( Auditory ) Nerve……………………………………...110
Ⅸ. The Glossopharyngeal Nerve…………………………………………………...111
Ⅹ. The Vagus Nerve………………………………………………………………..111
Ⅺ. The Accessory Nerve……………………………………………………………113
Ⅻ. The Hypoglossal Nerve…………………………………………………………114
Section 3 The Visceral Nervous System…………………………………………………114
Ⅰ. The Visceral Motor Nerves……………………………………………………..114
Ⅱ. The Visceral Sensory Nerves…………………………………………………...121
Chapter 3 The Central Nervous System……………………………………………………….122
Section 1 The Spinal Cord……………………………………………………………….122
Ⅰ. The External Features…………………………………………………………..122
Ⅱ. The Internal Structures………………………………………………………….123
Ⅲ. The Function……………………………………………………………………127
Section 2 The Brain………………………………………………………………………127
Ⅰ. The External Features of Brain Stem…………………………………………...127
Ⅱ. The Arrangement of the Cranial Nerve Nuclei in Brain Stem………………….130
Ⅲ. The Internal Structure of Medulla Oblongata…………………………………..132
Ⅳ. The Internal Structure of Pons………………………………………………….133
Ⅴ. The Internal Structure of Midbrain……………………………………………..135
Ⅵ. The Reticular Formation in Brain Stem………………………………………...137
Ⅶ. The Cerebellum…………………………………………………………………137
Ⅷ. The Diencephalon………………………………………………………………139
Ⅸ. The Telecephlon………………………………………………………………...142
Section 3 The Conduction Pathway of the Brain and Spinal Cord………………………148
Ⅰ. The Conscious Deep Sensory Pathway…………………………………………149
Ⅱ. The Unconscious Deep Sensory Pathway………………………………………150
Ⅲ. The Superficial Sensory Pathway of the Trunk and Limbs……………………..151
Ⅳ. The Superficial Sensory Pathway of the Head and Face……………………….151
Ⅴ. The Optic (Visual) Pathway………………………………………………….…152
Ⅵ. The Auditory Pathway…………………………………………………………..153
Ⅶ. The Pyranidal System…………………………………………………………..154
Ⅷ. The Extrapyramidal System…………………………………………………….155
Section 4 The Meninges, Blood Vessels of Brain and Spinal Cord, as well as Cerebrospinal
Circulation……………………………………………………………………..156
Ⅰ. The Meninges of the Brain and Spinal Cord……………………………………156
Ⅱ. The Blood Vessels of the Brain and Spinal Cord……………………………….159
Ⅲ. The Circulation of Cerebrospinal Fluid………………………………………...161
PART Ⅵ THE ENDOCRINE SYSTEM
Ⅰ. The Shape and Location of Thyroid Gland……………………………………..162
Ⅱ. The Shape and Location of Parathyroid Gland…………………………………162
Ⅲ. The Shape and Location of Suprarenal Gland………………………………….162
Ⅳ. The Shape and Location of Hypophysis………………………………………..163
Ⅴ. The Shape and Location of Pineal Body………………………………………..163
Liu Zhi-yu（刘执玉）
Introduction
Ⅰ. Definition of Anatomy
Anatomy is a important fasic medical course which deals with the morphology, structure
andfunction of human body. Though the primary concern of anatomy is the morphology and
structure of the body, and structure and function should always be considered together.
Ⅱ. Classification of Anatomy
1. Gross Anatomy: Systemic Anatomy, Surface Anatomy, and Regional Anatomy.
2. Comparative Anatomy: deals with structure and function related man and animals.
3. Development Anatomy: Study the development of the body from the fertilized age to the
maturity.
4. Microscopic and Electro-microscopic Anatomy: Some structure of the body is observed by
the microscopy and TEM.
Ⅲ. Anatomical Terms
1. Anatomical position
Body is standing erect .
Face and eyes are directed forward .
Hands are by both sides with palms directed forwards .
Feet are pointed forwards so that the hells and greater toes together .
2. The terms
Anterior-------- front or belly side
Posterior-------- back side
Superior-------- upper part
Inferior-------- lower part
Lateral-------- farther midline
Medial-------- nearer midline
External-------- outer side of body wall or body cavity
Internal-------- inner side of body wall
Superficial-------- nearer body surface
Deep-------- farther body surface
Proximal-------- nearer source or attachement of a structure
Distal-------- farther source
3. Axes and Planes
Sagittal axis: from the anterior to the posterior.
Sagittal plane: divides the body into left and right parts.
Median plane: a sagittal plane which passes through the body and divides it equal.
Coronal axis: from the left to the right, vertical to the sagittal axis.
Coronal plane: divides the body into anterior and posterior parts.
Vertical axis: from superior to inferior, vertical to the sagittal and coronal axis.
Transverse plane: divides body into the superior and inferior parts, at the right angle to
both the sagittal and coronal plane.
PARTⅠ THE LOCOMOTOR SYSTEM
The locomotor system includes the bones, articulations and skeleton muscles.
Chapter 1 Osteology
Section 1 Introduction
Bones in adult are 206 in number, which are divided into 3 parts: the bones of the skull, trunk
and extremities.
Ⅰ. The General Morphology and Classification of Bones
1. Long bones: a shaft and two ends; tuber-like; medullary cavity; mutrient foramen.
2. Short bones: for example, carpal and tarsal bones.
3. Flat bones: broad and flat, for example, ribs, sternum, scapulae, and many bones of the
skull .
4. Irregular bones: varied in shape, include many of the cranial bones, vertebrae, hip bones
and so on .
Ⅱ. The Structure of bones: Living bones consist of bony substance, periesteum and bony
marrow, and with abundant blood vessels and nerves.
1) Bony substance: compact bone and cancellous bone.
2) Bony periesteum: outer layer or fibrous membrane and inner layer or vascular membrane.
3) Bony marrow: red and yellow marrow in different age .
Ⅲ.Chemical Composition and Physical Properties
1. Chemical Composition
Inorganic
Organic
Calcium phosphate
Calcium carbonate
Cells, matrix
Collageous fibers
2. Physical properties
Inorganic
Children
Adult
Old man
1
2
4
Organic
:
:
:
1
1
1
soft & toughness
middle toughness
hard & gristle
Section 2 The Bones of the Trunk
The bones of the trunk include the vertebrae, sternum and the ribs.
Ⅰ. The Vertebrae
Ⅰ) The Composition of the Vertebral Column
Cervical vertebrae 7
Thoracic vertebrae 12
Composition
Lumbar vertebrae 5
Sacaral vertebra
1（5）
Coccygeal vertebra 1（4）
Ⅱ）General Features of A Vertebra
Body
Pedicles …………………………………………………...2
Laminae……………………………………………………2
Transverse processes ……………………………………...2
Sup. articular process……………………………………...2
Vertebra
Arch
Inf. articular process……………………………………….2
Spinous process……………………………………………1
Sup. vertebral notch……………………………………….2
Inf. vertebral notch………………………………………...2
Foramen
Ⅲ）Regional Differences
Vertebra
C
T
L
Body
…………….more ………..and………… more…………….. massive
Foramen
larger, triangular
smaller, rounder
larger, triagular
Spinous process
short, bifid
long slopiny
massive square
Transverse process
short, bifid
facet for rib
longer
Articular facet
horizontal
coronal
sagittal
Ⅳ）Specialized Vertebrae
1. The Atlas, First Cervical Vertebra
①No body and two lateral masses,
②Anterior and posterior arch
③A fovea for dens of axis,
④Sulcus for vertebral artery.
2. The Axis, The Second Cervical Vertebra
It has a dens, and its ant.articular surface for articulartion with the fovea dentis of atlas.
3. 6th C. vertebra: Coroid tubercle on the transverse processes.
4. 7th C. vertebra: the prominence, spinous process is long, nearly horizontal, and without
bifid.
Sup. and inf. costal focet on the body
5. Thoracic Ⅴ. Costal facet on the transverse process
Spinous process------long and sloping downwards.
Base------sacral promontory
Anterior surface------ ant .sacral foramen
6. Sacrum Ⅴ.
Posterior surface----median sacral crest, sacral hiatus, sacral cornae
Lateral----posterior sacral foramen
Sacral canal
Ⅱ. The Sternum
The sternum is a flat bone which lies in the midline of the anterior wall of the thorax.
Manubrium------iugular notch
Sternum
Body------facets for costal cartilages
Xiphoid process
The sternal angle: The junction of manubrium with the body, which is useful landmark
indicates the level of the articulation of the 2nd costal cartilarge with the sternum. According to
this landmark the order of the ribs and the intercostal space can be determined.
Ⅲ. The Ribs
True: 1st ------7th articulate to the sternum
1. Classification
False:8-12th, and 8-10th ribs form the arch of rib.
Floating: 11-12th ribs.
2. Composition and Features
Head
Neck
Body
Anterior end
Costal gloove
Articular focet on the head
Costal tubercle
Costal angle
3. First rib is short, sharply curved and flattened.
Superior and inferior surface
Inner and outer border
The rib
Scalene tubercle on the superior surface
Sulcus of subclavicular a .
Sulcus of subclavicular v .
Section 3 The skull
The skull consists of 23 bones, rests upon the superior end of the vertebral column. The
bones are closely fitted together by sutures or cartilages except the mandible and the hyoid. They
carry out the function of protection and support of the brain and the organs of sight, hearing and
balance. And the upper part of the digestive and respiratory system. It is devided into two parts,
the cranial and facial bones.
Ⅰ. General View
1. Division of skull 23 bones
Cranial portion 8 bones
Facial portion 15 bones
2. Bones
Cranial
Facial
Single
frontal
ethmoid vomer
sphenoid hyoid
occipital
mandible
Paired
perietal
temporal
maxilla
zygomatic
palatine
nasal
lacrimal
inf.nasal conchae
3. The mandible It is the only movable bone in the skull, which consists of a horse
shoe-shaped body and two flat rami.
The body
Alveolar arch on sup. border
Mental protuberance
Mental foramen
Mental spine
Base of mandible
The rami
Coranoid process
Condylar process
Mandibular notch
Mandibular foramen
Mandibular canal
Angle of mandible
4. The hyoid bone is located between the mandible and the larynx. It consists of a body and
two paired projections, the lesser and greater cornua.
Ⅱ. The Cranial Cavity The Floor of the cranial cavity has 3 fossa arranged like steps at the
different levels. They are the anterior, middle, and posterior cranial fossa.
1. The anterior cranial fossa
Composition
Orbital part of frontal bone
Lesser wing of sphenoid
Cribriform plate & crista galli of ethmoid
Structure
Cribriform plate
Crista galli
Cribriform foramen
2. The middle cranial fossa is formed by the body and great wing of the sphenoid; the
anterior surface of the petrous portion, and the squamous portion of the temporal bone.
The Structure of the Middle Cranial Fossa
The Middle
Optic foramen
Ant.clinoid process
Sella tubercle
Hypophyseal fossa
Dorsum sellae
Post.clinoid process
Trigeminal impression
The lateral
Sup.orbital fissure (Ⅲ ⅣⅤ1Ⅵ)
Carotid sulcus
Foramen lacerum
Foramen rotundam(Ⅴ2 )
Foramen ovlae (Ⅴ3 )
Foramen spinousum (mid.min.a)
Arcuate eminence
Roof of tympanic cavity
3. The posterior cranial fossa
Formed by the posterior surface of the petrous portion and occipital bone.
Foramen magnum
Hypoglossal canal (Ⅶ )
Internal occipital protuberance
Groove for transverse sinus
Jugular foramen (ⅨⅩⅪⅤ)
Internal auditory meatus(ⅦⅧ)
Ⅲ.The External Aspect of the Base of the Skull It is divided into two portions, the anterior
and posterior.
The Anterior Structures
Alveolar arch
Hard palate
Incision foramen
Greater palatine foramen
The Posterior Structures
Foramen magnum
Occipital condyles
Hypoglossal canal
Jugular foramen
Vomer
Posterior nasal aperture
Pterygoid plates
Lateral pterygoid plates
Medial pterygoid plates
Pterygoid fossa
Outer opening of carotid canal
Styloid process
Mastoid process
Stylomastoid foramen
Zygomatic arch
Mandibular fossa
Foramen lacerum
Spinous foramen
Oval foramen
External occipital protuberance
Ⅵ. The Anterior Aspect of the Skull
The main structures from superior to the inferior: Forehead, Two orbits, Bony nasal cavities,
Bony oris cabities.
The Bony Nasal Cavity
Anterior nasal aperture ( piriform aperture )
1. The apertures
Posterior nasal aperture ( communicates with nasopharynx )
2. The walls
Superior
Cribriform plate
( the roof )
Inferior
Medial
Hard palate
( the floor )
Nasal septum
Lateral
3 conchae and meatus
Special notes for the lateral wall
①The spheno-ethmoidal recess is situated between the superior concha and the body of the
sphenoid bone.
②The spheno-palatine foramen opens into the pterygopalatine fossa.
③The lower orifice of the naso-lacrimal canal opens into the inferior meatus.
3. The Communications of the Nasal Cavity
Piriform foramenFace
Posterior nasal aperture Nasopharynx
Sphenopalatine foramenPterygopalatine fossa
Cribriform foramenAnterior cranial fossa
Nasolacrimal cuctOrbital cavity
4. The Paranasal Sinuses
The sinuses
Frontal sinuses
Ethmoidal sinuses
Sphenoidal sinuses
Maxillary sinuses
Open into
middle nasal meatus
middle and sup. nasal meatus
sphenoethmoidal recess
middle nasal meatus
( poor drainage )
Ⅴ. The Skull at the Birth
1. The skull is large in proportion to the body 1/4 ( Adult 1/7 )
2. The facial portion is small to the cranial portion 1/8 ( Adult 1/4 )
3. The orbits are relatively large.
4. The nasal cavity is small in site.
5. Some bones are rudimentary.
6. The fontanels are unossified between the bones.
Section 4 The Bones of the Limbs
The appendicular skeleton include the bones of the upper and lower limbs.
Ⅰ. Bones of the Upper Limb includes shoulder girdle and bones of the freely movable upper
limb.
Ⅰ） The Should Cirdle It consist of the scapula and clavicle.
1. The clavicle It is S-shaped, and joins the trunk with the upper limb. The rounded medial
end, termed sternal end, termed sternal end, joint the manubrium by sternoclavicular joint. The
flattened lateral (or acromial) end articulates with the scapula.
2. The scapula which is a triangular flat bone situated on the thorax. It has three borders, the
meadial, lateral and superior borders; Three angles: the superior, inferior and lateral; and
two surfaces: the anterior or costal and the posterior or dorsal surfaces. There is a notch on
the superior border, termed scapular notch, lateral to this, a thick bent coracoid process projects
forward. The lateral angle of the scapula is a thickened one, which has a concave articular surface,
the glenoid cavity. There two tubercles above and below the cavity, termed the supraglenoid and
infraglenoid tubercles. The inferior angle is lower end of scapula, at the level of the seventh rib,
which is a landmark in the back for determination of the order of the ribs. The costal surface is
concave know as subscapular fossa. The spine of scapula is a triangular crest on the dorsal
surface. The supraspinus fossa and infraspinus fossa are above and below the spine. The acromin
is a triangular bony plate, which has an oval small focet for articulation with the clavicle.
Ⅱ）The Mobility Skeleton of the Upper Limb
1. The composition
The proximal
The middle
Humerus
Radius, ulna
2. The humerus:
head of humerus
anatomical neck
surgical neck
greater tubercle
lesser tubercle
intertubercular sulcus
crest of greater tubercle
crest of lesser tubercle
3. The radius:
head of radius
neck of radius
shaft of radius
ulnar notch
4. The ulna:
troclear notch
The distal
Carpal 8
Metacarpal 5
Phalanges 14
shalft of humerus
deltoid tuberosity
sulcus for radial n.
trochlea of humerus
olecranon fossa
lateral epicondyle
medial epicondyle
sulcus of ulnar n.
articular circumference
tuberosity of radius
interosseous border
styloid process ( radius )
tuberosity of ulna
coronoid process
shaft of ulna
olecranon
articularcircumfrence
radial notch
styloid process ( ulna )
5. The bones of the hand:
The carpal bones is divided into two groups:
The proximal group: scaphoid, lunate, triangular and pisiform bone.
The distal group: trapezium, trapczoid, capicate and hamate bone.
The metacarpal bones----base, head, shaft.
The phalanges----proximal, middle and distal phalanx, tuberosity of phalanges.
Ⅱ. Bones of the lower limb includes the pelvic girdle and the bones of the freely movable
lower limb:
Ⅰ）The Pelvic girdle is formed by two hip bones. The composition of the hip bone which is
fused by the ilium, ischium and pubis.
The ilium: liliac body, ala, crest, tuberosity
anterior superior iliac spine
anterior inferior iliac spine
posterior superior iliac spine
posterior inferior iliac spine
iliac fossa, arcuate line.
The ischium: ischial tuberosity, ischial spine, ischial body, greater sciatic notch, lesser cciatic
notch.
The pubis: pubic body, superior ramus of pubis, iliopubic eminence, pubic tubercle, pubic
crest, pectum of pubis, symphyseal surface, obturator foramen, pubic arch, subpubic angle ( in
man ), acetabular fossa, acetabular notch, lunate surface.
Ⅱ ） Mobility Skeleton of Lower Limb which is divided into three parts, the
proximal----femur; the middle----bibia, fibula; distal----tarsus( 7 ).
1. The femur:
head of femur
pectineal line
fovea for lig. of head
medial condyle
neck of femur
patellar surface
greater trochanter
lateral condyle
intertrochanteric crest
intercondylar fossa
intertrochanteric line
medial epicondyle
shaft of femur
lateral epicondyle
linea aspera
addactor tubercle
gluteal tuberosity
2. The tibia:
Superior articular surface
shaft of tibia
medial and lateral condyles
interosseous border
intercondylar eminence
popliteal line
articular surface for fibula
medial melleolua
tuberosity of tibia
fibular notch
3. The fibula: head of fibula, neck of fibula, shaft of fibula, tuberosity of fibula, interosseous
border, lateral melleolus, articular surface.
4. The patella
5. The tarsus: talus calcaneus navicular and cuboid bone, first second and third cuneforms
should be remembered.
6. The metatarsus 5, phalanges 14, the tuberosity of the fifth metatarsus is obvious land mark
which can be felt on the living body.
Chapter 2 Arthrology
Section 1 Introduction
The bones are connected together by articulations which are formed by means of fibrous,
cartilaginous or osseous tissues at different parts of their surface.
Ⅰ. The Classification of Articulation
Ⅰ）Inmovable Articulations ( synarthoses ) which include the fibrous joints( membrane ),
cartilaginous joints( synchodrosis ) and synosteosis, for example, the suture articulations in the
skull and ligament syndesmoses(e.g., the yellow lig. ).
Ⅱ）Movable Articulations ( diarthroses, synovial joint ) the bones are connected by the joint
capsule and ligament. The joint cavity presents freely movable.
Ⅲ）Semisynovial Joint: e.g. Pubic symphysis.
Ⅱ. The Structure of the Synovial Joint
Ⅰ）The Essential Structure
1. The articular surfaces. Generally there are two articular surfaces in a joint, the articular
head and fossa, which are covered by the cartilage.
2. The joint capsule. It enclosed the joint cavity, and consists of the fibrous layer and
synovial layer. The synovial layer lies insides of the fibrous capsule, which produces some
synovial fluid that lubricates the joint.
3. The joint cavity which is closed by synovial membrane and articular cartilage.
Ⅱ）The Accessory Structure
1. The ligament
2. The articular disc
3. The glenoid labrum with bursa
Ⅲ）The movement of joint:
1. Gliding or slipping movement
2. Flexion and extension ( Angular movement )
3. Adduction and abduction
4. Pronation and supination
5. Rotation
6. Circumduction
Section 2 The Articulations of Axis Skeleton
The 24 pieces of vertebrae, the sacrum and the coccyx are connected together to form the
vertebral column which supports the skull and bears the weight of the upper part of the body. And
the spinal cord, the spinal nerve roots, and meninges are located in the vertebal canal.
Ⅰ. The Joints Between the Vertebra The vertebrae are connected by joints, intervertebral
disc and ligaments.
Ⅰ）The Articulations Between the Vetebrae Bodies
Annulus fibrosus----fibrous loop
1. The Intervertebral Discs
Nucleus pulposas----pulpiform nucleas
2. The anterior longitudinal ligament
3. The posterior longitudinal ligament
Ⅱ）The Articulations of the Vertebral Arches
1. The joints of articular processes
2. Yellow ligament ( ligamenta flava)
3. Interspinous ligaments and intertransverse ligaments
4. Supraspinous ligaments
Ⅲ）The Lumbosacral Joints
Ⅳ）The Atlantooccipital Joints
Ⅱ. The Vertebral Column and Its Movements
Ⅰ）The View From the Lateral Aspect
The physiological curves:
1. The thoracic and pelvic carves ( concave ventrally ) as primary carves.
2. The cervical and lumbar curves ( convex forward ), as the secondary curves.
Ⅱ）The movements:
1. Flexion and extension
2. Lateral flexion
3. Rotation
4. Circumduction
Ⅲ. The Thorax
Ⅰ）The shape which is conical in shape, being narrow above and broad below, falttened from
before backward. It has the upper opening or thoracic inlet and the lower opening or thoracic
outlet. And the inlet is small and the outlet is wide and irregular.
12 thoracic vertebrae
Ⅱ）The Composition 12 pairs of ribs with costal cartilages
1 sternum
Ⅲ）The Upper Opening ( Thoracic inlet ) is formed by the upper margin of the first vertebra,
manubrium and first pair of ribs.
Ⅳ）The Lower Opening ( Thoracic outlet ) is bounded by the 12th vertebra, 12th and 11th ribs,
costal arch and xiphoid process.
Section 3 The Articulations of the Cranial Bones
Most of the cranial bones are connected by the sutures and synchondrosis (synostosis ) except
hyoid and mandible.
Ⅰ . The Temporomandibular Joint It is formed by the head of the mandible with
mandibular fossa and the articular tubercle of the temporal bone.
The articular capsule is attached to the margins of the circumference at the fossa and the
neck of the mandible.
The articular cabety is divided into two parts by the disk. Also there is the strong lateral
ligament to reinforce the joint.
Ⅱ. The Movements of the Temporomandibular Joint.
1. Opening and closing of the mouth
2. Protuusion
2. Retraction
4. Lateral movement of the jaws
Usually above movements are conbined in mastication.
Section 4 The Articulation of the Appendicular Bones
The articulations include all joints of the upper and lower limbs.
Ⅰ. The Joints of the Upper Limb
Ⅰ）The Articulation of the Girdle of the Upper Limb
1. The Sternoclavicular Joint It is formed by the medial end of the clavicle, the clavicular
notch of sternum, and the first costal cartilage.
The characteristics of the joint: Its capsule is strong, thick and strengthened by ligaments.
The movements of the joint are following: superiorly, inferiorly, anteriorly, posteriorly, in a
circumductory path and also rottory.
2. The acromioclavicular joint It is formed by the lateral end of the clavicle and the medial
border of the acromion. The movement is gliding.
3. The coracoclavicular ligament.
4. The coracoacromial ligament.
Ⅱ）The Articulations of the Free Upper Limb
1. The shoulder joint: which is a typical ball and socket joint between the glenoid cavity of
the scapula and the head of the humerus. The shallow glenoid cavity is deeped by the glenoid lip.
The joint capsule is a loose cac, thin, especially, lower portion, attached to the margin of the
glenoid cavity, also it si attached to the anantomical neck of the humerus.
The long head of the biceps brachii arises from the supraglenoid tubercle, passes through the
joint cavity. The capsule is strengthened superiorly by the coracohumeral ligament which passes
from the base of the coracoid process to the greater tubercle of the humerus.
The long head of the biceps brachii arises from the supraglenoid tubercle, passes through the
joint cavity. The capsule si strengthened superiorly by the coracohumeral ligament which passes
from the base of the coracoid process to the greater tubercle of the humerus.
The movements of the shoulder joint: which is the most movable joint in the body: flexion
and extension; abduction and adduction; rotation ( medial and lateral ); circumduction.
2. The elbow joint It is a compound joint in one synovial cavity, made up of three
articulations as follows: the humero-ulnar joint; the humeral radial joint; the proximal
radioulnar joint.
The joint capsule is much thin and loose. There are some ligaments, the radial collateral
ligament, the ulnar collateral ligament and the annular ligament which strengthen the capsule.
The movement of the elbow joint: flexion and extension, pronation and supination.
3. The articulations between radius and ulna:
① the proximal radioulnar joint
② the interosseous membrane
③ the distal radioulnar joint
The movements: pronation and supination.
4. The Radiocarpal Joint
It is formed by two joint surfaces which are the distal surface of the radial end together with
the disc below ulna, and the proximal surfaces of 3 carpal bones, the scaphoid, lunate and
triquetral.
Ⅱ. The Articulaions of the Lower Limb
It includes those of the pelvic girdle, and the free lower limb.
Ⅰ）The Articulations of the Girdle of the Lower Limb
1. The composition of the pelvis It is formed by the sacrum, coccyx and two hip bones, and
divided into the greater and lesser pelvis by the terminal line.
The terminal line----formed by the promontory of the sacrum, anterior border of the sacral
ala, arcuate line, pectin pubis, public crest and the upper border of the symphysis pubis.
The pelvic inlet is indicated by the terminal line. The pelvic outlet is bounded by the apex of
the coccyx, ischial tuberosity, sacrotuberous ligament, pubic arch, lowerborder of the symphysis
pubis.
2. The sacro-iliac joint is formed by the articular surfaces of the sacrum and ilium, and
strengthened by the ligaments, especially, interosseous sacroiliac ligament.
3. The symphysis pubis There is a interpubic disc in this articulation which is strengthened
by the superior pubic ligament and arcuate pubic ligament.
4. Some important ligament of the pelvis
The sacrospinous ligament
The sacrotuberosity ligament
The iliolumbar ligament
The obturator membrane
Ⅱ）The Articulation of the Free Lower Limb
1. The hip joint is a typical ball and socket joint, formed by the acetabulum of the hip bone
and the head of the femur.
The capsule is attached to the rim of the acetabulum, intertrochanteric line and crest.
The cavity of the joint is deeped by the acetabular lip, and the femoral capitate ligament is in
it.
The accessory structure of the joint: The acetabular labrum, acetabular ligament, capitate
ligment, iliofermoral ligament.
The movement of the joint: flexion, and extension, adduction and abduction, medial and
lateral rotation, circumduction.
