Section 1: Bones, Joints and Muscles

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Section 1: Bones, Joints and Muscles

1. Bones & Joints
● The bone as an organ- structure, development and growing. Biological
features.
Bones tissue supports fleshy structures, provides cavities for vital organs and harbours bone
marrow. Bone is specialized connective tissue and composed of calcified intercellular matrix
(bone matrix) and three cell types. These are:
- Osteocytes - found in cavities between layers of the bone matrix
- Osteoblasts - which synthesize the organic components of the matrix
- Osteoclasts - of Macrophage origin, giant multinucleated cell involved in bone
resorption.
Osteocytes communicate with the blood capillaries through canaliculi. These very thin
canals allow metabolites to exchange between osteocytes and the capillaries as they
material cannot diffuse through the calcified ECM.
All bones are lined on the internal surface by endosteum and on the external surface by
periosteum.
Osteoblasts:
Responsible for matrix synthesis, consisting of T
ype I collagen fibers, Proteoglycans
and several glycoproteins.
When engaged in matrix synthesis have cuboidal to columnar shape and are located on the
outside of the bone. Osteoblasts have the ultrastructure of cells actively synthesizing
proteins. Individual cells are usually surrounded by their own secretions and become
osteocytes.
Cells make contact by gap junctions, and molecules are passed via these structures from
cell to cell to provide nourishment for a chain of cells.
Osteocytes
These flat, almond shaped cells exhibit significantly reduced RER and golgi apparatus,
with more condensed nuclear chromatin. The cells are involved in maintaining the bony
matrix and their death is followed by resorption of this matrix.
They lie within small chambers called lacunae, which is within the bone matrix, remaining in
contact with other cells through the gap junction coupling process, still using the canaliculi
to communicate.
Osteoclasts
Osteoclasts pump out collagenase and other enzymes, forming an acidic environment
locally for dissolving hydroxyapatite and promoting localized collaged digestion
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Anatomy 2017 - Bones, Joints and Muscles
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Bone types
Bones can be long, short, flat, irregular or sesamoid (round). They are vascular and
innervated. Vasculation is usually one artery per bone, entering the bone marrow directly. All
bones are covered in a membrane called a Periosteum which helps support the bone.
Bone growth
Bone can be formed one of two ways:
- Endochondral ossification - where bone is formed onto a cartilage model replacing it
- Intramembranous - where bone is formed directly onto fibrous connective tissue and
there is no intermediate cartilage stage. This type of ossification occurs in a few
places such as the parietal bone.
Endochondral ossification
Takes place within a piece of hyaline cartilage which matches the shape of the bone
being created. The process is in two stages, the primary ossification centre, and
secondary ossification centre. The primary ossification centre is as follows.
- Bone tissue appears thanks to osteoblast activity as a collar surrounding the
cartilage model.
- This collar impedes diffusion of nutrients to underlying cartilage, as such it starts to
degrade.
- Chondrocytes produce alkaline phosphatase and sell, compressing the matrix
and leading to ossification.
- The death of the chondrocytes results in a porous structure formed from the
remanence of the collagens ECM.
- Osteoblasts then adhere to this and lay down layers of primary bone that
surround the cartilaginous matrix remnants.
The secondary ossification centre occurs after this:
- The bone starts to enlarge and arrange itself in rows
- The matrix beings to increase in quantity so the cells become further spread out
- Calcareous material is deposited between the rows of cells
- The matrix becomes more calcified
2. Bones of the vertebral column
33 vertebrae consisting of
- 7 Cervical
- 12 Thoracic
- 5 Lumbar
- 5 (fused) Sacral
- 4 (often fused) Coccyx
General points, all vertebrae have:
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An anterior body - Corpus vertebrae

Posterior to the body sits Arcus vertebrae
Between the Arcus and Corpus is foramen vertebrale
Each vertebrae has 7 processus, 6 pared 1 not.
The unpaired is called processus spinosus
2 paired are superior articular processes, 2 inferior articular processes
Cervical vertebrae
C1 - C7, the top two are special and dealt with separately, this is the Atlas and Axis.
Atlas
- Above the Atlas sits the Occipital condyles.
- It is much rounder and flatter than other vertebrae
- Giant (relatively) vertebral foramen
Superior view
Anterior tubercle - on Anterior arch

Anterior arch - Anterior bit of bone
Articular facet for dens - flat bit behind anterior tubercle
Transverse process - bits of bone sticking out sideways
Transverse foramen - holes on transverse process
Superior articular surface for lateral mass of occipital condyle
Tubercle for transverse ligament of atlas - tubercle sitting inferior to articulate surface
Groove for vertebral artery - groove posterior to articular surface
Posterior tubercle - on posterior tubercle
Posterior arch - posterior bit of bone
Vertebral foramen (large)
Inferior view
Inferior articular surface of lateral mass of axis
Axis Anterior view

Dens - upward boney projection that articulates with Atlas
With anterior articular facet for anterior arch of atlas
Pedicle - point at which Dens meets body of Axis
Superior articular facet for atlas
Inarticular part - connection between body and spinous process
Transverse process - as per class
Transverse foramen - as per class
Body - mass that Dens sits on
Inferior articular facet for C3 - inferior facing articular surface
Posterior view
Spinous process - as per class
Posterior articular facet on dens - for transverse ligament of atlas
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C3 - C7 Inferior view
Body
Area for articulation of left unc process of below vertebrae - sits laterally inferior on body
Transverse process - boney mass sticking out sideways
- Anterior tubercle
- Posterior tubercle
- Transverse foramen
- Coastal lamella - indent between tubercles
Pedicle - attachment between body and rest of bone
Inferior articular process and facet
Lamia - plate attaching body to spinous process
bifid spinous process - double pronged spinous process
Superior view
Articular surface of R/L uncinate process
Superior articular process and facet
Groove for spinal nerve - runs lateral to body across transverse foramen
Basically, Thoracic bodies a little bigger, Lumber much bigger. Thoracic spinous process
more angular downwards, non-bifid, lumbar spinous process shorter and l
stumpy. Thoracic includes articular facet for ribs.
3. Ribs and sternum

● Twelve pairs of ribs
● All ribs articulate with vertebral column, only upper seven articulate directly with
sternum. Next three articulate with costal cartilages of ribs above, ribs 11 and 12 are
floating ribs.
● Ribs have
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a. Head, neck, tubercle at posterior part

i. Head includes two articular facets
ii. Tubercle also has articular facet and non-articular surface
b. Costal groove on underside for intercostal nerves and vessels
Sternum
- Sternum includes MAnubrium (top), Body and Xiphoid process
- Manubrium
- Jugular notch, articulation for clavicular, attachment for first rib. At articular
point with body, is part of the articulation for rib II.
- Body
- Articular facets for ribs III-VI with transverse ridges across the body
- Xiphoid process
- Part of articular facet for rib VII
4. Clavicula, scapula and humerus
The Clavicle is a paired s-shaped bone.
L/R Identification
The flatter more rounded end should always be medial, this is the Sternal facet (joining with
the sternum). While the subclavian groove should always be inferior.
Parts Faces Borders
Shaft Superior face Anterior edge

Medial end Inferior face Posterior edge
Distal end
Articulates with?
Acromial bone at Acromial facet (distal)
Sternal bone at Sternal facet (medial)
Key Features Inferior view

Trapezoid line - impression running out of acromial facet
Conoid tubercle - tubercle at end of Trapezoid line
Subclavian groove - groove for subclavian muscle
Impression for costoclavicular ligament - sits at sternal ned
Scapula
Shoulder bone, pared, triangular in shape.
L/R identification
The Glenoid Cavity must always be lateral with the spine of the scapular posterior.
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Parts Faces Borders Angles
Spine Infraspinous fossa Superior border Inferior angle

Body Supraspinous fossa Medial border Superior angle
Neck Subscapular fossa Lateral border
Key Features
Acromion - coming out of spine to articulate with clavicle
Acromion angle - spine to Acromion join
Spine - sits on posterior of scapular
Coracoid process - sits over the glenoid cavity
Glenoid cavity - where there head of the humerus goes
Supraglenoid tubercle- tubercle on top of glenoid cavity
Posterior view
Suprascapular notch - Notch on superior border
Groove for circumflex scapular vessels - groove on lateral border
Notch connecting supraspinous and infraspinous fossae
Infraglenoid tubercle - tubercle below glenoid cavity
Humerus
Bone of upper arm, long paired bone.
L/R Identification
Olecranon fossa must be posterior with head of bone medial.
Parts Faces Borders
Proximal end Anterior medial Anterial

Distal end Anterior lateral Medial
Shaft Posterior Lateral
Key Features
Head - Obvs
Anatomical neck - line between the true bone before the head
Surgical neck - the thin bit, where it would really break
Intertubercular sulcus - groove between greater and lesser tubercle
Greater tubercle - the larger more lateral tubercle (near head)
Lesser tubercle - the smaller more medial tubercle (near head)
Crest of greater tubercle - raised runoff greater tubercle
Crest of lesser tubercle - raised runoff of lesser tubercle
Deltoid tuberosity - Lump half way down bone
Medial and lateral supracondylar ridge
Lateral and medial epicondyle
Capitulum - think lateral condyle
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Trochlea - think medial condyle

Radial fossa - Lateral anterior depression above capitulum
Coronoid fossa - medial anterior depression above trochlea
Posterior view
Olecranon Fossa - large depression posteriorly
Radial groove - groove running down the posterior of the bone
5. Radius and ulna
Radius
Outer bone of forearm. Long pared bone.
L/R Identification
Styloid process of radius must be lateral with radial tuberosity anteriorly medial.
Parts Faces Borders
Proximal end Anterior Anterior

Shaft Posterior Interosseous
Distal end Lateral Posterior
Key Features
Face of head of the radius - the flat bit on top of the head of the radius
Articular circumference of the radius - circle around the head of the radius
Radial tuberosity - tuberosity inferior to head of the radius
Styloid process of radius - distal end, lumpy extension
Articulate face with carpal bones - sits at distal end
- distal end of radius (inc. Styloid process) has two articular faces
- Articulate face for scaphoid bone
- Articulate face for lunate bone
Ulna
Long pared bone sits medially to the radius in the forearm.
L/R Identification
Styloid process of ulna must be medial with Olecranon Anterior.
Parts Faces Borders
Proximal end Anterior Anterior

Shaft Posterior Posterior?
Distal end Medial Interosseous
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Key Features
Olecranon - Big hook that hooks into humerous
Trochlear notch - between olecranon and coronoid process
Coronoid process - process that forms inferior part of ulna-humerus articulation
Ulnar tuberosity - tuberosity sitting below head of Ulna
Radial notch of ulna - a notch laterally for the radius to sit
Styloid process of ulna - boney process at distal end (the obvious bit on your wrist!)
6. Bones of hand
Carpal Bones
There are eight carpal (wrist) bones arranged in two rows (proximal and distal row). They
can be remembered as:
Some - Scaphoid - Looks like a spoon

Lovers - Lunate - half moon
Try - Triquetrum - T’ree articular faces
Positions - Pisiform - smallest
That - Trapezium - has a tubercle
They - Trapezoid -
Can’t - Capitate - ‘decapitate’ has a head
Handle - Hamate - has a hook
While looking at these we are going Lateral - Medial Proximal row then lateral - medial distal
row!
Metacarpal and Phalanges

The Metacarpal bones exist on all fingers and the thumbs have Head, shaft and base!
Phalanges are divided into proximal, middle and distal. These exist on all of the fingers
however there is only proximal and distal on the thumb.
The phalanges also have Head shafts and base while the distal phalanges also have a
tuberosity on their head!
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7. Bones of pelvis: sacrum and hip bone
Coxal Bone
The Coxal (Hip) bone is pared and triangular? in shape.
L/R Identification
The Acetabulum must be lateral facing and the pubic tuberculum must be anterior.
Parts
The coxal bone can be divided into three sub bones fused at the Acetabulum. Oss Illi, Oss
Ischi and Oss Pubi.
-
Parts
Illium
- Wing
- Body
- Spine (Posterior, inferior & superior. Anterior, inferior and superior)
Ischium
- Body
- Wing
- Spine
Pubis
- Superior wing
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- Inferior wing
Key Features Ilium, Lateral view

Iliac Crest - top bit of bone
- Includes - Intermediate zone, Tuberculum, Outer lip
Gluteal lines - ridges running across wing of iliac bone
- Posterior
- Anterior
- Inferior
Posterior Superior iliac spine
Posterior inferior iliac spine
Anterior superior iliac spine
Anterior inferior iliac spine
Greater Sciatic notch - Notch below posterior inferior iliac spine
Medial view
Iliac tuberosity - rough area on medial side
Auricular surface for sacrum - flatter section on iliac tuberosity
Arcuate line - runs as border between wing and body of ilium
Ischium, Lateral view

Ischial spine - pokey bit below greater sciatic notch
Lesser sciatic notch - notch below ischial spine
Ischial tuberosity - rough area (bit we sit on)
Ramus of ischium - wing that attaches to pubic ramus
Pubis, Lateral view
Superior pubic ramus - Wing connecting to ilium
Pubic tubercle - pokey out bit of pubis
Obturator crest - crest from pubic tubercle to acetabulum
Inferior pubic ramus - wing connecting to ischium
Pubis, Medial view
Iliopubic eminence - lump between ilium and pubis
Pecten pubis (pectineal line) - line from pubic tubercle up towards iliopubic eminence
Symphyseal surface - articular surface on other side of pubic tubercle
Obturator grove - groove thing in the obturator hole
Obturator foramen - hole between wings of pubis and Ischium
Acetabulum, Medial view

Lunate surface - Articular surface
Margin of acetabulum - outer ring
Acetabular notch - Notch on inferior part of the acetabulum (next to obturator)
Sacral
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……….
8. Femur, tibia and fibula
Femur
Long pared bone.
L/R Identification
Intercondylar fossa must always be posterior with the head of the bone medial.
Borders/surfaces?
…….
Parts
Proximal end
Shaft
Distal end
Key Features
Head
Fovea for ligament of head
Neck
Retinacular foramina - small holes on neck of bone
Greater Trochanter - tubercle like lump next to neck
Lesser trochanter - lower down tubercle lump next to neck
Intertrochanteric line - line that runs between trochanters (anteriorly)
Intertrochanteric crest - crest that runs between trochanters (posteriorly)
Posterior view
Quadrate tubercle - tubercle next to calcar
Pectineal line - line running out of lesser trochanter
Gluteal tuberosity - tuberosity running out of greater trochanter to linea aspera
Linea aspera - line runs down posterior of bone
- Medial lip
- Lateral lip
Popliteal surface - surface between two supracondylar lines (distal end)
Medial and lateral supracondylar lines
Medial and lateral epicondyles - projections either side of condyles
Medial and lateral condyles - obvs
Intercondylar fossa - gap between condyles on posterior
Adductor tubercle - Tubercle just above medial condyle
Anterior view
Patellar surface - Area between condyles for patellar
Tibia
Medially on leg, think the Tibia = Thicker. Pared long bone.
L/R Identifier
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Medial malleolus must always be medial while Tibial tuberosity must be anterior
Parts Faces Borders
Proximal Medial surface Anterior

Shaft Lateral surface Medial
Distal Posterior surface Interosseous
Key Features
Intercondylar eminence - Proximal articular face
- Lateral intercondylar tubercle
- Medial intercondylar tubercle
- Superior articular faces
Lateral condyle - Lateral side of intercondylar eminence
Medial condyle - Medial side of intercondylar eminence
Anterior view
Gerdy’s tubercle - tubercle near lateral condyle
Oblique line - runs from lateral condyle towards tibial tuberosity
Tibial tuberosity - central and anterior tuberosity
Inferior articular surface - distal end
Articular facet of medial malleolus
Posterior view
Groove for insertion of semimembranosus tendon - groove under medial condyle
Soleal line - runs from lateral condyle downwards
Nutrient foramen - hole on soleal line
Groove for tibialis posterior and flexor digitorum longus tendons
- groove on medial malleolus
Fibula
Lateral bone in leg (think Fibula = Fragile). Long and pared.
L/R Identification
There is an indent on the distal end of the Fibula (lateral malleolus) when you hold this so it
is positioned posteriorly and medially facing. (remember what the Bulgarians said!!!)
Parts Faces Borders
Apex Medial Anterior

Head Lateral Interosseous
Neck Posterior Posterior
Lateral Malleolus - lump at distal end
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- Articular facet of lateral malleolus
9. Bones of foot
Tarsal Bones
Bones of the ankle. There are seven!
Talus - proximal, medial to calcaneus

- Head
- Neck
- Trochlea
- Posterior process
- Groove for tendon of flexor hallucis longus
- Medial and lateral tubercle (Posterior of bone)
Calcaneus - Proximal, lateral to Talus
- Fibular (lump on lateral border?)
- Body
Plantar (below) view
- Sustentaculum tali
- Lateral Process
- Medial process
- Tuberosity
Cuboid - Distal and lateral (beneath your little toe)
Navicular - middle and medial
- Tuberosity
Cuneiform bones (x3) - sits below first three toes
- Medial
- Intermediate
- Lateral
Metatarsals and Phalanges

There are five metatarsal bones
There are Proximal, Middle and D

istal Phalanges on each
toe.
Each Metatarsal and Phalangeal has a Base, Shaft and

Head!
On the Distal Phalangeal there is a Tuberosity.
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10. Calvaria (cranial roof). Frontanelies
You know the bit of the skull which is cut off and floaty, that bit!!!
Note, consists of Frontal bone, Parietal bone and Occipital bone, features are:
- Coronal Suture Superior View
- Sagittal suture
- Lambdoid suture (occipital and parietal
border)
- Lambda (Occipital angle, that is to say, the
bit of occipital that protrudes furthest into
parietal)
- Frontal crest Inferior View

- Groove for superior sagittal sinus
- Granular foveolae
- Diploe (found in the bone cross section)
- Groove for superior sagittal sinus
The Fontanelle (soft spot), is the part of the infant

skull between the bones which consists of only membranous tissue
to allow for rapid brain growth. It is located between the frontal and
parietal bones,
11. Cranial base, external surface.

