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Lab List of Structures Note lymph nodes as encountered during the dissections. Use skeletons, cadavers, models, and diagrams. 1. Thorax a. Bony Landmarks and Surface Anatomy i. Sternum: manubrium jugular notch –trachea marker sternal angle-marks 2nd rib body xiphoid process ii. Ribs: (12 pairs) head, neck, tubercle, body, costal groove, costal cartilages (7 vertebrosternal (true), 3 vertebrochondral (false), 2 vertebral (floating and false) -note rib articulation with vertebra (most intervertebral) iii. Thoracic Vertebra: centrum, pedicle, transverse process, lamina, spinous process, superior and inferior articulating surfaces, spinal canal iv. Other surface features -clavicle-acromion joint forming point of shoulder -deltopectoral triangle –contains cephalic vein -thoracic apertures (superior and inferior) b. Female Breast i. Nipple, areola, mammary gland, suspensory ligaments, lactiferous ducts ii. retromammary space iii. nipple in males associated with T4 dermatome c. Muscles (innervations and actions) i. Pectoralis Major –adducts arm, note: pectoral nerves if present ii. Pectoralis Minor –draws scapula forward, note: pectoral nerves if present iii. Internal intercostals –expiration; depresses ribs iv. External intercostals –inspiration; elevates ribs v. Serratus Anterior –abduction and raising of arm (pushing), long thoracic nerve vi. Diaphragm -central tendon; aortic, IVC and esophageal hiatus; inspiration; phrenic nerve vii. Internal thoracic A&V viii. Intercostal nerve, and A&V –supplies intercostals d. Pleural Cavities i. Pleural membranes 1. Parietal pleura (diaphragmatic, cervical, costal, and mediastinal portions) 2. Visceral pleura 3. Phrenic nerves (ventral rami of C3-C5) ii. Lungs 1. Lobes: Superior and Inferior (middle on right lung), position in chest. 2. Fissures: oblique and horizontal 3. Trachea, primary bronchi 4. Root of the Lung: hilum, secondary (lobar) bronchus, pulmonary artery and veins, pulmonary ligament, note any visible pulmonary lymph nodes iii. Deep root of lung: segmental (tertiary) bronchi lead to bronchopulmonary segments iv. Left Pleural Cavity: descending aorta, thoracic aorta, intercostal A&V, intercostal nerves v. Right Pleural Cavity: Sympathetic trunk, sympathetic chain ganglia Page 1 of 13 e. Mediastinum –cavity between the two pleural cavities (anterior, middle, and posterior) i. Middle mediastinum –contains the heart with its ensheathing pericardium and the roots of the great vessels ii. Pericardium and Pericardial Sinus (Cavity) –parietal and visceral layers 1. Heart –before removing heart note the following: ascending aorta, superior vena cava, left vagus nerve and the recurrent laryngeal nerve, ligamentum arteriosum, pulmonary trunk, inferior vena cava, pulmonary veins a. External heart anatomy: right ventricle, right atrium, left ventricle, left atrium, apex, coronary sulcus, interventricular sulcus, auricles b. Coronary Circulation: Left Coronary artery: Left anterior descending (LAD) artery and the Circumflex artery Right Coronary artery: Right marginal artery and the Posterior Descending artery Coronary Veins: Small cardiac vein, Middle cardiac (posterior interventricular) vein, Great cardiac (anterior interventricular) vein, coronary sinus c. Internal heart anatomy: layers: epicardium (visceral pericardium), myocardium and endocardium Right atrium: Pectinate muscles, fossa ovalis, right auricle, interatrial septum, and openings of SVC, IVC and coronary sinus. Right atrioventricular (AV) valve (tricuspid) – 3 cusps, chordae tendinae connecting to papillary muscles in ventricle, Right ventricle: papillary muscles, moderator band, trabecula carnae, interventicular septum, pulmonary semilunar valve (3 cusps) opening of pulmonary trunk Left atrium: pectinate