2. The knee joint It is the largest and most complicated joint of the body. It is made up of the
articulations between the femoral and tibial condyles, and between the patella and the femur.
The capsule is attached to circumference of the articular surfaces.
The accessory structures of the joints.
The discs: medial and lateral meniscus.
In the cavity: the anterior cruciate ligament the posterior cruciate ligament.
Around the capsule: the medial ( tibial ) collateral ligament. The lateral (fibular) collateral
ligament. The oblique popliteal ligament. The transverse ligament of the knee. The suprapatellar
bursa. The synovial folds.
The movements: flexion and extension, medial and lateral rotation (in flexion position).
3. The tibio-fibular articulations: There are three articulations in it, the proximal
tibiofibular joint; the interosseous membrane; the distal tibiofibular articulation (ligament).
4. The ankle joint: The articular surface of the distal end of the tibia and fibula form a socket
which is articulated with trochlea of the talus. The joint capsule is attached to the circumference of
the articular surface and strengthened by the ligaments which are the medial (or deltoid) ligament,
the anterior talobibular ligament, the posterior talofiburlar ligament and the calcaneofibular
ligament.
The movements: dorsoflexion and plantal flexion abduction and adduction.
5. The articulation of the foot It includes those of the ankle joint, intertatarsal joints,
tarsometatarsal joint, inermetatarsal joints, metatarsophalangeal joint and the interphalangeal
joints.
6. The arches of the foot The bone of the foot are arranged in three arches. They are the
medial longitudinal arch which is formed by the calcaneus, talus, navicular, cuneiforms, and the
first, second, third metatarsals. And the talus is the kty bone in this arch. The lateral longitudinal
arch is formed by the calcaneas, cuboid and the lateral two metatarsals. The transverse arch is
formed by the cuboid, the three cuneiforms, and the bases of the metatarsal bones.
Chapter 3 Myology
Section 1 Introduction
The muscles may be divided into the three types: the skeletal muscle, smooth muscle and
cardiac muscle. Here the skeletal muscle is only discussed, which is a part of the locomotor
system. It is called voluntary muscle because its contraction is under the voluntary control. About
40% of the body weight is provided from the skeletal muscle. They produce all the voluntary
movements, and are essential to the performance of a great variety of body function. Every piece
of the skeletal muscles possesses a definite shape, structure, location and accessory apparatus, also
has rich supply of the bolld vessels, lymphatics, and nerves. So that, the natural shape, location
and action of the muscles are frequently discussed in this chapter.
Ⅰ. The Morphology: Each muscle is composed of the muscular fibres. Generally it can be
divided into the belly and tendon, and the later is attached to the bone. The muscles vary
extremely in their shape. It may be long, short, broad and circular band-like. In addintion, some
muscles have more than one belly or one origin. Some of them, howener, resemblance to feathers,
so we called them as pinnate muscles.
Ⅱ. The origin and Insertion: the end of fixed attachement of the muscle is called the
origin,the movable one the insertion. Most of muscles are attached either derectly or by there
tendons to bones, cartilages, ligaments and so on. In the limbs the more distal parts are usually
mobile. Therefore, the distal attachement is usually called the insertion. Some proximal end are
generally called the origin.
Ⅲ. The Action: the students should try to learn the origin and insertion of the major
muscleofthe body. These, of necessity, include some knowledge of the joint which muscle passes.
So that the action of the muscle can be understand. The basic action of the muscle is the
contraction. When the action of the muscle operates over some articulation we can see the group
of the muscles to make the movement of the joint. According to the action of the function of the
muscles the skeletal muscles can be divided into the following: the prime mover, antagonist,
synergist. Which are controlledly the nerves?
Ⅳ. The Supplementaty Structrue of Muscles
Ⅰ) The Fascia is formed by connective tissue, and divided into the superficial and deep
fascia.
Ⅱ) The Synovial Bursa is a connective tissue sac with a slippery inner surface, and filled
with synovial fluid. The bursa is present near the joint.
Ⅲ) The Synovial Tendon Sheath is a double layered synovial sheath, in which the tendon
runs, generally locates in the hand and foot.
Ⅳ) The Sesamoid Bones which are developed in some tendons near the joint.
Section 2 The Muscles of the Trunk
The muscles of the trunk may be divided into many groups: Rhe muscles of the back, the
muscles of the thorax, the diaphragm, the muscles of the abdomen and the muscles of the
perineam. The last one will be discussed in the urigenital system.
Ⅰ. The Muscles of the Back. Which are located on the posterior aspect of the trunk, and
canbe divided into two groups, the superficial and the deep. The superficial group includes the
trapezius, latissimus dorsi, levotor scapulae and rhomboid muscles. The deep group is a
complex group of muscles, which is mainly concerned the movement of the vertebral column.
Ⅰ) The Trapezius which is a large, triangular muscle. It arises from the superior muchal
line,external protuberance of the occipital bone, nuchal ligament, spine of 7th C vertebra, spines
and supraspinous ligament of the thorax vertebrae. And it is inserted into the lateral 1/3 of the
clavicle, acromion, and the spine of the scapula.
Actions ①Steadies, raises, descends, retracts, and rotates the scapula; ②Extends the head;
③Dropping shoulder.
Ⅱ) The Latissimus Drsi It is a large wide, triangular muscle, and located the both sides of
theback. It arises from the spines of the lower six thoracic vertebrae, the thoracolumbar fascia,
lumbar and sacral spinous process, and the iliac crest. And it is inserted into the floor of the
intertubercular groove.
Actions: Extends, adducts, medially rotates humerus; Elevate the body on the hand.
Ⅲ) Sacrospinal Muscle It is located in the vertebral groove on both side of the spine. The
Function: Bend and rotate the spinal column by acting on one side; extend the spinal column by
acting on both sides.
Ⅳ) The others: The levator scapulae, rhomboid muscles, and thoracolumbar fascia
Ⅱ. The Muscles of the Neck by their situations they are divided into four groups: the
superficial, suprahyoid, infrahyoid and the deep group.
Ⅰ) The Superficial Group
1. The platysma is a very thin and located in the superficial fascia of the neck.
2. The sternocleidomastoid muscle It arises from the manubrium and the medial 1/3 of the
clavicle, and is inserted into the mastoid process of the temporal bone.
The actions: ①The head is inclined laterally and the face is rotated to the opposite. ②
Flexthe neck by the acting of both sides.
Ⅱ) The Hyoid Muscles
1. The suprahyoid muscles: Digastric muscle, mylohyoid muscle, stylohyoid muscle,
geniohyoid muscle.
2. The infrahyoid muscles: The sternohyoid muscle, omohyoid muscle, aternothyroid
muscle, theyrohyoid muscle.
Ⅲ) The Deep Cervical Muscles The group of these muscles are located in front on both
sidesof the cervical vertebral column. They are the scalenus anterior, scalenus medius, scalenus
posterior.
The scalenus anterior which arises from the transverse process of the cervical vertebra, and
isinserted into the first rib. Above the first rib, there is a triangular space, scalene fissure between
the anterior and middle scalenus. The brachial plexus and subclavian artery emerge from this
space.
The action of the scalenus anterior and scalenus medius which elevate the first rib to
breath deeply, flex and rotate the cervical vertebral column to the opposite side.
Ⅲ. The Muscles of the Thorax which are divided into two groups: the extrinsic and
intrinsic muscles.
Ⅰ) The extrinsic muscles which include the pectoralis major, pectoralis minor, seratus
anterior and subcleivius.
1. The pectoralis major This is large, thick and fan-shaped muscle, covers the upperpart of
the chest. It arises from the medial half of the clavicle, the anterior surface of the sternum, the first
six costal cartilages, and the aponeurosis of the external oblique mascle of the abdomen. And it is
inserted into the crest of the greater tubercle of the humerus.
The Actions: ①Flexes, adducts, and rotates the humerus medially; ②Draws the body
upward when the arms are fixed, ③Elevates the ribs to help the inspiration when the scapula is
fixed.
2. The pectoralis minor is deep to the pectoralis major.
3. The seratus anterior overlies the lateral portion of the thorax..
Ⅱ) The Intrinsic Muscles which are located between the fibs and sternum or vertebrae. The
chief muscles of this group are the external and the internal intercostals muscles.
1. The external intercostals muscles which are located intercostals spaces superficially, arise
from the lower border of each rib, and are inserted into the upper border of the rib below.
2. The internal intercostals muscles They are lacated in each intercostals space deep to the
external intercostalmuscles. Their fibers run obliquely at right angle to those of the external
intercostals muscles. The actions: the external intercostals muscles elevate the ribs to help
inspiration, and the inernal interrcostal muscles muve the ribs downwards to help expiration.
Ⅳ. The Diaphragm It is a dome-shaped septum between the thoracic and abdominal cavity.
It is divided into the central tendon and peripheral muscular portion.
There are three openings in the diaphragm: ①The aortic hiatus is at the level of the 12th
thoracic vertebra, which transmits the abdominal aorta, the thoracic duct and ofthen the azygos
vein. ②The esophageal hiatus is at the level of the 10th thoracic vertebra, which transmits the
esophagus, vagal trunks. ③The vena caval foramen is at the level of 8th thoracic vertebra,
transmits the inferior vena cava.
The actions: ①the chiefly a muscle of inspiration, when diaphragm contracts it will
descends. The volumn of thoracic cavity is increased to help the inspiration. ②to increase the
intra-abdominal pressure.
Ⅴ. The Muscles of the Abdomen They lie between the lower margin of the thorax and the
pelvis, which are divided into two groups: the anterolateral and posterior groups.
Ⅰ）The Aanterolateral Group which forms the anterolateral wall of the abdominal cavity, and
consists of three flat muscles: the external oblique, internal oblique, and transverse abdominis;
one straplike muscle, the rectus abdominis.
1. The table for 3 flat muscles
ext. oblique m.
Origin
lower 8 ribs
int. oblique m.
tran. abdominis
Thoracolumbar fascia
Ant.2/3 of iliac crest
Lat. 2/3 of inquinal lig.
Direction Downward
Upward & forward
of fibers forward
at the right angle
medially
to the ext. oblique m.
Insertion Iliac crest
Linea alba
Inquinal lig.
Cart. of 7th to 10th ribs
Broad aponeurosis Pubic crest
Conjoint tendon
Spermatic cord
Formed
Linea alba
Conjoint tendon ……….
structure Inquinal lig.
Cremaster m…………...
Sup. inquinal ring Rectus sheath………….
Rectus sheath
Lower 6 costal cart.
Thoracolumbar fascia
Iliac crest
Iat. Of inquenal lig 1/3
Horizontally
Rectus sheath
Conjoint tendon
the same
2. The rectus abdominis which lies each side of the linea alba. It arises from the pubic
symphysis and the pubic crest, and inserted into the xiphoid process and anterior portion of the
costal arch.
3. The actions of the anterolateral muscles: ①Support and protect the viscera. ②Maintain
and increase the intra-abdominal pressure. ③The important actions are in respiration, defecation,
micturition, parturition, vormiting and cough. Also to help the movement of the column.
Ⅱ）The posterior group include the Psoas Major and Quadratus Lumborum. The psoas
major will be discussed in the muscles of the lower limb. The guatratus lumborum lies both side of
the column.
Section 3 The Muscles of the Head
The muscles of the head can be divided into the muscles of fasial expression and muscles of
mastication.
Ⅰ. The muscles of the facial expression which are the epicranial muscles (occipitofrontalis
muscle), orbicularis oculi, oricularis oris, baccinator muscles and muscles aroud the nose. Most of
them arise from the skull and are inserted into the skin of the face. They pull the skin in various
direction to express the emotion. The muscles around the mouth, eyes, nose, and ears are the
sphincters and dilators, which close or open the orifices.
Ⅱ. The muscles of mastication They pass the base of the skull to the lower jaw.
The table for muscles of mastication
Masseter
Temporalis
Origin
Zygomatic
Arch
insertion
Ramus&angle
of mandible
Elevates
mandible
Action
Temporal
fossa
Corocoid process
of mandible
Elevates
mandible
Med. pterygoid
Lat. pterygoid
Pterygoid process
of sphenoid bone
Greater wing &
ptery goid process
of sphenoid bone
Neck of
mandible
Movement of
mandible from
side to side
Angle of
mandible
Elevate mandible
protrude mandible
Section 4 The Muscles of the Upper Limb
According to different portions the muscles of upper limb are divided into four groups: the
muscles of the girdle, the muscles of arm, the muscles of forearm, and the muscles of the hand.
Ⅰ. The Muscles of the Shoulder which surround protect and act the shoulder joint. They
arise from the shoulder girdle and are inserted into thehumerus.
The table for muscles of the shoulder
Deltoid
Teres
major
Origin
Insertion
Action
Lat. 1/3 of clavicle
Acromian
Crest of spine
Inf. angle
of scapula
Deltoid tuberosity
of humerus
Abductor of
hunerus
Crest of lesser
Tubercle of humerus
Laterally rotates
and adducts
humerus……
And the supraspinous muscle lies in the supraspinous fossa, deep to the trapeius muscle. The
infraspinous muscle is in the infraspirnous fossa, and covered by the deltoid and trapezius muscles.
The teres minor lies below the infraspinous muscle. Other muscle is the subscapular muscle which
is a large, thick triangular lining on the costal surface of the scapula.
Ⅱ. The Muscles of the Arm which are divided into the anterior and posterior muscles
The table for muscles of the arm
GROUP
Biceps
Brachii
ANTERIOR
Name
Coracobrachialis
Brachialis
Origin
Coracoid process
(short head)
Supraglenoid
tubercle(long head)
Coracoid
process
Lower part of
Humerus
Insertion
Actions
Tuberosity of radius
Flexes elbow joint
Fascia of forearm
Supinates forearm
Flexes shoulder joint
Flexes and
adducts the arm
Flexes below
joint
Middle part
of humerus
Coracoid process
tuberosity of ulna
POSTERIOR
Triceps
Bracii
Infraglenoid
tuberosity of scapula
Olecranon of
(long head)
the ulna
The lateral to the groove
for radial n.(lat. head)
The medial to the groove
for radial n. (med. head)
Extends the forearm
Extends and
abducts the
shoulder joint
Ⅲ. The Muscles of the Forearm which consist of the anterior and posterior groups.
Ⅰ）The Anterior Group is located in front and medial side of the forearm, and divided into
two layers: the superficial and deep.
1. The superficial layer is consists of 6 muscles which are arranged from the lateral to the
medial side: The brachioradialis muscle, pronator teres, flexor carpi radialis muscle,
palmaris longus, flexor carpi ulnaris and the flexor digitorum superficialis.
The pronator teres It forms the medial borndary of the cuboid fossa, and lacates the front of
the proximal portion of the forearm. It arises from the medial enpicondyle of the humerus, and
inserted into the middle of the lateral surface of the radius.
The actions of the pronator teres: pronates forearm; flexes elbow joint.
2. The deep layer include 3 muscles: the flexor pollicis longus, the flexor digitorum
profundus and the pronator quadratus. They are closely to contact the radius, ulna and
interossous membrane.
Ⅱ）The Posterior Group The muscles of this group can be divided into two layers, the
superficial and deep layer. They are lacated on the back of the forearm.
The posterior group
Superficial layer
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor carpi ulnaris
Deep layer
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Ⅳ. The Muscles of the Hand which include 3 groups as follows:
Abductor pollicis brevis
1. The lateral group:
Flexor pollicis brevis
Oppponeus pollicis
Adductor pollicis
Lumbrical muscles
2. The intermediate group: Palmar interossei
Dorsal interossei
Abductor digiti minimis
3. The medial group: hypothenar Flexor digiti minimi brevis
Opponeus digiti minimi
Section 5 The Muscles of the Lower Limb
Which are divided into foru parts: The muscles of the hip, the muscles of the thigh, the
muscles of the leg, and the muscles of the foot.
Ⅰ. The Muscles of the Hip They are divided into the anterior group and posterior group
according to their location.
Ⅰ）The Anterior Group
1. The Iliopsoas It is consists of the psoas major and iliac muscle; the psoas major lies
lateral to the lumbar region of the vertebral column, iliac fossa and roof of the thigh. It arises from
the transverse processes. Vertebral bodies and intervertebral discs of L1 to L5 vertebrae, and
inserted into the lesser trochanter of the femur. The iliac muscle lies the lateral side of the psoas
major in the iliac fossa.
The Actions: Flexes the thigh; rotate the thigh lateally; if the lower limb is fixed it bends the
vertebral column forward and flexes the lumbar region laterally.
2. The Tensor Fasciae Latae lies on the lateroanterior sides of the thigh.
Ⅱ）The Posterior Group which lies chiefly in the gluteal region, so that they are also
called the gluteal muscles.
1. The Gluteus Maximus It is a large, thick muscle which arises from the iliac ala, sacrum
and coccyx, and the sacrotuberous ligament. It is inserted into the iliotibial band and the guluteal
tuberosity of the femur.
The actions: extends the thigh; rotates laterally; and keeps the posture.
2. The Gluteus medius and gluteus minimus They are located deep to the gluteus maximus
in order.
3. The Piriformis muscle It lies deep to gluteus medius, and is a landmark muscle.
Ⅱ. The Muscles of the Thigh They are divided into three groups: the anterior, posterior and
the medial.
Ⅰ）The Anterior Group The Satorius and the Quadriceps Femoris are in this group. They
extend the knee and help to flex the hip.
1. The Satorius It arises from the anterior superior iliac spine, passes the upper and anterior
part of the thigh to the medial side of the knee, and inserted into the medial surface of the upper
part of the tibia.
The actions: Extends the hip and knee joint, medially rotates the flexed knee.
2. The Qquadriceps Femoris It lies in front of the thigh. It is the largest and most powerful
muscle of the body. It is composed of 4 muscles: the rectus muscles, the vastus medialis, the
vastus lateralis, and the vastu intermedius. That is to say, these four muscles forms a strong
quadriceps femoris which arises from the anteroinferior iliac spine, line aspera, anterior surface of
the femur. It is inserted into the tibial tuberosity by the patellar ligament.
The actions: Extends the leg, flexes the thigh, act in climbing, running, rising from a sitting
position, and walking up and down stairs.
Ⅱ）The Medial Group These muscles locate on the medial side of the thigh. They are chiefly
adductors of the thigh: The pectineal muscle, adductou longus, gracilis, adductou magnus. The
adductor magnus has a insertion on the adductor tubercle above the medial epicondyle of the
femur. There is a hiatus between the aponeurotic insertion of the adductor magnus and the femur,
which is termed the adductou hiatus. Which allows the femeral vessels passing through it ingo
the popliteal fossa.
The action of the muscles of the anterior group: adduct, flex, and laterally rotate the thigh.
Ⅲ）The Posterior Group In this group there are 3 large muscles on the back of the thigh.
Thesemuscles are, as well as, called the hamstring muscles. They are the biceps femoris, the
semitendinous muscle, and the semimembranous muscle.
The actions: extends the thigh, flexes the leg, rotates the leg when the knee joint is flexed.
Ⅲ. The Muscles of the Leg It is divided into 3 groups:
Ⅰ）The Anterior Group Which lies in the front of the tibia, fibula and the interosseous
membrane. There are 3 muscles in this group. They are the tibialis anterior, the extensors
digitorum longus, and the extensor hallucis longus. The tibialis anterior arises from the lateral
surface of the tibia, and is inserted the medial cuneisform bone and the base of the first
metatarsal bone. It locates on the lateral side of the tibia, and its tendon becomes free in the distal
1/3 of the leg, passes deep to the retinaculum to the medial border of the foot.
The action of the anterior group: Dorsiflex the ankle joint, invert the foot, extend the big
toe,and extend digitorum longus.
Ⅱ）The Lateral Group It lies on the lateral side of the tibia, and consists of two muscles.
The table of the lateral group
Name
Origin
Peroneus
Longus
Lat. Surface
of upper part
of fibula
Peroneus
Brevis
below insertion
of peroneus
longus
Insertion
Action
Base of first
metatarsal bone
and med. cuneiform
bone
Tuberosity of
5th metatarsal
bone
Together they
plantar-flex the ankle
joint
Maintain the
transverse and
lateral longitudinal
arches of the foot
Ⅲ）The Posterior Group which plantar-flex ankle joint, and is divided into following layers.
The Superficial layer
The gastrocnemius
The soleus
The plantaris
The Deep layer
The flexor digitorum longus
The fibialis posterior
The flexor hallucis longus
1. The Tibialis posterior lies laterally to the flexor digitorum longus. It arises from the tibia,
fibula and posterior surface of the interosseous membrane, and is inserted into the navicular,
intermediate and lateral cuneiforms, and the bases of the 2nd, 3rd, 4th, metatarsals.
Acitons: flexes the ankle joint, inverted the foot medially.
2. The Triceps surae muscle. It is one of the powerful muscles. It has three heads, the two
heads arise from the medial and lateral condyles of the femur respectively, which form the
inferolateral and inferomedial bandaries of the popliteal fossa and unite together to form the
convex strong muscle as termed gastrocnemius. And another head is the soleus which lies
immediately deep to the gastrocnemius, and arises from the upper part of the posterior surface of
the tibia and fibula. The gastrocnemius and soleus muscles unite together to become the strongest
cal caneal tendon which inserts into the calcaneus bone.
The actions: Plantarflex the ankle joint: steadies the leg on the foot during standing; flexs the
knee.
Ⅳ. The Muscles of the Foot The extensor digitorum brevis on the dorsum, the muscles of
the sole are divided into 3 groups as follow:
The muscles of the foot
The medial
The intermediate
Abductor hallucis
Flexor hallucis brevis
Adductor hallucis
Flexor digitorum brevis
Quadratus plantae
Lambricates interosseous m.
The lateral
Abductor digitiminimi
Flexor digitiminimi brevis
THE PART Ⅱ SPLANCHNOLOGY
Chapter 1 Introduction
The splanchnology usually concerns with the study of the viscera. According to the function
which they perform, the viscera includes the digestive system, urigenital system and endocrine
system.
Most organs of these system are located in the thoracic cavity and the abdominal cavity, and
some of them are associated with the pleura and peritoneum.
In this course, we will discuss the general morphology and structure of the viscera. As well as,
some function will be concerned in our lessons.
Ⅰ. The Common Used Reference Lines of the Thorax
1. The anterior median line A vertical line through the median of the sternum.
2. The midclacicular line It extends downward vertically from the midpoint of the clavicle
and ususlly coincides with mammary line in male.
3. The anterior axillary line A vertical line downward from the anterior axillary fold.
4. The midaxillary line A vertical line midway between anterior and posterior axillary line.
5. The posterior axillary line A vertical line downward from the posterior axillary fold.
6. The scapular line A vertical line through the inferior angle of the scapula.
7. The posterior median line A vertical line through the spines of the thoracic vertebrae.
Ⅱ. The Abdominal Regions In order to describe the abdominal regions which contains the
viscera. The abdomen is divided into nine regions by four imaginary planes, the upper and lower
horizontal plane, and the right and left vertical planes. It is often used in the clinic.
The upper horizontal plane passes through the lowest point of the costal arch. And the
lower horizontal plane passes both iliac tubercles. The right and left vertical plane across the
middle point of the inquinal ligament passing above two horizontal plane at the right angle. In this
way the avdomen is divided into following portions.
Right
The upper row
The middle row
The lower row
hypochondriac
lumbar
iliac
Middle
epigastric
umbilical
hypogastric
Left
hypochondriac
lumbar
iliac
Chapter 2 The Digestive System
The digestive system means study of the alinmetary canal of the organs, which includes the
digestive canal and certain accessory organs, such as the lips, cheeks, palate, tongue and the teeth,
as well as includes some glands, the salivary glands, liver and pancreas. The alimentary canal is
about 9 m long extends from the mouth to the anus. It consists of the following parts: the mouth,
the pharynx, the esophagus, the stomach, and the small and large intestines.
Section 1 The Oral Cavity
The oral cavity can be divided into the vestibule and the oral proper cavity. The vestibule of
the mouth is a slit-like space. And the oral cavity proper is vounded by the alveolar arches, the
isthmus of fauces, the palate, and the tongue.
The isthmus of fauces is the bound of the oral cavity and phyrax between the palatoglossal
folds.
Ⅰ）The Teeth There are two sets of teeth in man, the deciduous and permanent.
The structure of teeth: Which includes the crown, the root, the neck, and the pulp. The
vessels and nerves pass the apical foramen at the apex of the teeth root into the pulp.
Ⅱ）The Tongue It is divided into three parts: the apex, body and the root. It has a dorsal
andinferior surface, on the dorsal surface there is a V-shaped groove termed the sulcus terminalis,
which is the boundary between the oral part and the pharyngeal part of the tongue. Also there are
four types of papillae on the tongue. They are the vallate papillae, fungiform papillae, filiform
papillae and the foliate papillae.
There is a lingual frenulum which is a vertical fold of mucous membrane in the midline
between the tongue and the floor of the mouth. On the both side of the lower end of the frenulum
there is a small elevation, the sublingual papilla, on the surface of which is the orifice of the duct
of the submandidubular salivary gland.
The Muscles of the tongue The muscles of the tongue are consist of intrinsic and extrinsic
muscles. The intrinsic muscles lie entirely in the tongue. And extrinsic muscles are three each side,
the hyoglossus, the styloglossus, and the genioglossus. The genioglossus draws the tongue
forward and downward, and helping to protrude the tongue. It arises from the middle spine of the
mandible, and is inserted into the both sides of the mental line of the tongue.
Ⅲ）The Salivary Gland There are 3 parts of the major salivary glands whose ducts open into
the mouth. As well as, there are many minor salivary glands in the lips, chee,s, tontue and palate.
Table of salivary gland
Name
Position
Orifice
Parotid Gland
The anteroinferior to the ear
The posterior border of masseter
The posterior mandibular fossa
Submandibular
Gland
In the upper part of neck, below
the floor of the mouth, and deep
to the mandibular body
Beneath the musous membrane
of the floor of the mouth
The oral surface of
the cheek opposite
the crown of the 2nd
upper molar tooth
The floor of the mouth
Sublingual Gland
the surface of sublingual fold
The Parotid Duct: It is about 5 cm long, passes forwards across the masseter muscle and
then turns inwards. It pieces the buccinator muscle and opens upon a small papilla on the oral
surface of the cheek opposite the crown of the second upper molar tooth.
Section 2 The Pharynx
The pharynx is the part of the alimentary canal; it is located behind the masal cavity, the
mouth and the larynx. It extends from the base of the skull to the level of 6th cervical vertebra to
continue the esophagus. The pharynx may be divided into three parts: the nasal, oral and the
laryngeal.