Mandibule
Cranial base, external surface

The cranial base is formed from from five bones:
- Ethmoid
- Sphenoid
- Occipital
- Paired frontal
- Paired temporal
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So, I’m really not sure how to put this content into words, I think we’ve just got to spend a
shed load of time in the bone room! Just don’t be a wimp about it and go do it!
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Mandible
Non-pared, forms the jaw
Parts
Body
Ramus (wing)
Alveolar part
Surfaces
Submandibular fossa
Sublingual fossa
Key Features
Condylar process - posterior part of temporomandibular joint
Head of Condylar process
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Neck of Condylar process

Coronoid process - anterior part of temporomandibular joint
Pterygoid fovea - tiny indent on neck of Condylar
Mandibular notch - the dip between Condylar and Coronoid processes
Mandibular foramen - large hole inside of mandible ramus
Lingula - bump on the mandibular foramen
Mylohyoid groove - groove running sub mandibular foramen
Mylohyoid line - runs out of groove along body
Mental Tubercle - Lumps on anterior of mandible, below alveolar part
Mental Protuberance - Chin
Mental foramen - two symmetrical holes on the chin
Oblique line - runs out from coronoid process, parallel to alveolar part
Intraalveolar septa - bits in between the teeth
Alveolar - the holes for the teeth
12. Cranial base, internal surface
Six bones:
- Ethmoid
- Frontal
- Occipital
- Parietal
- Sphenoid
- Temporal
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13. Lateral surface of the cranium. Temporal fossa,

infratemporal fossa, and pterygopalatine fossa
Temporal fossa:
- Medial border = Frontal bone, parietal bone, temporal bone +
sphenoid bone
- Anterior border = posterior surface of frontal process of zygomatic
bone and posterior surface of the zygomatic process of the frontal
bone
- Superior = pair of temporal lines arching across the skull
- Inferior = zygomatic arch laterally and infratemporal crest of the
greater wing of sphenoid medially
Infratemporal fossa
Wedge shape space deep to zygomatic arch, masseter muscle and
mandible, posterior to the maxilla. It is not a boney face, rather a space
directly below the Temporal fossa.
- Anterior = infratemporal surface of maxilla and the ridge
descending from zygomatic process
- Posterior = anterior tubercle of
temporal and spina angularis of
sphenoid
- Superior = greater wing of sphenoid,
below infratemporal crest
- Inferior = Medial pterygoid muscle
- Medially = lateral pterygoid plate
- Laterally = ramus of mandible
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Pterygopalatine fossa
Paired depression within the infratemporal fossa, posterior to the maxilla, between the
pterygoid process and maxillary tuberosity, close to the apex of the orbit. Communicates
with the nasal and oral cavities, infratemporal fossa, orbit, pharynx and middle cranial fossa.
14. Orbit
Bones include:
- Maxilla
- Zygomatic
- Frontal
- Ethmoid
- Lacrimal
- Sphenoid
- Paletine
Note key features:
- Superior orbital fissure (branches of V1 and IV
and superior ophthalmic vein)
- Inferior orbital fissure (inferior ophthalmic vein)
- Optical canal (for optic nerve and artery)
- Lacrimal groove
- Lacrimal foramen
15. Bony nasal cavity
Medial wall
- Anterior = Septal nasal cartilage
- Posterior = Vormer, perpendicular plate of ethmoid
Floor
- Sof tissue of external nose
- Upper surface of palatine process of maxilla and
horizontal plate of palatine bone. Together these =
hard palate.
Roof
- Cribriform plate of ethmoid bone
- Anterior = Nasal spine of frontal and nasal bone as well
as lateral process of septal cartilage and major wing
cartilages of external bone
- Posterior = anterior surface of sphenoid, wing of vomer
and adjacent sphenoidal process of palatine bone and
vaginal process of medial plate of pterygoid process.
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16. Joints system. Boney joints: synarthrosis, cartilaginous

joints, synostosis
Structural Class Structural Types Mobility

Characteristics
Fibrous Adjoining bones 1. Structure (short 1. Immobile

united by fibers) 2. Slightly
collagenic fibers 2. Syndesmosis mobile and
(longer fibers) immobile
3. Gomphosis 3. Immobile
(periodontal
ligament)
Cartilaginous Adjoining bones 1. Synchondrosis 1. Immobile

united by 2. Symphysis 2. Slightly
cartilage mobile
Synovial Adjoining bones 1. Plane Freely movable

separated by a 2. Hinge movements
joint cavity 3. Pivot depending on
covered with 4. Condyloid design of joint
articular 5. Saddle
cartilage and 6. Ball and Socket
enclosed within
an articular
capsule lined
with synovial
membrane
We can classify joints based on their structure (and thereby their function). Joints can be:
- Synarthroses
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- Non-moving e.g. cranial sutures

- Amphiarthroses
- Partially moving e.g. pelvic joint
- Diarthroses
- Moving joints e.g. elbow and knee
We also classify based on what they are made from as:

- Fibrous
- Use dense fibrous connective tissue (usually Synarthroses)
- Cartilaginous
- Use cartilage to joint bones (usually Amphiarthroses)
- Synovial
- Have a fluid filled synovial capsule (usually Diarthroses)
Synovial joints can be further subdivided based on their movement:

- Plane - carpal bones of writs, gliding movement
- Hinge*
- Condylar* - wrist joint - allow movement on two axes
- Pivot - radius and ulna, allows you to rotate your palm
- Pronation (turning posteriorly)
- Supination (turning anteriorly)
- Ball-and-socket - allows rotational movement
- Saddle - makes thumbs opposable
*Certain Synovial joints can be categorised as Angular movements (any movement which
changes the angle of a joint), these include
- flexion (reducing angle e.g. bringing forearm up)
- extension (increasing angle e.g lowering forearm)
- hyperextension (extension beyond normal anatomical point)
- abduction (movement of limb away from the midline)
- adduction (movement of limb towards the midline)
- circumduction (a combination of all five movements, like a lasso)
Joint capsules
Joint capsules exist in all synovial joints, they are made up of two membranes, a synovial
membrane, within which is the synovial fluid, and a fibrous membrane, which conveys
additional strength.
17. Synovial joints - structure and mechanics
A synovial joint contains:

- Fibrous joint capsule
- Synovial membrane
- Synovial fluid
- Articular cartilage (hyaline cartilage)
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It joints bones, providing the most mobile form of joint.
Some synovial joints have the additional features of:

- Articular discs
- Articular fat pads
- Tendons
- Accessory ligaments
- Bursae
Blood supply comes from arterial anastomosis around the joint.
There are six types of synovial joints:

- Gliding (e.g. carpals)
- Hinge (e.g. elbow)
- Pivot (e.g. distal radioulnar joint)
- Condyloid (e.g. radiocarpal joint)
- Saddle (e.g. sternoclavicular)
- Ball and socked (e.g. if you can’t think of one give up)
- Compound joints/Modified hip (knee)
Possible movements are:
- Abduction
- Adduction
- Extension
- Flexion
- Roation
18. Vertebral column. Vertebral joints: syndesmoses,

synchondroses and synovial joints. Configuration and
mechanics of the vertebral column.
24 articulating vertebrae. In between each

vertebrae are vertebral disks made of fibrous
cartilage.
Vertebral disks
- outside consists of annulus fibrosus
and inner is nucleus pulposus
- primary function is to absorb impact and
allow column to move
The vertebral column has two main types of

joints:
- Symphyses joints between vertebral
bodies
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- Synovial joints between articular processes

This means in total the average vertebra has six joints with adjacent vertebrae, 4 synovial
(two above and two below) and 2 symphyseal (1 above and 1 below). We will address each
type of joint in turn.
Symphyses joints - Two bones separated by cartilage

The key feature of the symphysis joints is the vertebral disks made from annulus fibrosus
and nucleus purposes. The articular faces are the superior and inferior faces of the body of
the vertebrae.
Zygapophysial joints (synovial joints) between the vertebral processes

These are the synovial joints between the superior and inferior articular facet of the
vertebrae. They facilitate flexion and e
xtension in the cervical regions, while limiting this
in the thoracic region where they facilitate rotation. The lumbar region allows flexion and
extension to a limited extent.
Ligaments
These joints are reinforced by the following ligaments:
- Anterior longitudinal - anterior of vertebral bodies
- Posterior longitudinal - posterior of vertebral bodies, in the vertebral canal
- Ligamenta flava - runs between the laminae of the vertebrae, form posterior part of
vertebral canal
- Supraspinous - runs over tips of spinous processes TI - end of sacrum
- Nuchae - runs from external occipital protuberance to CVII
- Interspinous - runs between spinous processes of ligaments
Atlantoaxial joint
- Formed of three Synovial joints, one medial, two lateral
- Allows for rotation of Atlas and therefore entire skull
- Articulation of dense with inferior articular facet of atlas for dense (medial)
- Superior articular facet of axis lines up with inferior articular facet of atlas
- Capsule of joint attached to margin of articular faces
Ligaments
- Transverse ligament from processes on atlas, across dense (create a ring like thing)
- Apex of dense connects with apical ligament of dens to anterior margin of foramen
magnum
- Altar ligaments attach dense to occipital condyles (allow flexion and extension of
head)
19. Thoracic joints. The thorax as a whole
The key joints are the Costovertebral joints and the Sternocostal joints
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Costovertebral joints articulate the heads of the ribs with the bodies of the thoracic
vertebrae. This is a gliding (plane) synovial joint which allows for rotation of rib around
longitudinal axis.
The costovertebral articulation forms two parts, the articulation of the rib with the transverse
processes and the articulation of the head of rib with the articular facets on the vertebral
bodies.
Two convex facets from the head attach to two adjacent vertebrae forming a synovial
gliding joint. The articular faces are the head of the rib and the inferior/superior articular
facet of the vertebrae.
The ligaments of the ribs articulation to the vertebrae are:

- Costotransverse ligament (between tubercles of ribs and the transverse processes)
- Lateral costotransverse ligament passes from the tubercle of the rib to the tip of the
transverse process
- Superior costotransverse ligament (attaches rib to superior transverse process)
- Intraarticular ligament (In the synovial joint)
Sternocostal joints articulate the cartilages of true ribs with the sternum and are arthrodial
joints (excepting R1 which is synarthrodial as it connects directly into the sternum without
any cartilage).
Xipsternal joint - between sternal body and head of xiphoid process (cartilaginous bottom
part of sternum)
Manubriosternal joint - joint between manubrium and body of sternum
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Interchondral joints - joint cartilage to cartilage on the 6-9th ribs where the ribs do not joint
directly to the sternum, instead to cartilage which then joins to the sternum.
Costochondrol joints - joint between rib and its cartilaginous aspect
20. Temporomandibular joint
This is a Hinge and Plane type synovial joint which allows for hinge, protrusion and
retraction movement.
It joints the mandibular condyles with the m

andibular fossa on the temporal bone of the
skull.
Between these two articular surfaces is an articular disk. When the jaw fully opens the
mandibular condyle moves to the articular eminence, anterior to the mandibular fossa.
The joint capsule originates at the border of the mandibular fossa, encloses the articular
eminence of the temporal bone and inserts at the neck of the mandible above the pterygoid
fovea.
The joint uses three ligaments:

- Sphenomandibular ligament (spine of sphenoid bone to lingula of mandible)
- Stylomandibular ligament (styloid process to angle of mandible)
- Temporomandibular ligament (triangular ligament, attached to zygomatic process of
temporal bone and lateral side of neck of the mandible)
21. Joints of pectoral girdle
The joints include:

- Shoulder (Glenohumeral Joint, next point)
- Acromioclavicular joint
- Sternoclavicular joint
Acromioclavicular joint
Connection between the acromion and the acromial end of the clavicle. It is a plane synovial
joint. Allows for:
- Protraction and retraction of scapula.
- Rotation of scapula
- Elevation and Depression (minimal)
The joint capsule is attached to the margins of the articulating surfaces, there is a disk
between the two articular surfaces.
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The ligaments involved are:

- Acromioclavicular ligament - this covers the joint capsule superiorly and inferiorly.
- Coracoclavicular ligament - attaches clavicle to coracoid process
- Trapezoid
- Conoid
Sternoclavicular joint
Connection between the sternum (manubrium) and the clavicle. It is a diarthrotic synovial
joint where the articular surface of the sternal end of the clavicle joins with the clavicular
notch of the manubrium sterni.
The bone is separated by a double hinged articular disk of fibrocartilage.
The joint allows for predominantly anteroposterior and vertical movement, along with some
rotation.
The ligaments of this joint are:

- Anterior sternoclavicular
- interclavicular
- Costoclavicular
- Posterior sternoclavicular
The joint capsule is supported by these four ligaments and is attached to the edges of the
articular surfaces
22. Glenohumeral or shoulder joint
Shoulder joint (Glenohumeral Joint)

Connection between the Glenoid cavity of the scapular and the head of the humerus. This
joint offers all of the angular movements.
Margins of glenoid cavity are surrounded by a cartilaginous border known as the Glenoid
labrum.
The joint capsule encloses the joint, attached to the anatomical neck of the humerus
The synovial membrane protrudes outside of the fibrous membrane of the joint capsule in
certain locations. These are known as bursae, there are a number surrounding the joint.
There are five ligaments involved in this joint:

- Transverse humeral ligament - attaches greater and lesser tubercle, covering the
intertubercular groove.
- Coracohumeral ligament - attaches from coracoid process to the anatomical neck of
humerus
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- Glenohumeral ligament - originates on margin of glenoid cavity and attach to lesser

tubercle
- Superior
- Medial
- Inferior
- Coracoacromial ligament - attaches between coracoid process and acromion
(outside of joint capsule)
23. Elbow joint. Junctions of forearm bones
Joint between humerus, ulna and radius. This is a synovial hinge joint offering flexion and
extension.
It is a compound joint meaning there are multiple joints within it, these are:
- Humeroradial joint - Capitulum of humerus and head of the radius
- Humeroulnar joint - Trochlea of humerus and trochlear notch of ulna
- Proximal radioulnar joint - Head of radius and radial notch of ulna (within joint
capsule)
All of these joints have their articular surfaces covered in hyaline cartilage.
Anteriorly the joint capsule attaches to the margins of the coronoid and radial fossa on the
humerus, the lateral and medial epicondyles and the annular ligament over the head of the
radius.
Posteriorly it is attached to the margins of the olecranon fossa and the margins of the
olecranon process on the ulna as well as the annular ligament once again.
The ligaments that support this joint are :

- Annular ligament - over the head of the radius (small), attaches to the ulna and
loops around the head of the radius to hold it in place. This is the supporting ligament
for the proximal radioulnar joint.
- Ulnar collateral ligament - triangular, runs medially along the capsule, corners of
triangle attached to the medial epicondyle, medial side of olecranon process and ulna
tuberosity.
- Radial collateral ligament - runs laterally along the capsule, attached to lateral
epicondyle of humerus and the annular ligament
The distal radioulnar joint joins the ulna and radius at the distal end. It is between the
articular surface of the head of the ulna and the ulna notch on the end of the radius, with a
fibrous disc, separating it from the wrist joint.
This is a synovial joint, with the capsule joining around the margins of the articular surfaces.
Both the distal and proximal radioulnar joints allow for pronation and supination of the
forearm.
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The distal radioulnar joint has an articular disc within it and is predominantly supported by
the Palmar capsular ligament.
24. Wrist joint. Carpal Joints
The ‘wrist joint’ or radiocarpal joint, is a Condyloid joint that consists of the:
- Distal ulnoradial joint (although this can be considered separate)
- Radius and the articular faces of the scaphoid, lunate and triquetral bones.
There is an articular disk that runs laterally between the radius and the styloid process of the
ulna, separating out the distal ulnoradial joint from the radiocarpal joint.
The joint is a condyloid synovial joint capable of performing

- Flexion
- Extension
- Abduction
- Adduction
- Circumduction (a combination of the above)
The more distal styloid process of the radius limits abduction.

The ligaments involved in the wrist joint are:
- Palmar radiocarpal (Radio-scaphoid and Radio-capitate)
- Palmar ulnocarpal (triquetrum, capitate and lunate)
- Dorsal radiocarpal (radius-triquetrum)
- Radial and ulnar collateral ligaments of the wrist joint (adjacent carpals)
Additionally there is the dorsal and palmar radioulnar ligament which forms part of this joint
along with supporting the distal radioulnar joint.
Carpal joints
These help position the hand in all five of its movement types (described above). There is
however limited movement. The joint is synovial and they share a common articular cavity
with the radiocarpal joint. The carpal joints are arthrodial or plane joints to allow for gliding.
Ligaments, palmer view:

These are the same as above, also ‘wrist’
- Radiocarpal ligament
- Radioscapholunate part
- Radiotriquetral part
- Radiocapitate part
- Ulnocarpal ligament
- Ulnolunate part
- Ulnotriquetral part
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- Ulno and radio collateral ligaments

Ligaments, dorsal view
- Radiocarpal ligament
- Ulnocarpal ligament
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The key intercarpal ligaments are:
- Dorsal intercarpal ligament
- Scaphoid - lunate
- lunate - triquetrum
- Palmar intercarpal ligament
- Scaphoid - lunate
- Luate to triquetrum
- Interosseous Intercarpal ligaments
- Trapezoitecapitate
- Trapeziotrapezoid
- Capitohamate
- Triquetrohamate
- Schaphohamate
- Scaphotrapeziotrapezoid
25. Carpometacarpal joints. Metacarpophalangeal joints.