muscles, auricle, openings for the pulmonary veins Left AV valve (bicsupid or mitral) –2 cusps, chordae tendinae Left ventricle: trabecula carnae, papillary muscles. (Note thicker wall of this ventricle.) opening for aorta, aortic semilunar valves cusps, (In ascending aorta, aortic sinus and openings for right and left coronary arteries) iii. Posterior and Anterior (to include structures superior to heart) Mediastinum 1. Posterior Mediastinum –azygous vein, hemiazygous vein, intercostal arteries and veins, thoracic duct, vagus nerves passing posterior to root of lungs, esophagus, esophageal hiatus, trachea, tracheal carina, tracheo-bronchial lymph nodes, primary bronchi, thoracic aorta, aortic hiatus, sympathetic trunk 2. Anterior Mediastinum –thymus gland (only in young), phrenic nerves - follow (above the root of the lung) to diaphragm a. Aortic Arch –Great arteries: brachiocephalic (innominate) trunk, left common carotid artery, and the left subclavian artery, descending aorta b. SVC –right and left brachiocephalic veins Page 2 of 13 2. Neck a. Bony Landmarks and Surface Anatomy i. Larynx (thyroid cartilage, cricoid cartilage), Hyoid (body, lesser and greater cornua), Mandible (body, symphysis, angle and ramus), Clavicle, Scapula ii. Triangles 1. Posterior Triangle –bounded by sternocleidomastoid (SCM), trapezius, and middle portion of clavicle -visible within triangle are the accessory nerve (XI), brachial plexus, inferior belly of omohyoid muscle, external jugular vein and a small portion of subclavian A&V -Deep muscles are the splenius capitis, levator scapulae, and the scalenes 2. Anterior Triangle –bounded by the SCM, the neck midline and the mandible; further divided into 4 smaller triangles: a. Muscular triangle –bounded by superior belly of omohyoid, anterior border of SCM, the hyoid and the midline of neck -contains the thyroid and parathyroid glands, the larynx, as wells as, the infrahyoid muscles (sternohyoid, sternothyroid, thyrohyoid muscles) i. Thyroid gland -left and right lobes, and isthmus; note thyroid A&V; deep ii. Parathyroids glands found on posterior surface of thyroid lobes (maybe too small and diffuse to recognize) iii. Larynx –thyroid cartilage with its laryngeal prominence, cricoid cartilage, epiglottis, true (vocal fold) and false (vestibular fold) vocal cords b. Submental triangle –bounded by the mandible, hyoid and anterior bellies of the diagastrics c. Carotid triangle –bounded by the superior belly of omohyoid, posterior belly of digastrics, and medial border of SCM -contains the carotid sheath which contains the common carotid artery, the vagus nerve and the internal jugular vein; also within the triangle the hypoglossal nerve -the common carotid divides into internal and external carotids; find the carotid sinus and carotid bodies at its bifurcation d. Submandibular (Digastric) triangle –bounded by the anterior and posterior bellies of the diagastrics, and the mandible -nearly filled with submandibular gland and submandibular lymph nodes iii. Root of Neck 1. thoracic duct, external and internal jugular veins, Subclavian A&V Page 3 of 13 3. Head a. Skull –find and study these features i. Frontal –glabella, superior orbital notch, coronal suture, supracillary process ii. Parietal –sagittal suture, lambda, bregma, sup. and inf. temporal lines iii. Occipital –lambdoidal suture, foramen magnum, external occipital protuberance, occipital condyles, median, sup., and inf. nuchal lines, condyles, jugular fossa, condylar canal iv. Temporal –squamosal suture, mastoid process, styloid process, external auditory meatus, zygomatic process, temporal lines, temporal fossa, note: pterion (area of a sphenoid fontanel), mastoid foramen, stylomastoid foramen v. Orbit –maxilla, lacrimal, lacrimal canal, sphenoid, frontal, ethmoid, optic