1. The Nasopharynx Anteriorly it communicates with the nasal cavity through two large
choanae. The pharyngeal opening of the auditory tube presents on the lateral wall of it.
Antero-supero-posteriorly to this opening there is a prominent termed the torus tubarins, behind
which lies the slitlike pharyngeal recess.
2. The oropharynx which is the continuous with the mouth through the isthmus of the fauces.
The palatine tonsil is located on each side of the oropharynx. And lodged in a tonsillar fossa.
3. The laryngopharynx which communicates above with the oropharynx and below with
esophagus. Anteriorly it communicates with the cavity of the larynx through the inlet of the larynx.
The piriform fossa lies on each side of the laryngeal orifice.
Section 3 The Esophagus
The esophagus is a muscular tube, about 25cm long, is continuous from the pharynx to the
stomach, it passes down through the lower part of the neck and the superor and posterior parts of
the midastinum, pierces the diaphragm at the level of the 10th thoracic vertebra, ends the cardial
orifice of the stomach.
There are 3 narrow portions for the esophagus: ①at its commencement, 15cm long from
theinxisor teeth; ②at the level where the left bronchus crossed, 25cm long from the incisor teeth;
③where it passes through the diaphragm, 46cm long from the incisor teeth.
Section 4 The Stomach
The stomach is located between the end of the esophagus and the beginning of the small
intestine. It lies in the epigastric, unbilical, and the left hypochondriac regions of the abdomen.
The shape and the position of stomach are varied from person to person. And the capacity varies
with age, being about 30ml at birth, and about 1500ml in the adult.
1. The Features: cardiac, cardiac notch, fundus, body, angular notch, pyloric autrum, pyrorus,
pyloric sphincter, greater and lesser curvature, anterior and posterior surface.
2. The stomach bed: are most important, the pancreas, the upper pole of the left kidney, the
left supararenal gland, the left crus of the diaphragm, the left colic flecture, the spleen, and the
posterior wall of the omental bursa. In fact, the stomach bed is the posterior relation of the
stomach.
Section 5 The Small Intestine
It is a convoluted tube, extending from the pyrorus to the iliocaecal valve, where it joints the
large intestine. It is about 6-7m long. The small intestine can be divided into the duodenum,
jejunum, and the ileum.
Ⅰ. The Duodemum which is the shortest, widest and most fixed part of the small intestine, it
hasn’t mesentery, and is only partially covered with peritoneum. The shape of the duodenum like
and incomplete cirecle, which encloses the head of the pancreas. It lies entirely above the level of
the umbilicus. It begins at the pylorus and end opposite the 2nd lumbar vertebra in the jejunum.
And it can be divided into four parts.
Ⅰ）The Superior part It begins at the pylorus, and ends the area of the neck of the
gallbladder. This part also is called the bulbus duodeni in the clinic.
Ⅱ）The Descending Part Its medial side is related to the head of the pancreas and common
bile duct. The two ducts come into the midial wall of the descending part of the duodenum, and to
form a short, dilated tube which is termed the hepatopancreatic ampulla.
Ⅲ）The Horizontal Part which begins at the right side of the lower border of the third
lumbar vertebra. The anterinor surface is covered with peritoneum.
Ⅳ）The Ascending Part At he level of the upper border of the second lumbar vertebra, where
it turns ventrally at the duodenojejunal flexure and is continuous with the jejunum. Its right border
attaches the upper part of the root of the mesentery. The terminal part of the duodenum and
duodenojejunal flexure are fixed on the posterior wall of the abdominal cabity by suspensory
muscle of the duodenum which also is termed the ligament of Treitz.
Ⅱ . The Jejunum and Ileum which are continuous with the duodenum from the
duodenojejunal flexure to the ileocaecal orifice where it joins the large intestine. The upper 2/5 of
this seganent of the small intestine is called the jejunum, and another lower 3/5 is the ileum. The
most part of ileum is located in the right lower part of the abdominal cavity.
The Comparision of Jejunum and Ileum
Jejunum
Location
Artery
Wall
LUQ
Few arcades
More
Thicker
More plica
Redder
More villi
Absent of a little
Ileum
RLQ
Several arcades
Lesser
Thinner
Fewer plica
Grey
Lesser villi
More lymph tissue
Section 6 The Large Intestine
The large intestine has a greater caliber. Usually its most part is more fixed on the posterior
wall of the abdominal cavity. There are three considerable characteristics, the taeniae coli or
longitudinal bands; the haustracoli or sacs; the epiploic appendices or adipose projections.
The parts of the large intestine: the caecum, the vermiform appendix, the colon-the
ascending, transverse, descending and the sigmoid colon, and the rectum.
Ⅰ. The caecum Usually it is located in the rught iliac fossa. The caecum is generally covered
completely with peritoneum. There are the ileocaecal valves on the wall of the caecum where the
ileum come into to joint the large intestine.
Ⅱ. The Vermiform Appendix It is varialble position, and usually it locates in the right iliac
fossa.
The Projection of the Root of the Appendix which is at the conjuction of the middle 1/3
and the lateral 1/3 of the line which connects the umbilicum and the anterior-superior iliac spine.
Ⅲ. The Rectum and Anal Canal which is continuous with the sigmoid colon at the S3. It
lies in the pelvic cavity.
The Rectum
1. Sacral flexure-downward and backward
2. Perineal fexure-downward and forward
3. Rectal ampulla-dilatation
4. Transverse rectal folds-two on left, one on right.
Anal canal
1. Anal columns
5. Anal pectin
2. Anal valves
6. White line
3. Anal sinus
7. Internal anal sphincter
4. Pectinate line
8. External anal sphincter
Section 7 The Liver
The liver is the largest gland in the body.
Ⅰ. The Position: In the right hypochondriac region,
the epigastric region,
the left hypochondriac region (a little part).
Ⅱ. The Lobes: Right lobe-large
Left lobe-small
Quadrite lobe
Caudate lobe-tail lobe
Ⅲ. The Features: Wedge-shaped organ
Two surfaces: the superior and inferior
“H”shaped structure formed by two longitudinal sulci and transverse sulcus
Ⅳ. The Ligaments: Falciform lig.
Round lig.
Right and left triangular lig.
Ant. And post. coronary lig.
Ⅴ. The Hepatic Porta (Porta Hepatis ) The transevese sulcus is called the hepatic porta.
1. Left and Right hepatic duct
2. Left and Right branches of the proper hepatic A.
3. Left and Right branches of the portal V.
4. Nerves
5. Lumphatics
Above structures which are surrounded by the connective tissue called Hapatic pedicle.
Ⅵ. The Structure Formed of “H”-shaped Sulcus
1. Left-anteriorly: hepatic round ligament
2. Left-posteriorly: hepatic venous ligament
3. Right-anteriorly: fossa for gallbladder
4. Right-posteriorly: sulus ofr vena cave
5. Transverse sulcus: hepatic porta
Ⅶ. The Surface Anatomy
The inferior bound of the liver is the same as its lower margin which may be represented by
and oblique line beginning the lowest point of the right costal arch at the right midaxillary line,
and runs to the left along the costal arch, as far as the tip of 9th costal cartilage, crossing to the top
of the left 8th costal cartilage, and ending in the 5th intercostals space at the left midclavicular line.
The superior bound of the liver is the same as the dome of the diaphragm, which begins 10th
rib at the right midaxillary line, runs to the superior border of 7th rib along the thoracic wall,
passing 5th costal cartilage at the midclavicular line, and reach 5th intercostals space to the medial
side of the left midclavicular line to unite with the lower margin of the liver.
Section 8 The Gallbladder and The Biliary Ducts
Ⅰ. The Gallbladder which lies in the fossa for gallbladder on the visceral surface of the
liver.
Ⅱ. The Features
1. A pear-shaped organ
2. Fundus
3. Body
4. Neck
5. Cystic duct
Ⅲ. Biliary Apparatus (bile ducts )
1. Left and right hepatic duct
2. Common hepatic duct
3. Cystic duct
4. Gallbladder
5. Common bile duct
Ⅳ. The Bypass of the Bile From the liver bile is produced by the hepatocytes in the
liverbile ductulesright and left hepatic ductcommon hepatic ductcystic
ductgallbladdercystic ductcommon bile ductdesending duodenum.
Ⅴ. The Special Notes
1. Major duodenal papulla In the medial wall of the descending part of the duodenum the
common bile duct contact with the pancreatic duct and unite to form hepatopancreatic ampulla
which opens into the descending part of the duodenum on the summit of the Marjou Duodenal
Papulla.
2. The sphincter of oddi There is the circular muscle around the lower part of the bile duct,
ampulla and terminal part of the main pancreatic duct, which is termed the Sphincter of Oddi
(sphincter of hepatopancreatic ampulla ).
Section 9 The Pancreas
The pancreas is only smaller gland than the liver. It is located the posterior wall of the
abdominal cavity at the level of L1, 2, behind the stomach and other many orghns.
Ⅰ. The Parts: the head, body, tail.
Ⅱ. The Duct: The pancreatic duct joints the common bile duct ot form the hepatopancreatic
ampulla and opens into the major duodenal papulla.
Ⅲ. The Function The pancreas produce both exocrine and endocrine secretions. The exocrine
fluid of pancreas are drain into duodenum by the series bile ducts. The Islets of Langerhans in
the pancreas secrete insuline which control blood sugar in the body.
Chapter 3 The Respiratory System
The respiratory system includes the respiratory tract and lungs. And the respiratory tract
composed of the nose, pharynx, larynx, trachea and main bronchi.
Section 1 The Nose
The nose is not only the first part of the respiratory tract but also an organ of smell and
phonation.
External nose-apex, dorsum, root, narse. wings
Ⅰ. The Nose
left and right cavity
Nasal cavity nasal septum
four walls
Roof: nasal bone and ethmoid bone
Floor: roof of the mouth
Ⅱ. The Walls
Medial wall: nasal septum
Lateral wall: sup. , mid., jinf., concha, meatus
Ⅲ. The Paranasal Sinus: 4 pairs paranasal sinuses.
lie in the frontal bone.
1. The Frontal Sinuses
open into the middle nasal meatus.
lie in the maxillary bone.
2. The Maxillary Sinuses
open into the middle nasal meatus.
within the ethmoid bone.
3. The Ethmoidal Sinuses
ant. mid. groups open into the mid. nasal meatus.
post. group opens into the sup. nasal meatus
lie in the sphenoid bone.
4. The Sphenoidal Sinuses
open into the sphenoethmoidal recess.
Section 2 The Pharynx and Larynx
The pharynx has already been discussed within the digestive system.
The larynx consists of the cartilages, joints, ligament and the muscles. It lies in the neck
region in front of the C5,6 vertebrae and the laryngopharynx.
Ⅰ. The Position Changes with Age
1. In adult: Above, near the hyoid bone and root of the tongue.
Below, at the level of C6 vertebra.
2. In child and female: higher position.
Ⅱ. The Laryngeal Prominence-a median elevation
The thyroid notch-at the upper border of the thyroid cartilage.
Vestibule
vestibular folds, slit
Intermediate cavity
Ⅲ. Cavity of Larynx
Of larynx
vocal foldes, slit of glottidis
Infraglottic cavity
Section 3 The Trachea and Bronchi
The trachea is located in the midline of the neck and upper thorax, and in front of the
esophagus. It extends from the lower border of the cricoid cartilage at the level of 6th cervical
vertebra to the level of the sternal angle, where it divides into the right and left main bronchi.
In child the trachea is smaller, deeper in position, and more movable than that in adult.
Tracheal cartilage
Smooth muscle
Ⅰ. The Composition of Trachea
Connective tissue
Mucous membrane 14-16 C-shaped
ring of cartilage
Right main bronchus: shoter, wider, more vertical
Ⅱ. The Bronchi
than the left one.
Left main bronchus: longer, less vertical.
Section 4 The Lungs
The lungs are the essential organs of the respiration. There are two lungs within the thoracic
cavity. Each lung is situated on the each side of thorax, and separated from each other by the heart,
other contents of the mediastinum.
Ⅰ. The Features
1. Right lung is shorter, wider than the left.
2. Each lung is conical, has an apex, a base, two surfaces, three borders.
3. Hilus of lung: root of lung-bronchi, pulmonary artery and veins, bronchial vessels,
lymphatics and lymph modes.
Ⅱ. The Lobes of the Lung
Right lung
Left lung
1. Horizontal fissure
1. Upper lobe
2. Oblique fissure
2. Lower lobe
3. Superior lobe
3. Lingulum
4. Middle lobe
4. Oblique fissure
5. Inferior lobe
The apex of the Lung is 2.5cm above medial 1/3 of the clavicle.
Section 5 The Pleura
The pleura is thin serous membrane which lies the inner surface of the thorax and the surface
of the lungs.
Ⅰ. The Parts
1. Visceral pleura: cover the lungs and fissures of lung
Costal pleura
2. Parietal pleura
Diaphragmatic pleura
Mediastinal pleura
Cupula of pleura
Ⅱ. Pleural Cavity and Recesse
1. Pleural cavity: two cavities separated
2. Costal diaphragmatic recess
3. Costal mediastinal recess
Ⅲ. The Projection of Margin of the Lungs and Pleura
Midclavicular line
Inf. margin of lung
6th
costodiaphragmatic
line of reflexion of
pleura
8th rib
rib
Midaxillary line
Post. median line
8th
at the level of spinal
process of T10
at the level of spinal
rib
10th rib
Chapter 4 The Urinary System
The urinary system includes two kidneys, two uriters, a urinary bladder and a urethra. Many
waste materials which are produced in living body, such as urea and uric acid, excess water and
some inorganic salts are excreted by this system. Also it can regulate the composition of the
internal environment of the body. Of course, the system is important to remain the water contents,
osmotic relations, and acid-base balance, in addition, the kidney has the endocrine function.
Section 1 The Kidneys
Ⅰ. The Location
1. On the posterior abdominal wall on both side of vertebral column.
2. The distance between the inferior extremities is longer than that of the superior extremities.
3. The superior extremity of the left kidney is at the level of the inferior border of the body of
the T11 vertebra, and the inferior extremity of the left kidney is at the level of the body L2
vertebra.
4. The right kidney is lower half vertebra than the left one.
5. The renal hilus is at the level of the first lumbar vertebra.
Ⅱ. The Features
1. Bean-shaped
2. Med. and lat. border, ant. and post. surface, sup. and inf. extremity.
3. Renal hilus is on the medial border
4. Renal pedicle (Calyces, Renal A. V. N. L., Adipose tissue)
5. Left kidney is slender, right kidney is shorter and broader.
Ⅲ. The Structure
1. Cortex: Renal column
2. Medulla: Renal pyramids, Renal papulla, Foramina of papullae, Minor calyces, Major
calyces, Renal pelvis.
Ⅳ. The Covering of the Kidneys
1. Fibrous capsule: Connective tissue fibre.
2. Adipose capsule: Adipose tissue layer.
3. Renal fascia: Two thin fascial membrane closely cover the kidney.
Section 2 The Ureters
The ureters are consist of two hollow muscular tubes which arises from the renal pelvis to the
urinary bladder. They are divided into three parts according to their course.
Ⅰ. The Parts
1. Abdominal part lies in front of psous muscle and behind the paritonium.
At the superior aperture of the lesser pelvis the left ureter passes through the terminal part of
the common iliac artery anteriorly, and the right ureter passes through the beginning of the right
external iliac artery anteriorly, to continue with the pelvic part.
2. Pelvic part passes downwards along the lateral wall of the lesser pelvis, then turns
medially at the level of the ischial spine to the base of the urinary bladder. Here the deferent ducts
crosses it anteriorly to its medial side.
In the female the pelvic part of ureter turns downwards, forwards and medially. At the level
of the ischial spine, 2cm lateral to the cervis of uterus, ti is crossed anteriorly by the uterine
vessels.
3. Intramural part passes obliquely through the wall of the urinary bladder, which opens
superolateral angle of the trigone of the bladder.
Ⅱ. The Constricted Part (Narrow Part):
1. At the junction of the ureter and renal pelvis.
2. At the point where ureter crosses the superior aperture of the lesser pelvis.
3. At the intramural part.
Section 3 The Urinary Bladder
The urinary bladder is a hollow, muscular organ which stores the urine. It varies in size,
shape, position and relations according to the amount of urine that it contains. The volume of
urinary bladder is quite difference with the age.
Ⅰ. The Feature
1. Four parts: Apex, Base, Body, Neck.
2. Four surfaces: Superior, Right and Left Lateral, Psoterior (Base).
Ⅱ. The Trigone of the Bladder It is a smooth triangular area on the base of the bladder. The
right and left orifice of ureter are at the each lateral angle of the trigone. The interuteteric ridge is
between the right and left orifice of ureter, which is the landmark to find the orifice of the ureter
when the inner side of urinary bladder is examined by the cystoscope in the living body.
Ⅲ. The Position
At birth, the urinary bladder lies at he relatively higher level.
Inadult, it is entirely within the lesser pelvis. While it is descended expanding upwards and
forwards into the abdominal cavity. In this case, the peritoneum is lifted away from the lower part
of the anterior abdominal wall, and the reflection there fore becomes higher. So that the pucture
and some operation on the bladder can be performed just above the symphsis pubis without
injuring the peritoneum.
Section 4 The Urethra
The urethra extends from the urinary bladder to the body surface. It is very different in male
and female.
Ⅰ. The Female: Narrow membrane canal, about 4cm long.
External orifice in the vestivule, and at the anterior to the vaginal opening.
Ⅱ. The Male: The urethra will be discussed in the male reproductive system.
Chapter 5 The Male Reproductive System
The male reproductive system includes the internal and external genital organs. The
internal genital organs are composed of the testis, ducts and the accessory gland. And the
external genital organs consist of the scrotum and penis.
Ⅰ. The Internal Genital Organs
Ⅰ）The Testis are located in the scrotum.
They are paired oval-shaped organs. Each testis has the superior and inferior extremities. The
lateral and medial surfaces, and anterior and posterior borders. The anterior border is free, and the
posterior border is mesorchial border which is connected with the epididymis and attached by the
misorchium. The blood vessels, nerves and the lymphatics pass through this border to enter of
leave the testis.
Ⅱ）The Series of Duct
1. The Epididymis It lies the superior extremity and the posterolateral surface of the testis.
A comma-shaped
The head----superior enlarged portion
The Features
The body----posterior portion
The tail----inferior portion
2. The Deferent Ducts It is the continuation of the epididymis duct. It can be divided into
four parts: the testicular part, funicular past, inquinal part and the pelvic part.
The special notes: The vasectomy is performed at the funicular part. The terminal portion of
the deferent duct is dilated, which termed the ampulla of the deferent duct. Here its end is narrow
and joins the duct of the seminal vesicle to form the ejaculatory duct.
3. The Urethra From the internal orifice in the urinary bladder to the external opening at the
end of the penis.
Prostatic part: urinary crest, seminal colliculu.
3 Parts
Membranous part: shortest and narrowest part within urogenital diaphragm.
Spongy part: bulb of urethral orifice
at the internal urethral orifice
3 Narrow Part
at the membranous part of urethra
at the external urethral orifice
at the prostatic part
3 Dilations
at the bulb of urethra
at the navicular fossa
prepubic curvature
2 Curvatures
infrapubic curvature
Seminal vesicle
Ⅲ. The Accessory Glands
Prostatic gland
Bulbourethral gland
1. The seminal vesicles are located the posterior to the base of the urinary bladder, lateral to
the ampulla of deferent duct, in front of the rectum. Its excretory duct joins with terminal part of
deferent duct to form the ejaculatory duct.
2. The prostate which lies in the lesser pelvic cavity, below the urinary bladder and around
the superior part of the urethra, and is infront of the rectum.
The features of prostate:
①Chestnut-shaped
②The base----broad superior extremity.
③The apex----inferior extremity rests on the urogenital diaphragm.
④The prostic sulcus----lies the midline of the posterior surface.
⑤The five lobes----ant. and post. lobes, median lobe, and two lateral lobes.
3. The bulbourethral glands lie in the deep transverse muscle of perineum, and opens into
the upper part of the spongy part of the urethra.
Chapter 6 The female reproductive system
The female reproductive system includes the internal genital organs and the external organs.
I. The internal genital organs which lies in the pelvic cavity , and consist of the ovaries,
conveying ducts, uterus and vagina.
I）The Ovaries
1. The position they lie in the ovarian fossa which is between the bifurcation of the
internal and external iliac arteries on the lateral wall of the lesser pelvic cavity.
2. The features:
①Oval-shaped organ
②Med. and lat. surfaces; ant. and post. borders; sup. and inf. extremities.
③Sup extremity is termed the tubal extremity, and inf. one is called the uterine extremity.
④Post. Border is free, and ant. border is attached to the post .surface of the broad ligament by
the mesorarium.
⑤The hilus of ovary is at the middle part of the anterior border.
⑥The size and the surface are much different between the childhood and adult.
3. The fixation The ovaries are maintained in the position by the ligaments.
①Suspensory ligament of ovary-ovarian vessels and ovarian plexus of nerves is in it.
②Proper ligament of ovary-rounded cord.
II）The Convey Ducts-The Uterine Tubes
1. The position : they are situated on the upper margins of the broad ligament of the uterus,
2. The parts: Infundibulum, ampulla, isthmus, uterine part.
III）The Uterus
1. The position It lies in the lesser pelvis between the urinary bladder and the rectum.
Anteflexion----The uter has an obtuse angle between its body and cervix.
Anteversion----The obtuse angle between the axis of uterus and the vagina
2. The features: In the adults, the uterus is shaped like an inverted pear and flatted from the
front to backwords. There are following structures in the uterus: fundus, body, isthmus, cervix,
cervical canal, uterine ostium, and lumen.
3. Supports of the uterus
①Muscles of the pelvic floor, neighbouring organs, and connective tissue.
②Broad ligament.
③Round ligament of uterus
④Cardinal ligament
⑤Sacro-uterne ligament.
4. Special notes:
The version angle of the uterus refers to the angle with which the cervix meets the vagina.
The normal position is titled anteriorly.
The Flexion Angle of the uterus refers to the angle with which the body of the uterus meets
the cervix. The normal position is titled anteriorly or anteflexed.
The structure in broad ligament of the uterus: uterine tube, ovary, proper ligament of ovary,
round ligament of uterus, blood vessels，lymphatics and connective tissue.
IV）The Vagina
1. Position Anteriorly the bladder urethra
Posteriorly the rectum, anal canal
2. Features The upper end of vagina----fornix
The posterior of fornix----posterior fornis
Special notes The wall of the posterior fornix is only thin wall part of vagina and layer of
peritoneum, which is between the fornix and rectouterine pouch, the drainage may be performed
through the posterior fornix.
II. The External Reproductive Organs
1. Mons pubis----fat pad
2. Labia majora
3. Labia minora
4. Anterior commissure
5. Posterior commissure
6. Clitoris
7. Vaginal orifice
8. Hymen
9. External urethral meatus
10. Vaginal vestibule
11. Greater vestibuler gland
Ⅳ. The Mamma in Female
1. The location
①Vertically the anterolateral of thorax,3rd-7th ribs
②Transversely from the parastrnal line to the midaxillary line
③The nipple is on the centre of the mamma and commonly lies at the level of the 4th
intercostals space.
2. The features In the young adult female
①Each mamma forms a round eminence lying within the superficial fascia
②The nipple is on the centre of the mamma, which has orifices of 15—20 lactiferous ducts.
③The base of the nipple is encircled by a pigment area of the skin called the areola of
mamma.
3. The structures
①Mammary gland and adipose tissue
②Each mammary gland--15-20 lobes→excretery ducts→lactiferous ducts→lactiferous
sinus→opens on the nipple.
③The Cooper ligament.
V. The Perineum
The perineum is the diamond-shaped region of the outlet of the pelvis, which include all soft
tissue between the symphysis pubs and the coccyx.
The perineum may be divided into the anterior urogenital triangle and the posterior anal
triangle.
In the clinic the perineum is the soft tissue between the anus and external genital organs.
And in the female the region between the vagina and anus is known as the obstetrical
perineum.
The pelvic diaphragm: the levator ani; coccygeal muscle; and superior and inferior fasciae of
the pelvic diaphragm.
Chapter 7 The Peritoneum
I.The Concept
1. The peritoneum is the serous membrane in the abdominal cavity and partly also in THD
pelvic cavity, which lies on the surfaces of the visceral organs and the wall of the abdominal and
pelvic cavity.
2. The parietal peritoneum lies on the walls of the abdominal and pelvic cavity.
3. The Visceral peritoneum lies the surface of the visceral organs.
4. The peritoneal cavity: The parietal and visceral layers of the peritoneum are in actual
contact continued .The potential space between them is the peritoneal cavity.
5. The communications in the male, the peritoneal cavity is closed. In the female, it
communicates with the external indirectely through the uterine tubes, uterus, and vagina.
Ⅱ. The Relationship between Viscera and Peritoneum
1. The intraperitoneal viscera
2. The interperitoneal viscera
3. The retroperitoneal viscera such as kidney, ureters, supernal gland , pancreas , middle part
of the rectum , the descending and inferior parts of the duodenum.
Ⅲ. The Peritoneal Reflections: The lesser omentum and the greater omentum.
1. The lesser omentum extends from the liver to the stomach and the duodenum, which
include the hepatogastric ligament and hepatoduodenal ligament.
2. The epiploic foramen lies the posterior to the free margin of the hepatoduodenal ligament.
It is only a passage from the epiploic bursa to the peritoneal cavity.
3. The greater omentum is the largest peritoneal fold. It is made up of four layers which
extend between the stomach, duodenum and the transverse colon.
4. The gastrocolic ligament extends between the stomach and the transverse colon.
5. Omental barsa is a flattened narrow space behind the lesser omentum and the stomach.
IV.The mesenteries it is usually double layers fold of the peritoneum, which fix the organs,
such as jejunum, ilium, to the posterior abdominal wall.
1. The mesenterium the root of mesentery is attached to the posterior wall of the abdomen,
which is directly obliquely downwards from the duodenojejunal flexure to the upper part of the
right sacro-iliac joint.
2. The mesoappendix
3. The mesocolon transversum
4. The mesocolon sigmoideum
V.The Ligaments
1. The ligaments of the liver
①Falciform ligament
②Coronary ligament
③Right and left triangular ligament
④Round ligament of the liver
⑤lesser omentum
hepatogastric lig
hepatoduodenal lig.