Interphalangeal joints of hand.
Carpometacarpal joint
The other joints between the carpal bones and metacarpal bones are:
- Trapezoid - M2
- Capitate - M3
- Hamate - M4
- Hamate - M5
These are all gliding joints that allow for extension and flexion.
The ligaments involved are the:

- Palmar and Dorsal metacarpal ligaments
- Palmar and dorsal carpometacarpal ligaments
- Flexor retinaculum (palmar, runs across from Trapezium to hamate)
Metacarpophalangeal joints
Condylar joints, allows for flexion, extension, abduction and adduction. (This excludes the
joint for the thumb, M1, which is a saddle joint allowing for the additional oposible
movement)
Ligaments:
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- Palmar ligament
- Collateral ligament
- Deep Transverse ligament (linking palmar ligaments laterally)
Joint capsule attaches to margins of articular surfaces of bones.
Interphalangeal joints
Similar set up as the metacarpophalangeal joints. They are hinge joints with flexion and
extension. Have collateral ligaments on either side of the joint along with palmar ligaments
(however no dorsal ligament, only the joint capsule which makes sense if you look at the
joint)
26. Joints of pelvic girdle. Shape and size of the pelvis
The joints of the pelvic girdle are:

- Lumbosacral joints
- Sacro-iliac joints
- Pubic symphysis joint
The lumbosacral joints join the superior part of the sacrum with the lumbar part of the
vertebral column. This joint consists of:
- Two zygapophysial joints between the superior and inferior articular process
- An intervertebral disc which joints the bodies of L5 and S1.
Ligaments:
- ilio sacral ligament, running from transverse processes of L5 to Illium.
- Anterior and posterior longitudinal ligaments continue to run along the bodies of the
vertebrae, attaching to S3.
The joint offers flexion and extension movement.
The sacro-iliac joint is a diarthrodial joint between the sacrum and the ilium of the pelvis.
It is a synovial plane joint allowing

for minimal movement but allows
shock absorption.
Allows for extension and flexion of

sacrum, along with innominate tilt o
f
sacrum anteriorly and posteriorly.
The ligaments involved are:

- Anterior sacroiliac ligament -
anterior and inferiorly to the
joint
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- Lumbosacral ligament - anterior part of ileum to transverse process of LV

- Iliolumbar ligament - runs for margin of ileum to transverse process of LV
(Now posteriorly)
- Sacrospinous ligament -
Sacrum to ischial spine
- Sacrotuberous ligament -
Sacrum to ischial tuberosity
Pubic symphysis joint lies anteriorly

between the surfaces of the pubic
bones (symphyseal surface is articular
surface).
Has superior and inferior pubic

ligament.
Allows minimal movement but essential for cushioning and absorbing stress related to
physical activity. Can move a number of millimeters to fulfill this function.
Don’t forget the Obturator membrane.
27. Hip joint
Between the head of the femur and the lunar face of the acetabulum, this is a synovial ball
and socket joint.
The line of the joint capsule sits around the outside of the acetabulum and the
intertrochanteric crest on the femur.
As with the shoulder joint the acetabulum has a cartilaginous collar known as the acetabular
labrum.
The ligaments involved in this joint are:

● Transverse acetabular ligament (internal, across acetabular notch)
● Ligament to the head of the femur (internal, attaches to the fovea of the femur)
● Iliofemoral lg (attaches between anterior and inferior iliac spine - intertrochanteric
crest
● pubofemoral lg (attaches on illiopubic emenence - intertrochanteric crest)
● ischiofemoral lg (posterior attaches from ischio - the greater trochanter)
The joint allows for a wide range of movements including:

- Abduction
- Adduction
- Flexion
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- Extension
- Medial rotation
- Lateral rotation
28. Knee joint
Knee joint is between the condyles of the femur and the intercondylar surface of the Tibia.
This is a synovial hinge joint offering flexion and extension along with a little bit of rotation.
Between the condyles and the Tibial condylar surfaces sit meniscus which is a cartilaginous
disk to prevent rubbing, they are attached to each other by the Transverse ligament of the
knee. The minsci are attached to the intercondylar eminence.
The joint capsule attaches to the margins of the articular surfaces and to the superior and
inferior outer margins of the menisci along with the margins of the patella. It does not
encapsulate the cruciate ligaments. There are bursa create around the joint.
Ligaments are
- Anterior and posterior cruciate ligaments, crossing the intercondylar fossa
- Medial and lateral collateral ligaments - attach to epicondyles on either side of the
femur, and on the neck of the Tibia medially and the head of the Fibula laterally.
- Patellar ligament - attaches patella to Tibial tuberosity and quadriceps femoris.
- Meniscofemoral ligament - attaches from meniscus to femur
29. Junctions of the leg bones. Ankle joint
There is a proximal and distal Tibiofibular joint.
Proximally this joint is synovial, athrodial joint and offers very little movement. There are two
ligaments of note. The fibular collateral ligament (or lateral collateral ligament) attaching the
head of the Fibula to the lateral condyle of the femur, and the Anterior and posterior ligament
of joint, connecting the head of the Fibula to the lateral condyle of the Tibia. The joint
capsule covers the articular surfaces of the bones.
Additionally there is an interosseus membrane running between the two bones.
The distal (or inferior) tibiofibular joint is NOT synovial, between the medial side of the distal
end of the fibula and the lateral concave surface of the Tibia. Effectively the Fibula is held
against the Tibia with Anterior and Posterior tibiofibular ligaments.
Ankle joint
Between the Talus, Tibia and Fibula.
Synovial hinge allowing dorsiflexion and plantar flexion.
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The distal ends of the Tibia and Fibula effectively form a socket for the Talus to sit in. The
lateral and medial malleoli form the lateral and medial walls of this socket. The roof of the
socket is formed by the inferior surface of the Tibia.
Synovial membrane attaches to margins of articular surfaces (that is articular surface of

lateral and medial malleolus and anterior articular surface of Talus)
Key ligaments involved in the ankle are:

- Medial ligament (attach from the Tibia)
- Tibiocalcaneal part
- Tibionavicular part
- Anterior tibiotalar part
- Posterior tibiotalar part
- Lateral ligament (attach from the Fibular)
- Calcaneofibular ligament
- Anterior & posterior talofibular ligament
30. Subtalar or talocalcaneal joint. Transverse tarsal joint & 31.

Cuneonavicular and intercuneiform joints.
Metatarsophalangeal and interphalangeal joints.
Note - This is two separate syllabus points, however it is easier to understand as one!
Joints in the foot are below, they are all plane synovial and allow for pronation and
supination:
- Subtalar joint = inferior of Talus + superior of Calcaneus
- *Talocalcaneonavicular = anterior Talus + anterior calcaneus + posterior navicular
- *Calcaneocuboid joint = Anterior Calcaneus + Posterior of cuboidal
- Cuneonavicular joint = Cuneiform + Navicular - minimal movement
- Cuboidalnavicular = Cuboid + Navicular - fibrous joint
*Together these form the transverse tarsal joint as it runs across the foot, original….
We will look at the ligaments joint by joint

Subtalar joint (Calcaneal facet on inferior surface of talus + posterior talar facet on superior
surface of calcaneus)
- Lateral, medial and posterior talocalcaneal ligaments
- Interosseous talocalcaneal ligaments
Talocalcaneonavicular joint (Anterior and middle calcaneal facets on inferior surface of
talar head + anterior and middle talar facets on the superior surface and sustentaculum tali
of the calcaneus)
- Interosseous talocalcaneal ligament (posteriorly)
- Talonavicular ligament (superiorly)
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- Plantar calcaneonavicular ligament (inferiorly)

- Bifurcate ligament (calcaneonavicular part) (laterally)
- Calcaneonavicular ligament
Calcaneocuboidal joint (Facet on the anterior surface of calcaneus and facet on posterior
surface of cuboid)
- Plantar calcaneocuboid ligament (inferiorly)
- long plantar ligament (inferiorly to the plantar calcaneocuboid ligament)
- Calcaneocuboid ligament
- Bifurcate ligament (Cuboidal part)
And then, the joints to the metatarsal bones:
Tarsometatarsal articulations
Articulations between the three cuneiform bones, cuboid bone and the metatarsal bones.
These are arthrodial (plane) joints that allow for a gliding movement.
Connected by the following ligaments:

- Dorsal
- M1 - 1st cuneiform
- M2 - One from each cuneiform
- M3 - One from 3rd cuneiform
- M4 - One from 3rd cuneiform and one from cuboid
- M5 - one from cuboid
- Plantar (longitudinal, Oblique, bands)
- Interosseus (x3)
- Lateral surface of 1st Cuneiform - M2
- 3rd Cuneiform - M2
The bones connect by:
- 1st Cuneiform - M1
- 2nd Cuneiform - M2
- Cuboidal - M4 & 5
Metatarsophalangeal joints
Joints between Tarsal bones and Phalanges. They are ellipsoid synovial allowing for
extension, flexion, abduction and adduction. Supported by:
- Collateral ligaments
- Plantar ligaments
- Deep Transverse ligament
Interphalangeal joints
Joints between the phalanges. Hinge joints allowing for flexion and extension.
- Collateral ligaments
- Plantar ligament
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Muscles
32. Structure of muscles (body). Structure of fasciae, tendons,
sesamoid bones, synovial sheaths and bursae. Mechanics of
muscles
Borrowed from Physiology cos I’m superbly lazy!!!

Muscle can be categorised into three types, Skeletal, Cardiac and Smooth, with Skeletal and
Cardiac both being sub categorised as ‘Striated’ muscle.
We will first dissect the muscle into its structural components and then consider the
elements of each component.
- A full muscle is composed of groups of fascicles
- Each fascicle is composed of groups of muscle cells (or myocyte/myofiber)
- Each muscle cell (myocyte/myofiber) contains groups of actin and myosin filaments
known as Myofibrils
- Surrounding the muscle is the Epimysium connective tissue

- Surrounding the fascicles is Perimysium connective tissue
- Surrounding each myofibril is Endomysium connective tissue
- Within each Myocyte/Myofiber is:
- Sarcolemma: Muscle cell plasma membrane
- Sarcoplasm: Muscle cell cytoplasm
- Actin and Myosin filaments (Myofibrils)
- T-tubules
- Sarcoplasmic reticulum
- Mitochondria
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Myocyte/Myofiber cells fuse together making them multinuclei, we will look in detail at the
structure of the Myocytes/Myofibers.
Sarcomeres are the functional units of Striated muscle. The primary microfilaments in
Sarcomeres are Actin (thin) and myosin (thick) filaments. These bands create the dark and
light bands seen in a light microscope (making them striated). We can divide the formation of
these filaments into ‘Bands’ with accompanying ‘Lines’.
- I band
- Where the thin filaments do not overlap with thick filaments. Found at either
end of the Sarcomere unit.
- A band
- Where the thick and thin filaments overlap
- H Band
- Where the thick filament does not overlap with thin filaments. Found in centre
of Sarcomere
Key lines in the Sarcomere are:
- M Line
- The centre of the Sarcomere where the thick filaments are attached to one
another.
- Z Line
- At the end of each Sarcomere where the actin filaments are bound to one
another by proteins. The Z line marks the boundaries of each Sarcomere.
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Actin (thin) filament

Composed of 300-400 G-actin protein molecules, that combine to form the linear F-actin.
This F-actin is held together by the protein nebulin. Each individual G-actin protein has an
active site for the binding of the the myosin head. This site is blocked by a protein called
Tropomyosin, which is held in place by Troponin protein. When Ca2+ ions bind to the
Troponin this moves the Tropomyosin to reveal the binding site.
Myosin (thick) filament

Each thick filament holds about 500
double stranded myosin molecules. Each
myosin molecule has a tail, hinge and
head.
Note another important protein in this

process is Titin. Titin is bound to the end of the thick filaments and has elastic properties that
help pull the thick filament back into its original resting position after being stretched.
Note, as well as Titin there are two other structural proteins in the Sarcomere:
- Desmin
- Integrates the sarcolemma, Z disk and nuclear membrane
- Alpha Actin
- Help anchor actin molecules
Mechanism of muscle contraction

The mechanism of muscle contraction is known as the ‘Sliding Filament’ theory. The stages
are as follows:
- The active site of the Actin is exposed by the binding of Ca2+ to the Tropomyosin
complex.
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- If active sites are available and the head holdes ADP+P a cross bridge is formed,
creating actin-myosin.
- P1 Will then be released causing the ‘Power Stroke’ to occur
- At the end of the Power Stroke ADP will be released
- When ATP then attaches to the ATP binding site the cross-bridge detaches
- The myosin head is then reactivated by the the conversion of ATP to ADP+P.
This process takes a matter of milliseconds
As stated above, the first stage in this process is for Ca2+ ions to attach to the Tropomyosin
complex and free the active site on the Actin. For this to happen there must be an influx of
Ca2+ ions into the myofibril. This happens thanks to the depolarization of the sarcolemma
membrane.
As the sarcolemma depolarizes, calcium channels open, and Ca2+ enters the cell.
Furthermore, the T-tubules described above help the Ca2+ ions diffuse through to all of the
myofibrils.
This Ca2+ influx is further facilitated by the Sarcoplasmic reticulum which is able to store
calcium ions and pump them out into the sarcoplasm when the muscle fiber is stimulated.
The sarcolemma depolarizes as a result of stimulation by the innervating nerve fiber.

Myoneural synapses release the neurotransmitter acetylcholine which affects the
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sarcolemma as per a standard synapse, causing the opening of Calcium ion channels,
leading to sarcolemma depolarization. The sarcolemmal depolarization reaction is much
stronger than a normal neuron to ensure the muscle contracts.
Also note, there is only ever one motor neuron per muscle cell.
Fascia = surround muscles to form fascial compartments, provides connection and

communication in form of ligaments, tendons, joint capsules and septa. Has high collagen
density.
Tendons = Connect muscle to bone with high collagen levels. Composed of dense, regular
connective tissue fascicles, encased in dense, irregular CT.
sesamoid bones = Small bone embedded within tendon or muscle. Act as pulleys,
providing surface for tendons to slide. Example is the Patella, embedded within the
quadriceps tendon.
synovial sheaths = one of two membranes of a tendon sheath which cover a tendon (the
other is the outer fibrous sheath). It is found where tendon passes under ligaments and
through osseofibrous tunnels in order to reduce friction.
Bursae = is a fluid filled sac designed to counter friction at a joint, formed by extensions of
the joint capsule.
33. Facial muscles
Facial muscles are about 20 flat muscles lying under the facial skin. They mostly originate
from the skull or fibrous structures, radiating to the skin through an elastic tendon. All
innervated by branches of facial, vasculated by facial.
Muscles of mouth:
- Orbicularis oris muscle, encircles the mouth, used for pouting (duck face people
have developed ones...we all know who I’m thinking of…#group61residentpouter!)
innervated by Cranial VII, buccal branch, superior and inferior labial artery,
- Buccinator muscle, quadrilateral found in cheek, between maxilla and mandible.
Originates on alveolar process of maxillary bone and mandible temporomandibular
joint. Inserts on orbicularis oris. Innervated buccal branch of VII, vasculated Buccal A.
- Levator labii superioris muscle, extends from side of nose to zygomatic bone.
Origin on medial infraorbital margin, inserts on upper lip (labii superioris alaeque
nasi). Zygomatic branch of facial nerve, facial artery.
- Depressor labii inferioris muscle, just below lower lip. Origin on bolique line of
mandible, inserts on lower lip, orbicularis oris. Facial nerve (mandibular branch) and
facial artery.
- Levator labii superioris alaeque nasi, HAS THE LONGEST NAME OF ANY
MUSCLE IN AN ANIMAL (as opposed to the muscles in plants??? lol), still pretty
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cool, one for the pub quiz. Origin on upper frontal process of maxilla and inserts on
lateral part of nostril and lip. Innervated by buccal branch of facial, vasculated by
facial.
- Mentalis, paired, at tip of chin. Origins on mentum and inserts on chin soft tissue
(apparently another one for the pouters, not looking at anyone!!!!). Nerve is
mandibular branch of facial, artery is facial
- Risorius muscle, originates on parotid fascia, inserts on modiolus (corner of mouth,
the Joker wrecked his), innervated by Buccal branch, vasculated by facial artery.
Helps to draw back angle of mouth
- Levator anguli oris, arises from canine fossa of the maxilla, inserts on modiolus,
innervated by Buccal of facial nerve, facial artery. Allows us to smile!! :D
- Depressor anguli oris, originates from mandible, inserts on modiolus, innervated by
mandibular branch of facial, vasculated by facial
- Zygomaticus major and minor, originates on zygomatic bone, inserts on upper lip,
innervated by buccal branch of facial N, vasculated by facial A.
Muscles of the nose
- Nasalis muscle, originates on Maxilla, inserts on Nasal bone, innervated by Buccal
branch, vasculated by superior labial. Compresses bridge of nose.
- Procerus muscle, small pyramidal muscle at top of nose, origin from fascia over
lower nasal bone, insertion on skin of lower part of forehead between eyebrows.
Innervated buccal branch, vasculated facial artery.
Muscles of the eyelid
- Orbicularis oculi, muscle that closes the eyelids. Origin is frontal and lacrimal bone
(medial aspect of orbital) and inserts on lateral palpebral ligament (a fibrous band on
the eyelids). Nerve is Temporal and Zygomatic (branches of facial), artery is
opthalmic.
- Depressor supercilii. Originates on medial orbital rim, inserts on medial aspect of
bony orbit. Depression of eyebrow. Facial nerve and branches of ophthalmic artery
- Corrugator supercilii. Medial aspect of eyebrow, used to help close the eye.
Originates on supraorbital ridge, inserts on forehead skin. Facial nerve and
Ophthalmic artery.
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-
Muscles of cranium and neck
- Epicranius muscle. Also known as Occipitofrontalis muscle. Covers part of skull
with occipital belly and frontal belly. Originates on Occipital and Frontal bones
respectively, both insert on Galea aponeurotica (tissue layer that covers top of the
cranium). Innervated by facial, vasculated by Occipital artery and
supraorbital/supratrochlear for occipital and frontal bellies respectively.
- Platysma muscle. A broad sheet of muscle arising from the chest and shoulders,
allowing for the drawing down of lip and corner of mouth. Origin is subcutaneous
tissue of infraclavicular and supraclavicular regions. Inserts on base of mandible, skin
of cheek and lower lip and angle of mouth. Artery is submental and suprascapular.
Nerve is cervical branch of facial.
Muscles of external ear
- Auricular muscle. All surround the ear in respective positions, originating on
temporal fascia and inserting to a location in ear. Innervated by auricular nerve,
vasculated by posterior auricular artery.
- Superior
- Anterior
- Posterior
34. Masticatory muscles
There are four, all innervated by the Mandibular (V3) nerve:

- Masseter, most powerful muscle, responsible for closing mouth, quadrangular with
two parts. Lies on top of pterygoids and temporalis muscle. Originates from maxillary
process of zygomatic and zygomatic arch of temporal. Both parts attach to ramus of
mandible. Masseteric artery.
- Temporalis, originates from temporal fossa, inserts onto coronoid process of
mandible. Closes and retracts mandible. Deep temporal arteries.
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- Medial pterygoid, has two heads deep and superficial. Originates from maxilla and
lateral pterygoid plate of sphenoid. Both insert on ramus of mandible near angle.
Vasculated by pterygoid branches of maxillary artery.
- Lateral pterygoid, two heads, superior and inferior. Superior originates on greater
wing of sphenoid, while inferior originates from lateral pterygoid plate of sphenoid.
Both attach on neck of mandible, acting to protract mandible and allows side to side
movement. Vasculation by pterygoid branches of maxillary artery
35. Suboccipital muscles
Four suboccipital muscles:

- Rectus capitis posterior major, origin of spinous
process C2, inserts inferior nuchal line, artery
occipital, nerve Dorsal ramus of suboccipital (C1).
- Rectus capitis posterior minor, origin tubercle of
atlas, inserts medial part of inferior nuchal line, artery
occipital, nerve dorsal ramus suboccipital (C1)
- Obliquus capitis superior, origin lateral mass of atlas, inserts inferior nuchal line,
artery occipital, nerve dorsal ramus of suboccipital (C1).
- Obliquus capitis inferior, origin of spinous process of axis, inserts, lateral mass of
atlas, suboccipital nerve, occipital artery.
36. Superficial muscles of the back
The muscles of the back are divided into three groups:

- Superficial - associated with movements of the shoulder
- Intermediate - associated with movements of the thoracic cage
- Deep - associated with movements of the vertebral column
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The deep muscles are embryonically developed in the back and as such are intrinsic
(responsible for maintaining posture and moving the vertebral column) muscles. All other
muscles are extrinsic (responsible for moving the upper limbs).
Superficial muscles of the back:

- Trapezius - broad flat triangular muscle sitting at the top of the back. Originates from
ligamentum nuchae of skull and the spinous processes of C7-T12. Insertions on
clavicle, acromion and scapular spine. Responsible for scapular elevation and
depression as well as rotation during abduction of arm. Innervation from accessory
nerve and C3 + C4 spinal nerves, Superficial cervical artery
- Latissimus Dorsi - Sits a little below the Trapezius, wrapping around the side of the
body. Broad origin from T6-T12, iliac crest,
thoracolumbar fascia and the inferior three
ribs. Attachment onto tendon onto
intertubercular sulcus of the humerus.
Responsible for extension, adduction and
medial rotation of upper limb. Innervation
from Thoracodorsal nerve, Thoracodorsal
branch of subscapular artery
- Levator Scapulae - small strap like
muscle over back of neck. Originates from
Transverse processes of C1-C4 and
attaches to medial border of scapula.
Responsible for elevation of scapular.
Innervation from Dorsal scapular nerve,
dorsal scapular artery
- Rhomboids
- Rhomboids Minor - sits below Levator Scapulae and above Rhomboid
major. Originates spinous processes of C7-T1 , inserts on medial border of
scapula between spine and angle.
- Rhomboids Major - Larger that minor, sits inferiorly. Originates from spinous
processes of T1 - T5 vertebrae. Attaches to the medial border of the scapula
at the level of the spine of scapula. Both responsible for retraction and
rotation of scapular. Innervated by Dorsal scapula nerve, dorsal scapular
artery
Additionally, the two Serratus muscles can be considered intermediate or superficial, the
questionary seems to place them as superficial
- Serratus posterior superior x3- Is a thin, rectangular shaped muscle that lies deep
to the Rhomboid muscles on the back. Originates from lower part of ligamentum
nuchae and spines of C7-T3. Attaches to ribs 2-5. Responsible for e levation of ribs
2-5. Innervated by Intercostal nerves, Intercostal arteries
- Serratus posterior inferior - A broad and strong muscle that lies underneath
latissimus dorsi midway down the back. Originates from spines of T11-L3 and
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attaches to ribs 9-12. Responsible for depression of ribs 9-12. Innervated by

Intercostal nerves, Intercostal arteries
37. Deep muscles of the back. Thoracolumber fascia
Deep muscles of the back:

Covering all of the deep muscles of the back is the thoracolumbar fascia. It is continuous
with the deep fascia in the neck, in the thoracic region it covers the deep muscles and
separates them from the superficial and intermediate muscles, while attaching medially to
the spinous processes of the thoracic vertebrae and laterally to the angels of the rib. It has a
Anterior, Middle and Posterior layer.
The deep muscles of the back can also be divided into three groups, Superficial,
Intermediate and Deep. We shall look at these in turn, superficial to deep.
Superficial
- Splenius Capitis - Deep muscle at back of the
neck, sort of sits alongside Levator scapular.
Originates from lower aspect of ligamentum
nuchae and spinous processes of C7-T3/4.
Inserts onto the mastoid process and occipital
bone. Responsible for rotation of head to same
side. Innervated by posterior rami of lower
cervical spinal nerves, Muscular branches of
aorta
- Splenius Cervicis - Sits just inferior to Splenius capitis, alongside Levator scapular.
Originates from spines of T3-6, inserting on transverse processes of C1-3/4.
Responsible for rotation of head to same side. Innervated by posterior rami of lower
cervical spinal nerves, Transverse cervical artery and occipital artery
Intermediate
These three longitudinal muscles run up the back and combine to form a muscular column
known as erector spinae. All three have common tendons which arise from Lumbar and
lower thoracic vertebrae, Sacrum, Posterior aspect of iliac crest, Sacroiliac and
supraspinous ligaments.
- Iliocostalis - Lateral of the three muscles. Has lumborum, thoracis and cervicis
parts. Originates from common tendinous origin (see above) and inserts on the
costal angle of the ribs and cervical transverse processes. Responsible for rota
lateral flex of vertebral column and helps with extension of vertebral column and
head. Innervated by posterior rami of spinal nerves, Intercostal and lumbar arteries
- Longissimus - Situated between iliocostalis and spinalis. The largest of the three
columns, divided into parts thoracis, c
ervicis and capitis. Originates from common
tendon (see above) and inserts to the lower ribs, transverse processes of C2-T12
and mastoid process of skull. Responsible for flex of vertebral column and helps with
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extension of vertebral column and head. Innervated by posterior rami of spinal

nerves, Lateral sacral artery
- Spinalis - Located medially (most centrally) of the three. The smallest of the three
columns, divided into Thoracis, Cervicis and Capitis parts. Originates from
common tendon (see above) and inserts onto spinous process of C2, T1-T8 and
occipital bone of skull. Responsible for lateral flex of vertebral column and helps with
extension of vertebral column and head. Innervated by posterior rami of spinal
nerves, Lateral sacral artery
Deep
- Semispinalis - Most superficial of the Deep, Deep muscles. Sits below the erector
spinae (specifically, beneath Longissimus). Has parts thoracis, cervicis and capitis.
Originates from Transverse processes of C4-T10. Inserts on spinous processes of
C2-T4 and occipital bone. Responsible for e xtension and contralateral rotation of
head and vertebral column. Innervated by posterior rami of spinal nerves,
Descending branches of occipital artery and dorsal rami of top two posterior
intercostal arteries
- Multifidus - is located beneath semispinalis muscle, best developed in the lumbar
area. Is actually multiple individual muscles. Originates from Sacrum, posterior iliac
spine, common tendon of erector spinae, mamillary process of lumbar vertebrae,
transverse processes of T1-T3 and articular processes of C4-C7. Fibers insert 2-4
vertebral segments above their origin. Consists of three fibers, one short and two
long. Responsible for stabilization of vertebral column. Innervated by posterior rami
of spinal nerves, Supplied segmentally by deep cervical artery, posterior intercostal
arteries, subcostal arteries and lumbar arteries.
- Rotatores - A series of small muscles around the vertebrae, most prominent in
thoracic region. Originates from vertebral transverse processes and then inserts on
immediately superior vertebrae lamina and spinous process. Responsible for
stabilization and rotation of vertebral column. Innervated by posterior rami of spinal
nerves, Supplied segmentally by deep cervical artery, posterior intercostal arteries,
subcostal arteries and lumbar arteries.
Three other minor deep intrinsic muscles are:

- Interspinales - spans adjacent spinous processes, stabilizing the vertebral column
- Intertransversarii - spans adjacent transverse processes
- Levatores costarum - originates transverse processes C7-T11, attaching to ribs
below to elevate.
38. Muscles of neck. Cervical fascia
The neck has four major compartments which are enclosed by an outer musculofascial
collar, these are:
- The vertebral compartment with cervical vertebrae and associated muscles
- The visceral compartment with glands (thyroid, parathyroid and thymus) and parts
of the respiratory and digestive tracts
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- The two vascular compartments, one on either side, with major blood vessels and
the vagus nerve.
We can broadly designate the neck into an Anterior and Posterior triangle, both of which
are covered by the Platysma muscle arising from the Pectoral and deltoid muscles, and
inserting on the muscles of the mouth, used in mouth depression.
Anterior triangle of the neck:

Designated by the anterior border of the sternocleidomastoid, midline and inferior border of
the madable.
Within this triangle we have suprahyoid and infrahyoid muscles.
There are four suprahyoid bones:

- Stylohyoid muscle attaches styloid process of the skull to the lateral area of the
body of the hyoid bone. Innervated by the facial nerve and vasculature by Superior
thyroid artery and the suprahyoid branch
of the lingual artery.
- Digastric muscle (two belly muscle,
anterior and posterior) loops from the
medial surface of the mastoid process,
attaching to the hyoid bone and the
digastric fossa of the mandible. Anterior
innervated Mandibular nerve of V3 +
Trigeminal (CN5), vasculated submental
branch of facial artery. Posterior
innervated by Facial nerve (CN7)
vasculated by Occipital artery.
- Mylohyoid muscle forms the floor of the
mouth, it is a fan shaped muscle that is
attached all the way around the edge of
the mandible and inserts on the hyoid
bone. Innervated by Mylohyoid nerve,
vasculated by Mylohyoid branch of
inferior alveolar artery.
- Geniohyoid muscle is a thin muscle that
runs from the hyoid bone to the inside
surface of the mandible, just to the side of
the midline. Innervated by Hypoglossal
nerve (V1), vasculated by lingual artery.
There are four infrahyoid bones
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- Sternohyoid muscle extends from hyoid bone to the sternum. It depresses the
hyoid bone in swallowing. Innervated by branch of Ansa Cervicalis, vasculated by
superior thyroid artery.
- Omohyoid muscle sits lateral to the sternohyoid and originates just medial to the
scapular notch on the scapula, inserting on the hyoid bone. It has a superior and
inferior belly. Innervated by Ansa cervicalis, vasculated by inferior thyroid artery.
- Thyrohyoid muscle sits below the Sterno and Omo hyoid bones and attaches to the
thyroid cartilage to the hyoid bone. Innervated by Hypoglossal nerve (V1), vasculated
by superior thyroid artery.
- Sternothyroid muscle runs in continuity to the Thyrohyoid muscle (again deep to
the Sterno and Omo hyoid bones). It attaches the Sternum to the thyroid cartilage.
Innervated by Ansa Cervicalis, vasculated by superior thyroid artery.
Vessels and nerves of Anterior

triangle:
- Common carotid artery
- With internal and
external branches
- Anterior and Inferior jugular
vein
- Vagus nerve
- Recurrent pharangeal nerve
We can further subdivide the

Anterior triangle of the neck into
four smaller triangles, these are:
Submandibular triangle
Outlined by inferior border
of the mandible superiorly
and the anterior and
posterior bellies of the
digastric muscle inferiorly.
Submental triangle
Outlined by hyoid bone
inferiorly, anterior belly of the
digastric muscle laterally and the
midline
Muscular triangle
Outlined by hyoid bone superiorly,
superior belly of the omohyoid
muscle and anterior border of the
sternocleidomastoid muscle
laterally
Carotid triangle
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Outlined by superior belly of the omohyoid muscle anterior inferiorly, stylohyoid

muscle and posterior belly of digastric superiorly, and anterior border of
sternocleidomastoid posteriorly.
Posterior triangle of the neck:

Bounded by the anterior border of the trapezius muscle, posterior margin of the
sternocleidomastoid muscle, and the clavicle at the base. There are a number of muscles
that run though this triangle, these are below.
- Scalene muscles originate on the transverse processes of the cervical vertebrae

and insert on the 1st and 2nd rib. Innervated by C3-C6, vasculated by Ascending
cervical artery.
- Anterior - upper surface 1st rib
- Medius - further back on upper surface 1st rib
- Posterior - upper surface 2nd rib
- Splenius capitis originates on the spinous processes of the vertebrae (C7-T4) and
inserts on the occipital bone and mastoid process. Innervated by Posterior ramus C3,
C4, Vascularized by branches of aorta.
- Levator scapulae originates on upper surface of scapula and inserts on transverse
processes of cervical vertebrae. Innervated by Posterior ramus C3, C4 and dorsal
scapular nerve, Vasculated by dorsal scapular artery.
- Omohyoid muscle (see above)
Vessels and nerves of posterior triangle:

- Subclavian artery
- Subclavian vein
- External jugular vein
- Vertebral vein
- Cervical plexus
Additionally there are muscles known as prevertebral and lateral muscles. These muscles
are located between the prevertebral fascia and vertebral column, they are:
- Longus capitis
- Longus colli
- Rectus capitis anterior
- Rectus capitis lateralis
Fascia
The neck has four fascia layers, these are:
- Superficial fascia
- Consisting of the Platysma muscle begins in the superficial fascia of the
thorax and up to attach to the mandible. Innervated by cervical branch of
facial nerve VII.
- Deep cervical fascia which has three layers
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- Investing layer - surrounds all structures of the neck. Attached to ligamentum

nuchae and the spinous process of C8.
- Prevertebral layer - surrounds the vertebral column and associated deep
muscles.
- Pretracheal layer - encloses the Trachea, Esophagus and Thyroid. A
collection of fascias in reality.
- Carotid sheath - encloses Common carotid artery, Vagus nerve and Internal
jugular vein bundle
39. Muscles of thorax
The Thorax consists of a Thoracic wall which we will focus on here consisting of skeletal
elements and muscles, along with the Pectoral region. The wall is made up of:
- Posteriorly - twelve thoracic vertebrae and their discs
- Laterally - by the twelve ribs and tree layers of flat muscle
- Anteriorly - by the sternum (body and xiphoid process).
We divide the Thorax into a superior and inferior thoracic aperture, the inferior cealed by the
diaphragm.
The pectoral region of the thorax has three main muscles, these are:
- Pectoralis major - originates on medial half of clavicle and anterior surface of
sternum and first seven costal cartilages. Inserts on lateral lip of intertubercular
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sulcus of humerus. Innervated by Medial and lateral pectoral nerves (Ventral
branches of C5-T1), vasculated by pectoral branch of Thoracoacromial trunk
- Pectoralis minor - originates on anterior surface of third, fourth and fifth rib inserting
on the coracoid process. Innervated by Medial pectoral nerves and vasculature by
pectoral branch of thoracoacromial trunk.
- Subclavius - originates at Rib 1 and inserts on groove on inferior surface of middle
third of clavicle. Innervated by nerve to subclavius (from Cervical plexus) and
vasculated by clavicular branch of thoracoacromial trunk.
The thoracic wall is made up of intercostal muscles of

which there are five:
- External intercostal muscle - Attached on rib
above and below, innervated by intercostal
nerve, vasculated by intercostal artery
- Internal intercostal - Attached on lateral edge
of intercostal groove of rib above, inserts on
inferior rib, deep to the attachment of external
intercostal. Innervated and vascularized by
intercostal nerve and artery.
- Inner Intercostal - Originates on medial edge
of intercostal groove of rib above, inserts on
internal aspect of superior margin of inferior
rib. Innervated and vascularized by intercostal nerve a
nd artery.
NB! The Intercostal Nerve, Artery and Vein all run in between the Innermost intercostal and
Internal Intercostal.
- Subcostales muscle - strap like muscle that connects the inside of the rib with rib
one or two below. Attaches near angle of rib and innervated by Intercostal nerves
and arteries.
- Transversus Thoracis - Originates on the 2nd - 6th rib cartilages, attaching to the
body of the sternum and xiphoid process. Innervated and vascularized by Intercostal
nerves and arteries.
40. Diapraghm
The diaphragm is a musculo tendinous sheet that separates the abdominal and thoracic
cavities. It consists of a central tendinous part to which the circumferentially arranged muscle
fibers attach.
The diaphragm is attached to LII and LIII by the Left and right crux respectively, the right
being larger. The crura (plural for crux apparently) are connected via the median arcuate
ligament) which runs anterior to the aorta. This is one of three tendinous arches, the others
being the Medial arcuate and Lateral arcuate ligaments which attach to LI, LII and transverse
process of LI and rib XII respectively.
The following pass through the diaphragm:
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- Aorta, just to the left of midline via the aortic hiatus. Through this same space runs
the thoracic duct (lymphatic system) and sometimes azygos vein.
- Esophagus passes through musculature
- The caval opening allows the inferior vena cava to pass through along with the right
phrenic nerve. The left phrenic nerve passes through the muscular part of the
diaphragm.
- Other small things pass through, such as the splanchnic nerves, hemi-azygos vein,
sympathetic trunks, superior epigastric vessels and other nerves and vessels.
There are two ‘Domes’ of the Diaphragm, caused by the abdominal organs forcing them up:
- Left dome produced by fundus of stomach and spleen
- Right dome produced by Liver
Blood supply superiorly is via the musculophrenic and pericardiophrenic (branches of

internal thoracic) and superior phrenic (branch of thoracic aorta. Inferior blood supply comes
from the inferior phrenic arteries, off the abdominal aorta.
Innervation is via the phrenic nerves.
41. Muscles of abdomen
The anterolateral wall of the Abdomen is formed by three flat muscles and two vertical
muscles. The flat muscles are:
- External oblique - most superficial, originates on outer surface of lower eight ribs,
inserts on lateral lip of iliac crest. Innervated by anterior branches of lower 6 T spinal
nerves vasculated by intercostal arteries.
- Internal oblique - middle muscle, originates on thoracolumbar fascia, iliac crest
band lateral part of inguinal ligament, inserts on inferior border of lower four ribs,
aponeurosis, pubic crest and pectineal line. Innervated by Anterior branches of lower
six T spinal nerves, vasculated by i ntercostal arteries.
- Transverse abdominis - the deepest of the three flat muscles. Originates on
Thoracolumbar fascia, medial lip of iliac crest, lateral ⅓ of inguinal ligament and
costal cartilages, inserts on on linea alba. Innervated by anterior branches of lower 6
T spinal nerves, vasculated by intercostal arteries.
The two vertical muscles are:

- Rectus abdominis - Originates on pubic crest, pubic tubercle and pubic symphysis
inserting on costal cartilages of ribs V - VII + xiphoid process. Innervated by anterior
branches of lower 7 spinal nerves, vasculated by intercostal arteries.
- Pyramidalis - Small muscle starts just in front of pubis and inserts on linea alba,
innervated by T12 and vasculated by intercostal artery.
Running between the two Rectus abdominis muscles is a fibrous structure that runs between
the two muscles and forms the midline down the abdomen.
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The posterior wall of the Abdoman is made up of five muscles. These are:
- Quadratus Lumborum
- Located laterally in the posterior abdominal wall with quadrilateral shape.
Originates on iliac crest and inserts on Transverse processes of L1-L2.
Innervated by Anterior rami of T12-L4, vasculated by Lumbar arteries
- Psoas Major
- Near midline of posterior wall, lateral to lumbar vertebrae. Attached to
vertebral bodies T12-L5, running deep to the inguinal ligament and attaching
to the lesser trochanter of the femur. Innervated by anterior rami of L1-L3
nerves, vasculated by lumber branch of iliolumbar artery.
- Psoas Minor
- Only present in 60% of population. Located anterior to the psoas major.
Attaches to bodies of T12+T1, onto superior ramus of pubic bone (pectineal
line). Innervated by anterior rami of L1.
- Iliacus
- Fan shaped muscle, inferior on the posterior abdominal wall. Combines with
psoas major to form iliopsoas, a major flexor of the thigh. Attaches from
surface of iliac fossa and inferior iliac spine, combines with psoas major to
insert on lesser trochanter of femur. Innervated by Femoral nerve (L2-L4),
vasculated by medial circumflex artery.
- Diaphragm
42. Inguinal canal
Inguinal triangle, also called Hesselbach’s triangle:

Borders: -
- Lateral margin of rectus sheath - Medial border
- Inferior epigastric vessels - Superior lateral border
- Inguinal ligament - Inferior border
Mnemonic - RIP (Rectus, Inferior epigastric vessels, Poupart’s (Inguinal) ligament
Contents include spermatic cord/Round ligament, with genital branch of genitofemoral

nerve and ilioinguinal nerve.
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43. Muscles of shoulder girdle
Muscles of the Rotator cuff

These muscles sit on the scapular and stabilise the shoulder joint. The muscles included
here are:
- Supraspinatus - sits above the scapular spine posteriorly. Originates on the
supraspinous fossa of scapula, insertion greater tuberosity of humerus. It is
responsible for abduction of arm. Suprascapular nerve, Suprascapular Artery
- Infraspinatus - sits below the scapular spine posteriorly. Originates from
infraspinous fossa and inserts on the greater tuberosity of humerus. Responsible for
uprascapular nerve, Suprascapular Artery
lateral rotation of arm. S
- Subscapular (anterior) - large muscle originating on subscapular fossa and inserting
on lesser tuberosity of humerus. Responsible for internal arm rotation. Upper and
lower subscapular nerves, Subscapular artery
- Teres minor - origin on lateral border of scapula and inserts on greater tuberosity of
humerus. Responsible for lateral rotation of arm. Axillary nerve, Circumflex Scapular
artery
Muscles of the Shoulder
We shall deal here with the Coracobrachialis, Deltoid and Teres major muscles.
- Coraco brachialis - originates on coracoid process, inserts underneath bicep,
anteriorly, midway down the humerus. Responsible for flexing the glenohumeral joint.
Musculocutaneous nerve, Brachial artery
- Deltoid - divided into three parts based on insertion points, all insert on the deltoid
tuberosity of humerus, responsible for abduction, anterior flex, medial rotation and
rotation of glenohumeral joint. Axillary nerve, Posterior circumflex humeral artery
- Clavicular part, originates on Clavicle
- Acromial part, originates on Acromion of scapula
- Spinous part, originates on spine of scapular
- Teres major - originates on inferior angle of scapular, inserts on crest of lesser
tubercle of humerus. It sits just below the infraspinous muscle of the rotator cuff.
Responsible for arm adduction and medial rotation. Lower subscapular nerve,
Circumflex scapular artery
44. Muscles of arm. Brachial fascia
There are five muscles that are located in the Brachial region in the body, these can be
divided anteriorly (flexors) and posteriorly (extensors) these are separated by a lateral and
medial intermuscular septum.
In the anterior portion there are two muscles, these are all innervated by the
musculocutaneous nerve and vasculature by the Brachial artery:
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- Biceps brachii - Long head originates on supraglenoid tubercle of scapula + short

head originates on coracoid process of scapular. Inserts onto radial tuberosity. Acts
to flex and supinate the forearm.
- Brachialis - behind the biceps brachii, originates anteriorly on the humerus, inserts
on ulna tuberosity. Flexor of forearm on elbow.
In the posterior portion there is only one muscle, innervated by the radial nerve and
vasculated by the deep brachial artery:
- Anconeus muscle - this can be seen as part of the upper or lower arm, I’ve gone for
lower arm, see below.
- Triceps brachii - long head originates from infraglenoid tubercle of scapular, lateral
and medial heads from posterior humerus. Inserts onto olecranon of elbow joint,
allowing for extension.
45. Muscles of forearm - anterior and lateral group
We can divide the sub-brachial art (forearm) into anterior f lexor groups and posterior
extensor groups.
Anterior flexor groups

These can be further subdivided into three layers, superficial , intermediate and deep layer,
these generally all originate on the medial epicondyle of the humerus. All muscles of the
Anterior group are Median nerve (or branches of) other than the Flexor carpi ulnaris:
There are four muscles of the Superficial layer involved in pronation and flexion of the hand,
all are vasculated by the Ulnar artery. These muscles are:
- Palmaris longus - inserts at Palmar aponeurosis, helping to flex the wrist.
- Flexor carpi ulnaris - 2 Heads, one inserts posteriorly at the ulnar and one on the
medial epicondyle. Inserts on pisiform, flexes the wrist on the ulnar side. Ulna nerve,
- Flexor carpi radialis - inserts on base of third and fourth metacarpals, flexes and
abducts the wrist on the radial side.
- Pronator teres - inserts on ulna, allows for pronation of sub-branchial region. Ulnar
Artery & Anterior Ulnar recurrent artery
There is one muscle in the intermediate level, also vasculated by the Ulnar artery
- Flexor digitorum superficialis - originates on medial epicondyle of humerus and
the oblique line of the radius. Then splits into four tendons passing through carpal
tunnel, to insert on the middle phalanx of the four fingers (not the thumb). Upon
insertion the tendons split into two to allow for the passage of the flexor digitorum
profundus tendons. This muscle flexes at the intermediate interphalangeal joint and
the metacarpophalangeal joints.
There are three muscles in the deep layer, all ar vasculated by the Anterior interosseous
artery and innovated by the Anterior interosseous nerve (a branch of the Median nerve)
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- Flexor digitorum profundus - originates on ulna and interosseous membrane to

insert on distal phalanx of each finger (not thumb). The muscle flexes the distal
phalangeal joints (and MCP joint). Ulnar artery & Anterior interosseous artery
- Flexor pollicis longus - inserts medially on the radius and inserts on the distal
phalanx of the thumb, working on the joints of the thumb.
- Pronator quadratus - inserts on distal anterior surface of ulna, goes to distal anterior
surface of radius, Lies below these other deep muscles, rectangular shape, works to
pronate on the wrist
46. Muscles of the forearm - posterior group. Antebrachial

fascia
Posterior extensor group

All of these muscles have a common origin on the lateral epicondyle of the humerus. They
produce extension of the wrist joint, extension of the fingers and thumb and supination of the
forearm. All are innervated by the radial nerve.
We can divide these into the superficial and deep layers.
There are seven muscles on the superficial layer. All of the tendons pass through the
posterior retinaculum at the distal end of the arm and are innovated by the Radial nerve
(Deep, superficial and branches of). We will address these lateral to medial:
- Brachioradialis muscle - inserts on the lateral distal part of the radius. Responsible
for helping flexion of the elbow. Radial nerve, Radial recurrent artery
- Extensor carpi radialis longus - inserts on the dorsal side at the base of the
second metacarpal. It allow for wrist extension and adduction. Radial nerve, Radial
artery
- Extensor carpi radialis brevis - inserts on the dorsal side at the base of the second
and third metacarpals. It also allows for wrist extension and adduction. Deep radial
nerve, Radial artery
- Extensor digitorum - splits into four tendons which insert on the dorsal side at base
of the middle and distal phalanx on the four fingers. Deep radial nerve, Interosseous
recurrent artery & Posterior interosseous artery
- Extensor digiti minimi - inserts on the dorsal hood of the little finger. Extends the
little finger. Deep radial nerve, Interosseous recurrent artery
- Extensor carpi ulnaris - Inserts on the medial dorsal surface of the base of the 5th
metacarpal (little finger). Extends and adducts the wrist. Deep radial nerve, Ulnar
artery
- Anconeus muscle - inserts posteriorly on the ulna and olecranon. Extends the
elbow joint. Nerve to anconeus from radial nerve, interosseous recurrent artery
There are five muscles in the deep layer of the posterior extensor group of the forearm.
These largely originate on the posterior surfaces, distally of the ulna, radius and
interosseous membrane. They are all innervated by the posterior interosseous nerve, a
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continuation of the deep radial nerve and almost all vasculated by the Posterior interosseous
artery (excluding Supinator muscle). We will look at each muscle in turn, going from most
proximal to distal.
- Supinator muscle - has two heads, a superficial and deep head. The superficial
head originates on the lateral epicondyle of the humerus while the deep head
originates on the posterior of the ulna. This inserts lower on the radius and is
responsible for supinating the forearm. Recurrent interosseous artery
- Abductor pollicis longus - originates posterior surface of ulna and radius, inserts
on base of first metacarpal (thumb). It abducts the thumb. Posterior interosseous
artery
- Extensor pollicis longus - originates posterior surface of ulna, insertion on base of
distal phalanx of thumb. It extends the carpometacarpal and metacarpophalangeal
osterior interosseous artery
joints of the thumb. P
- Extensor pollicis brevis - originates posterior surface of radius, inserts on dorsal
surface of base of proximal phalanx of first metacarpal (thumb). It extends the
carpometacarpal and metacarpophalangeal joints of the thumb. Posterior
interosseous artery
- Extensor indicis - originates posterior surface of ulna, inserts on extensor hood
(spanning proximal and middle phalanges) of index finger. Posterior interosseous
artery
47. Muscles and synovial sheaths of hand
Muscles acting on the hand are intrinsic or extrinsic. The extrinsic have been covered above
while the intrinsic will be dealt with (yes, it’s meant to sound threatening) here.
Three thenar muscles that are at the base on the dorsal side of the thumb. All innervated by
the median nerve:
- Opponens policies (tubercle of trapezium to the lateral metacarpal of thumb)
- Abductor Pollicis brevis (tubercle of scaphoid and trapezium to lateral side of
proximal phalanx of thumb)
- Flexor Pollicis Brevis (tubercle of trapezium to the base of proximal phalanx of
thumb)
Hypothenar muscles all work on the little finger,

similar to thenar muscles, innervated by Ulnar
nerve:
- Opponens Digiti Minimi (originates from
hook of hamate inserts on medial margin
of metacarpal V)
- Abductor Digiti Minimi (originates from
pisiform inserts on proximal phalanx of
little finger)
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- Flexor Digiti Minimi Brevis (originates from hook of hamate, inserts on base of
proximal phalanx of little finger)
There are four Lumbricals in each hand, each associated with a finger. They are attached
to the extensor and flexor tendons to allow for flexing at the CP and extending at the
interphalangeal joints of each finger. They originate on the tendons of each flexor digitorum
profundus and they insert on the extensor hood.
Interossei muscles are the most superficial of all the dorsal muscles. They are found in
between the metacarpal bones. Attaching on the lateral and medial surfaces of the
metacarpals, while inserting on the extensor hood and proximal phalanx of each finger. Each
helps with Adduction and Adduction.There are two groups:
- Dorsal interossei
- Palmar interossei
48. Muscles of pelvis
These are the muscles that sit on the buttucks region and operate on the hip joint, the hip
joint offers the following movements:
- Flexion
- Extension
- Abduction
- Adduction
- Medial + Lateral rotation
The muscles of the Gluteal region are responsible for extension, abduct and laterally rotate
the femur. We can divide these into the deep and superficial groups
Superficial muscles of the Gluteal region

Almost all innervated by superior gluteal nerve and vasculature by superior gluteal artery.
- Tensa iliac lartae - originates on iliac crest, behind anterior greater iliac spine.
Inserts onto the a lateral fascia called the iliotibial tract. This muscle stabilizes the hip
and knee in extension. Lateral circumflex femoral artery, superior gluteal artery.
Superior gluteal nerve
- Gluteus Maximus - rectangular shape originates on ilium, posterior lower sacrum
and coccyx. Inserts onto the back of iliotibial tract and the Gluteal tuberosity of the
femur. This muscle extends the thigh and stabilizes the hip joint. Superior and inferior
gluteal arteries. Inferior gluteal nerve.
- Gluteus Medius - lies between maximus and minimus,
originates on ilium and inserts laterally on greater trochanter of
femur. It abducts the femur at the hip joint. Superior gluteal
artery. Superior gluteal nerve
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- Gluteus Minimus - originates on external surface of ilium and inserts on the greater
trochanter of the femur. Superior gluteal artery. Superior gluteal nerve.
Deep muscles of the Gluteal region

These are smaller muscles mostly responsible for lateral rotation and abduction of the hip
joint, these all lie under the Gluteus maximus, medius and minimus. We will look at them
superior to inferior. All vasculated by inferior gluteal artery.
- Piriformis - Originates on the anterolateral surface of sacrum insertion greater
trochanter of femur. Inferior gluteal, lateral sacral and superior gluteal arteries.
Innervated by branches of S1 and S2
- Gemellus superior - originates near ischial spine. Inserts on greater trochanter of
femur. Vasculated by inferior gluteal artery. Innervated by nerve to obturator internus
- Obturator internus - originates on the medial aspect of the obturator membrane
(over the obturator foramen). Inserts on Greater Trochanter on femur. Inferior gluteal
artery. Innervated by nerve to obturator internus.
- Gemellus inferior - originates on Ischial tuberosity. Inserts on greater trochanter of
Femur. Inferior gluteal artery. Innervated by nerve to Quadratus femoris.
- Quadratus femoris - originates anterior to the ischial tuberosity, inserts between the
greater and lesser trochanter. Inferior gluteal artery. Innervated by nerve to
Quadratus femoris
49. Muscles of thigh. Fascia lata
We divide these into the Anterior, Medial and Posterior muscular groups, each compartment
is divided by an intermuscular septa. These compartments have different actions of the Hip
and Knee joint and are innervated by different nerves.
Anterior Compartment Extensor compartment Femoral nerve