foramen, sup. & inf. orbital fissures vi. Sphenoid –pterygoid process, greater and lesser wings vii. Nasal area –nasal bone, external nares and conchae, perpendicular plate of ethmoid viii. Maxilla –infraorbital foramen, alveoli, teeth, incisive foramen, palatine process ix. Zygomatic –frontal process x. Palantine –greater and lesser palantine foramen, transverse and median palatine sutures xi. Mandible –alveoli, teeth(by type), coronoid process, mandibular condyle, mental foramen, mandibular foramen, mandibular notch, ramus, angle, symphysis xii. Vomer –internal nares xiii. Sinuses (ethmoid, maxillary, frontal and sphenoid) –see x-rays b. Face i. Muscles, nerves and superficial vessels 1. Masseter –elevates jaw, Trigeminal nerve 2. Buccinator –presses cheek inward, Facial nerve 3. Frontalis (occipitofrontalis)–wrinkles forehead, raises eyebrows, Facial nerve 4. Orbicularis oculi –closes eyelids, blinking, squinting, Facial nerve 5. Orbicularis oris –closes lips, kissing, Facial nerve 6. Zygomaticus –smiling muscle, Facial nerve 7. Temporalis –elevate jaw, Trigeminal nerve c. Interior of Skull and Brain i. Cranial Fossa, greater and lesser wing of sphenoid, crista galli, sella turcica (hypophyseal fossa, anterior and posterior clinoid processes, chiasmatic groove, dorsum sella), transverse sinus depression, petrous portion of temporal ii. Openings: foramen magnum, foramen ovale, foramen rotundum, hypoglossal canal, internal auditory meatus, foramen spinosum, jugular foramen, cribiform foramina, optic canal, carotid canal, foramen lacerum iii. Brain and Meninges 1. Meninges: a. dura mater (two layers: an outer rough layer that adheres to the skull and an inner smooth lining that rests against the arachnoid (distinguishable only where they separate to allow venous blood flow through venous sinuses); see diagrams in book (Figs. 7.16, 7.17, 7.18 A & B) to understand meningeal blood flow, venous sinuses, arachnoid granulations and the flow of CSF and blood drainage) -note space between dura and arachnoid (subdural space) is potential space normally devoid of fluid –in trauma (like concussions) may fill with blood, same is true for epidural space which normally only contains the meningeal arteries -three dural folds help to suspend brain within cranium (tentorium cerebelli, falx cerebri, and falx cerebelli) b. arachnoid –membrane with fibrous extensions that create the subarachnoid space which is filled with CSF; the subarachnoid space directly connects via three brain foramen to the 4th ventricle of the brain where CSF forms c. pia mater –thin, transparent covering of brain Page 4 of 13 2. Brain a. Gross External features i. Cerebrum divided in half by longitudinal cerebral fissure into the: 1. cerebral hemispheres –divided into lobes: frontal, parietal, occipital, temporal with two large fissures: Lateral (Sylvius) and Central (Rolando) sulci -note other gyri and sulci ii. Cerebellum –sulci and folia, right and left cerebellar hemispheres and the vermis iii. Thalamus –hypothalmus, optic chiasma, infundibulum, pituitary gland iv. Midbrain –superior and inferior colliculi, pineal gland, mammillary body v. Pons vi. Medulla oblongata b. Sagittal Features of Brain i. Distinguish features from above list ii. Corpus callosum, intermediate mass, fornix, septum pellucidum, choroid plexus, arbor vitae, the 4 ventricles, and the cerebral aqueduct c. Blood Supply i. Circle of Willis, internal carotid artery vertebral arteries, posterior communicating, anterior communicating, basilar artery and posterior, middle and anterior cerebral arteries; see x-rays too ii. Study Blood Supply from book pages 893-897 d. Cranial Nerves 12 know by name and number –from model and book diagrams d. Orbit of eye and Eye i. Review bones of eye socket ii. Socket Anatomy and associated structures 1. Eyelids (palpebrae) –conjunctiva, eyelashes, medial and lateral angles (canthi), caruncle 2. Muscles a. Orbicularis oculi -squinting, Facial nerve b. Levator palpebrae superioris –raises upper eyelid, Occulomotor nerve c. Superior rectus, inferior rectus, medial rectus, inferior oblique -move eyeball, Occulomotor nerve d. Superior oblique –move eyeball, Trochlear nerve (note: trochlea) e. Lateral rectus -move eyeball, Abducens nerve 3. Lacrimal Apparatus –lacrimal gland, lacrimal ducts, lacrimal punctum, nasolacrimal duct 4. Eye a. Sclera - cornea b. Iris - ciliary body, choroid, lens, suspensory ligaments, anterior and posterior chambers of anterior segment, posterior segment with vitreous humor (body), pupil c. Retina- optic nerve d. Agueous and Vitreous humor Page 5 of 13 e. Temporal Region and Ear i. Landmarks: Temporal bone: mastoid process, styloid process, squamosal portion, external acoustic meatus, zygomatic arch, mandibular foss and ramus, stylomastoid foramen ii. See muscles dissected previously iii. Parotid gland and duct, facial nerve iv. Ear 1. Outer ear: pinna, auditory canal, tympanum 2. Middle ear: ear ossicles (malleus, incus and stapes), tensor tympanii and stapedial muscles, Eustachian (auditory or pharyngotympanic) tube, round and oval window, Vestibulocochlear nerve –model or diagrams only 3. Inner Ear: cochlea, semicircular canals, vestibule f. Oral Cavity and Pharynx i. Lips and red margin, gingiva, vestibule, labial frenulum ii. Maxilla –hard palate, teeth (incisor, canine, bicuspids, tricuspids) iii. Mandible iv. Tongue –Papilla (fungiform, filiform, vallate), lingual frenulum, lingual tonsil, apex, root v. Palatoglossal arch, soft palate, uvula, palantine tonsils vi. Pharynx, (oropharynx, nasopharynx, laryngeal-pharynx) vii. Nasal cavity: conchae, Eustachian tube, adenoids Page 6 of 13 4. Abdomen a. Bony Landmarks and Surface Anatomy i. Xiphoid process ii. Costal margin iii. Pubic symphysis (marks L1 dermatome) and tubercle, and the anterior iliac spine the inguinal ligament connects the pubic tubercle and anterior iliac spine iv. Abdominal regions (9) and quadrants (4) v. Umbilicus (marks level of T10 dermatome) b. Muscles (innervation, blood supply, AOI) i. External and Internal Oblique –compresses and supports viscera ii. Rectus abdominis and linea alba –flexes trunk iii. Transversus abdominis (aponeurosis of IO and TA join to form conjoint tendon in inguinal region) -compresses and supports viscera iv. Epigastric A&V c. Peritoneal Cavity i. Mesenteries 1. Peritoneum 2. Falciform ligament and ligamentum teres 3. Lesser omentum (hepatogastric and hepatodoudenal ligaments) 4. Omental bursa and epiploic (omental) foramen 5. Greater Omentum a. gastrosplenic ligament b. gastrophrenic ligament c. gastrocolic ligament 6. Mesentery Proper ii. Stomach 1. Fundus, body, antrum, and pylorus; open to find rugae 2. Greater and lesser curvatures iii. Small Intestine –plicae circularis 1. Doudenum –major duodenal papilla (ampulla of Vater) and the sphinter of Oddi – these small structures from diagrams only) 2. Jejenum 3. Ileum iv. Pancreas 1. Head, neck, body, tail 2. Pancreatic duct (diagram / model) v. Liver 1. Right and left lobes (quadrate and caudate lobes) 2. Hepatic ducts 3. Common hepatic duct vi. Gall Bladder – open to find rugae and stones if present 1. Cystic duct 2. Common bile duct, Hepatic artery proper, Hepatic portal vein all found in hepatodoudenal ligament vii. Spleen 1. Hilum, red pulp, white pulp viii. Large Intestine (Colon) –plica semilunaris, haustra, taenia coli, epiploic appendages 1. Cecum and vermiform appendix a. mesoappendix 2. Ascending Colon a. Right colic (hepatic) flexure 3. Transverse Colon a. Transverse mesocolon 4. Descending Colon a. Left colic (splenic) flexure and phrenicocolic ligament 5. Sigmoid Colon a. sigmoid