2. The ligaments of the stomach
①Gastrohepatic ligament.
②Gastrosplenic ligament
③Gastrocolic ligament
④Gastrophrenic ligament
3. The ligaments of the spleen
①Gastrosplenic ligament
②Lienorenal ligament
③Lienophrenic ligament
4. The structures in the hepatoduodenal lig.
①Hepatic proper artery
②Portal vein
③Bile duct
④Lymph vessels and nodes
⑤Hepatic plexus of nerves
VI.The Pouches and Recesses
1. The pouches in the lesser pelvis, the peritoneum drips downwards to from the large fossa
termed the pouch. In the male, the rectovesical pouch lies between the rectum and urinary bladder.
In the female, the rectouterine pouch is located between the rectum and the uterine, and the
vesicouterine pouch is formed between the anteroinferior surface of the uterus and the posterior
surface of the urinary bladder.
2. The Recesses: Duodenojejunal recesses, retrocaecal recesses, and the intersigmoid recess.
(Liu zhi-yu）
PART Ⅲ
ANGIOLOGY
Angiology comprises the cardiovascular system and the lymphatic system.
Chapter 1 The Cardiovascular System
Section 1 Introduction
Ⅰ. Composition
Ⅰ）Heart: a pump to maintain the flow of blood
Ⅱ）Arteries: carrying blood away from the heart to various body tissues
Ⅲ）Veins: carrying blood from capillary networks back to the heart.
Ⅳ）Capillaries: simply thin endothelial tubes with an enclosed basement membrane
(exchange vessels)
Ⅱ. The Cardiovascular Circuits
Ⅰ）Systems or Greater Circulation
Left ventricle→aorta and its branches→capillaries of the body (air and material exchange)
→venules→veins→superior and inferior vena cava→right atrium.
Ⅱ）Pulmonary or Lesser Circulation
Right ventricle→pulmonary trunk and its branches→capillaries of the lung (air exchange)→
pulmonary veins→left atrium.
Section 2 The Heart
Ⅰ. Position of the heart
Ⅰ）It lies in the middle mediastinum within the thoracic cavity, and is enclosed by the
pericardium.
Ⅱ）It is anterior to the thoracic vertebra 5 to 8, and posterior to the sternal body and costal
cartilage 2 to 6.
Ⅲ）Two-thirds of it lies on the left of the median line and one-third on the right.
Ⅱ. External Morphology of the Heart
The heart is a hollow, mascular organ of a somewhat conical form and has an apex, a base,
two surfaces, three borders, and three grooves.
Base: faces backwards, upwards and to the right. It is formed mainly by the left atrium, and,
to a small extent, by the right atrium.
Apex: formed by the left ventricle, is directed downwards, forwards, and to the left, It is
situated in the 5th left intercostals space, 1-2cm medical to the left mid-clavicular plane (apex beat
place).
Sternocostal surface (anterior surface): faces forwards and upwards, are formed mainly by
the right atrium and the right ventricle, and a lesser portion of its left is formed by the left auricle
and the left ventricle.
Diaphragmatic surface (inferior surface): is directed downwards and backwards, is formed
by the left ventricle and the right ventricle.
Right border: formed by the right atrium.
Left border: formed chiefly by the left ventricle, and by the left auricle.
Inferior border: formed by the right ventricle and cardiac apex, is nearly horizontal.
Coronary groove: it separats the atria from the ventricle.
Anterior interventricular groove: on the sternocostal surface.
Posterior interventricular groove: on the diaphragmatic surface. The anterior and posterior
interventricular grooves mark the line of separation between the ventricles, and intersect at apical
cardiac notch. Atrioventricular crux is the intersecting point between the coronary groove and
the posterior interventricular groove.
Ⅲ. Internal Morphology of the Heart (Cavities of the Heart)
Ⅰ）Right Atrium
1. Two portions:
Proper atrium (anterior portion)
divided by terminal sulcus
Sinus of vena cava (posterior portion)
2. Three inlets:
Orifice of the superior vena cava
Orifice of the inferior vena cava
(Valve of the inferior vena cava)
Orifice of the coronary sinus
(Valve of the coronary sinus)
3. One outlet:
Right atrioventricular orifice
4. Right auricle is a triangular process towards the left. Terminal crest is a longitudinal
muscular ridge and opposite to terminal sulcus. Pectinate muscles are formed by many parallel
muscular ridges.
5. Interatrial septum: oval fossa is on its lower part.
Ⅱ）Right Ventricle
It can be separated into two parts, inflowing tract and outflowing tract, by the
supraventricular crest.
1. Inflowing tract:
1) One inlet: right atrioventricular orifice (tricuspid valve).
2) Tricuspid valve (anterior, posterior and septal) →chordae tendineae→papillary m.
3) Trabeculae carneae: Septomarginal trabecula is a muscular band which extends from
the ventricilar septum septum to the base of the anterior papillary m.
2. Outflowing tract:
1) One outlet:
Pulmonary orifice (pulmonary valve: three semilunar valve, nodules of the semilunar
valve)
2) Outflowing tract→arterial cone→pulmonary orifice→pulmonary trunk.
Ⅲ）Left Atrium
1. Four inlets: The opening of the right and left pulmonary veins.
2. One outlets: Left atrioventricular orifice.
3. Left auricle: projecting forwards.
Ⅳ）Left Ventricle
It can be separated into two parts, inflowing tract and outflowing tract, by the anterior cusp
of mitral valve.
1. Inflowing tract:
1) One inlet: left atrioventricular orifice (mitral valve)
2) Mitral valve(anterior and posterior) →tendinous cord→papillary m.
2. Outflowing tract:
1) One outlet: aortic orifice (aortic valve)
2) Outflowing tract: aortic vestibule→aortic orifice→aorta
3) Aortic sinuses: are three slight dilatations (right, left and posterior) between aortic cusps
and aortic wall, from two of which the coronary arteries arise.
Ⅳ. Structure of the Heart
Ⅰ）Cardiac wall: comprises three layers, named from within outwards endocardium,
myocardium and epicardium.
Ⅱ）Intreratial Septum and Interventricular Septum
1. Interatrial septum: slops obliquely, and divides the left and right atrium.
2. Interventricular septum: is placed obliquely.
muscular part: a greater portion
membranous part: a lesser portion
3. The skeleton of the heart (or the support framework of fibrous tissue of the heart); is
composed of fibrous rings and fibrous trigones (left and right).
Ⅴ.The Conducting system of the Heart
Ⅰ）Function
1. Initiating and conducting electrical impulse.
2. Maintaining the normal cardiac rhythm.
3. Ensuring the proper coordination of the atrial and ventricular contractions.
Ⅱ）Composition
1. Sinonatrial node(SA node)
It initiates each cardiac cycle. It is situated at the junction between the right atrium and the
superior vena cava. It is covered only with the epicardium and commonly called the pacemaker.
2. Atrioventricular node (AV node)
It passes sinoatrial impulse towards the ventricles, and it lies on the right side and lower part
of the interatrial septum , under the endocardium, just anterosuperior to the orifice of coronary
sinus.
3. Atrioventricular bundle (His bundle)
From atrioventricular node, it extends through the right fibrous trigone to the posterior
margin of membranous part of the interventricular septum, and then turns forwards, at the superior
margin of the muscular part, it divides into the right and left limbs.
4. Right and left limbs
They passes towards the apex immediately beneath the endocardium of each surface of the
interventricular septum respectively. The left limb consists of two main strands, an anterior and a
posterior.
5. Purkinje fibres
The limbs ramify a number of branches, the terminal conducting fibres or Purkinje fibres are
continuous with the cardiac muscle fibres.
Ⅵ. The Vessels of the Heart
Ⅰ）Arteries
1. Right coronary artery.
It arises from the right aortic sinus, and passes between the root of the pulmonary trunk and
the right auricle to the coronary groove. Following the sulcus, it runs to the diaphragmatic surface.
At the atrioventricular crux, it divides into two branches---posterior interventricular branch and
posterior branch of left ventricle.
The right coronary artery supplies the right atrium, right ventricle, posterior 1/3 of the
interventricular septum, posterior wall of the left ventricle, the sinoatrial node and the
atrioventricular node.
2. Left coronary.
It arises from the left aortic sinus, and passes forwards between the root of the pulmonary
trunk and the left auricle to reach coronary groove, where it gives off the following branches.
1) Anterior interventricular branch
It descends along the anterior interentricular groove, and supplies anterior wall of the left
ventricle, lesser portion of the anterior wall of the right ventricle, and anterior 2/3 of the
interventricular septum.
2) Circumflex branch
It passes to the left in the coronary groove and supplies to the diaphragmatic surface of the
left ventricle and the wall of the left atrium.
Ⅱ）Veins
1. Smallest cardiac veins: end directly into the cardiac cavities.
2. Anterior cardiac veins: open directly into the right atrium.
3. Coronary sinus
It situated in the posterior part of coronary sulcus between the left atrium and left ventricle,
and opens into right atrium. Its tributaries are:
1) Great cardiac vein
2) Middle cardiac vein
3) Small cardiac vein
Ⅶ. Pericardium
It comprises two sacs, named the fibrous pericardium and serous pericardium.
Ⅰ）Fibrous pericardium
It is continuous with the external coats of the great vessels, while its base is attached to the
central tendon of the diaphragm.
Ⅱ）Serous Pericardium
It consists of a visceral layer covering the heart and a parietal layer lining the fibrous
pericardium. Between two layers, the potential space called pericardial cavity exists.
1. Transverse sinus: lies behind the commencement of the aorta and pulmonary, in front of
superior vena cava and left atrium.
2. Oblique sinus: lies between the posterior wall of the left atrium, left and right pulmonary
veins, inferior vena cava and posterior wall of the pericardium.
Section 3 The Arteries
Ⅰ. Arteries of Pulmonary Circulation
Ⅰ）Pulmonary Trunk
It arises from the right ventricle, at first in front of the ascending aorta, and turns upwards,
backwards and to its left side. In the concavity of the aortic arch, it divides into right and left
pulmonary arteries.
Ⅱ）Pulmonary Arteries
The right pulmonary artery is slightly longer and larger than the left pulmonary artery.
They run horizontally to the hilus of the right and left lung respectively.
Ⅲ）Arterial Ligament
It is a fibrous cord connecting the beginning of the left pulmonary artery with the concavity
of the aortic arch.
Ⅱ. Arterial of Systemic Circulation
ascending aorta
Aorta--------------------------------------------------------------------------the right second sternocostal
(passing to right, and left arise from upwards ventricle forwards)
aortic arch
thoracic aorta
Joint---------------------------------------the left side of T4 vertebra--------------------------------------
(arching to the left and backwards)
(descending along vertebral column)
Abdominal aorta
At anterior to T12 vertebra-----------------------------------------------------at the lower border of L4
(passing through the aortic hiatus
of diaphragm into abdominal cavity)
left common iliac artery
Vertebra----
right common iliac artery
Ⅰ）Ascending Aorta: it arises from the left ventricle at the level of the 3rd intercostals space
and behind the left margin of sternum, to reach the 2nd right sternocostal joint. It send out to
branches called right and left coronary arteries.
Ⅱ）Aortic Arch: it is from the 2nd right sternocostal joint to the inferior border of T4 vertebra.
From right and left, three branches are given off from the convex aspect of aortic
arch---brachiocephalic truck, the left common carotid artery and the left subclavian artery.
The brachiocephalic trunk divides into the right common carotid and right subclavian
arteries at the level of the right sternoclavian joint.
1. Common carotid artery
The left one springs from the aortic arch, while the right one arises from the brachiocephalic
trunk. Each passes upwards behind the sternoclavicular joint, then along the lateral to the trachea
and esophagus, at the level of the upper border of the thyroid cartilage, it divides into the external
and internal carotid arteries.
Carotid sinus: is a dilatation of the terminal part of the common carotid artery and the
beginning part of the internal carotid artery. It acts as a pressure-receptor for regulating arterial
blood pressure.
Carotid glomus: is behind the point of division of the common carotid artery. It acts as a
chemoreceptor for regulating the oxygen-carbon dioxide ratio.
1) External carotid artery: Its main branches are as follows:
①Superior thyroid artery→supplying the upper part of thyroid gkand and larynx.
②Lingual artery→supplying tongue, palatine tonsil and sublingual gland.
③Facial artery→supplying submandibular gland, the structures of face, and palatine tonsil.
④Superficial temporal artery→supplying the soft tissue of frontal, temporal and parietal
regions, parotid gland, orbicular muscle of eye.
⑤Maxillary artery→supplying external auditory canal, middle ear, meninges, cheek,
palatine tonsil, lower and upper teeth and gums, muscles of mastication, nasal cavity, and palate.
2) Internal carotid artery: It ascends to the base of skull and enters the cranial cavity
without giving off branches in the neck. This is the major artery to the brain and orbital structures.
2. Subclavian artery
The left one springs from aortic arch; the right, from brachiocephalic trunk. At the outer border of
the first rib, it becomes the axillary artery. Its important branches are as following.
1) Vertebral artery→supplying the brain and spinal cord.
2) Internal thoracic artery→supplying anterior thoracic wall, pericardium, diaphragm, and
upper abdominal wall.
3) Thyrocervical trunk→Its one important branches is inferior thyroid artery, which
supplies thyroid gland.
3. The arteries of upper limb
Outer border of the first rib
thoracoacromial a.
axillary a.
lower border of teres major m.
branchial a.
the neck of radial bone
lateral thoracic a.
subscapular a.
thoracodorsal a.
circumflex scapular a.
posterior circumflex humeral a.
----------profound brachial a.
principal a. of thumb
------radial a.
-----ulnar a.
superficial palmar branch
terminal branch
deep palmar arch
common interosseous a. superficial
deep palmar branch
palmar arch
terminal branch
Ⅲ）Toracic Aorta
It descends from the lower border of T4 vertebra to the lower border of T12 vertebra, where
it passes though the aortic hiatus of the diaphragm and becomes the abdominal aorta. Its branches
are:
posterior intercostals a.(9 pairs)
parietal branches
visceral branches
-to 3-11 intercostal space and upper part of abdominal wall
subcostal a.-abdominal wall.
bronchial a.
esophageal a.
pericardial a.
Ⅳ）Abdominal Aorta
It continuous with thoracic aortic hiatus of the diaphragm and ends in fronts of L4 vertebra
by dividing into the left and right common illac a. The branches are as following:
inferior phrenic a.
Parietal branches
lumbar a.
middle suprarenal a.
paired renal a.
testicular a.(ovarian a.)
visceral branches
celiac trunk
single superior mesenteric a.
inferior mesenteric a.
1. Celiac trunk
It is a short trunk just below the aortic hiatus of the diaphragm or approximately at the level of t12
vertenra.
Left gastric a.
esophageal branchabdominal part of esophagus.
gastriccardiac orifice and
lesser curvature of stomach.
anastomosing
proper hepatic a.
common
hepatic a.
Ganstroduodenal a.
right gastic a. lesser curvature
of stomach.
left hepatc a.
right hepatic a.
custic a. gallbladder
superior pancreaticoduodenal a.
pancreas, duodenum.
right gastroepiploic a.
greater curvature
Of stomach, greater omentum.
Anastomosing
Left gastroepiploic a.
greater curvature of stomach, greater omentum.
splenic a.
short gastric a. fundus of stomach
pancreatic branchbody of and tail of pancreas
splenic branchspleen
2. Superior mesenteric a.
It is about at the level of L1 vertebra, and passes obliquely between the head of pancreas and
the horizontal part of duodenum, and enters the root of the mesentery to reach the right iliac fossa.
jejunal and ileal a. jejunum and ileum.
to ascending colon, cecum, terminal part of ileum
ileocolic a.
appendicular a. appendix.
right colic a. ascending colon
middle colic a. transverse colon
3. Inferior mesenteric a.
It is opposite L3 vertebra, passes downwards and to the left to reach the left iliac fossa, then
terminates as superior rectal a.
left colic a. descending colon
sigmoid a. sigmoid colon
superior rectal a. rectum
Ⅴ）Common Iliac Arterty
The common of iliac artery diverge from the abdominal aorta opposite L4 vertebra. Each
artery passes downwards and laterally, and ends at the level of the sacroiliac joint by dividing the
external and internal iliac arteries.
1. Internal iliac artery
obturator a. adductor m. and hip joint
parietal branches
superior gluteal a.
gluteal m. and hip joint
inferior gluteal a.
umbilical a. superior vesical a.--urinary bladder
inferior vesicle a.urinary bladder, prostate, seminal, vesicle, vagina
visceral branches inferior rectal a. rectum
uterine a. uterus, uterine tube, ovary and vagina
internal pudendal a. anal region perineum and external genital
organs.
Relation between uterine a. and ureter: The uterine a. runs downwards along the lateral
wall of pelvis, and turns medially in the broad lig. Towards the cervix of uterus, about 2 cm from
the cervix it crosses above and in front of the ureter.
2. External iliac artery
Each runs downwards along the medial border of psoas major m. and enters the thigh behind
the inguinal ligament to become the femoral artery. One branches of it is called interior
epigastric a. which anastomoses with superior epigastric a. behind rectal abdominal m. cends
vertically to end the right atrium at the level of the 3th right sternocostal joint.
3.The arteries of lower limb
behind midpoint
lateral circumflex femoral a.
of inguinal lig.
adductor hiatus
lower border of
popliteal m.
femoral a. deep femoral a.
↓
articulating
popliteal a.
branch
muscular branch
m. of thigh and knee joint
medial circumflex femoral a.
m. of thigh and hip joint
perforating a. m. of thigh
femur
-posterior tibial a. peroneal a. m. of leg, tibia and fibula
-anterior tibial a. dorsal pedal a.
Section 4 The Veins
ⅠVeins of Pulmonary Circulation
Pulmonary veins are four in number, two from each lung, a superior an an inferior. They
return the oxygenated blood from the lungs to the left atrium of the heart.
Ⅱ. Veins of Systemic Circulation
They may be arranged into three groups.
superior vena cava system
inferior vena cava system(portal venous system)
cardiac venous system
Ⅰ）Superior Vena Cava System
The system is composed by the superior vena cava and its tributaries which collect the blood
from the head and neck, the upper limb, the wall and some organs of the thorax, and the upper part
of abdominal wall.
1. Superior vena cava
It is formed by the junction of right and left brachiocephalic veins just behind the first right
costal cartilage close to the sternum, and des 缺
2. Brachiocephalic (lnnominate) veins
It is formed, behind the sternoclavicular joint, by the union of the internal jugular and
subclavian veins of its side. The angle of the union is termed the venous angle.
1) Internal jugular vein
It originates from the jugular foramen, and unites with the subclavian vein to form the
brachiocephalic vein. The chief extracranial tributaries are:
① Facial vein
②Retromandibular vein
ophthalmic v. facial v.
↑
↓
cavernous sinus
↑
internal jugular v.
↓
pterygoid plexus
↓
anterior
maxillary v.
retromandibular v. branch
superficial temporal v.
posterior branch
posterior
external
subclavian v.
auricular v.
occipital v.
jugular v. or venous
angle
2) Subclavian vein
It begins at the out border of the first rib and ends behind the sternoclavicular joint.
External jugular v. is the major tributary of subclavian v. and passes downwards and
backwards on the surface of the sternocleidomastiod m. to end in the subclavian v.
3) The vein of the upper limb
They are divided into two sets, superficial and deep, and rich in valves.
① The superficial veins
Dorsal digital v. dorsal metacarpal v. dorsal venous network:
The radial part of dorsal venous networkcephalic v. the front of radial side of forearm,
and elbowouter border of biceps m. goove between deltoid and pectoralis major m. pierces
deep fasciaaxillary v.(or subclavian v.)
The ulnar part of dorsal venous networksbasilic v. the ulnar side of forearmmedial to
biceps m. a little below midpoint of armperforates deep fasciabrachial v.(or axillary v.)
Median cubital v. lying on the cubital fossa, running obliquely between the cephalic and
basilica v.
②The deep veins
With the exception of the axillary vein, they are generally arranged in pairs, flanking the
corresponding arteries.
3. Azygos vein
It begins as the continuation of right ascending lumbar vein. It ascends along the right side
of the thoracic vertebra to the level of T4 vertebra, where it arches forwards over the root of the
right lung to end in the superior vena cava.
It receives the blood from posterior intercostals v. of the right side, esophageal v. bronchial v.
hemiazygos v.
Ⅱ）Inferior Vena Cava System
The system is composed by the inferior vena cava and its tributaries, which collect the blood
from the abdominal and pelvic part, as well as the lower limbs.
1. Inferior vena cava
It is formed by the junction of the two common iliac veins anterior to L5vertebra, a little to the
right. It ascends on the right side of abdominal aorta, passes in the groove for inferior vena cava of
liver, through the vena caval opening of the diaphragm, to reach the thoracic cavity and open into
the right atrium.
2. Common iliac vein
It is formed by the union of the external and internal iliac veins in front of the sacroiliac joint, and
by uniting with opposite one to form the inferior vena cava at the level of L5 vertebra.
1) Internal iliac vein
The tributaries of the internal iliac vein can be divided into two sets.
parietal tributaries
inferior rectal v.
visceral tributaries interior
pudendal v.
uterine v.
2) External iliac vein
It is the upward continuation of the femoral vein, begins behind the inguinal ligament.
3) The veins of the lower limb
They can be subdivided into two sets, superficial and deep, like those of the upper limb. Both
sets are provided with valves.
① The superficial veins
Dorsal digital v. dorsal metatarsal v. dorsal venous arch
Lateral margin of dorsal venous archsmall saphenous v. behind the lateral
malleolusthe midline of the back of legbetween the two heads of gastrocnemius m.
popliteal fossaperforates the deep fasciapopliteal v.
Medial margin of dorsal venous archgreat saphenous v. in front of the medial
malleolushe medical side of leg and knee jointbehind the medial condyle of femurthe
medial side of thighsaphenous opening(at about 3-4 cm inferolateral to the pubic tubercle)
perforating deep fasciafemoral v.
The five tributaries of great saphenous v. are as following:
superficial lateral femoral v.
superficial medial femoral v.
external pudendal v.
superficial epigastric v.
superficial circumflex iliac v.
② The deep veins of the lower limb
They accompany the arteries and their branches, and are similarly named.
3. The tributaries of the inferior vena cava
They are also divided into parietal and visceral.
Parietal
tributaries
inferior phrenic v.
right
lumbar v. (4 pairs) 
ascending lumbar v
left
visceral
tributaries
testicular v.
lefteft renal v.
(ovarian v.)
rightinferior vena cava
renal v.
leftleft renal v.
suprarenal v.
rightinferior vena cava
hepatic v. : right, middle, left
4. Portal vein
It is formed by the junction of the superior mesenteric and splenic veins, behind the beck of
the pancreas.
It passes upwards and to the right to enter hepatoduodenal ligament, behind the common bile
duct and proper hepatic artery to reach the porta of liver, where it divides right and left branches to
enter the liver. In the liver this vein ramifies like an artery and ends in capillary-like vessels
termed sinusoids.
It collects the blood from abdominal part of esophagus, stomach, small intestine, large
intestine9with the exception of the lower part of the anal canal), and from pancreas, gallbladder,
spleen.
1) The major tributaries of the portal vein
superior mesenteric v.
portal v.
splenic v.
superior mesenteric v.
inferior mesenteric v. 
splenic v.
left gastric v.
right gastric v.
portal v.
cystic v.
paraumbilical v.
2) The anastomoses between the portal venous system and the vena caval system
They may collectively offer an effective collateral circulation in case of obstruction of the
portal vein.
①Esophageal venous plexus: at the junction of the esophagus and stomach.
Portal v. left gastric v. esophageal venous plexusesophageal v. azygos v. superior
vena cava.
②Rectal venous plexus: at the ano-rectal junction
Portal v. splenic v. inferior mesenteric v. superior rectal v. rectal venous
plexusinferior rectal and anal v. internal iliac v. common iliac v. inferior vena cava.
③Periumbilical venous network: at the umbilicus.
Portal v. paraumbilical v. periumbilibal venous networkssuperficial epigastric v.
great saphenous v. femoral v. external iliac v. common iliac v. inferior vena cava.
thoracoepigastric v. lateral thoracic v. xillary v. subclavian v. brachiocephalic v.
superior vena cava.
superior epigastric v. nternal thoracic v. brachiocephalic v. superior vena cava.
inferior epigastric v. external iliac v. common iliac v. inferior vena cava.
④At the posterior abdominal wall: the small tributaries of the inferior and superior
mesenteric v. anastomoses with the tributaries of the vena cava, such as the lower posterior
intercostals v. inferior phrenic v. lumbar v. renal v. testicular9ovarian) v.
Chapter 2 The Lymphatic System
Section 1 Introduction
Ⅰ. Composition
lymphatic vessels
lymphatic organs
lymphatic tissue
lymph capillaries
lymph vessels
lymphatic trunk
lymphatic duct
lymph node
spleen
thymus
tonsil and lymph nodules
in alimentary canal and
respiratory tract.
Ⅱ. Charactor
Ⅰ）Lymphatic vessel
1. Lymph capillaries
They are present in almost all tissues of the body but the brain, spinal cord, epidermis, cornea,
lens, enamel, cartilages, et al.
2. Lymph vessels
They are rich in valves which give them a characteristic beaded appearance, and arranged in
superficial and deep sets.
3. Lymphatic trunks
The lymph vessels unite one another to form nine lymphatic trunks, they are: right and left
jugular trunks
right and left subclavian trunks
right and left bronchomediastinal trunks
right and left lumbar trunks
intestinal trunks
4. Lymphatic ducts
The right lymphatic duct and thoracic duct are formed by nine lymphtic trunks
respectively.
Ⅱ） Lymphatic organs
Lymph nodes are small, oval bodies, situated in the course of lymph vessels so that the lymph
passes through them on its way to blood.
The afferent lymph vessels enter the nodes on its convex surface.
The efferent lymph vessels leave the nodes on its concave surface called the hilus.
Lymph from some organ or area of the body is drained into the local corresponding lymph
nodes, which are termed termed regional lymph nodes for this organ or area.
Ⅲ）Lymphatic tissue
They are widespread in the wall of the alimentary canal and respiratory tract, and can be
called subepithelial lymphatic tissue.