Posterior Compartment Abductor compartment Sciatic nerve
Medial Compartment Adductor compartment Obturator nerve
Anterior Compartment
This compartment has four different muscles, and the ends of the
iliopsoas muscles (we will not look at these here, just know they insert on
the lesser trochanter of the femur).
Rectus femoris - Most superficial, two heads, one originates on the

anterior inferior iliac spine one just superior to the acetabulum. Inserts via
the quadriceps tendon on the patella bone. This flexes hip and knee.
Descending branch of lateral femoral circumflex artery.
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Vastus lateralis - sits under the Rectus femoris, originates on lateral side of femur and
inserts via the quadriceps tendon on the patella bone. Lateral circumflex femoral artery
Vastus intermedius - sits between lateralis and medialis, originates on anterior side of
femur and inserts via the quadriceps tendon on the patella bone. Femoral artery
Vastus Medialis - sits medial to lateralis, originates on medial side of femur and inserts via
the quadriceps tendon on the patella bone. Femoral artery
Sartorius - strap like muscle that originates on anterior
superior iliac spine to the medial surface on the proximal
part of the tibia. It flexes the thigh and knee joint. Femoral
artery
NB! We collective describe the first three as our Quadricep
muscles.
Medial Compartment
Mainly Adduct the thigh. Six muscles, innervated by
obturator nerve (unless specified). Mainly originated on the
body of the pubis and illiopubic ramus, then insert a various
points on the femur.
Gracilis muscle - originates medial aspect of pubis and

inserts on medial, proximal part of the tibia (in between
sartorius muscle and semitendinosus muscle). As well as
thigh adduction, helps flex the knee. Medial circumflex
femoral artery
Pectineus muscle - originates on the anterior part of the pubis and inserts on the pectineal
line of the femur. Obturator artery. Innervated by femoral nerve
Adductor longus - originates on pubis, inserts on the middle third of the femur. Can
medially rotate as well as adduct the thigh. Deep femoral artery
Adductor brevis - lies under longus, originates on pubis and originates a bit higher on the
femur, on the upper third of the femur. Deep femoral artery
Adductor magnus - biggest and deepest of the adductor muscles. Has adductor part
(lateral) and hamstring part (medial, this is innervated by the sciatic nerve). Originates on
ischial tuberosity (for hamstring) and ischial pubic ramus (for lateral part). Inserts on
adductor tubercle on medial condyle of femur (for femur) and the adductor (lateral) part
inserts on the posterior surface of the femur. Also offers rotation as well as adducting. Deep
femoral artery
Obturator externus - originates on external surface of the obturator membrane, inserts on
the inter trochanteric fossa on the femur. Responsible for lateral rotation of the femur.
Obturator artery
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Posterior compartment of the thigh

These muscles extend and rotate the hip joint and flex and rotate the knee joint. The three
muscles in this compartment originate on the ischial tuberosity. We collectively call these the
hamstring muscles.
Biceps Femoris - this lies laterally and has two heads. One head originates on the ischial
tuberosity, as with the others, and one head (the short one) originates on the lateral lip of the
linear aspara of the femur. This inserts on the head of the fibula. The muscle winds around
the posterior compartment. Deep femoral artery, perforating arteries.
Semitendinosus - sits above the semimembranosus, originates on ischial tuberosity, inserts
on medial aspect of upper tibia. Inferior gluteal artery, perforating arteries.
Semimembranosus - sits under semitendinosus, originates on ischial tuberosity, inserts on
medial condyle of femur and medial aspect of upper tibia, and blends with knee joint facia.
Profunda femoris, gluteal arteries.
50. Muscles of leg - anterior and lateral group

These muscles are responsible for dorsiflexion of the foot, extension of digits and inverting
(pointing in) the foot. These muscles are vasculated by the Anterior tibial artery and
innervated by the deep branch of the common perineal nerve, itself a branch of the sciatic
nerve.
Tibialis anterior - attaches on the inferior part of the lateral condyle of the Tibia. Inserts
medially on the foot to cuneiform bone. Involved in Dorsiflexion, inverting and arch support.
Anterior tibial artery
Extensor hallucis longus - sits under Tibialis anterior, tendon sids medially to Tibialis
anterior. Originates on middle part of Fibula and inserts on top of distal phalanx of big toe.
This extends the big toe and offer dorsiflexion. Anterior tibial artery
Extensor digitorum longus - Originates superiorly to extensor hallucis longus, this
originates on the lateral condyle of the femur. Spits to form four tendons around the ankle,
these then insert on the top of the of the distal phalanges. Anterior tibial artery
Peroneus/fibularis tertius - Small muscle that originates on the medial surface of the
fibular, very distally (it can be joined with the extensor digitorum longus). It inserts medially
on the base of the 5th metatarsal. Everts the foot and assists with dorsiflexion. Anterior tibial
artery.
Lateral compartment
These muscles evert the foot (pointing feet away from each other). These muscles are
innervated by the superficial branch of the common perineal nerve, itself a branch of the
sciatic nerve.
Peroneus/fibularis longus - originates on the head of the fibular and tendon inserts
medially at the distal end of the cuneiform bone and the base of the first metatarsal (this
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means it crosses the foot diagonally). Everts, and assists in plantar flexion. Also provides
arch support. Peroneal/Fibular artery
Peroneus/Fibularis brevis - Originates on lateral surface, ⅔ down of the Fibular. Inserts
onto the base of the 5th metatarsal, responsible for eversion. Peroneal/Fibular artery
51. Muscles of leg - posterior group. Deep fascia of leg or

fascia cruris
These muscles are responsible for plantarflexion (stamping on plant) of the foot, flexion of
digits and invert the foot. Two muscles also flex the knee. These muscles are innervated by
the Tibial nerve, a branch of the sciatic nerve.
We separate the posterior compartment into superficial and deep. We will look superficial to
deep.
Superficial layer
Gastrocnemius - has two heads, one originates on medial and one on lateral condyles of
femur. Inserts on the calcaneus, via the calcaneal tendon (achilles tendon). This muscle
plantar flexes the foot and flexes the knee. Sural arteries.
Plantaris - very small muscle belly but long muscle tendon. Lies under medial head of
gastrocnemius muscle, originates on lower part of supracondylar ridge of femur. Inserts with
calcaneal tendon onto calcaneus. Responsible for plantar flexion at ankle joint and flexing
knee. Sural arteries
Soleus - Originates on proximal part of Fibula and Tibia, inserts with the calcaneal tendon
on the calcaneus. This muscle sits under both the Plantaris and Gastrocnemius. Popliteal
artery, posterior tibial artery, peroneal artery.
Deep layer
Tibialis posterior - Originates between tibia and fibula at proximal part of the interosseous
membrane. Runs down and inserts on the tuberosity of the navicular and medial cuneiform
bone. Responsible for plantar flexion of ankle and inverts foot. Posterior tibial artery
Flexor Hallucis longus - originates on posterior surface of proximal Tibia, inserts on base
of distal phalanx of big toe. This means the tendon runs all the way along the bottom of our
foot. Peroneal artery (branch of posterior tibial artery)
Flexor digitorum longus - Sits posterior surface of tibia, originates at the xyz and inserts on
bases of lateral four distal phalanges (does the job of the Flexor Hallucis longus but for the
other toes). This obviously flexes the digits. Posterior tibial artery
Popliteus - originates on lateral femoral condyle, inserts on posterior surface of proximal
part of tibia. Actual goes into the knee joint. This muscle unlocks the knee by laterally
rotating the femur. Popliteal artery
52. Muscles, fasciae and synovial sheaths of foot. Configuration mechanics and
deformations of the foot
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These are the muscles that start and end in the foot. They offer support to the arches of the
feet as well as controlling fine motor movements of the toes. These muscles can be
separated into the plantar and dorsal groups.
Excluding the extensor digitorum brevis, and first two dorsal interossei muscles (which are
innervated by the deep fibular nerve), all foot muscles are innervated by the medial and
lateral plantar nerves, branches of the Tibial nerve.
Dorsal group
Extensor digitorum brevis - originates on the superior lateral part of the calcaneus. Splits
off into four, one tendon attaches to the base of the proximal phalanx of the large toe, the
other three attach laterally to the tendons of the extensor digitorum longus. Does not act on
the little toe, extends the Metacarpal phalangeal muscles in the rest. Dorsalis pedis artery.
Plantar Group
There are four different layers of muscles, we will look at them starting most superficially.
Superficial group
Flexor digitorum brevis - originates on the medial process of the calcaneus and forms four
tendons which insert on the sides medial phalanges of the lateral four digits. This forms the
base of the foot. This flexes the lateral four digits. Medial and lateral plantar arteries.
Abductor hallucis - Sits medial to the above, this makes up the medial side of the foot and
originates at the medial process of the calcaneal tuberosity and inserts medially at the base
of the proximal phalanx of the big toe. It flexes and abducts the big toe at the MTP joint.
Medial plantar artery. Medial plantar nerve.
Abductor digiti minimi - sits laterally to the above. Originates on the lateral side of the
calcaneal tuberosity and inserts at the base of the proximal phalanx of the little toe. Lateral
plantar artery. Lateral plantar nerve.
Layer 2 (deeper than superficial group)

Quadratus plantae - two heads, medial and lateral, attaching to either side of the calcaneal
tuberosity. Form tendon which inserts on lateral side of flexor digitorum longus tendon. Helps
FDL to flex toes 2-5.Lateral plantar artery. Lateral plantar nerve
Lumbricals - x4 lumbricals, these originate on the side of the flexor digitorum longus
tendon. These are bipennate muscles, meaning they have two sets of fibers which insert
onto the extensor hood of the lateral four digits. They flex the Metacarpophalangeal joints
while extending the interphalangeal joints. Common palmar digital arteries (among others).
Median nerve
Layer 3 (deeper than Layer 2)

Flexor hallucis brevis - lies underneath tendon of flexor hallucis longus. Has two origins,
one on cuboid bone and one on tendon of tibialis posterior muscle. Inserts with two heads
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medially and laterally on the base of the proximal phalanx of the big toe. Common palmar
digital arteries. Medial plantar nerve
Adductor hallucis - has transverse (runs horizontally) and oblique (runs more vertically)
heads.
- Transverse head originates on deep transverse metatarsal ligament of lateral three
toes
- Oblique head originates on tendon of fibularis longus and bases of metatarsals 2-4.
These all insert on the base of the proximal phalanx of the big toe. Lateral plantar artery.
Lateral plantar nerve.
Flexor digiti minimi brevis - originates on base of 5th metatarsal and fibularis longus
tendon and inserts laterally on base of 5th proximal phalanx. Flexes small toe. Ulnar artery.
Deep branch of ulnar nerve.
Layer 4 (deepest layer)

Interosseous muscles
X3 Plantar interosseous muscles - on the medial sides of metatarsal 3-5. They originate
at the base of the metatarsal and insert at the base of the proximal phalange. Plantar artery.
Lateral plantar nerve.
X4 Dorsal interosseous muscles - on both sides of the metatarsals, inserting on proximal
phalanges of toes 2-4. Dorsal and palmar metacarpal artery. Deep branch of ulnar nerve.
Deformations of the foot

……..
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Section 2: Internal Organs & Endocrine

53) Alimentary system - overview and development (PT)
The digestive system is a group of organs working together to convert food into energy and basic
nutrients to feed the entire body. Food passes through a long tube inside the body known as the
alimentary canal or the gastrointestinal tract (GI tract). The individual components of the alimentary
canal is oral cavity, salivary glands, oesophagus, stomach, small intestine, large intestine, liver,
gallbladder and pancreas
a) Ontogenesis:
The Alimentary system arises initially during the process of gastrulation from the endoderm of the
trilaminar embryo (week 3) and extends from the buccopharyngeal membrane to the cloacal
membrane.
During the 4th week three distinct regions:
● Foregut- (The anterior part of the alimentary canal, from the mouth to the duodenum). It
includes the abdominal esophagus, stomach, duodenum, liver, pancreas and gallbladder.
The foregut is supplied by the celiac trunk.
● Midgut- (duodenum to colon- this is where most of the intestine develops). It includes the
duodenum (inferior to major duodenal papilla), jejunum, ileum, cecum, appendix, ascending
colon and right 2/3rd of the transverse colon. The midgut is supplied by the mesenteric
artery.
● Hindgut or epigaster-is the posterior (caudal) part of the alimentary canal. In mammals, it
includes the distal third of the transverse colon and the splenic flexure, the descending
colon, sigmoid colon, and rectum. It includes the left 1/3rd of the transverse colon,
descending colon sigmoid colon, rectum and upper part of the anal canal. The hindgut is
supplied by the inferior mesenteric artery.
Topograph
y:
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The digestive system consists of the tract from the mouth (oral cavity) to the anus, as well as the
digestive glands emptying into this tract, primarily the salivary glands, liver, and pancreas.
Histology and physiology:

All regions of the GI tract have certain structural features in common. The GI tract is a hollow tube
with a lumen of variable diameter and a wall made up of four main layers:
1) Mucosa-innermost layer of tissue. Lines the alimentary canal lumen from mouth to the anus.
three major functions:
● Secrete mucus, digestive enzymes, and hormones
● Absorb the end products of digestion into the blood
● Protect against infectious disease
2) Submucosa - is external to the mucosa, is areolar connective tissue containing a rich supply
of blood and lymphatic vessels, lymphoid follicles, and nerve fibres which supply the
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surrounding tissues of the GI tract wall. Its elastic fibres enable the stomach to regain its
normal shape after temporarily storing a large meal.
3) Muscularis - surrounds the submucosa. The muscularis is responsible for segmentation and
peristalsis. It typically has an inner circular layer and an outer longitudal layer of smooth
muscle cells. In several places along the tract, the circular layer thickens and forms
sphincters that act as valves that control food passage from one organ to the next, they also
prevent backflow.
4) Serosa -is the outermost layer of the intraperitoneal organs (it’s also considered the visceral
peritoneum). In most alimentary canal organs, its made up of areolar connective tissue
covered with mesothelium, a single layer of squamous epithelial cells.
Blood Supply:
Branch Level of Embryonic part of the Adult gut supplied
origin gut supplied
Coeliac Trunk/celiac artery T12 Foregut ● Esophagus,

● Stomach,
● Liver
● Gall bladder
● Proximal duodenum,
● Spleen,
● Pancreas
Superior Mesenteric L1 Midgut ● Distal duodenum
● Part of pancreas
● Jejunum,
● ileum;
● caecum,
● Appendix,
● Ascending colon,
● Right transverse colon
Inferior mesenteric L3 Hindgut ● Left transverse colon
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● Descending colon
● Sigmoid colon
● Rectum
The Celiac trunk:
Branch Course Branches Distribution
● Runs upwards and slightly to the left (+) Esophagel branches ● Esophagus
towards the caradiac orifice of the ● Stomach
stomach
Left gastric
● Turns downwards to follow the lesser
artery
curvature where it forms an
anastomosis with the right gastric
artery.
● Runs to the right, along the upper (+) right gastric ● Stomach
border of the head of the pancreas, ● Liver
behind the lesser sac (+) gastroduodenal ● Gall bladder
● crosses in front of the inferior vena ● Duodenum
cava in the right gastropancreatic fold. which gives off.
Common ● Passes below the omental foramen
hepatic #) superior
artery ● Ascends in the free edge of the lesser pancreaticoduodenal
omentum, as the hepatic artery #) Right gastroepiploic
proper .
● The bile duct lies on its right side and (+) Left hepatic
portal vein behind it. (+) Cystic artery
● The third branch of the coeliac trunk. (+) Left gastro-epiploic ● Spleen
● Runs to the left along the upper artery ● Pancreas
border of the pancreas, behind the ● Fundus of the
omental bursa. (+) Short gastric arteries stomach
● Often passes under cover of the upper ● Greater
border of the pancreas at certain (+) Pancreatic branches omentum
Splenic
points in its course.
artery
● It is tortuous.
● Traced to the left, it runs across the
left suprarenal and left kidney. It
enters the splenorenal ligament and
so reaches the hilus of the spleen.
Nerve supply:
The Enteric system is a division of the visceral part of the nervous system and is a local circuit in the
wall of the GI tract. It consists of motor and sensory neurons organised into myenteric and
submucosal plexuses between the layers of the gastrointestinal walls. The enteric system regulates
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and coordinates gastric secretory activity, gastrointestinal blood flow and the contraction and
relaxation cycles of the smooth muscle (peristalsis). The enteric system does receive input from the
post-ganglion sympathetic and preganglionic parasympathetic neurons.
Lymphatic drainage:
Lymphatic drainage is through vessels and nodes that eventually end in large collection of pre-aortic
lymph nodes at the origins of the three anterior branches of the abdominal aorta which supply the
lower part of the rectum, spleen, pancreas, gallbladder and liver. These collections are referred to as
the celiac, superior mesenteric, and inferior mesenteric group of the pre-aortic nods.
The celiac trunk (foregut) drains the pre-aortic odes near the origin of the celiac trunk. These celiac
nodes also receive the lymph (fluid in the lymphatic system) from the superior mesenteric and
inferior mesenteric groups of pre-aortic nodes and lymph from celiac nodes entering the cisterna
chyli.
The superior mesenteric artery (midgut) drains to pre-aortic nodes. Superior mesenteric nodes also
receive the lymph from the inferior mesenteric groups of pre-aortic nodes and the lymph from the
superior mesenteric nodes drains to celiac nodes
The inferior mesenteric artery (hindgut) drains to pre-aortic node and lymph from the inferior
mesenteric nodes drains to the superior mesenteric nodes.
54) Oral Cavity
The oral cavity (mouth) includes the lips, cheeks, palate (roof of the mouth), floor of the mouth and
the part of the tongue in the mouth (oral tongue). A mucous membrane lines and protects the inside
of the mouth. The structures in the oral cavity play an important role in speech, taste and the first
steps of digestion.
The oral cavity begins at the border between the skin and the lips (vermillion border). The roof of
the mouth is formed by the hard palate. The oral cavity leads into the oropharynx, which includes
the soft palate, the back of the tongue and the tonsils. The inner surface of the cheeks forms the
sides of the oral cavity. The lowest part of the oral cavity is the floor of the mouth, which is covered
by the tongue. The human mouth is for Breaking up, eating, moistening, and tasting food, Speaking,
Facial expression, Breathing
The oral cavity can be divided into specific areas, including:

● lips
● labial mucosa (inner lining of the lips)
● commissure of lips (where the upper and lower lips meet at the corner of the mouth)
● vestibule (a space bounded by the teeth and gums on the inside and the mucosal surface of
the lips and cheeks on the outside)
● oral tongue (the front two-thirds of the tongue)
● floor of the mouth
● buccal mucosa (the inner lining of cheeks)
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● gingiva (gums)
● retro molar trigone (the area just behind the back molars in the lower jaw)
● hard palate (the bony part at the front of the roof of the mouth)
● teeth
● lower jaw (mandible)
● upper jaw (maxilla)
Oogenesis:
The primary oral cavity develops from the ectodermally-lined stomodeum. However with atrophy of
the oro-pharyngeal membrane a portion of the foregut also contributes to the formation.
The oral
cavity spans
between
the oral
fissure (ante
riorly – the
opening
between the
lips), and
the orophary
ngeal isthmus (posteriorly – the opening of the oropharynx).
It is divided into two parts by the upper and lower dental arches (formed by the teeth and their bony
scaffolding). The two divisions of the oral cavity are the vestibule, and the mouth cavity.
Vestibule
The two divisions of the oral cavity are the vestibule and oral
cavity proper.
The horseshoe-shaped vestibule is situated anteriorly. It is the

space between the lips/cheeks, and the gums/teeth.
The vestibule communicates with the mouth proper via the space
behind the third molar tooth, and with the exterior through
the oral fissure. The diameter of the oral fissure is controlled by
the muscles of facial expression – principally the orbicularis oris.
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Opposite the upper second molar tooth, the duct of the parotid gland opens out into the vestibule,
secreting saliva.
Mouth Proper
The mouth proper lies posteriorly to the vestibule. It is bordered by a roof, a floor, and the cheeks.
The tongue fills a large proportion of the cavity of the mouth proper.
The Roof
The roof of the mouth proper consists of the hard and soft palates.
The hard palate is found anteriorly. It is a bony plate that separates the nasal cavity from the oral
cavity. It is covered superiorly by respiratory mucosa (ciliated pseudostratified columnar epithelium)
and inferiorly by oral mucosa (stratified squamous epithelium).
The soft palate is a posterior continuation of the hard palate. In contrast to the hard palate, it is a
muscular structure. It acts as a valve that can lower to close the oropharyngeal isthmus, and elevate
to separate the nasopharynx from the oropharynx.
The Floor
The floor of the oral cavity consists of several structures:
● Muscular diaphragm – comprised of the bilateral mylohyoid muscles. It provides structural
support to the floor of the mouth, and pulls the larynx forward during swallowing.
● Geniohyoid muscles – pull the larynx forward during swallowing.
● Tongue – connected to the floor by the frenulum of the tongue, a fold of oral mucosa.
● Salivary glands and ducts.
Structures of the oral cavity floor.
The Cheeks
The cheeks are formed by the buccinator muscle, which is lined internally by the oral mucous
membrane.
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The buccinator muscle contracts to keep food between the teeth when chewing, and is innervated
by the buccal branch of the facial nerve (CN VII).
Histology:
This diagram shows across section through the lip and tooth, showing some of the main features of
these structures.
All of the oral mucosa is made up of a thick

stratified squamous epithelium, supported by
a lamina propria. The epithelium is thick
because the epithelial lining of the oral cavity
is subject to a lot of wear and tear.
In mobile areas, such as the soft palate,
underside of the tongue, floor of the mouth,
and mucosal surfaces of the cheeks and lips,
the epithelium is not keratinised.
In other areas, such as the gums (gingivae),

hard palate, and most of the upper surface of
the tongue, the epithelium is keratinised.
Underneath the oral mucosa, there is a tough collagenous submucosal layer, with accessory salivary
glands, except where the oral mucosa lies over bone, where the submucosa is thin.
Blood supply
The organs and structures of the oral cavity and its structures require a fair amount of blood flow,
coming from the following branches of the external carotid artery:
● Superior labial branches of the facial arteries and infraorbital arteries: Supply blood to the
upper lip
● Inferior branches of the facial arteries and mental arteries: Supply the lower lip
● Superior alveolar arteries (from the maxillary artery): Supply blood to the upper teeth
● Inferior alveolar arteries (from the maxillary artery): Supply the lower teeth
● Greater and lesser palatine arteries: Supply the palate
● Branches of the lingual artery: Supply blood to the tongue
● Dorsal lingual arteries: Supply the posterior part of the tongue
● Deep lingual artery: Supplies the anterior part of the tongue and communicates with the
dorsal arteries at the apex
● Sublingual artery: Supplies the sublingual gland and the floor of the oral cavity
● Branches of the external carotid and superficial temporal arteries: Supply the parotid
salivary glands
● Submental arteries: Supply the submandibular glands and sublingual glands
Veins of the oral cavity generally follow the arteries and have the same names. The veins of the
palate drain into the pterygoid venous plexus. The lingual veins of the tongue drain into the internal
jugular vein.
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Nerves:
Sensory innervation of the oral cavity is supplied by the branches of the trigeminal nerve (CN V).
The hard and soft palates are innervated by

the greater palatine and nasopalatine nerves.
They are both derived from the maxillary
branch (V2) of the trigeminal nerve.
The floor of the oral cavity receives sensory
innervation from the lingual nerve – a branch
of the mandibular (V3) division of the
trigeminal nerve. The tongue is also innervated
by special sensory fibres for taste from
the chorda tympani, a branch of the facial
nerve (CN VII).
The cheeks are innervated by the buccal nerve. It is also a branch of the mandibular division of the
trigeminal nerve.
Lymphatic drainage
Lymph from the upper lip, teeth, lateral parts of the anterior part of the tongue, and gingivae drains
into the submandibular lymph nodes. Lymph from the lower lip and apex of the tongue drains into
the submental lymph nodes.
Lymph from the medial anterior portion of the tongue drains into the inferior deep cervical lymph
nodes, and the posterior portion of the tongue drains into the superior deep cervical lymph nodes.
The parotid glands drain their lymph into the superficial and deep cervical lymph nodes. The
submandibular glands drain lymph into the deep cervical lymph nodes.
55) Tongue
The tongue is a muscular organ in the mouth. The tongue is covered with moist, pink tissue called
mucosa. Tiny bumps called papillae give the tongue its rough texture. Thousands of taste buds cover
the surfaces of the papillae. Taste buds are collections of nerve-like cells that connect to nerves
running into the brain.
The tongue is anchored to the mouth by webs of tough tissue and mucosa. The tether holding down
the front of the tongue is called the frenum. In the back of the mouth, the tongue is anchored into
the hyoid bone. The tongue is vital for chewing and swallowing food, as well as for speech.
The four common tastes are sweet, sour, bitter, and salty. A fifth taste, called umami, results from
tasting glutamate. The tongue has many nerves that help detect and transmit taste signals to the
brain.
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A) Ontogenesis
The development of the tongue it started with the two longitudinal bulbous ridges, with contributes
from the first four branchial arches. These ridges join, give rise to the longitudinal line (median
sulcus) down the centre of your tongue. The contribution from the second branchial arch is grown
over by that of the third arch, but the nerve supply remains. Using this information, we can
understand why the majority of the tongue’s innervation is by CN V and CN IX.
Looking further towards the back of a tongue – there is a transverse line near the root of the tongue.
This is called sulcus terminalis, and in the centre, where it meets the median sulcus, there is a pit.
This is the now-closed top of a deep pit, the foramen cecum (blind window), at the end of which lies
the thyroid gland. During development, this descends from the tongue down into the neck, If on the
way down, the pit (thyroglossal duct) doesn’t close behind the gland, midline thyroglossal cysts or
fistulae may remain.
Topography
When the mouth is closed, the
relaxed tongue takes up most of
the space inside the oral cavity.
The tongue is basically muscles
surrounded by a mucous
membrane. It has several parts:
Root: This posterior one-third of
the tongue is attached to the
floor of the oral cavity.
Body: The mobile anterior two-
thirds of the tongue is the body.
Apex: The apex is the tip of the
tongue.
Dorsum: This part is the surface
of the tongue. The terminal
sulcus and the foramen cecum
mark the area where the root
and the body meet. It also has a
midline groove that divides the
tongue into left and right
halves.
Inferior surface of the tongue:
This part has a thin transparent membrane. A large fold of mucosa, called the frenulum, can be seen
running down the midline. The ducts of the submandibular salivary glands are found at the base of
the frenulum.
The anterior part of the tongue contains a large number of lingual papillae:
- Vallate papillae: These papillae lie just anterior to the terminal sulcus and contain taste buds
and lingual glands that secrete serous fluids.
- Foliate papillae: These small folds along the sides of the tongue contain taste buds.
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- Filiform papillae: These papillae cover a large portion of the dorsum. They’re thread-like and
sensitive to touch but do not contain taste buds.
- Fungiform papillae: These mushroom-shaped papillae appear as red spots. They’re most
concentrated on the apex and sides of the tongue. They also contain taste buds.
The muscles of the tongue:

The tongue has a lot of movement due to eight pairs of muscles. They’re divided by the lingual
septum. Four pairs are intrinsic, and four pairs are extrinsic. All the muscles of the tongue, except for
the palatoglossus, are innervated by the hypoglossal nerve (CN XII). The palatoglossus is innervated
by the pharyngeal plexus (CN X).
Intrinsic muscles:
● Superior longitudinal muscle: This muscle originates on the submucosal fibrous layer and
the septum and inserts into the margins of the tongue and mucous membrane. It curls the
tongue upward and also shortens it.
● Inferior longitudinal muscle: Originating in the root of the tongue and on the hyoid bone,
this muscle inserts into the apex. It curls the tongue downward and shortens it.
● Transverse muscle: This muscle originates on the septum and inserts on the lateral margins
of the tongue. It narrows and protrudes the tongue.
● Vertical muscle: This muscle originates on the submucosal fibrous layer of the dorsum and
inserts on the inferior surfaces of the borders of the tongue. It flattens and broadens the
tongue.
Extrinsic muscles:
● Genioglossus: This fan-shaped muscle originates on the mandible and inserts onto the entire
dorsum of the tongue and the hyoid bone. It protrudes the tongue and assists with other
movements.
● Hyoglossus: This thin muscle originates on the hyoid bone and inserts onto the inferior and
lateral parts of the tongue. It depresses and shortens the tongue.
● Styloglossus: This small, triangular muscle originates on the styloid process of the temporal
bone and inserts onto the posterior parts of the tongue. It retrudes (pulls back) the tongue
and curls its sides.
● Palatoglossus: This crescent-shaped muscle originates on the palatine aponeurosis and
inserts onto the posterolateral part of the tongue. It elevates the posterior part of the
tongue and depresses the soft palate.
Histology:
Anterior surface of the tongue.
The tongue is a mass of skeletal muscle, connective
tissue with some mucous and serous glands, and
pockets of adipose tissue, covered in oral mucosa.
A V-shaped line (shallow groove)- the sulcus terminalis,
divides the tongue into an anterior 2/3 and a posterior
1/3.
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The mucosa covering the upper surface of the tongue is thrown into numerous projections called
the lingual papillae in the anterior 2/3rd of the tongue.
In the posterior 1/3rd, there are no papillae, but there are lots of lymphoid follicles present.
The three types of papillae are:
o Fungiform (mushroom like)- Not keratinised but highly vascular which gives them a red
colour. Most fungiform have tastebuds
o Filiform (filum - thread like)- Most common, keratinised, they look white
o Circumvallate -These papillae have taste buds in the medial walls of the cleft. These papillae
are larger than the other two types of papillae. Glands, called Von-Ebner's glands (serous
glands) open into the cleft.
Blood supply
The lingual artery (branch of the external carotid) does most of the supply, but there is a branch
from the facial artery, called the tonsillar artery, which can provide some collateral circulation.
Drainage is by the lingual vein.
Nerve supply
The lingual nerve provides sensory innervation to the to
the 2/3 of the tongue.
In the anterior ⅔, general sensation is supplied by

the trigeminal nerve (V). Specifically the lingual nerve, a
branch of the mandibular nerve (CN V3).
On the other hand, taste in the anterior 2/3 is supplied

from the facial nerve (VII). In the petrous part of the
temporal bone, the facial nerve gives off three branches,
one of which is chorda tympani. This travels through the
middle ear, and continues on to the tongue.
The posterior ⅓ of the tongue is slightly easier. Both touch and taste are supplied by
the glossopharyngeal nerve (IX).
Lymphatic Drainage:
Three main vessels
- Marginal vessels. These are vessels in the margins of the tongue. They drain lymphatic
vessels to submental nodes, jugulo-omohyoid nodes and the jugulodigastric node.
- Central vessels: These are vessels line central portion of the tongue. They end in the
submandibular lymph nodes and the jugulo-diagastric and the jugulo-omohyoid nodes.
- Dorsal vessels: These run in the dorsum of the tongue. They end in the jugulodigastric and
the jugulo-omohyoid nodes.
All the nodes drain into the deep cervical nodes from where they pass on to the jugular trunk. The
jugular trunk enters the thoracic duct on the left and the right lymph duct on the right or the jugulo
subclavian junction on the right.
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56) Teeth
The teeth are attached to sockets( alveoli) in two elevated arches of bone on the mandible below
and the maxilla above (alveolar arches). The gingivae (gums) are specialised regions of the oral
mucosa that surrounds the teeth and covers adjacent regions of the alveolar bone.
Adults have 32 teeth.
● The incisor teeth are the front teeth and have one root and chisel crown. Function is to
cut
● The canine teeth ( bicuspid) have a crown with two pointed cusps. One on the buccal
(cheek) side and the other on the lingual (tongue) or palatal side. Generally have one
root. Function to grind.
● The molar teeth are behind the premolar, have three roots and crowns with three to five
cusps. Function to grind.
Ontogenesis:
Two successive sets of teeth develop in humans, deciduous teeth (baby teeth) and permanent teeth.
The deciduous teeth emerge from the gingivae at between six months and two year of age.
Permanent teeth begin to emerge into adulthood. The 20 deciduous teeth consist of two incisors,
one canine and two molar teeth on each side of the upper and lower jaws. These teeth are replaced
by the incisors, canine and premolar teeth of the permanent teeth. The permanent molar teeth
erupt posterior to the deciduous molar and require the jaws to elongate forward to accommodate
them.
Histology:
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The tooth can be divided into two main areas: the crown and the root.
Most of the hard tissue in teeth is dentine, a special calcified tissue, derived from mesenchyme. The
dentine in the root is covered by a layer of cementum, calcified tissue derived from mesenchyme.
The tooth is then connected to bone by the periodontal ligament, which has wide bundles of
collagen fibres, and is embedded in bony ridge called alveolar ridge.
• Enamel: The hardest, white outer part of the tooth. Enamel is mostly made of calcium phosphate,
a rock-hard mineral.
• Dentin: A layer underlying the enamel. Dentin is made of living cells, which secrete a hard mineral
substance.
• Pulp: The softer, living inner structure
of teeth. Blood vessels and nerves run
through the pulp of the teeth.
• Cementum: A layer of connective
tissue that binds the roots of the teeth
firmly to the gums and jawbone.
• Periodontal ligament: Tissue that
helps holds the teeth tightly against the
jaw.
Teeth is made up of three layers,

enamel, dentine and a pulp cavity. The
crown is protected by layer of enamel, a
very hard, highly mineralised tissue,
which is derived from ectoderm.
Cementum, dentine and enamel differ from bone, in that they are not vascularised. Enamel also
does not have collagen as its main constituent. It is made up of crystals or prisms of calcium
phosphate. The centre of tooth is made up of a pulp cavity that extends down through the roots as a
root canal. This region contains the nerve and blood supply to the tooth.
Gums, or gingiva is the name for the oral mucosa that covers the tooth. At the gingival crevice (or
sulcus), the cells in the epithelium of the gum adhere to the tooth enamel via a basement
membrane.
Blood supply:
All teeth are supplied by the vessels that branch from the maxillary branch.
● Inferior alveolar artery- all lower teeth supplied by this. The inferior alveolar artery which
originates from the maxillary artery in the infratemporal fossa. The vessel enters the
mandibular canal and passes anteriorly in the bone, it divides opposite the first premolar
into incisors and mental branches. Mental branch leaves the mental foramen to supply the
chin, while the incisor branch supplies the anterior teeth.
● The posterior superior alveolar artery originates from the maxillary artery just after the
maxillary artery enters the pterygopalatine fossa and it leaves the fossa through the
pterygomaxillary fissure. It descends on the posterolateral surface of the maxilla, branches,
and enters small canals in the bone to supply the molar and premolar teeth.
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● The anterior superior alveolar artery originates from the infra-orbital artery. The anterior
superior alveolar artery originates from the infra-orbital artery in the infra-orbital canal. It
passes through bone and branches to supply the incisor and canine teeth.
Gingival supply
The gingivae are supplied by multiple vessels and the source depends on which side of each tooth
the gingiva is—the side facing the oral vestibule or cheek (vestibular or buccal side), or the side
facing the tongue or palate (lingual or palatal side):
● Buccal gingiva of the lower teeth is supplied by branches from the inferior alveolar artery,
whereas the lingual side is supplied by branches from the lingual artery of the tongue.
● Buccal gingiva of the upper teeth is supplied by branches of the anterior and posterior
superior alveolar arteries.
● Palatal gingiva is supplied by branches from the nasopalatine (incisor and canine teeth) and
greater palatine (premolar and molar teeth) arteries.
Nerves supply:
All nerves that innervate the teeth and gingivae are branches of the trigeminal nerve [V]
Lymphatic drainage:
Inferior alveolar veins from the lower teeth, and superior alveolar veins from the upper teeth drain
mainly into the pterygoid plexus of veins in the infratemporal fossa, although some drainage from
the anterior teeth may be via tributaries of the facial vein.
The pterygoid plexus drains mainly into the maxillary vein and ultimately into the retromandibular
vein and jugular system of veins. In addition, small communicating vessels pass superiorly, from the
plexus, and pass through small emissary foramina in the base of the skull to connect with the
cavernous sinus in the cranial cavity.
Venous drainage from the teeth can also be via vessels that pass through the mental foramen to
connect with the facial vein.
Veins from the gingivae also follow the arteries and ultimately drain into the facial vein or into the
pterygoid plexus of veins.
Lymphatic vessels from teeth and gingivae drain mainly into the submandibular, submental and
deep cervical nodes.
Major salivary glands-parotid, submandibular, sublingual
Salivary glands are glands that open or secrete into the oral cavity. Most of them are small glands in
the submucosa or mucosa of the oral epithelium lining the tongue, palate, cheeks, and lips, and
open into the oral cavity directly or via small ducts. In addition to these small glands are much larger
glands, which include the paired parotid, submandibular, and sublingual glands.
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Histology of the salivary glands:

Salivary glands are made up of secretory acini (acini - means a rounded secretory unit) and ducts.
There are two types of secretions - serous and mucous. The acini can either be serous, mucous, or a
mixture of serous and mucous.
A serous acinus secretes proteins in an isotonic watery fluid.