mesocolon 6. Teniae coli, haustra, and epiploic appendages Page 7 of 13 ix. Kidneys 1. Hilum, perirenal fat a. capsule, cortex, medulla, renal columns, renal pyramids, major and minor calyx, renal pelvis, renal sinus, stones if present 2. Ureters 3. Renal A & V x. Adrenal glands xi. Abdominal Vessels 1. Abdominal aorta and Inferior Vena Cava (IVC) 2. Celiac artery a. common hepatic trunk b. left gastric a. c. splenic a. 3. Superior Mesenteric artery a. Intestinal A&V b. Ileocolic a. c. Middle and right colic a. 4. Inferior Mesenteric artery a. Left colic a. b. Sigmoidal a. 5. Gonadal A&V 6. Lumbar A&V 7. Common Iliac A&V 8. Internal and External Iliac A&V 9. Hepatic Portal Vein a. Superior Mesenteric vein b. Splenic vein c. Inferior Mesenteric vein d. Pancreaticodoudenal veins e. Intestinal veins f. Colic veins Page 8 of 13 5. Pelvis and Perineum a. Bony Landmarks and Surface Anatomy and other important features. i. Greater and lesser (true) pelvis, pelvic brim ii. Formed by the os coxae, sacrum and coccyx iii. Os coxae: pubis (pubic symphysis), ilium (iliac crest), and ischium (ischial tuberosity, ischial spine) iv. Sacrum –sacral promontory, sacral canal, sacral foramina v. Acetabulum, obturator foramen, pubic arch, lesser and greater sciatic arch (which form foramen when bounded by ligaments vi. Understand differences in male vs. female bony pelvis vii. Urogenital triangle borders: both ischial tuberosities and the pubic symphysis viii. Anal triangle borders: ischial tuberosities and the coccyx b. Vessels and Nerves i. Common iliac A&V ii. External Iliac A&V iii. Internal iliac A&V iv. Umbilical and Vesicular A&V c. Viscera i. Sigmoid colon, Rectum ii. Ureters iii. Urinary bladder 1. Trigone 2. Urethra (in male has three sections: prostatic, membranous, and penile) iv. Female 1. External Genitalia a. Mons pubis b. Vulva i. Labia majora ii. Labia minora (vestibule is space between minora) iii. Clitoris iv. Prepuce of clitoris v. Urethral and Vaginal openings vi. Perineal body c. Anus d. Muscles –diagrams only i. Ischiocavernosus ii. Bulbospongiosus iii. External anal sphincter 2. Ovary a. Ovarian ligament b. Suspensory ligament c. Mesovarium (part of broad ligament) d. Ovarian A&V 3. Fallopian tubes (oviducts or uterine tubes a. Ampulla, infundibulum, fimbria, isthmus b. Mesosalpinx (part of broad ligament) 4. Uterus a. Fundus, body b. Cervix with its Internal and External Os c. Layers: perimetrium, myometrium, endometrium d. Broad ligament (mesometrium segment) e. Round ligament f. Rectouterine pouch g. Vesicouterine pouch 5. Vagina a. Fornices (2 lateral, anterior and posterior) b. Rugae, hymen Page 9 of 13 v. Male 1. External Genitalia a. Penis i. Glans penis, prepuce (foreskin) (frenulum if present), raphe ii. Corpora cavernosa (base is crus) iii. Corpus spongiosum 1. Bulb of penis (bulb and crus makes up root of penis) iv. Penis septum v. Penile urethra b. Scrotum i. Raphe and Dartos tunic and muscle 2. Testis a. Tunica vaginalis (parietal and visceral layers) b. Gubernaculum 3. Epididymis a. Head, body, tail 4. Spermatic cord a. Pampiniform plexus and Testicular artery b. Ductus (Vas) deferens c. Inguinal canal 5. Ductus Deferens 6. Seminal Vesicles 7. Prostate gland a. Ejaculatory duct 8. Bulbourethral glands 6. Back and Spinal Cord --skip all of this a. Bony Landmarks and Surface Anatomy i. Review vertebrae anatomy (Thoracic and Lumbar) ii. Review Scapula b. Muscles (note: thoraco-lumbar fascia) i. Trapezius ii. Latissimus dorsi iii. Erector spinae iv. Multifidus Page 10 of 13 7. Lower Limb a. Bony Landmarks and Surface Anatomy i. Sacrum: sacral promontory, sacral hiatus, median sacral spine, sacral foramina, ala, pelvic face, coccyx ii. Os coax: acetabulum, obturator foramen, pelvic cavity, pelvic inlet and outlet, pelvic brim, pubic symphysis, greater