Section 2 The Lymphatic Ducts of the Body
Ⅰ. Thoracic Duct
Right and left lumbar trunks
anterior to
-----------------------------------chyle cistern--------------L1 vertebra
Intestinal trunk
Aortic hiatus of diaphragmthoracic cavityright and anterior to
T5
thoracic inlet
vertebral column --------------inclining to the left-----------------root of
vertebral
left subclavian trunk
neck-----------------------------------left venous angle
left bronchomediastinal trunk
left jugular trunk
The thoracic duct receives lymph from the lower limbs, the abdominopelvic part(wall and
viscera), left lung, left half of the heart, left half of thoracic wall, left upper limb, and left half of
the head and neck.
Ⅱ. Right Lymphatic Duct
right subclavian trunk
right jugular trunk right
venous angle
right bronchomediastinal trunk
The right lymphatic duct receives lymph from right upper limb, right half of the head and
neck, right lung, right half of the heart, right half of thoracic wall, superior surface of right lobe of
liver, and part of diaphragm.
Section 3 The Lymph Vessels and Nodes of the Body
Ⅰ. The Lymph vessels and Nodes of the Head Neck
Ⅰ） Lymph Nodes of the Head
They lie at the junction between the head and neck, and are arranged in a circle from posterior
to anterior, which are occipital, mastoid, parotid, submandibular, submental lymph nodes.
Submandibular lymph nodes: lie in the submandibular triangle or near submandibular
gland, receive the lymph vessels from the face and mouth; their efferents pass to lateral cervical
lymph nodes.
Ⅱ） Lymph Nodes of the Neck
They include anterior and lateral cervical lymph nodes, the latter comprises two groups.
1. Superficial lateral cervical lymph nodes
They are placed along the external jugular vein superficial to sternocleidomastoid m. they
receive lymph vessels from the neck and mastoid lymph nodes, and their efferents reach the deep
lateral cervical lymph nodes.
2. Deep lateral cervical lymph nodes
They lie along the internal jugular vein from the base of the skull to the root of the neck.
upper group: retropharyngeal lymph nodes
behind the nasopharynx.
lower group: supraclavicular lymph nodes
along subclavian a. and branchial plexus.
They receive the lymph vessels from the head and neck, the tongue, larynx, cervical part of
esophagus and trachea, thyroid gland, upper part of thoracic wall and breast; their efferents form
the jugular trunk.
Ⅱ. The Lymph Vessels and Nodes of the Upper Limb
Ⅰ）Cubital (Supratrochlear) Lymph Nodes
Which are superficial to deep fascia above the medial epicondyle of the humerus.
Ⅱ）Axillary Lymph Nodes
They lie in the axillary fossa, and may be divided into five groups.
1. Lateral lymph nodes: arranged along the axillary vessels, and receive the superficial and
deep lymph vessels of the upper limbs.
2. Pectoral lymph nodes: lie along the lateral thoracic vessels, and receive the lymph vessels
from anterolateral wall of thorax and abdomen, the lateral and central part of mammary gland.
3. Subscapular lymph nodes: lie on the posterior wall of axillary cavity and follow the
subscapular vessels. They receive lymph vessels from the back of neck and the dorsal aspect of
trunk (or neip).
4. Central lymph nodes: embedded in the fat of central part of axilla, and receive efferents
from all the preceding axillary lymph nodes.
5. Apical lymph nodes: lie along the proximal side of the axillary vein, and receive lymph
vessels from central lymph nodes and the upper part of breast. Their efferents unite to form the
subclavian trunk.
Ⅲ. The Lymph Vessels and Nodes of the Thorax
parasternal lymph nodes
lymph nodes of thoracic wall intercostals lymph nodes
supraphrenic lymph nodes
lymph nodes of thoracic
anterior mediastinal lymph nodes
viscera
posterior mediastinal lymph nodes
tracheobronchial lymph nodes
bronchopulmonary lymph nodes
Ⅰ）Anterior Mediastinal Lymph Nodes
They are placed anterior to the large vessels of thoracic cavity and pericardium, and drained
into the bronchomediastinal trunk.
Ⅱ）Posterior Mediastinal Lymph Nodes
They are in front of the esophagus and thoracic aorta, and drained into the thoracic duct.
Ⅲ）Bronchopulmonary and Tracheobronchial Lymph Nodes
pulmonary lymph nodes: along branches of bronchus and pulmonary a. receiving lymph
↓
vessels of lung.
bronchopulmonary lymph nodes: in the hilus of each lung.
↓
tracheobronchial lymph nodes: around the bifurcation of trachea, draining
(superior and interior)
the lungs, bronchi, trachea, and heart.
↓
paratracheal lymph nodes: at the side of trachea.
(right and left)
↓anterior mediastinal lymph nodes
bronchomediastinal trunk
(right and left)
Ⅳ. The Lymph Vessels and Nodes of the Abdomen
Ⅰ）The Lymph Vessels and Nodes of the Abdominal Wall
Lumbar lymph nodes: lie along around the abdominal aorta and interior vena cava. They
receive lymph vessels from the posterior abdominal wall, the abdominal paired viscera (kidney,
suprarenal gland, ovary, testis, epididymis) and from the common iliac lymph nodes. Their
efferents unite to form the right and left lumber trunks.
Ⅱ）The Lymph Vessels and Nodes of Abdominal Unpaired Viscera
They are dividable into celiac, superior mesenteric and inferior mesenteric lymph nodes,
which lie around the origin of the corresponding artery. They receive the lymph vessels from the
region which are supplied by the corresponding artery, their efferents unite to form intestinal
trunk.
1. Celiac lymph nodes
They are the terminal group for the stomach, duodenum, liver, gallbladder, pancreas and
spleen, and their afferents are derived from the outlying lymph nodes which are placed along
branches of the celiac artery.
right and left gastric lymph nodes
right and left gastroepiploic lymph nodes
pyloric lymph nodes
hepatic lymph nodes
pancreaticosplenic lymph nodes
2. Superior mesenteric lymph nodes
They receive efferents from the following lymph nodes.
mesenteric lymph nodes
ileocolic lymph nodes
right colic lymph nodes
middle colic lymph nodes
3. Inferior mesenteric lymph nodes
They collect the lymph from the underlying lymph nodes.
left colic lymph nodes
sigmoid colic lymph nodes
superior rectal lymph nodes
Ⅴ. The Lymph Vessels and Nodes of the Pelvis
They consist of three groups: external iliac lymph nodes, internal iliac lymph nodes and
sacral lymph nodes, which collect the lymph from pelvic wall, viscera of pelvic cavity, and lower
limbs. Their efferents pass to the common iliac lymph nodes, which are drained into right and
left lumber lymph nodes.
Ⅵ. The Lymph Vessels and Nodes of the Lower Limb
Ⅰ）Popliteal Lymph Nodes
They are imbedded in the fat of the popliteal fossa, and drained into deep inguinal lymph
nodes.
Ⅱ）Superficial inguinal Lymph Nodes
They lie superficial to deep fascia, below the inguinal ligament, and along the terminal part
of the great saphenous vein.
They receive the superficial lymph vessels from the lower part of anterior abdominal wall,
gluteal region, perineum,, external genital organs, the lower limbs except lateral side of the foot
and posterolateral part of the leg. They send their efferents chiefly to deep inguinal lymph nodes.
Ⅲ）Deep Inguinal Lymph Nodes
They lie around terminal part of the femoral vein, receive efferents from the superficial
inguinal lymph nodes and the deep lymph vessels of the lower limbs. Their efferents pass to
external iliac lymph nodes.
Section 4 The Spleen
Ⅰ. Position
It is situated in the left hypochondriac region, deep to the 9th to 11th rib and its long axis is in
line of the 10th rib. It is not palpable below the left costal margin (arch).
Ⅱ. Shape
two surface
diaphragmatic---convex
visceral---concave, hilus of spleen
two borders
superior---sharper, splenic notch(2-3)
inferior---blunter
two extremities anterior
posterior
Section 5 The Thymus
The thymus consists of two elongated lobes closely bounded by fibrous tissue. Its greater
portion lies in the front of superior mediastinum of thoracic cavity, and lesser portion extends
inferiorly into anterior mediastinum or superiorly into the neck.
PART IV THE SENSE ORGANS
Chapter 1 Introduction
Sense organs are referred to the special receptors of the body, their structures consist of
receptor and accessory apparatus, such as visual, auditory and vestibular apparatus.
Receptors are the simple structures which receive the stimulation from the external or
internal environment of the body. They may be divided into three kinds, viz. exteroceptors,
enteroceptors, proprioceptors, on the bases of the location and the origin of the sense.
Chapter 2 The Visual Apparatus
The visual apparatus receives stimulation of light, and consists of eyeball and accessory
apparatus.
Section 1 The Eyeball
The eyeball is embedded in the fat inside the orbit; spherical in shape.
Anterior and posterior poles are referred to the central points of anterior and posterior
surface of the eyeball, the line jointing the poles is termed the optic axis. An imaginary line
encircling the eyeball, midway between the poles, is the equator. Visual axis joins the centre of
the pupil to the central fovea of the retina, and decussate sharply with optic axis.
cornea
external tunic
sclera
iris
walls middle tunic
ciliary body
choroids
iridial part
eyeball
internal tunic
blind part
(retina)
ciliary part
optic art
aqueous humor
contents
lens
vitreous body
ⅠThe Wall of the Eyeball
It consists of three tunics, viz. external, middle and internal.
Ⅰ）External Tunic(Fibrous Tunic)
1. Cornea: is the anterior 1/6, transparent, and more convex, nonvascular but rich in
numerous sensory nerve terminals.
2. Sclera: is the posterior 5/6, white in colour and opaque, pierced by the optic nerve
posteriorly.
Venous sinus of sclera (Sachem’s canal) is a circular canal deep to the junction between the
cornea and sclera.
Ⅱ）Middle Tunic(Vascular Tunic)
This layer contains numerous blood vessels and pigment cells and is brown in colour.
1. Choroid: is the posterior 2/3, and covers the inner surface of the sclera.
2. Ciliay body: lies at the inner surface of the junction of the cornea and the sclera, and
consists of the ciliary ring, the ciliary processes and the ciliary muscles. The lens is attached to
the inner side of the ciliary processes by the ciliary zonule (suspensory ligaments)
3. Iris: is the most anterior coloured part as a circular perforated disc. Near its centre is a
round aperture. named pupil.
Iris divide the space between the cornea and the lens into two parts, anterior and posterior
chambers. Iridocorneal angle (angle of anterior chamber) is in anterior chamber, at which the
cornea meet with the iris.
Iris contains two sets smooth muscles, sphincter m. of pupil and dilator m. of pupil which
are arranged circularly and radially respectively.
Ⅲ）Internal Tunic (Retina)
It may be divided into the optic part, the ciliary part and iridial part. The latter two part are
known as the blind part, because of lacking light-sensitive elements.
Optic disc is a white, round eminence at which the optic nerve pierces the retina. It is
insensitive to light, and termed the “blind spot”. About 3.5mm to the temporal side of the optic
disc, there is an oval yellowish area, named the macula lutea, it shows a central depression
termed the central fovea, where visual acuity is highest.
Ⅱ. The Contents of the Eyeball.
They include the aqueous humor, the vitreous body, and the lens, which are all transparent
and avascular, with the cornea altogether form the refractive media. Each plays a part in
refracting the light entering the eye.
Ⅰ）Aqueous Humor
It is colourless and transparent water fluid, and fills the chambers of the eye. The circulating
route of aqueous humor is as follows.
Secreted by the ciliary bodyposterior chamberpupilanterior chamberiridocorneal
anglevenous sinus of scleraanterior ciliary v. the veins of eye.
Ⅱ）Lens
It lies between the iris and the vitreous body. It is a transparent and elastic, biconvex body
lacking vessels and nerves.
Suspensory ligament connects the ciliary process to the capsule of the lens which encloses
the lens.
During near visionhe ciliary m.contractsciliary zonule relaxconvexity of lens
increasesindex of refracting increasebringing near objects into sharp focus on retina
Ⅲ）Vitreous Body
It is a transparent, jelly-like substance which fills the space between the lens and the retina.
Section 2 The Accessory Apparatus of the Eyeball
The accessory apparatus of the eyeball includes the eyelid, the conjunctiva, the lacrimal
apparatus, the extraocular muscle and the fasciae, the adipose corpus of orbit, et al.
Ⅰ. Eyelids or Palpebrae
Upper eyelid
medial canthus
palpebral fissure
Lower eyelid
lateral canthus
From outside inwards, each eyelid includes: skin, subcutaneous tissue, orbicularis oculi m.
tarsus and conjunctiva.
Ⅱ. Conjunctiva
It is a thin and transparent mucous membrane.
palpebral conjunctiva
ocular conjunctiva
conjunctival fornices superior conjunctival fornix
inferior conjunctival fornix
Ⅲ. The Lacrimal Apparatus
Ⅰ）Composition and Opening
lacrimal gland-----------------------tears
↓
lacrimal punctum
↓
lacrimal canaliculus
(superior and inferior)
↓
lacrimal passages
lacrimal sac
↓
nasolacrimal duct
↓
lateral wall of inferior nasal meatus.
Ⅱ）Location
1. Lacrimal gland: lies in the lacrimal fossa situated in superolateral portion of orbit.
2. Lacrimal sac: is lodged in the fossa of lacrimal sac situated in the medial wall of the orbit.
Ⅳ. The Extraocular Muscles
Which include the levator palpebral superioris, the four rectus and two oblique muscles.
name
action
superior rectus
inferior rectus
medial rectus
lateral rectus
superior oblique
inferior oblique
superior palpebral levator
nerve supply
turn eye upward, inward
turn eye downward, inward
turn eye inward
turn eye outward
turn eye downward, outward
turn eye upward, outward
elevates upper eyelid
Section 3 The Blood Vessels of the Eye
Ⅰ. The Arteries of the Eye
internal carotid a.
↓
ophthalmic a.
superior nasal a.
↓
inferiorior nasal a.
central retinal a.------- superior temporal a.
inner layer of retina
Ⅲ
Ⅲ
Ⅲ
Ⅵ
Ⅳ
Ⅲ
Ⅲ
inferior temporal a.
Ⅱ. The veins of the Eye
They are two in number, the superior and inferior ophthalmic veins and are devoid of
valves.
Chapter 3 The Auditory and Vestibular Apparatus
The auditory and vestibular apparatus is divided into three parts: the external, middle, and
internal ears. The external and middle ears are a sound collecting and transmitting apparatus. The
internal ear is such an organ that can receive the stimulaton of both sound waves and changes of
the position of the head.
auricle
external ear
external acoustic meatus
tympanic cavity
tympanic cavity
middle ear
auditory tube(pharyngotympanic tube)
mastoid antrum
mastoid air cells
cochlea
osseous labyrinth vestibule
internal ear
bony semicircular canals
cochlear duct
membranous labyrinth
utricle and saccule
membranous semicircular ducts
Section 1 The External Ear
Ⅰ. Auricle: projects from the side 0f the head．Auricular lobule ties below the auricle, and is
composed of fibrous and adipose tissue.
Ⅱ. External Acoustic Meatus: extends from the external acoustic porus to tympanic
membrane.
The lateral l／3 is cartilaginous, and the medial 2／3 is osseous. It is a curved tube．From
outside inwards, first it runs forwards and upwards. then backwards，and finally forwards and
downwards.
In childhood, the external acoustic meatus is shorter and more narrow, the tympanic
membrane is more horizontal.
Section 2 The Middle Ear
This part is between the external and inner ear.
Ⅰ. Tympanic Cavity
It is an irregular air-filled．space within the temporal bone, and contains auditory ossicles
ligaments, muscles, vessels and nerves. It communicates anteriorly with the nasopharynx through
the auditory tube, and posteriorly with the mastoid air cells through the mastoid antrum.
Ⅰ）The Wall of the Tympanic Cavity
1. Superior wail (Tegmental wall)
It is a thin plate separating the middle cranial fossa from the tympanic cavity.
2. Inferior wall (Jugular wall)
It separates the tympanic cavity from the jugular fossa.
3. Anterior wall (Carotid wall)
It is close to internal carotid artery. There are two parallel canals on this wall, semicanal for
tensor tympani and semicanal for auditory tube.
4. Posterior wail (Mastoid wall)
On the upper part, here is an opening of mastoid antrum, which passes to mastoid air cells
through mastoid antrum, On the lower part, the pyramidal eminence and prominence of facial
canal exist.
5. Lateral wail (Membranous wall)
It is almost entirely formed by the tympanic membrane, only the superior part of this wall is
formed by the lateral wall of the epitympanic recess.
Tympanic membrane is oval and semi-transparent, lies obliquely between tympanic cavity
and external acoustic meatus. Umbo is formed by the traction of the terminal point of the handle
of the malleus. It also has two parts:
flaccid part: upper 1/4
tense part: lower 3/4, cone of light
6. Medial wall (labyrinthine wall)
It is the lateral wall of the inner ear.
promontory: on the middle of this wall.
vestibular window: posterosuperior to promontory.
(fenestra ovalis)
cochlear window: posteroinferior to promontory, closed by the secondary
(fenestra rotunda) tympanic membrane in vivo
prominence of facial nerve canal: posterosuperior to vestibular window.
Ⅱ）The Auditory Ossicles
The tympanic cavity contains a chain of three ossicles: the malleus incus, and stapes, which
connects the tympanic membrane and the fenestra vestibule.
Ⅱ. The Auditory Tube
Lateral1/3--bony partpharyngeal orifice of auditory tubenasopharynx
Medial 2/3--cartilaginous partorifice of tympanic cavity of auditory tubetympanic cavity
The auditory tube is shorter，wider and horizontal in infant, therefore the pharyngeal
inflammation may along the auditory tube spread into the tympanic cavity.
Ⅲ. The Mastoid Ant rum and Mastoid Ai r Cells
The mastoid antrum is air-filled space between the tympanic cavity and the mastoid air cells.
Mastoid air cellsmastoid antrumtympanic cavity
(posterior)
(middle)
(anterior)
Section 3 The Internal Ear
The internal ear lies between the tympanic cavity and the base of the internal acoustic meatus,
viz. in the petrous part of the temporal bone.
Osseous labyrinth
perilymph
Membranous labyrinth
endolymph
Ⅰ. The Osseous Labyrinth
It includes the cochlea, the vestibule and the semicircular canals, from before backwards
along the long axis of the petrous part of the temporal body.
Ⅰ）Vestibule
posterior: five openingsemicircular canal
anterior: one openingcochlear
fenestra vestibule
fenestra cochleae
Ⅱ）Bony semicircular Canals
ampullar crus(bony ampulla)
anterior semicircular canal
single crus
commune crus
single crus
posterior semicircular canal
ampullar crus(bony ampulla)
lateral semicircular canal
single crus
(horizontal semicircular canal)
ampullar crus(bony ampulla)
Ⅲ. Cochlea
It resembles the shell of a snail. It is composed of the bony canal of cochlea winding spirally
for 5/2~11/4 turns around the central modiolus which projects the osseous spiral lamina. The
bony canal is divided into two parts by this lamina and the basilar membrane of the cochlear duct.
scala vestibule-------upper part
two parts
(vestibular scale)
communicating through helicotrema
scala tympani-------lower part
(tympanic scale)
cochlear apex--------toward anterolateral
apex and base
(cochlear cupula)
cochlear base--------toward bottom of internal acoustic meatus
Ⅱ. The membranous Labyrinth
It is a series of membranous canal and sacs which lie within the bony labyrinth. From before
backwards, it includes: the cochlear duct, the utricle and saccule, and the membranous
semicircular ducts.
Ⅰ）The Utricle and Saccule
-----------------------membranous semicircular duct
five opening
utricle------posterosuperior part: macula of utricle
↑
(base)
∣ utriculosaccular duct
static balance organs
↓
saccule------anteroinferior part: macula of saccule
(anterior wall)
--------------------cochlear duct
uniting duct
Ⅱ）The Membranous Semicircular Ducts
They lie within the bony semicircular canal, and are similar to them in shape and names.
On the wall of membranous ampulla, there are the ampular crests which are the organs of
kinetic balance.
Ⅲ）The Cochlear Duct
It lies in the bony canal of the cochlea.
A transverse section through the cochlea shows that this canal is divided into three separated
channels, namely, the tympanic scale, the vestibular scale and the cochlear duct. The cochlear
duct is triangular on the transverse section, and has three walls.
vestibular scale
superior wall: vestibular membrane
cochlear duct
lateral wall: the thickened endosteum
osseous spinal lamina
inferior wall: basilar membrane
tympanic scale
(spiral membrane)
cochlear duct
The spiral organ is the receptor for auditory sensation, situated on the basilar membrane.
Ⅲ. The Internal Acoustic Meatus.
It is a short canal within the petrous part of the temporal bone.
Liu Zhiyu (刘执玉)
PART Ⅴ THE NERVOUS SYSTEM
Chapter 1 Introduction
The nervous system is a master system in the living body, it regulates and intergrates the
activities of all the other bodily systems for the benefit of the organism as a whole:
Ⅰ. Subdivision of Nervous System
The nervous system may be divided into the following parts:
telencephalon
brain
diencephalon
central nervous
cerebellum
midbrain
system﹙CNS﹚
brain stem
pons
medulla oblongata
spinal cord
peripheral
cranial nerves (12 pairs)
nervous
spinal nerves (31 pairs)
system (PNS)
visceral sensory n.
visceral n.
sympathetic n
visceral motor n.
parasympathetic n.
Ⅱ. The Activity Mode of Nervous System
The functional unit of the nervous system is the reflex arc, a linkage of afferent and efferent
neurons
1. receptor
2. afferent n. (sensory n.)
reflex arc
3. center
4. efferent n. (sensory n.)
5. effector
Ⅲ. The Basic Terminology in Nervous System
Ⅰ）Terms in CNS
1. Grey matter----collections of cell bodies and dendrites.
2. White matter----collections of nerve fibres.
3. Cortex----a mantle of grey matter on the brain,such as cerebral cortex.
4. Nucleus----a group of cell bodies which have the same shape and function.
5. Tracts----In white matter, a bundle of nerve fibres which have the same origin, terminaion,
passway and function。
Ⅱ）Terms in PNS
1. Ganglion----collections of cell bodies。
2. Nerve----collections of nerve fibres held together by connective tissue sheath。
Chapter 2 The Peripheral Nervous System
The peripheral nervous system ( PNS ) is the nervous structures out-side the brain and spinal
cord. It is composed of nerves and ganglia, and usually divided into three portion: ①cranial
nerve attaching to the brain. ② spinal nerve attaching to the spinal cord. ③visceral nerve
innervating the viscera, heart and vessels, and gland.
Section 1 The Spinal Nerves
There are thiry-one pairs of spinal nerves, each of them arises from two roots attached to the
cord, an anerior root (motor fibres ) and a posterior root (sensor fibres). Two roots unite o form
the spinal nerve at the intervertebral foramen. The spinal ganglion is an enlargement of the
posterior root near the intervertebral foramen.
cervucak n. ----8 pairs
thoracic n. ----12 pairs
Spinal n. (31 pair)
lumbar n. ----5 pairs
sacral n.
----5 pairs
coccygeal n. ----1 pairs
The spinal nerves are mixed nerves which contain two kinds of fibres.
somaic sensory fibres-supplying skin, skele-tal m., tendon and
joint.
Sensory nerve fibres
visceral sensor fibres-supplying viscera, heart and vessels, and
gland.
somaic motor fibres-innervating skeletal m.
Motor nerve fibres
visceral motor fibres-innervating cardiac m.
smooh m. and gland.
The trunk og spinal nerve is short and gives off two major branches,
①larger mixed n.
anterior ramus
(venral ramus )
posterir ramus
(dorsal ramus)
②suppling the skin and muscles of anterolateral region of the body
and upper and lower extremities.
③forming plexus: cervixal, brachial, lumbar and sacralplexuses,
except ventral rami of thoracic n.
①smaller mixed n.
②supplying the skin and muscle of dorsal region of the body
③segmental distribution
Ⅰ. The Cervical Plexus
Ⅰ）Formation
It is frmed by the anterior rami of the four upper cervical n. (C1-4).
It is situated deeply in the upper part of the neck, covered by the upper part of the
sternocleidomastoid m., and anterior to the levator scapulae and scalenus medius muscles.
Ⅱ）Branches
1. Superficial (cutanous) branches
They emerge near the middle point of the posterior border of the sternocleiddomastoid m.
and have a fan-shaped distribution.
lesser occipital n.
great auricular n.
transverse cervical n.
supraclavicular n
2. Deep (muscular) branches
The most important branch of the cervical plexus is phrenic nerve, a mixed nerve.
Anterior rami of cervical n. 3～5phrenic n. laeral border of anterior scalene m.
inlet of thorax
aterior, medial to the m. between subclavian a. and v. -----------------------thoracic
cavityin front of the root of lung between pericardium and mediastinal pleuradiaphragm.
Motor fibresdiaphramg
pleurac, pericardium, peritoncum.
Sensory fibres
right phrenic n. liver,gallbadder, and bile duct.
Ⅱ. The Brachial Plexus
Ⅰ）Formation
It is formed by anterior rami of nerver C5～8 and T1. It is situated in the supeoposterior side of
subclvian a., behind the clavicle, and in axillary fossa.
Five rootsthree trunks (upper, moddle and lower) two divisions (anterior, posterior)
three cords (lateral ,medial and posterior) severn important branches.
Ⅱ）Branches
1. Long thoracic n. supplying the anterior seratus m.
2. thoracodorsal n. supplying latissimus dorsi m.
3. Axillary n.
Posterior cordaxillary n. quadrilateral pacewinding round surgical neck of
humerusdeep to detoid m.
Muscular branchesdeltoid m., teres minor m.
Cutancous branches skin on shoulder and superolateral part of arm.
4. Musculocutaneous n.
Lateral cord musculocutaneous n. piecing coracobrachialis m. between bieceps
branchi and branchialis m.
Muscular branches the three m. above.
Cutanous branches (lateral antebrachial cutanous n.) skin of lateral side of forcarm.
5. Median n.
Two roots of medial cord and lateral cordembracing axillary a. median n. medial to
biceps brachii m. in armcrossing branchial a. cubital fossapiercing pronator teres m.
carpal canal
------------------------wristhand.
Muscular branchesm. in front of forearm except brachioradialis m. flexor carpi ulnaris m.
and ulnar half of flexor digitorum pro-fundus m.; m. of thenar eminence except adductor
pollicis m. 1～2 lumbricalis m.
Cutanous branchesradial half of palm ;pslmar surface of radial 31／2 fingers.
6. Ulnar n.
Medial cordulnar n. medial to axillary a. piercing medial intermuscular septumback
of armulnar grooveforearm, wrist, hand.
flexor carpi ulnaris m.
ulnar half of flexor digitorum profundus m.
muscular branches
adductor pollicis m.
hypothenar eminence
interosseous m. (palmar, dorsal)
3～4 lumbricalis m.
cutanous branchesskin on ulnar side of hand;palmar and dorsal surface of ulnar 11/2and
21/2fingers.
7. Radial n.
Posterior cordradial n. behind axillary a. between long and medial head of triceps m.
radial groove
lateral
superfical branch
---------------------lateral side of arm----------------------------
epicondyle of humberus
deep branch
brachiordialis m.
Muscular branches
extensors of arm and forearm.
skin on dorsal surface of arm and forearm
Cutaneous branches
skin on dorsal surface of lateral half of hand and lateral 21/2
Ⅱ. The Ventral Rami of the Thoracic Nervers
They are twelve pairs: the uuper eleven are called intercosal n., which pass into intercosal
space and run between internal and exteral intercostals m. along costal groove; the twelfth is
called subcostal n. They supply muscles and skin of the thoracic and abdominal wall.
The distribution of the anterior branches of the thoracic nerves is segmental. On the anterior
surface of trunk, they present about the level of:
T2——the sternal angle
T4——the nipple
T6——the xiohoid process
T8——the costal arch
T10——the umbilicus
T12——the midpoint between umbilicus and symphysis pubis (or anterior superior iliac
spine)
Ⅳ. The lumbar Plexus
Ⅰ）Formation
It is derived from anterior rami of nerver T12, L1-4 and coverd by the psoas major m.
Lumbosacral trunk is formed by anterior rami of part of L4, L5 nerves, to take part in sacral
plexus.
Ⅱ）Branches
1. Femoral n.
Descending between psoas major and iliacus m. deep to inguinal ligament muscular
spacefemoral trigone in front side of thigh
pectineus m.
Muscular branches
quadriceps femoris m.
sartorius m.
skin of anterior surface of thigh and knee joint.
Cutaneous branches
saphenous n.-medial side of leg and foot.
2. Obturator n.
Medial border of psoas major m. along lateral pelvic wall through obturator
through obturator canal
canal-----------------------------------------medial part of thigh.
Muscular branchesm. of medial group of thigh
Cutaneous branchesskin of medial sie of thigh
Ⅴ. The Sacral Plexus
Ⅰ）Formation
It is formed by lumbosacral trunk (L4, 5), the ventral rami of sacral n. (S1, 5) and coccygeal n.
(C0). It is tocated in front of sacrum and piriformis m., and behind internal iliac a.
Ⅱ）Branches
1. Superior gluteal n.
It leaves the pelvis via the greater sciatic foramen above the piriformis m.and supplies
the gluteus medius m., glutecus minimus m., and tensor fasciae latae m.
2. Inferior gluteal n.
It leaves the pelvis through the greaer sclatic foramen below the piriformis m. and distributes
the gluteus maximus m.
3. Pudendal n.
Greater sciatic foramen inferior to piriformis m. winding round ischial
lesser sciatic foramen
spine------------------------------------ischiorectal fossainnervating m. and skin of the perineum
and external genital organs.
inferior rectal n. (anal n.)
Its branches
perineal n.
dorsal n.of penis or clitoris
4. Sciatic n.
It is largest nerve in the body.
Leaving pelvis through greater sciatic foramen below piriformis m. deep to gluteus
maximus m. between ischial tuberosity and greater trochanter of femurposterior compartment
of thighdeep to biceps femoris m. uperior angle of popliteal fossatibial n. and common
peroneal n.
The trunk of sciatic n. supplies the muscles of posterior group of thigh.
1）Tibial n.
Descending in popliteal fossadescending and supplying muscles of posterior group of
medial planter n.
legbehind medial malleolusplantar lateral planter n. skin and m. in dorsum of foot.
2）Common peroneal n.
Descending along medial border of biceps femoris m. winding aroud fibular neck tofront
side of leg
peroneus longus and brevis m.
Superficial peroneal n. ----
skin of lateral side of leg, dorsum
of fot and toes.
---------
m. of anterior group of leg, dorsum
Deep peroneal n. ----------
of foot
skin between the first and second toes.
In summary, the common peroneal n. supplies the muscles of anterior and lateral group of leg,
and the skin on lateral side of leg, dorsum of foot and toes.
Section 2 The Cranial Nerves
There are twelve pairs of cranial nerves attach to brain , which leave or enter the skull
through a series of foramina in the base of the cranium.They are listed as follows by Roman
numerals.
Nature, Origin and Passage of Cranial Nerves
Nerve
Nature
ⅠOlfacotry
ⅡOptic
ⅢOculomotor
ⅣTrochlear
sensory
sensory
motor
motor
ⅤTrigeminal
mixed
Superfical
origin on brain
telencephalon
diencephalons
midbrain
midbrain
pons
Passage of the skull
cribriform foramen
optic canal
superior orbital fissure
superior orbital fissure
superior orbital fissure
(ophthalmic)
round foramen
ⅥAbducnet
motor
pons
ⅦFacial
mixed
pons
ⅧVestibulocochlear
ⅨGlossoPharyngeal
ⅩVagus
ⅪAccessory
ⅫHypoglossal
(maxillary)
oval foramen
(mandibular)
superior orbital fissure
internal acoustic port
facial canal
stylomastoid foramen
internal acoustic port
senory
pons
mixed
medullaoblongata
jugular foramen
mixed
motor
motor
medullaoblongata
medullaoblongata
medullaoblongata
jugular foramen
jugular foramen
hypoglossal canal
They components of cranial n. are more complex than tha of spinal n., the former consists of
seven kinds of fibres.
General somatic sensory fibres
Special somatic sensory fibres
Sensory fibres General visceral sensory fibres
Special visceral sensory fibres
General somatic motor fibres
Motor fibres
General visceral motor fibres
Special visceral motor fibres
Ⅰ. Olfactory Nerve (CN I)
It is a sensory n. and serves the smell sense.
Central processes of olfactory cells in mucous membrance of upper parts of superior nasal
cribriform plate
concha and nasal septumolfactory fibres-------------------------------------olfactory bulb.
Ⅱ. Optic Nerve (CN Ⅱ)
It is composed by special somatic sensory fibres conducting visual stimulation.
optic disc
optic canal
Ganglion cells of retina-------------piercing scleraoptic n. ------------------middle cranial
fossaoptic chiasma, optic tractdiencephalon.
Ⅲ. Oculomotor Nerve(CN Ⅲ)
somatic motor n.- oculomotornucleus
Motor n.
---------------
visceral motor n.-accessory oculomotor nucleus
(Edinger-Westphal nucleus)
interpeduncular fassa
oculomotor n. -------------------------------------leaving skull---------lateral wall of cavernous
superior orbital fissure
sinus---------------------------------------------------------------orbtial cavity
superior rectus m.
superior ramus
--------------------
inferior ramus
levator palpebrae superioris m.
inferior retus m.
medial retus m.
inferior oblique m.
A short branch given off by the n. for inferior oblique m. (parasymatthetic n.) ciliary
sphincter m. of pupil (iris)
ganglion (relay) sphincter m. of pupil (relay) ----
ciliary m.
reflex of light(pupil)
-------
regulating convexity of lens
Ciliary ganglion is a parasympathetic ganglion situated between optic n. and lateral rectus
m.near orbital apex.
Ⅳ. Trochlear Nerve (CN Ⅳ)
This is the smallest cranial nerve.
Leaving skull below inferior colliculus of midbraincurving around lateral surface of
cerebral pedunclelateral wall of cavernous sinusuperior orbital fissureorbitsupplying
superior oblique m.
Ⅴ. Trigeminal Nerve(CN Ⅴ)
This is the largest one of cranial nerve and a mixed nerve containing somatic sensory and
special visceral fibres.
Motor, pontil, spinal tract, mesencephatic nuclcus of trigeminal n.
larger sensory root
ophthalmic n.
 trigeminal n.
maxillary n.
smaller motor root
mandibular n.
Sensory fibres: skin of face (divided by mouth slit, palpebral fisure); mucousmembrance,
----
of oral cavity,nasal cavity,paranasal sinus;teeth, brain meninges.
Motor fibres: m. of mastication, mylhyoid m. anterior belly of digastric m.
Trigeminal ganglion is a sensory ganglion situated in anterior surface of apex of petrous part
of temporal bones.
Ⅰ）Ophthalmic Nerve
It is a sensory nerve.
Trigeminal ganglionophthalmic n. lateral wall of cavernous sinussuperior orbital
fissureorbit.
1. Lacrimal n.
This nerve supplies the lacrimal gland and the upper eyelid.
2. Frontal n.
It has 2～3 branches , in which the supraorbital nerve passes through the supraorbital
notch (or foramen) to the skin of the frontal area.
3. Nasociliary Nerve
It supplies the nasal mucous membrane, ethmoidal sinuses, lacrimal sac, the skin of dorsal surface
of the nose, eyeball, and eyelid.
Ⅱ）Maxillary Nerve
It is a sensory nerve.
Trigeminal ganglion----maxillary n. ---------lateral wall of cavernous sinus-------round
orbit
foramen-------inferior orbital fissure---------------infraorbital n.
1. Infraorbital n.
Maxillary n. orbitinfraorbital groove, canal, foramenskin of lower eyelid, nose, and
upper lip.
2. Zygomatic n.
It supplies the skin of the temporal and zygomatic area of face.
Parasymapathetic postganglionic fibres from facial n. zygomatic n. communicating
branchlacrimal n. lacrimal gland.
3. Supperior alveolar n.
Anterior, middle, posterior branchessuperior dental plexusmaxillary sinus, upper teeth
and gums.
Ⅲ）Mandibular Nerve
It is a mixed nerve and the largest division of the trigeminal nerve.
smaller anterior trunk: mainly motor n.
Leaving skull through oval foramen---------
larger posterior trunk: mainly sensory n.
1. Auriculotemporal n
Arising by two rootsencircling meningeal a. piercing parotid glandtemporal
regionskin of temporal area.
Parasympathetic secretory fibres from glossopharyngeal n. auriculotemporal n. parotid
gland.
2. Buccal n.
It supplies the skin and mucous membrane of the check.
3. Lingual n.
general sense--anterior 2/3 mucous membrane of tongue and floor of oral cavity.
ligual n.
special sense: chorda tympani
(taste sense) of facial n.
lingual n.
tastefibres-------------tastebud of anterior 2/3 tongue.
parasympathetic secretory fibres---------------
-------------------submandibular ganglion (relay) ----submandibular and lingual gland.
4. Inferior alveolar n.
terminal branch
A mixed n. submanidibular foramen, canalinfeior alveolar plexus-------------------------
mental foramenmental n.
sensory fibres----lower teeth, gum, skin and mucous membrane of chin and lower lip.
Moter fibres ----mylohyoid and anterior belly of digastric m.
5. Nerve of muscles of mastication
It innervates all muscles of mastication.
Ⅵ. Abducent Nerve (CN Ⅵ)
Arising from abducent nucleuspontomedullary groovein cavernous sinus lateral to
internal carotid a. superior orbital fissureorbitsupplying lateral rectus m.
Ⅶ. Facial Nerve (CN Ⅶ)
special visceral motor fibres (facial nucleus)
general visceral motor fibres (superior salivatory mucleus)
special visceral sensory fibres (geniculate ganglion)
Emerging from pontomedullary groove lateral to abducent n. internal acoustic
meatusfacial canalstylomastoid foramenpiercing parotid glandface.
Ⅰ）The Vranches within the Facial Canal
lingual n.
taste fibrestaste bud of anterior 2/3 tongue.
Chorda tympani-----------
parsympathetic fibressubmandibular ganglion
submandibular and lingual gland.
Ⅱ）The Branches outside the Facial Canal
Facial n. parotid plexus (in parotid gland ) five branches
temporal branch: frontal m. and orbicularm. Of eye.
zygomatic branch: zygomatic m. and orbicular m. of eye.
buccal branch: buccinatorm. And orbicular m. of mouth.
mandibular branch: m. of lower lip.
cervical branch: platysma m.
The facial n. also gives off amall muscular branches to occipital m., posterior auricular m.,
posterior belly of digastric m., and stylohyoid m.
Pterygopalatine ganglion is a parasympathetic ganglion located in the pterygopalatien fossa
under the maxillary nerve.
Submandibular ganglion is also a parasympathetic ganglion situated below the lingual
nerve, deep to submandibular gland.
Ⅷ. Vestibulocochlear (Auditory ) Nerve (CN Ⅷ)
cochlear part (nerve) --------auditory sense
Two parts
vestibular part (nerve) --------balance sense (equilibrium)
Ⅰ）Vestibular Nerve
Macula of utricle and sccule
peripheral processes
Ampullary crest of membranous
←————————vestibular ganglion
semicircular canal
central processes
(in bottom of internal acoustic meatus)——————→vestibular n. →internal acoustic meatus
enter skull
——————→vestibular nuclei (in brain stem).
Ⅱ）Cochlear Nerve
peripheral
central
Spiral organ←——————spiral ganglion (in modiolus)——————→internal acoustic
processes
processes
meatus→pontomedullary groove→dorsal and ventral cochlear nuclei (in brain stem).
Ⅸ. Glossopharyngeal Nerve (CN Ⅸ)
special visceral motor fibres
general visceral motor fibres (parasympathetic fibres)
special visceral sensory fibres
general visceral sensory fibres
general somatic sensory fibres
This nerve is a mixed n. in nature and origins on the posterolateral sulcus in the medulla
oblongata. It leaves the skull with the vagus nerve and accessory nerve through the jugular
foramen. On its trunk there are two sensory ganglia, the superior and inferior.
Ⅰ）Tympanic Nerve
Tympanic n. tympanic plexuslesser petrosal n. otic ganglionauriculotemporal n.
parotid gland.
Otic ganglion is also a parasympathetic ganglion situated below ovalforamen.
Ⅱ）Carotid Sinus Branch
They run downward along internal carotid artery to supply the carotid body and carotid sinus.
Ⅲ）Lingual Branches
They supply the posterior third of the mucous membrane and taste bud of tongue for general
and taste sense.
Ⅹ. Vagus Nerve (CN Ⅹ)
It is the mixed nerve of the longest route and widest distribution.
viscera in cervical part, and thoracic
general visceral motor fibres:
and abdominal cavity innervating cardiac,
(parasympathetic fibres)
smooth., and gland.
visera in cervical part and
general visceral sensory fibres:
thoracic and abdominal cavity
general somatic sensory fibres: dura mater, skin of auricle and external acoustic meatus.
special visceral motor fibres:
laryngeal and pharyngeal m., soft palate.
Emerging from posterolateral sulcus in medulla oblongataleaving skull through jugular
foramenforming superior and inferior ganglianeckdescending within carotid sheath (behind
internal jugular v. and internal carotid or common carotid a. ) root of necksuperior thoracic
aperturethoracic cavity:
Left vagus n. between left common carotid a. and subclavian a. anterior to aortic
archposterior to root of left lung (left pulmonary plexus) descending in front of
esophagusesophageal plexusanteior vagal trunkthrough esophageal opening of diaphragm
anterior gastric branch
abdominal cavity-----
hepatic branchhepatic plexus
Right vagus n. in front of subclavian a. right to tracheabehind root of right lung (right
pulmonary plexus) descending posterior to esophagusesophageal plexusposterior vagal
trunkthrough esophageal opening of diaphragmabdominal cavity
posteror gastric branch
celiac branchceliac plexus
Ⅰ）The Branches in the Neck
Superior laryngeal nerve
Inferior ganglionmedial to internal carotid a. greater cornu of hyoid bone
internal laryngeal branchcricothyroid m.
-------
esternal laryngeal branchpiercing thyrohyoid membranemucous membrane of
larynx above slit of glottis for sense.
Ⅱ）The Branches in the Thorax
Recurrent laryngeal nerve
Right: higher, winding right subclavian a.
-----groove between trachea and esophagus
Left: lower, winding aortic arch
lower border of inferior pharyngeal constrictor m. inferior laryngeal n. larynx.
Motor fibres: all laryngeal m. except cricothyroid m.
Sensory fibres: mucous membrane of larynx below the slit of glottis
Ⅲ）The Branches in the Abdomen
1. Anterior gastric branch
along lesser curvature of stomach
Anterior vagal trunkanterior gastric branch-------------------------------------------------------
anterior gastric wall
4~6 small branches -----------------------------terminating in “crow’s foot” anterior wall of
pyloric part (canal and antrum)
2. Hepatic branch
Anterior wagal trunkhepatic branchhepatic plexus
3. Posterior gastric branch
along lesser curvature of stomach
Posteror vagal trunkposterior gastric branch-------------------------------------------------4~6
posterior gastric wall
small branches---------------------------------terminating in “crow’s foot” posterior wall of
pyloric part (canal and antrum)
4. Celiac branch
Posterior vagal trunkceliac branchceliac plexussupplying liver, pancreas, kidneys,
spleen, small intestine, caccum, transverse colon, ascending colon, appendix, (digestive canal
prior to left colic flexure)
Ⅺ. Accessory Nerve (CN Ⅺ)
It is a motor nerve (special visceral motor fibres ), formed by the union of the cranial and
spinal roots.
Cranial root (ambiguous nucleus): emerging from posterolateral sulcus in medulla
oblongataleaving skull through jugular foramenjoining vagus n. laryngeal and pharyngeal
m.
Spinal root (accessory nucleus of cervical segments in spinal cord): entering skull through
foramen magnumsternocleidomastoid m. and trapezius m.
Ⅻ. Hypoglossal Nerve (CN Ⅻ)
It is mainly composed of somatic motor fibres.
Hypoglossal n. (hypoglossal nucleus ) emerging from anterolateral sulcus of medulla
oblongataleaving skull through hypoglossal canalbetween internal carotid a. and internal
jugular v. supplying all extrinsic and intrinsic m. of tongue.
Section 3 The Visceral Nervous System
The visceral nervous system has two group of fibres, i.e. sensory fibres and motor fibres, is
a part of the nervous system distributed in the viscera, cardiovascular system and secretory glands.
The motor fibres are also termed autonomic or vegetative fibres because they regulate the
common involuntary metabolic activities of the animal and vegetable.
Ⅰ. Visceral Motor Nerves
Differences between Visceral and Somatic Motor Nerves
Somatic n.
1. skeletal m.
2. one kind of fibres
3. a single neuron
(lower cntre effector)
4. distributed in the form of nerve trunk
5. thick myelinated fibres
6. voluntary
consciousness
Visceral n.
cardiac m. smooth m., and gland
sympathelic fibres
two
parasympathetic fibres
two neurons
preganglionic neuron (fibre)
postganglionic neuron (fibre)
nerve plexus
preganglionic-thin myelinated fibres
postganglionic-unmyelinated fibres
involuntary
unconsciousness
In visceral motor nerve, two neurons are needed from lower nervous centres to effector.
Preganglionic neuron is the first neuron whose cell body is located in the brain stem and
spinal cord, and sends out the pregangliionic fibres.
Postganglionic neuron is the second neuton situated in the peripheral visceral nerve ganglia,
and gives rise to postganglionic fibres.
The visceral motor nerve is divide into the sympathetic and parasympathetic division on
basis of their features in function, shape, pharmacology and neurobiachemisty.
Ⅰ）Sympathetic System
1. Position of lower centres
They are situated in lateral grey horn of T1 (C8 ) ~L2 (L3 ) segments of the spinal cord. This
division is also termed the thoracolumbar part.
2. Peripheral part
prevertebral ganglion
sympathetic ganglion
paravertebral ganglion
branches from the ganglia
sympathelic plexus
3. Sympathetic ganglia
1) Parasympathetic ganglia
They arranged symmetrically on either side of the spinal colum, and are connected by
interganglionic branches to form two sympathetic trunks, that extend from the base of the skull to
the coccyx and are divided into cervical, thoracic, lumbar, sacral and coccygeal portions.
Ganglion impar is unpaired ganglion formed by fusing of two sympathetic trunks at the coccyx.
2) Prevertebral ganglia
They are located in front of vertebral column.
celiac ganglia
aorticorenal ganglia
superior mesenteric ganglia
inferior mesenteric ganglia
4. Communicative ramus
They are divided into white and grey ones to link the sympathetic ganglion with the
corresponding spinal nerve.
1) White communicative rami
They are the preganglionic fibres send by the nerons of lateral horn in T1~L3 segments of the
spinal cord.
Preganglionic fibresanterior rootspinal n. white communicative ramiparavertebral
ganglion.
The preganglionic fibre of a white communicative ramus, after entering the sympathetic
trunk, may terminate in three ways:
①Ending in corresponding paravertebral ganglia.
②Passing up and down in the trunk to terminate in paravertebral ganglia above and below.
③Passing through paravertebral ganglia.
2) Grey communicative rami
They are the postganglionic unmyelinated fibres, emitted by paravertebral neurons and
situated between the sympathetic trunk and the 31 pairs of spinal nerve. They also course in three
ways:
①Accompanying with corresponding spinal n. to peripheral blood vessels, sweat gland, and
arrector pili m. (arrector m. of hair) .
②Surrounding artery as a layer of nerve plexus to innervate the branches of that arteries.
③Terminating in certain organs derectly.
5. The general distributions of sympathetic nerve
1) Cervical portion of sympathetic trunk
It is dorsal to the carotid sheath and ventral to the transverse processes of the cervical
vertebrae.
superior cervical ganglion: in front of C2, 3 transverse processes
middle cervical ganglion: C6
inferior cervical ganglion: C7
Cervicothoracic ganglion (stellate ganglion) is the ganglion fused by inferior cervical
ganglion with the first thoracic ganglion.
The distributions of postganglionic fibres are:
①Through 8 pairs cervical n. to vessels of upper limb, head and neck.
②Surround the arteries to form internal and external carotid plexus, subclavian plexus,
vertebral plexus to smooth m. and gland of upper limb, head and neck.
③Pharyngeal branchpharyngeal plexuscardiac plexuscardiac m.
2) Thoracic portion of sympathetic trunk
It is in front of the heads of the ribs and 10~12 pairs in number.
①Through 12 pairs of intercostals n. to blood vessels, gland, arrector pili m. of abdominal
and thoracic wall.
②The upper 5 ganglia to thoracic aorta, esophagus, trachea, bronchi and to take part in
pulmonary and cardiac plexus.
③Greater splanchnic n.
It is formed by contributions from 5 (6) ~9 (10) thoracic ganglia (preganglionic neuron ),
which terminate in the celiac ganglion.
④Lesser splanchnic n.
It is formed by branches (preganglionic fibres) of 10~12 thoracic ganglia, which end in the
aorticorenal ganglion.
The postganglionic fibres of the celiac and aorticorenal ganglia supply the liver, spleen,
kidney and digestive tract as far as the left colonic flexture.
3) Lumbar portion of sympathetic trunk
It is ventrolateral to the body of lumbar vertebra and along the medial margin of the psoas
maior muscle.
①Distributing through 5 pairs lumbar n.
②Lumbar splanchnic n.
It is formed by the preganglionic fibres terminating in abdominal aortic plexus and
mesenteric plexus. After exchanging neurons in these plexus, the postganglionic fibres supply the
digestive tract below left colonic flexure, pelvic viscera, and lower limbs.
4) Pelvic portion of sympathetic trunk
It lies against the ventral surface of the sarum, and medial to anterior sacral foramen.
①Supplying through sacral and coccygeal n.
②Taking part in pelvic plexus.
Ⅱ）Parasympathetic System
1. Lower centre
It lies in the cranial parasympathetic nuclei in brain stem and S2~4segments of the spinal cord
(sacral portion).
2. Peripheral part
apraorgan ganglia
parasympathetic ganglia
intraorgan ganglia
fibres sending off from these ganglia
parasympathetic plexus
ciliary ganglion
paraorgan
submandibular ganglion
ganglia
sphenopalatine ganglion
otic ganglion
3. Cranial portion of parasympathetic system
Their preganglionic fibres run in the cranial nerves Ⅲ, Ⅶ, Ⅸ, Ⅹ, the details about this
will be presented here.
1) Parasympathetic nucleus of oculomotor nerve (Edinger-westphal nucleus)
Preganglionic fibres from E-W nucleusoculomotor n. (Ⅲ) ciliary ganglion (relay)
postganglionic fibresciliary m. and pupillary sphincter m.
2) Superior salivatory nuclei
Preganglionic fibres from superior salivatory nucleifacial n. (Ⅶ) greater petrosal n.
pterygopalatine ganglion (relay) 
maxillary n. zygomatic n. lacrimal n. lacrimal gland.
postganglionic fibres
gland in nasal, oral cavity and mucous membrane of palatine.
Facial n. chorda tympapnilingual n. submandibular ganglion (relay) postganglionic
fibressubmandibular gland and sublingual gland.
3) Inferior salivatory nuclei
Preganglionic fibres from inferior salivatory nucleiglossopharyngeal n. (Ⅸ) tympanic n.
tympanic plexuslesser petrosal n. otic ganglion (relay) postganglionic
fibresauriculotemporal n. parotid gland.
4) Dorsal motor nucleus of vagus
Preganglionic fibres dorsal motor nucleus of vagusvagal n. (Ⅹ) abdominal and thoracic
viscera (synapse) postganglionic fibrescorresponding abdominal and thoracic organs (except
descending colon, sigmoid colon and pelvic viscera).
4. Sacral portion of parasympathetic system
Their preganglionic fibres arising from parasympthetic nuclei in S2~4 segments of spinal cord
form pelvic splanchnic nerve, which takes part in pelvic plexus. After exchanging the neurons, the
postganglionic fibres innervate the alimentary canal distal to left colonic flexure, pelvic viscera
and external genital organs.
Ⅲ）Differences between Sympathetic and Parasympathtetic Nerve
1. Different central centre
sympathetic----thoracolumbar part: C8 (T1) ~ L2 (L3)
cranial part: brain stem
parasympathetic---sacral part: S2~4
2. Different locations of peripheral ganglia
prevertebral
sympathetic
paravertebral
preganglionic fibre is shorter
paraorgan
parasympathetic intraorgan
preganglionic fibre is longer
4. Different distributions
sympathetic----much wider
parasympathetic----much narrowly, without nerve supply in blood vessels, sweat gland,
arrector pili m., medullary part of suprarenal gland.
5. Different actions to a visceral organ
The viscera receives a dual autononic supply. In most cases, the two sets of nerves function
antagonistically to one another. Such as:
increasing heart-beating
elevating blood pressure
sympathetic
dilating bronchi
wider opening of pupil
inhibiting digestive activity
parasympathetic: on the contrary
Ⅳ）The Visceral Plexuses
The sumpathetic nerve and parasympathetic nerve are usually combined with the visceral
sensory nerve into extensive plexuses called visceral plesuses in the way to viscera.