and lesser sciatic notch, arcuate line 1. Ilium: ala (wing), iliac crest, iliac spines (by anatomical position), iliac fossa 2. Ischium: ischial tuberosity, ramus, ischial spine 3. Pubis: ramus, pubic tubercle, pubic arch iii. Femur: head, neck, greater and lesser trochanter, intertrochanteric crest, intertrochanteric line, gluteal tuberosity, linea aspera, medial and lateral condyles, medial and lateral epicondyles, intercondylar fossa iv. Patella v. Tibia: medial and lateral condyles, intercondylar eminence, tibial tuberosity, medial malleolus, fibular notch vi. Fibula: head, neck, lateral malleolus vii. Foot: Tarsals (calcaneus, talus, cuboid, cuneiforms (3), navicular), meatarsals, phalanges viii. Femoral Triangle –borders are the sartorius, adductor longus and inguinal ligament; contains femoral A&V and nerve b. Hip i. Muscles and Nerves 1. Gluteus maximus ii. Joint 1. Iliofemoral ligament 2. Ischiofemoral ligament 3. Pubofemoral ligament 4. Ligamentum teres iii. Vessels, Nerves, Lymph 1. Sciatic nerve 2. Femoral nerve 3. External Iliac A&V 4. Femoral A&V 5. Inguinal lymph nodes c. Femoral (thigh) i. Muscles 1. Sartorius 2. Gracilis 3. Quadriceps femoris a. Vastus lateralis b. Vastus medialis c. Rectus femoris d. Vastus internus (intermedius) 4. Tensor fascia latae (tendon becomes iliotibial tract) 5. Adductor longus 6. Adductor magnus (note: Adductor hiatus) 7. Hamstring muscles: a. Biceps femoris b. Semitendinosus c. Semimembranosus ii. Vessels and Nerves 1. Femoral A&V 2. Popliteal A&V (note: popliteal fossa) 3. Great Saphenous V. 4. Femoral nerve 5. Saphenous nerve Page 11 of 13 d. Knee i. Quadriceps tendon ii. Patella iii. Patellar ligament iv. Lateral (fibular) collateral ligament v. Medial (tibial) collateral ligament vi. Anterior cruciate ligament (ACL) vii. Posterior cruciate ligament (PCL) viii. Medial and lateral menisci e. Crural (lower foreleg) i. Muscles (note: extensor retinaculum) 1. Gastrocnemius 2. Soleus 3. Flexor digitorum longus 4. Flexor hallicus longus 5. Tibialis anterior 6. Extensor digitorum longus 7. Fibularis (Peroneus) longus ii. Vessels and Nerves 1. Anterior and Posterior Tibial A&V 2. Fibular A&V 3. Tibial nerve 4. Common peroneal (fibular) nerve f. Pedal (Foot) Page 12 of 13 8. Upper Limb and Girdle a. Bony Landmarks and Surface Anatomy i. Scapula –acromion, spine, coracoid, glenoid cavity, subscapularis fossa, supraspinatus fossa, infraspinatus fossa ii. Humerus –head, neck, surgical neck, greater and lesser tubercle, trochlea, capitulum, olecranon fossa iii. Radius –radial tuberosity, head, styloid process iv. Ulna –olecranon process, coronoid process, trochlear notch, styloid process v. Hand –carpals (Scaphoid (navicular), Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate), metacarpals, phalanx vi. Brachium, antebrachium, cubital fossa, olecranon b. Shoulder i. Muscles 1. Deltoid 2. Supraspinatus 3. Infraspinatus 4. Subscapularis 5. Teres minor 6. Teres major ii. Joint 1. Rotator cuff –know parts of 2. Biceps brachii tendons iii. Vessels, Nerves and Lymph 1. Axillary A&V 2. Subscapular A. 3. Basilic V. –diagram or model 4. Cephalic V. –diagram or model 5. Musculocutaneous nerve 6. Radial nerve 7. Median nerve 8. Ulnar nerve 9. Axillary lymph nodes c. Brachium i. Muscles 1. Biceps brachii (short and long heads) 2. Brachialis 3. Triceps Brachii (long, lateral and medial heads) ii. Vessels 1. Brachial A&V 2. Median cubital vein -diagram d. Antebrachium i. Muscles 1. Flexors a. Flexor carpi radialis b. Palmaris longus c. Flexor carpi ulnaris d. Pronator teres e. Flexor retinaculum 2. Extensors a. Brachioradialis b. Extensor carpi radialis longus c. Extensor carpi radialis brevis d. Extensor digitorum e. Extensor carpi ulnaris f. Extensor retinaculum e. Hand i. Thenar and lumbricals muscles, carpal tunnel Page 13 of 13