1. Caridiac plexus
It is formed by superior, middle, infeior cervical ganglia, cardiac branches sending off from
T1~5 ganglia and supplies the cardiac muscles.
superficial cardiac plexus----below aortic arch.
deep cardiac plexus----between aortic arch and bifurcation of trachea.
2. Pulmonary plexus
It lies in front of and behind the root of lung called anterior and posterior pulmonary plexus
respectively, which supply the lung.
3. Celiac plexus
It is located in front of abdominal aorta, and surrounds the roots of the celiac and superior
mesenteric arteries.
Secondary plexus----hepatic, splenic, pancreatic, superior mesenteric, gastric, renal
plexuses.
4. Abdominal aortic plexus
It is caudalward continuation of celiac plexus.
5. Hypogastric plexus
superior hypogastric plexus----in front of L5 vertebra between two common illiac a.
inferior hypogastric plexus----both sides of rectum.
Ⅱ. The Visceral Sensory Nerves
They conduct the impulse from enterioceptor of the viscera to the central nervous system.
The visceral sensory fibres have their own features in function and morphology which are
different from those of the somatosensory ones.
1. The mumber of the visceral sensory fibres is less.
2. A high pain threshold.
3. Poorly localized visceral sensation (general feeling).
4. Insensitive to cutting, crushing, burning.
5. Sensitive to excessive tension, contraction of smooth m., and certain pathological
condition.
Chapter 3 The Central Nervous System
Section 1 The Spinal Cord
Ⅰ. External Features
Ⅰ）The Spinal Cord: a culindrical structure and slightly flattened anteroposteriorly, is
locatedin the vertebral canal and invested by meninges.
upper end: continuing with medulla oblongata at the level of foramen magnum.
Inferior border of L1 vertebra in adult.
lower end:
L3 vertebra in baby.
The spinal cord tapers gradually and becomes conical termination known as midullary cone.
A slender nerveless structure descending from medullary cone is termed filum terminale. Cauda
equine, a divergent sheaf of caudal spinal roots, is gathered around the filum terminale.
Ⅱ）Segments of Spinal Cord
The spinal cord is consisted of 31 segments in corresponding to the rootlets of a pair of
spinalnerves, viz. C8, T12, L5, S5, C01.
Ⅲ）Two Enlargements
cervical enlargement (C4~T1): associating with brachial plexus innervating upper limb.
lumbosacrla enlargement (L2~S3): associating with lumbosacral plexus innervating lower
limb
Ⅳ）Fissure and Sulcus
anterior median fissure
posterior midian sulcus
anterolateral sulcus----anterior root (motor fibres)
posterolateral sulcus----posterior root (sensory fibres)
Ⅴ）Corresponding Relation between Spinal Segment and Vertebrae
Spinal segment
Vertebra
upper cervical (C1~4)
lower cervical (C5~8)
upper thoracic (T1~4)
middle thoracic (T5~8)
lower thoracic (T9~12)
L1~5
S1~5 , C01
C 1~4
corresponding spinal segment-1
corresponding spinal segment-2
corresponding spinal segment-3
T10~12
L1
Such as: C6 spinal segment is at the level of C5 vertebra.
Ⅱ. Internal Structure
central canal: longitudinal canal
on transverse section
grey matter: meurons and nerve fibres
white matter: fibrous tracts
anterior horn: anterolaterally
grey matter
posterior horn: posterolaterally
(butterfly-shaped core)
lateral horn: laterally
grey commissure: around central canal
anterior funiculus: between andterior median fissure and anterolateral
sulcus.
white matter
posterior funiculus: between poslerior median sulcus and posterolateral
sulcus.
lateral funiculus: between anterolateral and posterolateral sulcuses.
anterior white commissure: anterior to grey commissure.
Ⅰ）Grey Matter
The grey matter of the spinal cord contains an enormous mumber of neurons of varying in
size and shape. Cell collection with common cytological characteristics, whose axons can be
followed to a common termination and subserve the same function, are referred to as nucleus.
1. Nuclei in anterior horn
α-motor neuron----large multipolar neuron, innervating skeletal m. (extrafuasl fibres),
producing contraction of muscle.
γ-motor meuron----smaller neuron, innervating intrafusal fibres, regulating muscular
tonus.
medial group----presented in most segments of spinal cord, innervating skeletal m. of head
and neck.
lateral group----presented in cervical and lumbosacral enlargements, innervating skeletal m.
of four extremities.
2. Nuclei in posterior horn
intermediolateral column nuclei: preganglionic neurons of sympathetic n. presented in
T1~L3 spinal segments.
sacral parasympathetic nuclei: preganglionic neurons of parasympathetic n. presented in
S2~4 spinal segments.
3. Nuclei in posterior horn
genlatiniform substance: outer cap-like portion of head of posterior horn.
posteromarginal nucleus: dorsal to gelatiniform substance, covering tip of posterior horn.
proper nucleus: ventral to gelatiniform substance.
dorsal (thoracic) nucleus: in base of posterior horn, well defined in C8~L1 spinal
segments.
4. Cutoarchitectural lamination
Laminal Ⅰ: correspond to posteromarginal nucleus.
Laminal Ⅱ: gelatiniform substance.
Laminal Ⅲ, Ⅳ: proper nucleus.
Laminal Ⅴ, Ⅵ: base of posterior horn.
Laminal Ⅶ: thoracic nucleus, intermediolateral column in intermedial zone.
Laminal Ⅷ: base of anterior horn.
Laminal Ⅸ: several distinct groups of somatic motor neurons----α, γ cell of anterior horn.
Laminal Ⅹ: area surrounding central canal.
Ⅱ）White Matter
In general, tract of fasciculus indicates the functional fibre bundles having the same origin,
course and termination.
asending tracts----from spinal cord to different segments of brain.
descending tracts----from different segments of brain to spinal cord.
proper tracts----from spinal cord to spinal cord (short ascending and descending tracts),
with anterior and posterior rootlets, completing intrasegment and
intersegment reflex.
1. Ascending tracts
1) Gracile fasciculus and cuneate fasciculus
Gracile fasciculus
origin
termination
location
function
Cuneate fasciculus
spinal ganlia below
spinal ganglia above
T4 spinal segment
T4 spinal segment
gracile nucleus
cuneate nucleus
inmedulla oblongata
inmedulla oblongata
medial part of
lateral part of
posterior funiculus
posterior funiculus
conscious proprioceptive sensation, and fine of discriminating tactile in
muscles, tendon, joint and skin.
2) Posterior and anterior spinocerebellar tracts
Lateral
spinocerebellar tract
location
Anterior
spinocerebellar tract
posterolateral periphery
of lateral funiculus
thoracic nucleus
anterolateral periphery
of lateral funiculus
origin
intermedial zone
(Lamina Ⅴ~Ⅶ)
termination cerebellar cortex
cerebellar cortex
through inferior cerebellar
through superior
function
unconscious proprioceptive sensation, touch and pressure sensation of skin
3) Spinothalamic tract
Posterior
spinothalamic tract
Anterior
spinothalamic tract
location
lateral funiculus,
anterior funiculus
medial to anterior spinocerebellar tract
origin
proper nucleus of posterior horn (Lamina Ⅰ, Ⅵ, Ⅴ)
termination ventral posterolateral nucleus in dorsal thalamus
function
apin and thermal sense
touch and pressure sense
2. Descending tracts
1）Corticospinal tracts
location
Lateral
corticospinal tract
Anterior
corticospinal tract
media to posterior
spinocerebellar tract
bothe sides of anterior
median fissure
in lateral funiculus
in anterior funiculus
origin
precentral gyrus and other cerebral cortex
course
crossed fibres
uncrossed fibres
termination motor cells of anterior horn of spinal cord
function
voluntary movements
2) The other descending tracts
Location
Function
rubrospinal tract ventral to lateral corticospinal
tract in lateral funiculus
vestibulospinal
anterior funiculus
tact
testospinal tract anterior funiculus
medal longitudinal fasciculus
reticulospinal
tract
anterior funiculus
anterior and lateral funiculus
facilitating fexor motor neurons
increasing extensor muscle tone
responsing to visual and auditory
stimuli.
banlance reflex
regulating visceral activity and
muscular tone
Ⅲ. Function fo the Spinal Cord
1. Conduction of excitation.
2. Reflexing activity.
3. Connecting trunk and extremities through 31 pairs spinal nerves.
Section 2 The Brain
It is deivided into four principal areas: the brain stem, cerebellum, diencephalons and
telecephalon.
Ⅰ. External Features of Brain Stem
The brain stem consists of three parts, from below upwards, the medulla oblongata, pons and
midbrain. Its upper border is optic tract, lower border is foramen magum.
Ⅰ）External Features of Medulla Oblongata.
1. Ventral surface
pontomedullary groove: upper border of medulla oblongata.
anterior median fissure: continuing with that of spinal cord.
pyramid: formed by corticospinal tract.
decussation of pyramids: formed by crossing fibres.
olive: posterolateral to pyramid (inferior olivary nucleus).
anterolateral sulcus: CN Ⅻ emerging from it.
posterior olivary sulcus: dorsal to olive, from above downwards, CN Ⅸ, Ⅹ, Ⅺ
emerging from it.
2. Dorsal surface
The superior part of the dorsal surface forms the lower half of the floor of the fourth
ventricle.
gracile tubercle: an elongated swelling produced by gracile nucleus.
cuneate tubercle: cuneate nucleus.
inferior cerebellar peduncle: superolateral to cuneate tubercle formed by fibres entering
cerebellum.
Ⅱ）External Features of Pons
1. Ventral surface
pontomedullay sulcus: from medial laterally, CN Ⅵ, Ⅶ, Ⅷ attaching on it.
basilar sulcus: shallow groove for basilar a.
basilar part: ventral surface bulges forwards and shows mumerous small transverse
tidges.
middle cerebellar peduncle: a compact mass joining with basilar part.
root of CN Ⅴ: between basilar part and middle cerebellar peduncle.
2. Dorsal surface
The dorsal surface of the pons forms the upper half of the floor of the fourth ventricle.
superior cerebellar peduncle: foming lateral wall of the fourth ventricle.
anterior medullary velum: a delicate lamina of white matter connecting two superior
cerebellar peduncle, CN Ⅳ emerging from it .
Ⅲ）Rhomboid Fossa
The floor of the fourth ventricle is rhomboidal in shape, named rhomboid fossa. It si formed
by the dorsal surface of both superior part of the medulla oblongata and the pons.
lower border: gracile tubercle, cuneate tubercle, and inferior ferebellar peduncle.
upper boder: superior cerbellar peduncle.
lateral angle: lateral recess curving ventrally.
medullary striae: from lateral angle to median sulcus, dividing medulla oblongata.
median sulcus: longitudinally
limiting sulcus: lateral to median sulcus.
medial eminence: between two sulcuses above.
vestibular area: triangular area lateral to limiting sulcus, overlying nucleus of vestibular
n.
acoustic tubercle: on lateral angle of vestibular trigone, overlying posterior cochlear
nucleus.
hypoglossal trigone: on medial eminence below medullary striae, overlying hypoglossal
nucleus (superomedially).
vagal trigone: inferolaterally, overlying dorsal vagal nucleus.
postrema and locus ceruleus
facial colliculus: a round swelling on medial eminence above medullary striae, overlying
abducent nucleus.
Ⅳ）The Fourth Ventricle
It lies behind the pons and the upper half of the medulla oblongata, and in front of the
cerebellum. The roof is toward the cerebellum, and the floor is rhomboid fossa. This ventricle
contains cerebrospinal fluid, which communicates with midbrain aqueduct and central canal.
superior cerebellar peduncles
anterior part
anterior medullary velum
roof
posterior medullary velum
posterior part
choroids tela of the fourth ventricle
highly vascular tufts of pia matter, producing cerebrospinal
fluid.
three apertures
median aperture: above tip of inferior angle of rhomboid fossa.
↓
subarachnoid space
two lateral apertures: on tip of each lateral recess.
Ⅴ）External Features of Midbrain
It is a short part of brain stem, located between the optid tract of diencephalons above and the
upper margin of pons below. Midbrain aqueduct passes through its centre.
1. Ventral surface
cerebral peduncles: formed by descending fibres.
interpeduncular fossa: a deep depression, CN Ⅲ emerging from the medial of it.
2. Dorsal surface
superior colliculus: (visual reflex centre) brachium of superior
Quadrigeminal body: colliculuslateral geniculate body
inferior colliculus: (audiroty reflex centre) brachium of inferior
colliculusmedial geniculate body
Ⅱ. Arrangement of Cranial Nerve Nuclei in Brain Stem
The cranial nerve nuclei are located in the dorsal portion of brain stem. They arrange as
following from midline to lateral:
Somatic motor nucleivisceral motor nucleivisceral sensory nucleisomatic sensory
nuclei.
In the brain stem, the limiting sulcus divides sensory and motor cranial nerve nuclei. The
cranial nerve motor nuclei are medial to the limiting sulcus, and the cranial nerve sensory nuclei
are lateral to the limiting sulcus.
The functional components of cranial nerve nuclei are:
1. Somatic motor nuclei (general)
oculomotor nucleus
in midbrain
trochlear nucleus
abducent nucleus----in pons
hypoglossal nucleus----in medulla oblongata
2. Special visceral motor nuclei
motor trigeminal nucleus----in pons
facial nucleus----in pons
ambiguous nucleus
in medulla oblongata
accessory nucleus
3. General visceral motor nuclei
parasympathetic mucleus of oculomotor nerve----in midbrain
superior salivatory nucleus----in pons
inferior salivatory nucleus
in medulla oblongata
dorsal vagal nucleus
4. Visceral sensory nuclei (general and special)
Solitary nucleus-in pons and medulla oblongata
5. General somatic sensory nuclei
trigeminal mesencephalic nucleus----in midbrain
trigeminal pontine nucleus----in pons
trigeminal spinal nucleus----in pons and medulla oblongata
6. Special somatid sensory nuclei
vestibular nucleus
in pons and medulla oblongata
cochlear nucleus
Ⅲ. Internal Structure of Medulla Oblongata
The medulla oblongata can be divided into two parts, the upper and lower. The structures of
the lower part are almost the same as those in spinal cord, but the strutures in the upper part are
changed.
1. Edcussation of pyramids
2. Decussation of medial lemniscus
3. Appearance of inferior olivary nucleus and inferior cerebellar peduncle
4. Enlargement of central canal to form the fourth ventricle floor
Ⅰ）Decussation of Pyramids
corticonuclear tract: hypoglossal nucleus and lower part of facial
nucleus receive the fibres only from
contralateral corticonuclear tract.
pyramids tract
---------------lateral corticospinal tract
crossed
corticospinal tract
---------------anterior corticospinal tract
uncrossed
Ⅱ）Decussation of Medial Lemniscus
ipsilaterally
Gracile and cuneate fascidulus----------------gracile and cuneate nucleus ( in medulla
sending out fibres
oblongata) --------------------decussation of medial lemniscusmedial lemniscusdorsal
thalamus.
Ⅲ）Inferior Olivary Nucleus and Infeior Cerebellar Peduncle
olivocerebellar tract
inferior cerebellar peduncle
posterior spinocerebellar tract
Ⅳ）Nuclei of Cranial Nerves
1. Hypoglossal nucleus
It is located in both sides of the midline, underneath the hypoglossal trigone. The mucleus
only receives the contralateral fibres from corticonuclear tract, and innervates the muscle of
tongue.
2. Nucleus of accessory neve
medullary partlower end of anbiguous nucleuscranial rootinnervating muscles of
larynx and pharynx.
spinal partfrom anterior horn of the upper cervical spinal cordspinal
rootinnervating sternocleidomastoid m. and trapezius m.
3. Nuclei of vagal nerve
1) Dorsal vagal nucleus: located underneath vagal trigone, lateral to hypoglossal nucleus;
innervating many cervical, thoracic and abdominal viscera.
2) Solitary nucleus: located dorsolateral to dorsal vagal nucleus; trceiving the fibres from all
cervical, thoracic and abdominal mucous membrane.
3) Ambiguous nucleus: placed deeply in reticular formation; giving rise to the fibres to
pharyngeal and laryngeal muscles.
4) Trigeminal spinal nucleus: lying on medial side of spinal tract; receiving impulse from
posterior wall of external acoustic meatus.
4. Nuclei of glossopharyngeal nerve
1) Ambiguous nucleus: giving rise to the fibres to stylopharyngeal m.
2) Solitary nucleus: srceiving impulse from pharynx, auditory tube and posterior 1/3 of
tongue (general visceral sense and gustatory sense).
3) Infeiror salivatory nucleus: to parotid gland.
4) Trigeminal spinal nucleus: collecting the fibres from skin of ear.
Ⅳ. Internal Structure of Pons
dorsal portion----pontine tegmentum
two parts
ventral portion----basilar portion
The anterior margin of the trapezoid body is the boundary zone between the ventral and
dorsal portion. The muclei of CN Ⅴ, Ⅵ, Ⅶ, Ⅷ are tound in pons.
Ⅰ）Basilar Portion
1. Pyramidal tract
corticospinal tract
corticonuclear tract
2. Corticopontine tract: arising from the cells in frontal, parietal, temporal and occipital
regions of cerebral cortex; and terminating in pontine nuclei ispilaterally.
3. Pontine nuclei: comprising all the masses of neurons scattered on this part; the fibres from
these nuclei form middle cerebellar peduncle. They relay impulses from the cerebral cortex to the
cerebellum.
Ⅱ）Pontien Tegmentum
1. Cochlear nuclei (Dorsal and ventral cochlear nuclei): located on lateral surface of
inferior cerebellar peduncle; concerning with hearing.
sending out fibres
Fibres from cochlear n. dorsal and ventral cochlear nuclei------------------------crossing to
turning upward
opposite sidetrapezoid body--------------------lateral lemniscusinferior colliculusmedial
geniculate bodycerebral cortex.
2. Vestibular nuclei: four in number (inferior, superior, medial an lateral); underneath
vestibular trugone; concerning with equilibrium sense.
sending out fibres
vestibulospinal tract
Fibres from vestibular n. vestibular nucleus-------------------
medial longitudinal tract
the fibres to cerebellum
3. Nuclei of facila nerve
1) Facial nucleus: lying on dorsolateral to superior olive nucleus; innervating muscles of
facial expression.
upper part: receiving fibres from corticonuclear tract of both sides;innervating
nucleus
muscles above palpebral fissure.
lower part: receiving fibres from corticonuclear tract of opposite side
only;innervating muscles below palpebral fissure.
2) Superior salivatory nucleus: in the lateral of reticular formation; controlling the secretion
of submandibular gland, sublingual gland, lacrimal gland and glands in mucous membrane of nose
and mouth.
3) Solitary nucleus: concerning with the taste in anterior 2/3 of tongue.
4. Abducent nucleus: located underneath facial colliculus; innervating lateral rectus m.
5. Nuclei of trigeminal nerve
1) Motor trigeminal nucleus: located medial to rootlet of trigeminal n. and dorsolateral to
reticular formation; innervating m. of mastication.
2) Trigeminal pontine nucleus: lying lateral to motor trigeminal nucleus; conceying impulse
of touch sense from skin and mucous membrane of face and forehead.
3) Trigeminal spinal nucleus: a continuation of trigeminal pontine nucleus; conveying the
impulse of pain and thermal sense in skin and mucous membrane of face and forehead.
4) Trigeminal mesencephalic nucleus: lying near lateral margin of central grey matter;
conveying proprioceptive impulses from teeth, hard palate, m. of mastication, and joint capsules.
Ⅴ. Internal Structure of Midbrain
tectum----superior and inferior colliculus
central grey matter
ascending tract
tegmentum black substance
reticular formation
(substantia nigra)
red nucleus
cerebral peduncle
superior cerebellar peduncle
pyramidal tract
base of cerebral peduncle
corticonuclear tract
Ⅰ）Tectum
1. Superior colliculus: consisting of several layers of grey and white matter, a visual reflex
centre.
Occipital cortex
superior colliculustectospinal tractmotor nucleus in brain stem,
Retinaoptic tract
anterior horn of spinal cordresulted in movements of head and eyes in response to visual and
auditory stimulus.
2. Inferior colliculus: nucleus of inferior colliculus, auditory reflex centre.
Cochlear nucleus
inferior colliculusbrachium of inferior colliculusmedial geniculate
Lateral lemniscus
bodysuperior colliculustectospinal tractmotor nucleus in brain stem and spinal
cordreflex in response to auditory stimulus.
Ⅱ）Tegmentum
1. Central grey matter
1) Nuclei of oculomotor nerve
oculomotor nucleus: at the level of superior colliculus; comprising paired lateral and
single central nuclei; innervating all xtraocular m., except lateral
rectus m. and superior oblique m.
accessory oculomotor muclei (Edinger-Westphal): dorsomedial to oculomotor nucleus;
giving rise to preganglionic parasympathetic fibres to ciliary
ganglion (synapse); then sending out postganglionic fibres to ciliary
m. and sphincter m. of pupil.
2) Trochlear nucleus: dorsal to medial longitudinal fasciculus; their fibres decussating
completely in anterior medullary velum; innervating superior oblique m.
2. Red nucleus: ovoid mass in centre of tegmentum and dorsomedial to substantia nigra.
Cerebral and cerebellar cortexred nucleusrubrospinal tractfacilitating flexor motor
neurons.
Ⅲ）Substantia Nigra
A lamina of grey matter containing numerous, deeply pigmented nerve cells; lying between
tegmentum and base of cerebral peduncle; extending through the whole length of midbrain and
subthalamic region; grat development in man.
Ⅳ）Base of Cerebral Peduncle
It is the most ventral part of midbrain.
frontopontine tract (medial 1/5)
corticopontine tract
parietopontine
occipitopontine
tract (lateral 1/5)
temporopontine
pyramidal tract
corticospinal tract
(middle 3/5)
corticonuclear tract
Ⅵ. Reticular Formation in Brain Stem
It has long been recognized that scattered among the more conspicuous fibre bundles and
nuclei of the brain stem are extensive field of intermingled grey and white matter collectively
termed the reticular formation.
Ⅶ. Cerebellum
The cerebellum lies in the posterior cranial fossa, and is connected with the dorsal surface of
brain stem by three cerebellar peduncles (superior, middle and inferior). It consists of two
cerebellar hemispheres joined by a narrow median strip, the cerebellar vermis.
Ⅰ）Subdivision of Cerebellum
1. Three lobes depending on the groove and fissure on its surface.
flocculi (flocculus)
flocculonodular lobe
nodule
(inferior surface)
peduncle of flocculi
anterior lobe (prior to primary fissure)
posterior lobe (between primary fissure and posterolateral fissure)
Three parts on its development and connection of afferent fibres.
archicerebllum: viz. flocculonodular lobe, the oldest part; relating to vestibular nerve
and nuclei; maintaining equilibrium.
paleocerebellum: including anterior lobe, pyramid of vermis and uvula of vermis in
posterior lobe; receiving fibres from anterior and posterior
spinocerebllar tracts; regulating muscular tone.
neocerebellum: the newest and largest part; including posterior lobe except pyramid of
vermis and uvula of vermis; connecting with cerebral cortex through
middle cerebellar peduncle; coordinating skilled movements initiated at
cortical level.
Cerebellar tonsils are two elevated masses on both sides of the uvula of vermis, nearby the
foramen magnum.
Ⅱ）Internal Structures of Cerebellum
1. Cerebellar cortex: It is a superficial grey matter, which surrounds the white matter called
medullary body.
2. Cerebellar nuclei
dentate nucleus: the largest one close to vermis.
emboliform nucleus
medial to dentate nucleus.
globose nucleus
fastigial nucleus: mear midline above roof of the fourth ventricle.
Ⅲ）Fibrous Connection
1. Vestibulocerebellum (Archicerebellum)
inferior cerebellar peduncle
Vestibular nucleus of merves--------------------------------------archicerebellum---------------efferent fibre
brain stem
----------------
inferior
vestibular nucleusvestibulospinal tract.
fastigial nucleus----------------------
cerebellar peduncle reticular formationreticulospinal tract.
2. Spinocerebellum (Paleocerebellum)
superior and inferior
Anterior and posterior spinocerebellar tract-----------------------------paleocerebellum-----cerebellar peduncle
inferior cerebellar peduncle
vestibular nucleus.
fastigial nucleus--------------------------------
efferent fibres
----------------------
reticular formation.
emboliform nucleus
superior cerebellar peduncle
------------------------------------------------------
globose nucleus
red nucleusrubrospinal tract.
---------------------
reticular formationreticulospinal tract.
3. Pontocerebellum (Neocerebellum)
middle cerebellar piduncle
Corticopontil tractpontil nucleus---------------------------------neocerebellum----------------efferent fibres
superior cerebellar peduncle
--------------------dentate nucleus------------------------------------ventrolateral nucleus of dorsal
(decussation)
thalamussomatomotor area.
Ⅷ. Diencephalons
The diencephalons is almost entirely surrounded by the hemispheres of the cerebrum, and
consists of five parts, viz. the epithalamus, thalamus (dorsal thalamus), hypothalamus,
subthalamus, metathalamus.
Ⅰ）Esternal Features of Diencephalon
1. Dorsal thalamus (Thalamus)
They are two oval grey masses. The third ventricle is a space just between two dorsal
thalamus.
anterior tubercle of thalamus: amarrow eminence in anterior end of dorsal surface.
pulvinar: elevation in posterior end.
hypothalamic sulcus: from interventricular foramen to midbrain aqueduct, us a division
between thalamus and hypothalamus.
intermediante mass of dosal thalamus: trey matter connecting two thalamus, dorsal to
hypothalamic sulcus.
medullary stria and terminal stria
2. Metathalamus
It lies inferolateral to pulvinar.
brachium of inferior colliculus
medial geniculate body-----------------------------------inferior colliculus (auditory sense)
brachium of superior colliculus
lateral geniculae body --------------------------------------superior colliculus (visual sense)
3. Epithalamus
It lies around the roof of the third ventricle.
medullary stria of thalamus: a longitudinal fibrous tract between dorsal and medial
surface of thalamus
habenular trigone
habenular commissure: between two habenular trigone.
pineal body: commecting habenular commissure posteriorlly.
posterior commissure: below habenular commissure.
4. Hypothalamus
It is situated below hypothalamic sulcus, and forms the side wall of the lower part of the third
ventricle.
anterior
optic chiasmoptic tract (terminal lamina)
↓
cinereous tuberinfundibulumhypophysis
posterior mammillary body
5. The third ventricle
It is a median sagittal fissure just between two dorsal thalamus.
anterior: terminal lamina
posterior: passing to midbrain aqueduct
roof: choroids tela, passing to lateral ventricle through interventricular foramen.
floor: mammillary body, cinereous tuber, infundibulum, optic chiasm.
Ⅱ）Internal Structures of Diencephalon
1. Dorsal thalamus and metathalamus
Dorsal thalamus is an ovary grey mass medial to the internal capsule and lateral to the third
ventricle.
1) Internal medullary lamina “Y” of thalamus
anterior nuclear group
medial muclear group (dorsomedial nucleus)
dorsolateral nucleus
dorsal layer
posterolateral nucleus
pulvinar
lateral
ventral anterior nucleus
nuclear group
ventral lateral nucleus
ventral layer
ventral
ventral posterolateral nucleus (VPL)
posterior
nucleus ventral posteromedial nucleus (VPM)
2) Nucleus
median nucleus
interalaminar nucleus
special relay nucleus: ventral layer of lateral nuclear group, medial and lateral geniculate
bodies.
association nucleus: medial nuclear group, dorsal layer of lateral nuclear group, anterior
nuclear group.
3) Special relay mucleus
①Ventral anterior and ventral lateral nuclei
They connect the xomatic motor area of cerebral cortex with cerebellar cortex.
②Ventral posterior nucleus
medial lemniscus
ventral paosterolateral nucleus: receiving
spinothalamic tract
trigeminal lemniscus
ventral posteromedial nucleus: receiving
gustatory fibres
③Medial and lateral geniculate bodies
They are the relay nuclei of auditory and visual pathways.
2. Enpithalamus habenularnucleus
3. Subthalamus
subthalamic nucleus
red nucleus
substantia nigra
4. Hypothalamus
supraoptic nucleus: dorsal to optic chiasm.
paraventricular nucleus: close to the third ventricle .
nucleus of mammillary body: in mammillary body.
acruate (infundibular) nucleus: near infundibulum.
Ⅸ. Telecephalon
The telecephalon comprises mainly two large cerebral hemispheres, which are almost
completely separated by the longitudinal cerebral fissure. At the bottom of this fissure, there is a
large bundle of transverse fibres, the corpus callosum, which crosses between the two
hemispheres. The transverse cerebral fissure intervenes between the hemispheres and the
cerebellum.
cerebral cortex----grey matter
basilar nucleus
medullary centre---white matter
lateral ventricle
gyrus (gyri): upfolds on surface of hemisphere.
fissures (sulcus or sulci): downfolds on surface of hemisphere.
Ⅰ）External Features of Telecephalon
superolateral surface
surfaces
medial surface
in ferior (basilar)surface
lateral sulacus
sulci or fissures
central sulcus
parieto-occipital sulcus
preoccipital notch
frontal lobe
parietal lobe
lobes
occipital lobe
temporal lobe
insula
1. Superolateral surface
1) Frontal lobe
precentral sulcus
parallel
central sulcus
precentral gyrus: between precentral and central sulcus
superior and inferior frontal sulcus: prior to precentral sulcus parallel.
superior, middle and inferior frontal gyrus
2) Parietal lobe
postcentral sulcus: parallel to central sulcus.
postcentral gyrus: between central and postcentral sulcus.
interparietal sulcus: parallel to upper margin of hemisphere.
superior parietal lobule
supramarginal gyrus
inferior parietal lobule
angular gyrus
3) Temporal lobe
superior and inferior temporal sulcus
superior, middle, inferior temporal gyrus
transverse temporal gyrus: two short gyri
4) Occipital lobe: irregular sulci and gyri.
5) Insula: There are shorter sulci.
2. Medial and inferior surface
1) Inferior surface of frontal lobe
orbital sulcus
orbital gyrus
olfactory tract
olfactory bulb
olfactory trigone
anterior perforated substance
2) Medial surface of parietal lobe
patacentral lobule: extension of precentral and postcentral gyri.
3) Inferior and medial surface of temporal lobe
occipitotemporal sulcus
inferior
medial occipitotemporal gyrus
lateral occipitotemporal gyrus
collateral sulcus
rhinal sulcus
parahippocampal gyrus: medial to collateral sulcus.
medial
uncus (unci)
hippocampal sulcus
dentate gyrus
hippocampus
4) Medial surface of occipital lobe
calcarine sulcus: arcuating posteriorly.
cuneus lobe: between calcarine and parieto-occipital sulci.
lingual gyrus: inferior to calcarine sulcus.
5) The other sulci and gyri
sulcus of corpus callosum
cingulate sulcus
cingulate gyrus
Ⅱ）Internal Structures of Telecephalon
1. Lateral ventricle
It lies within the cerebral hemisphere, contains cerebrospinal fluid which passes to the third
ventricle by the interventricular foramen.
central part----lying in parietal lobe
four
anterior horn----extending into frontal lobe
parts
posterior horn----extending into occipital lobe
inferior horn----extending into temporal lobe
Choroid tela of lateral ventricle is within central part and infeior part.
2. Basilar nucleus
The group of nucleus lies near the floor of the cerebral hemisphere, deep in the white matter.
head
caudate nucleus
body
meostriatum
tail
putamen
corpus striatum
lenticular nucleus
pallid globe----paleostriatum
claustrum: between insula cortex and lenticular nucleus.
amyglaloid body: deep to uncus, anterior end of inferior hon of lateral ventricle.
The function of corpus striatum is mainly concerned with the regulation of movement.
3. Cerebral cortex
The cerebral cortex consists of archicortex, paleocortex and niocortex. Brodmann’s map was
published in 1909 and consists of approximately 50 areas.
1) Somatic motor area Ⅰ
① Lying precentral gyrus and anterior portion of paracentral lobule.
② Receiving fibres from postcentral gyrus, ventrolateral nucleus, ventral anterior nucleus
and ventral posterolateral nucleus.
③ Sending out fibres to form pyramidal tract.
④ Controlling voluntary movements of opposite side of body.
⑤ Characteristics:
precise functional representation.
representation appears inverted, such as head and neck inferiorly, following hand. Arm,
trunk and thigh; but head and face are upright.
size of cortical area for a particular part of body is determined by the functional
importance and complexity fo the part.
2) Somatic sensory area Ⅰ
① Lying postcentral gyrus and posterior portion fo paracentral lobule.
② Receiving fibres from ventral posterior nucleus of dorsal thalamus for pain, thermal,
tactile (touch), pressure, position, movement sense of opposite side of body.
③ Characteristics:
inverted representation, but head and face are upright.
precise functional representation.
size of cortical area depends on functional important and sensitivity of the sense region.
3) Visual area
① Lying medial surface of occipital lobe around calcaren sulcus (adjacent portion of cuneus
lobe and lingual gyrus).
② Receibing fibres from lateral geniculate body.
③ The left half of visual field is represented in the visual area of right hemisphere, and vice
versa.
4) Auditory area
① Lying transverse temporal gyrus.
② Receiving fibres from medial geniculate body.
③ Representing bilaterally.
5) Language areas (Speech areas)
The hemisphere relating to language function is termed dominant hemisphere, mostly in the
left hemisphere because the right handed-persons are much more than the left ones.
① Motor speech area: in posterior portion of inferior frontal gyrus.
② Auditory speech area: in posterior portion of superior temporal gyrus.
③ Writng area: in posterior portion of middle frontal gyrus.
④ Visusl speech area: in angular gyrus.
4. Medullary centre of hemisphere
1) Commissural fibres
They interconnect corresponding area in the opposite hemispheres.
① Corpus callosum
It transverse the floor of cerebral longitudinal fissure and connects the cortex of two cerebral
hemisphere. It includes four parts, viz. rostrum, genu, body, splenium, from before backwards.
② Anterior commissrue
It is H-shaped arcuate fibrous bundles anterior to fornix.
③ Fornix and fornix commissure
They are bilateral C-shaped white fibres originating from fimbria of hippocampus to nucleus
of mammillary body.
2) Association fibres
They interconnect different cortical area in the came hemisphere.
uncinate fasciculus
superior longitudinal fasciculus
inferior longitudinal fasciculus
3) Projecting fibres
They are referred to ascending and descending fibres connecting cerebral cortex and
subcortical structures, such as spinal cord and brain stem.
Internal capsule lies between caudate nucleus, dorsal thalamus medially and lentiform
nucleus laterally, and is a “><” shaped layer of white matter. The division and its fibres are as
following.
① Anterior limb of internal capsule
It lies between caudate nucleus and lentiform nucleus.
frontopontine tract
containing
anterior thalamic radiation (thalamocortical fibres)
Posterior limb of internal capsule
②Posterior lim of internal capsule
It lies etween thalamus and lentiform mucleus. Its three parts and passing fibres are:
thalamolenticular part
retrolenticular part
corticospinal tract
corticorubral tract
centra thalamic radiation (thalamocortical tract,
such as, trigeminal lemnisus, spinothalamic lemniscus,
medial lemniscus)
optic radiation
parietopontine tract
occipitopontine tract
auditory radiation
sublenticular part
temporopontine tract
③Genu of internal capsule
It is an angle area between anterior and posterior limbs, and contains corticonuclear tract.
Ⅲ）Limbic System
Limbic lobe includes septal area, cingulated gyrus, parahippocampal gyrus, hippocampus
and dentate gyrus, which circle corpus callosum, almost becoming a ring.
Limbic lobe adds cortical and subcortical structures closely related to it, such as amygdaloid
body, septal area, sepptal nucleus, hypothalamus, epithalamus, anterior nucleus of dorsal thalamus,
tegmentum of midbrain, then limbic system is formed.
Section 3 The Conduction Pathways of the Brain and Spinal Cord
They are the routes formed by chains of neurons, through which sensory awareness reaches
the cerebral cortex and a motor response is initiated. The conduction pathways are commonly
classified into ascending (sensory) and descending (motor) ones.
Ascending pathways conduct impulse of various receptors of body to cerebral cortex or other
higher centres of brain, and enable the individual to be conscious of his environment. They
generally involve three orders of neurons.
deep sense (proprioceptive sensation)----fine touch, pressure, position, movement,
sense
vibratory sense.
superficial sense----pain, thermal, and simple touch.
Descending pathways bring cerebral cortex and other subcortex into communication with
effector tissues (such as muscles and glands), through anterior horn of spinal cord. Thus the body
is able to respond to environment change. Two orders of neurons are usually involved.
Ⅰ. The Conscious Deep Sensory Pathway
muscles, tendons,
peripheral processes
---------------------------------------------------------joints, skin.
accompanying corresponding spinal nerve
1
2
central processes
-------------------------------------------------------------------<·--------entering posterior funiculus of spinal
spinal ganglia
cord as a garcile and cuneate
gracile and cuneate
(first order neuron)
fasciculus through dorsal root of
nucleus
spinal cord
(second order neuron)
3
decussation of medial lemniscus ×
-----------------------------------<·-----------------------------------------ascending as medial lemniscus
ventral posterolateral nucleus of dorsal thalamus (third order
neuron)
through posterior limb of internal capsule
①superior, middle part of postcentral gyrus
------------------------------------→
②posterior part of paracentra lobule
(thalamocortical tract)
③precentral gyrus
Ⅱ）The Deep Sensory Pathway of Head and Face
The exact route of this pathway is still unknown.
Ⅱ. The Unconscious Deep Sensory Pathway
Ⅰ）Posterior Spinocerebellar Tract
1
muscles, tendons, touch,
peripheral process
pressure receptors of lower limbs
--------------------------------------------and lower part of trunk
spinal nerve
spinal ganglia
2
central
posterior spinocerebellar tract
----------------<·---------------------------------→inferior cerebellar peduncle→
processes
ipsilateral lateral funiculus
thoracic nucleus
→cortex of paleocerebellum
Ⅱ）Anterior Spinocerebellar Tract
1
proprioceptive impulse of
lower extremities and
lower part of trunk
peripheral process
central
----------------------------------------------------spinal nerve
processes
spinal ganglia
2
anterior spinocerebellar tract
----<·-------------------------→superior cerebellar peduncle→cortex of paleocerebellum
contralateral lateral funiculus ×
grey layer Ⅴ-Ⅶof
lumbar enlargement
Ⅲ. The Superficial Sensory Pathway of Trunk and Limbs
1
skin of
peripheral processes
central processes
trunk and
-----------------------------------------------------------------extremities
accompanying
entering spinal cord through dorsa roots
corresponding
spinal ganglia
spinal nerve
2
3
ascending 1~2 spinal segments, then crossing ×
------<·---------------------------------------------------------<·--------or cross one segment, spinothalamic tract
cells of posterior
ventral posterolateral nucleus
horn (ⅠⅣⅤ)
of dorsal thalamus
(thalamocortical tract)
superior, middle part of postcentral gyrus
----------------------------→
posterior limb of internal capsule
posterior part of paracentral lobule
A hemisection of spinal cord would cause loss of pain and temperature sensation on the
opposite side of the body below the section, since the fibres of lateral spinothalamic tract are
crossed.
Because the gracile and cuneate fasciculus as well as spinothalamic tract have the same
function in touch sense, and because the latter crosses over in spinal cord, the former uncrossed, a
hemisection of the spinal cord ont result in complete loss of the sensations of touch.
Ⅳ. The Superficial Sensory Pathway of the Head and Face
1
2
skin, mucous
peripheral processes
central processes
of head
---------------------------------------------------------<·----and face
trigeminal nerve
entering pons
semilunar ganglion
trigeminal pontine nucleus
trigeminal spinal nucleus
3
cross
×
------------------------------<·--------------------------------------------trigeminal lemniscus
posterior limb of internal capsule
ventral posteromedial
nucleus of dorsal thalamus
---------→lower part of postcentral gyrus
Ⅴ. Optic (Visual) Pathway
Visual field is the images of the objects in a visual space scope, which is divided into two
part, the nasal half and temporal half. The retina itself also in cludes the nasal half and temporal
half.
1
2
rod and
peripheral
central
----------------- -------------------<·------------optic nerve---
cone cells
processes
processes
bipolar cells
ganglion cells
3
------optic chiasm---------------------------------optic tract---------<·---------nasal fibres of retina cross
temporal fibres of retina uncross ×
lateral geniculate body
optic radiation
----------------------------→both sides of calcarine sulcus (suneus lobe and lingual gyrus)
posteror limb of internal capsule
the impulse from upper half retina arrive the dorsal band of calcarine sulcus (cuneus lobe).
The impulse from lower half retina arrive the ventral band of calcarine sulcus (lingual gyrus).
The impulse from macula arrive the posterior portion of calcarine area.
The impulse from peripheral retinal area end in the anterior portion of calcarine area.
Light (Pupillary) Reflex
partial fibres
Cells of retina→optic nerve, optic chiasm, optic tract-----------------------<·-----through brachium
of superior colliculus pretectal area
oculomotor
sphincter muscle of pupil
------<·-------------------------<·---------→
(regulating contraction of pupil)
nerve
ciliary muscle
parasympathetic
ciliary ganglion
(regulating convexity of lens)
oculomotor nucleus
(Edinger-Westphal)
Destruction (Inetrruption) analysis
1. Grossing fibres of optic chiasm: would cause blindness of two temporal visual field
(bilateral or bitemporal hemianopsia).
2. Laeral (uncrossed) fibres of potic chiasm: would result in blindness of two nasal visual
field (bimedial or binasal hemianopsia) .
3. Optic tract, lateral geniculate body, optic radiation, optic cortex on one side would cause
blindness in the medial half visual field of one eye (destrcted side) and in the lateral half of the
other one (undestructed side).
4. One optic nerve would result in blindness in the corresponding eye with loss of the
papillary (light) reflex.
Ⅵ. The Auditory Pathway
1
2
spiral organ
peripheral
central processes
-----------------·--------------------------------<·------(Corti’s organ)
processes
cochlea nerve
bipolar cells of
dorsal and ventral
cochlear spiral ganglion
cochlear nuclei
3
trapezoid body
brachium of inferior
-------------------------------<·---------------------------------<·----------cross lateral lemniscus ×
colliculus
inferior colliculus
medial geniculate body
-------------------------------→transverse temporal gyrus
posterior limb of internl capsule
Ⅶ. Pyramidal System
Two orders of neurons are primarily involved, the upper and lower efferent neurons.
upper efferent
hypoglossal nucleus, lower portion
neurons
corticonuclear tract
of facial nucleus are controlled by
pyramidal tract genu of internal capsule opposite corticonuclear tract; ①
·--------------------others by bilateral corticonuclear tract.
decussation of pyramid
×
precentral gyrus, anterior part
corticospinal tract
lateral corticospinal tract
②
of paracentral lobule
anterior part of
crossing segment by segment
(cortex)
posterior limb of
in spinal cord
×
Internal capsule
anterior corticospinal tract
③
lower efferent neurons
exteraocular m.
masticatory m.
-----------<·-----------→
facial m.
①
laryngeal m.
motor nucleus of cranial nerve
pharyngeal m.
lingual m.
-----------------------<·----------------→
②
voluntary m. of trunk and extremities
-----------------------<·----------------→
③
cells of anterior horn of spinal cord
Ⅷ. Extrapyramidal System
Ⅰ）Concept and Composition
It is a common name for all the structures which control voluntary muscle activities, except
the pyramidal system. It mainly consists of cerebral cortex, corpus striatum, red nucleus, black
substance, cerebellum, reticular formantion, vestibular nucleus.
Ⅱ）Two Simple Descending Pathway
1.
cerebral cortex
pons
thalamus
cerebellum
red nucleus
spinal cord
2.
cerebral cortex
corpus striatum ----→thalamus
subthalamus
black substance
reticular formation
spinal cord
Ⅲ）Two Systems and Four Tracts
1. Neostriatrum----pallid glaobe system
1) Cerebral cortex----corpus striatum----dorsal thalamus----cerebral cortex circle route.
2) Corpus striatum----black substance circle route
3) Pallid globe----subthalamus circle route
2. Corticopontocerebellar system
cortex----pons----cerebellum----dorsal thalamus----cortex circle route
3. Four tracts
Reticulospinal tract
Rubrospinal tract
Tectospinal tract
Vestibulospinal tract
Ⅳ）Function
1. Regulating muscular tone.
2. Maintaining the normal body posture (balance).
3. Coordinating muscular activities (precise motions).
4. Producing habitual and rhythmic movement.
Section 4 The Meninges, Blood Vessels of Brain and Spinal Cord, as
well as Cerebrospinal Circulation
Ⅰ. The Meninges of Brain and Spinal Cord
The brain and spinal cord are enclosed by three layers of membrane, the dura mater,
arachnoid, pia mater, from external inwards. They protect and support the brain and spinal cord.
Ⅰ）Dura Mater
1. Spinal dura mater
It extends from the foramen magnum to the level of the second sacral vertebra, from which it
tapers and forms a covering for the filum terminal of spinal cord.
1) Epidural space
spinal dura mater
lying between
periosteum of vertebral canal
containing: loose conjunctive tissue, lymphatic vessels, fat, venous plexus, especially root
of spinal nerve.
Being not continuous with cranial cavity upward.
2) Subdural space
spinal dura mater
between
spinal arachnoid
2. Cranial dura matter
1) Double layers: periosteal, meningeal.
2) Loosely contacting with skullcap: closely attached to base of skull.
3) Falx and tentorium formed by meningeal layer.
cerebral falx: extending into cerebral longitudinal fissure.
cerebellar tentorium: between cerebral hemisphere and cerebellum.
tentorial notch: anterior free margin of cerebellar tentorium.
cerebellar falx: extending into two cerebellar hemisphere.
4) Dural venous sinus
Lying between meningeal and peiosteal dura in some place.
Characteristics: novalves, no smooth m., no contractivity.
superior sagitaal sinus: lying in superior convex border of cerebral falx.
inferior sagittal sinus: inferior concave border of cerebral falx.
straight sinus: at the junction between cerebral falx and cerebellar tentorium.
transverse sinus: in transverse sulcus, posterior margin of cerebellar tentorium.
sigmoid sinus: in sigmoid sulcus.
confluent sinus: at confluence of superior sagittal sinus and straight sinus.
cavernous sinus: each side of sella turcica
internal carotid a.
intrasinus
abducent n. (CN Ⅵ)
oculomotor n. (CN Ⅲ)
lateral wall of sinus
trochlear n. (CN Ⅳ)
ophthalmic n. (CN Ⅴ1)
maxillary n. (CN Ⅴ2)
superior petrosal sinus: insuperior angle of petrous portion of temporal bone.
inferior perusal sinus: in inferior margin of posterior surface of petrous portion of
temporal bone.
The blood draning in dural venous sinus
superior sagittal sinus
occipital sinus
inferior sagittal sinusstraight sinusconfluent transverse sigmoid internal jugular v.
cavernous sinussuperior petrosal sinus
inferior petrosal sinus
Ⅱ）Arachnoid
Arachnoid is atranslucent, delicate, avascular membrane between dura and pia mater.
1. Spinal arachnoid
spinal arachnoid
lying between
subarachnoid space:
spinal pia mater
containing cerebrospinal fluid
2. Cranial arachnoid
1) Subdural space: between cranial dura mater and cranial arachnoid
2) Subarachnoid space
① Between cranial arachnoid and cranial pia mater
② Enlargement in some area
subarachnoid cisterns
cerebellomedullary cistern
③ Arachnoid granulation: especially in superior sagittal sinus, allowing cerebrospinal
fluid to be reabsorbed into dura venous sinus.
Ⅲ）Pia Mater
The pia mater is a delicate vascular membrane, and rich in nerves. It is closely attached to the
surface of brain and spinal cord.
1. Spinal pia mater
Denticular ligament: is formed by spinal pia mater, which lies between dorsal and ventral
roots of spinal nerve, and is attached to inner surface of spinal dura mater.
2. Cranial pial mater
The cranial pia mater combines its capillaries and ependymal cells to form the choroids tela
of the ventricle. Folds of choroids tela form choroids plexuses, which produce cerebrospinal
fluid.
Ⅱ. The Blood Vessels of the Brain and Spinal Cord
Ⅰ）The Arteries of Brain
internal carotid a. ----anterior 2/3 of cerebral hemisphere, anterior part
two resource
of diencephalon
vertebral a. ----posterior 1/3 of cerebral hemisphere, brain stem,
cerebellum, posterior part of diencephalon
1. Internal carotid artery
Arising fom common carotid a. ascending to floor of skullcarotid canalcavernous
sinusanterior clinoid process.
1) Posterior communicating a. ----communicating with posterior cerebral a.
2) Anterior choroidal a. ----forming arachnoid plexuses in lateral ventricle, supplying optic
tract, internal capsule, base of cerebral peduncle and pallid globe.
3) Anterior cerebral a.
anterior communicating a.----connecting two anterior cerebral a. supplying medial
surface of cerebral hemisphere anterior to
parietooccipital sulcus, inferior surface of frontal lobe.
central branches----caudate nucleus, lenticular nucleus, internal capsule.
4) Middle cerebral a. ----supplying supralateral surface of hemisphere and insula.
Central branch----caudate nucleus, lenticular nucleus, internal capsule.
2. Vertebral artery
Arising from subcalvian a. transverse foramen of C1-6 vertebraeforamen
magnumposterior cranial fossapontomedullary sulcusconfluence of two vertebral a. to
form basilar a. basilar sulcussuperior border of pons.
1) Branches of vertebral a.
① Anterior and posterior spinal a. ----spinal cord.
② Posterior inferior cerebellar a. ----inferior surface of cerebellum, medulla oblongata.
2) Branches of basilar a.
① Anterior inferior cerebellar a. ----inferior surface of cerebellum.
② Labyrinthine a. ----inner ear.
③ Pontine a. ----pons.
④ Superior cerebellar a. ----upper part of cerebellum.
⑤ Posterior cerebral a.
supplying base and medial surface of temporal lobe and occipital lobe.
central branches----dorsal thalamus, medial and lateral geniculate body, hypothalamus,
subthalamus.
taking part in arachnoid plexuses of lateral and the third ventricles
3. Cerebral arterial circle (Willis circle)
angerior cerebral a.
(beginning prat)
posterior cerebral a.
anterior communicating a.
posterior communicating a.
internal carotid a. (terminal part)
It encircles the optic chiasm, cinereous tuber, mammillary body over sella turcica.
Ⅱ）The Veins of Brain
superficial and deep group
great cerebral v.
Ⅲ）The Vessels of Spinal Cord
anterior spinal a. v.
posterior spinal a. v.
Ⅲ. The Circulation of Cerebrospinal Fluid
1. Cerebrospinal fluid (CSF) is formed by choroids tela the in lateral, the third and fourth
ventricles.
2. Circulation
Lateral ventricleinterventricular foramenthe third ventriclemidbrain aqueductthe
fourth ventriclemedian and lateral apertures of the fourth ventriclesubarachnoid
spacesarachnoid granulationssuperior sagittal sinusinternal jugular v.
PART ⅥTHE ENDOCRINE SYSTEM
The endocrine system consists of the endocrine glands and endocrine tissues. The endocrine
glands have no ducts, therefore they are known as ductless glands, which have a rich supply of
blood vessles and pass their secretions derectly into the vascular channels. The secretions are
called hormones, which have special effects on the body.
Ⅰ. The Shape and Location of Thyroid Gland
It likes “H” shaped body.
lateral lobesattaching to lateral surface of lower part of larynx and upper part of trachea.
(right and left)
upper end: midpart of thyroid cartilage.
-----→
Lower end: the sixth tracheal cartilage ring.
isthmus: in front of 2~4 tracheal cartilage.
Ⅱ. The Shape and Location of Parathyroid Gland
They are four small yellowish ovoid or lentiform bodies.
upper one pair: at the middle part of posterior border of thyroid gland.
lower one pair: near inferior thyroid a. or at lower 1/3 of posterior part of thyroid gland.
Ⅲ. The Shape and Location of Suprarenal Gland
They are a pair of small yelloweish-brown bodies, lying on medial part of superior end of
each kidney, and behind the peritoneum.
right----triangular shape.
left----crescent-like shape or semilunar shape
Ⅳ. The Shape and Location of Hypophysis
It is an ovary gland situated in the hypophyseal fossa of sphenoid body.
adenohypophysis
two parts
neurohpophysis
Ⅴ. The Shape and Location of Pineal Body
It is an ovary body located in the posterosuperior to thalamus, attached the posterior part of
the roof of the third ventricle by handle.
Liu Zhiyu