A mucous acinus secreted secretes mucin - lubricant In a mixed serous-mucous acinus, the serous
acinus forms a serous demilune around mucous acinus.
The secretory units merge into intercalated ducts, which are lined by simple low cuboidal
epithelium, and surrounded by myoepithelial cells.
These ducts continue on as striated ducts. These have a folded basal membrane, to enable active
transport of substances out of the duct. Water resorption, and ion secretion takes place in the
striated ducts, to make saliva hypotonic (reduced Na,Cl ions and increased carbonate, and potassium
ions).
The striated ducts lead into interlobular (excretory) ducts, lined with a tall columnar epithelium.
The glands are divided into lobules by connective tissue septa. Each lobule contains numerous
secretory units, or acini.
● Sublingual glands have mainly mucous acini.
● Parotid glands have mainly serous acini.
● Submandibular glands have a mixture of mucous and serous acini.
Parotid gland:
The parotid gland is a bilateral salivary gland located in the face. It produces serous saliva, a watery
solution rich in enzymes. This is then secreted into the oral cavity, where it lubricates and aids in the
breakdown of food. The gland on each side is entirely outside the boundaries of the oral cavity in a
shallow triangular-shaped trench formed by:
▪sternocleidomastoid muscle behind,
▪the ramus of the mandible in front, and
▪superiorly, the base of the trench is formed by the external acoustic meatus and the posterior
aspect of the zygomatic arch.
Topography:
The parotid gland is a bilateral structure, which displays a lobular and irregular morphology.
Anatomically, it can be divided into deep and superficial lobes, which are separated by the facial
nerve. It lies within a deep hollow, known as the parotid region. The parotid region is bounded as
follows:
● Superiorly – Zygomatic arch.
● Inferiorly – Inferior border of the
mandible.
● Anteriorly – Masseter muscle.
● Posteriorly – External ear and
sternocleidomastoid.
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The secretions of the parotid gland are transported to the oral cavity by the Stensen duct. It arises
from the anterior surface of the gland, traversing the masseter muscle. The duct then pierces the
buccinator, moving medially. It opens out into the oral cavity near the second upper molar.
The parotid gland encloses the external carotid artery, the retromandibular vein, and the origin of
the extracranial part of the facial nerve [VII].
Blood supply:
Blood is supplied by the posterior auricular and superficial temporal arteries. They are both branches
of the external carotid artery, which arise within the parotid gland itself.
Venous drainage is achieved via the retromandibular vein. It is formed by unification of the
superficial temporal and maxillary veins.
Nerve supply:
The parotid gland receives sensory and autonomic innervation. The autonomic innervation controls
the rate of saliva production.
Sensory innervation is supplied by the auriculotemporal nerve, a branch of the mandibular nerve
(V3).
The parasympathetic innervation to the parotid gland has a complex path. It begins with the
glossopharyngeal nerve (cranial nerve IX). This nerve synapses with the otic ganglion (a collection of
neuronal cell bodies). The auriculotemporal nerve then carries parasympathetic fibres from the otic
ganglion to the parotid gland. Parasympathetic stimulation causes an increase in saliva production.
Sympathetic innervation originates from the superior cervical ganglion, part of the paravertebral
chain. Fibres from this ganglion travel along the external carotid artery to reach the parotid gland.
Increased activity of the sympathetic nervous system inhibits saliva secretion, via vasoconstriction.
Submandibular gland:
The submandibular glands are bilateral salivary glands located in the face. Their mixed serous and
mucous secretions are important for the lubrication of food during mastication to enable effective
swallowing and aid digestion.
Topography:
The submandibular gland is located within the anterior
part of the submandibular triangle. The boundaries of
this triangle are:
● Superiorly: Inferior body of the mandible.
● Anteriorly: Anterior belly of the digastric
muscle.
● Posteriorly: Posterior belly of the digastric
muscle.
Anatomical Structure
Structurally, the submandibular glands are a pair of
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elongate, flattened hooks which have two sets of arms; superficial and deep. The positioning of
these arms is in relation to the mylohyoid muscle, which the gland hooks around.
● Superficial arm – comprises the greater portion of the gland and lies partially inferior to the
posterior half of the mandible, within an impression on its medial aspect (the submandibular
fossa). It is situated outside the boundaries of the oral cavity.
● Deep arm – hooks around the posterior margin of mylohyoid through a triangular aperture
to enter the oral cavity proper. It lies on the lateral surface of the hyoglossus, lateral to the
root of the tongue.
Secretions from the submandibular glands travel into the oral cavity via the submandibular duct
(Wharton’s duct). This is approximately 5cm in length and emerges anteromedially from the deep
arm of the gland between the mylohyoid, hyoglossus and genioglossus muscles. The duct ascends on
its course to open as 1-3 orifices on a small sublingual papilla (caruncle) at the base of the lingual
frenulum bilaterally.
Nerve supply:
Three principal nerves:
● lingual nerve,
● hypoglossal nerve
● facial nerve (marginal mandibular branch)
Lingual nerve: Beginning lateral to the submandibular duct, this nerve courses anteromedially by
looping beneath the duct and then terminating as several medial branches. The terminal branches
ascend on the external and superior surface of hypoglossus to provide general somatic afferent
innervation to the mucus membrane of the anterior two-thirds of the tongue.
Hypoglossal nerve: Lies deep to the submandibular gland and runs superficial to hyoglossus and
deep to digastric muscle.
Facial nerve (marginal mandibular branch): Exits the anterior-inferior portion of the parotid gland at
the angle of the jaw and traverses the margin of the mandible in the plane between platysma and
the investing layer of deep cervical fascia curving down inferior to the submandibular gland.
The submandibular glands receive autonomic innervation through parasympathetic and sympathetic
fibres, which directly and indirectly regulate salivary secretions respectively.
Parasympathetic
Parasympathetic innervation originates from the superior salivatory nucleus through pre-synaptic
fibres, which travel via the chorda tympani branch of the facial nerve (CNVII). The chorda tympani
then unifies with the lingual branch of the mandibular nerve (CNViii) before synapsing at the
submandibular ganglion and suspending it by two nerve filaments.
Post-ganglionic innervation consists of secretomotor fibres which directly induce the gland to
produce secretions, and vasodilator fibres which accompany arteries to increase blood supply to the
gland. Increased parasympathetic drive promotes saliva secretion.
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Sympathetic
Sympathetic innervation originates from the superior cervical ganglion, where post-synaptic
vasoconstrictive fibres travel as a plexus on the internal and external carotid arteries, facial artery
and finally the submental arteries to enter each gland. Increased sympathetic drive reduces
glandular blood flow through vasoconstriction and decreases the volume of salivary secretions,
resulting in a more mucus and enzyme-rich saliva.
Blood supply:
Blood supply is via the submental arteries which arise from the facial artery; a branch of the external
carotid artery.
Venous drainage is through the submental veins which drain into the facial vein and then the
internal jugular vein.
Sublingual gland:
The sublingual glands are the smallest of the three paired salivary glands. They are deeply situated.
They produce a mixed secretion which is predominately mucous in nature. These secretions are
important in lubricating food, keeping the oral mucosa moist and initial digestion.
Topography:
*see picture above*
They are situated under the tongue, bordered laterally by the mandible and medially by genioglossus
muscle. The glands form a shallow groove on the medial surface of the mandible known as the
sublingual fossa.
Medially, the submandibular duct and its lingual nerve relation pass immediately next to the
sublingual glands between genioglossus.
Both sublingual glands unite anteriorly and form a single mass through a horseshoe configuration
around the lingual frenulum. The superior aspect of this U-shape forms an elevated, elongate crest
of mucous membrane called the sublingual fold (plica sublingualis). Each sublingual fold extends
from a posterolateral position and traverses anteriorly to join the sublingual papillae at the midline
bilateral to the lingual frenulum.
Secretions drain into the oral cavity by minor sublingual ducts (of Rivinus), of which there are 8-20
excretory ducts per gland, each opening out onto the sublingual folds.
Through anatomical variance, a major sublingual duct (of Bartholin) can be present in some people.
This large accessory duct arises from the inferior aspect of the sublingual gland and then adheres to
the passing submandibular duct on its medial side. Drainage then follows the submandibular duct
out through the sublingual papillae.
Blood supply:
Blood supply is via the sublingual and submental arteries which arise from the lingual and facial
arteries respectively; both of the external carotid artery.
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Venous drainage is through the sublingual and submental veins which drain into the lingual and
facial veins respectively; both then draining into the internal jugular vein.
Nerve supply:
The sublingual glands receive autonomic innervation through parasympathetic and sympathetic
fibres, which directly and indirectly regulate salivary secretions respectively. Their innervation is the
same as that of the submandibular glands.
Lymphatic drainage:
Vessels that supply the parotid gland originate from the external carotid artery and from its
branches that are adjacent to the gland. The submandibular and sublingual glands are supplied by
branches of the facial and lingual arteries.
Veins from the parotid gland drain into the external jugular vein, and those from the submandibular
and sublingual glands drain into lingual and facial veins.
Lymphatic vessels from the parotid gland drain into nodes that are on or in the gland. These parotid
nodes then drain into superficial and deep cervical nodes.
Lymphatics from the submandibular and sublingual glands drain mainly into submandibular nodes
and then into deep cervical nodes, particularly the jugulo-omohyoid node.
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58) Isthmus of fauces-tonsils:
The tonsils are masses of lymphoid tissue and form an important part of our immune system located
at the gateway of respiratory and digestive tract. They act as the first line of defense against
ingested or inhaled pathogens. Four types of tonsils are arranged into a ring around the oropharynx
and nasopharynx, known as Waldeyer’s ring of lymphoid tissue.
Ontogenesis:
The tonsils are part of MALT (mucosa associated lymphoid tissue). MALT can also be found in the
bowel, in Peyer’s patches. In general MALT is relatively undeveloped at birth with low cellularity.
Tonsils start to develop around 14-15th week of embryonic life, while germinal cenres are absent at
this stage. Palatine tonsils and tonsillar fossa are believed to be the derivatives of the 2nd
pharyngeal pouch. The epithelial lining proliferates and forms buds, which form the primordium of
the palatine tonsil.
Topography:
The oropharyngeal isthmus is the opening between the oral cavity and the oropharynx (see Fig.
8.266). It is formed:
▪laterally by the palatoglossal arches;
▪superiorly by the soft palate; and
▪inferiorly by the sulcus terminalis of the
tongue that divides the oral surface of the
tongue (anterior two-thirds) from the
pharyngeal surface (posterior one-third).
The oropharyngeal isthmus can be closed by

elevation of the posterior aspect of the tongue,
depression of the palate, and medial movement of
the palatoglossal arches toward the midline.
Medial movement of the palatopharyngeal arches
medial and posterior to the palatoglossal arches is
also involved in closing the oropharyngeal isthmus.
By closing the oropharyngeal isthmus, food or
liquid can be held in the oral cavity while
breathing.
Histology:
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Tonsils are large non-encapsulated (or partially encapsulated) masses of lymphoid tissue, that lie in
the walls of the pharynx and nasopharynx and at the base of the tongue.
The luminal surface of the tonsils are covered with a stratified squamous epithelium (in common
with the oral epithelia). The tonsils have many invaginations which form blind crypts. Below the
epithelium, there are many lymphoid follicles beneath which have germinal centres like the lymph
nodes.
The epithelial cells are able to phagocytose bacteria, and transfer them to macrophages, which then
present the foreign antigens to B-cells, which are activated (with the help of T cells). Again, like the
MALT, the activated cells mostly secrete IgA type antibodies, which are secreted locally.
Blood supply:
The arterial supply of the tonsils is derived from the following arteries:
1. Tonsillar artery
2. Ascending pharyngeal artery
3. Tonsillar branch of the facial artery
4. Dorsal lingual branch of the lingual artery
5. Ascending palatine branches of the facial artery
Venous blood drains through a peritonsillar plexus. The plexus drains into the lingual and pharyngeal
veins, which in turn drain into the internal jugular vein.
Nerve supply:
The tonsils are innervated via tonsillar branches of the maxillary nerve and the glossopharyngeal
nerve.
Lymphatic:
Tonsils do not possess afferent lymphatics. Efferent lymphatics drain directly to the jugulodigastric
nodes and upper deep cervical nymph nodes and indirectly through the retropharyngeal lymph
nodes.
59) Pharynx:
The pharynx is a muscular tube that connects the nasal cavities to the larynx and oesophagus. It is
common to both the gastrointestinal and respiratory tracts.
It begins at the base of the skull and ends inferiorly to the cricoid cartilage (C6). It is comprised of
three parts; the nasopharynx, oropharynx and laryngopharynx (from superior to inferior).
Topography:
There are two types of muscles that form the walls of the pharynx – longitudinal and circular. Both
types are innervated by the vagus nerve, except for the stylopharyngeus, which is innervated by the
glossopharyngeal nerve.
Circular
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● The circular muscles contract sequentially from superior to inferior to constrict the lumen
and propel the bolus of food inferiorly into the oesophagus.
● They are stacked like glasses and are an incomplete muscular circle, anteriorly attaching to
structures in the neck.
● They are all innervated by the vagus nerve (CN X):
● Superior pharyngeal constrictor is
found in the oropharynx.
● Middle pharyngeal constrictor is
found in the laryngopharynx.
● Inferior pharyngeal constrictor is
found in the laryngopharynx and
has two components. The superior
component (thyropharyngeus) has
oblique fibres that attach to the
thyroid cartilage and the inferior
component (cricopharyngeus) has
horizontal fibres that attach to the
cricoid cartilage.
Longitudinal
● The longitudinal muscles shorten
and widen the pharynx, and
elevate the larynx during
swallowing.
● Stylopharyngeus: from the styloid
process of the temporal bone to
the pharynx, innervated by the
glossopharyngeal nerve (CN IX)
● Palatopharyngeus: from hard
palate of the oral cavity to the
pharynx, innervated by the vagus
nerve (CN X)
● Salpingopharyngeus: from the
Eustachian tube to the pharynx,
innervated by the vagus nerve (CN X). In addition to contributing to swallowing, it also opens
the Eustachian tube to equalize the pressure in the middle ear with the atmosphere.
Histology:
The oral pharynx is lined by a stratified squamous non-keratinizing type of epithelium and lacks both
muscularis mucosae and submucosa. The epithelium rests on a lamina propria that contains a thick
layer of longitudinally oriented elastic fibers (a useful diagnostic feature). The muscularis externa is
composed of somewhat irregularly arranged skeletal muscle, the longitudinal and constrictor
muscles of the pharynx. Mucous glands seen in this muscular layer in some of our glass slides are the
extensions of those present in the lamina propria.
Blood supply:
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Arterial supply is via branches of the external carotid artery: ascending pharyngeal, lingual, facial and
maxillary arteries.
Venous drainage is achieved by the pharyngeal venous plexus, which drains into the internal jugular
vein.
Nerve supply:
Innervation of the majority of the pharynx
is achieved by the pharyngeal plexus,
which comprises of:
● Branches of the glossopharyngeal nerve (CN IX)
● Branches of the vagus nerve (CN X)
● Sympathetic fibres of the superior cervical ganglion.
Sensory: Each of the three sections of the pharynx have a different innervation:
● The nasopharynx is innervated by the maxillary nerve (CN V2).
● The oropharynx by the glossopharyngeal nerve (CN IX).
● The laryngopharynx by the vagus nerve (CN X).
Motor: All the muscles of the pharynx are innervated by the vagus nerve (CN X), except for the
stylopharyngeus, which is innervated by the glossopharyngeal nerve (CN IX).
Lymphatic drainage:
Lymphatic vessels from the pharynx may enter directly either the superior deep cervical nodes or
pass through the retropharyngeal or paratracheal nodes to enter the same deep cervical nodes.
All the nodes drain into the deep cervical nodes from where they pass on to the jugular trunk. The
jugular trunk enters the thoracic duct on the left and the right lymph duct on the right or the
jugulosubclavian junction on the right.
60) Oesophagus:
The oesophagus is a fibromuscular tube, approximately 25cm in length, that transports food from
the pharynx to the stomach. It originates at the inferior border of the cricoid cartilage, C6, extending
to the cardiac orifice of the stomach, T11.
Ontogenesis:
In early embryogenesis, the esophagus develops from the endoderm primitive gut tube. The ventral
part of the embryo abuts the yolk sac. During the second week of embryological development, as
the embryo grows, it begins to surround parts of the sac. The enveloped portions form the basis for
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the adult gastrointestinal tract. The sac is surrounded by a network of vitelline arteries. Over time,
these arteries formed into the three main arteries that supply the developing gastrointestinal tract:
the celiac artery, superior mesenteric artery, and inferior mesenteric artery. The areas supplied by
these arteries are used to define the midgut, hindgut and foregut.
The surrounded sac becomes the primitive gut. Sections of this gut begin to differentiate into the
organs of the gastrointestinal tract, such as the esophagus, stomach, and intestines. The esophagus
develops as part of the foregut tube. The innervation of the esophagus develops from the
pharyngeal arches.
Topography:
The oesophagus originates in the neck, at the level of the sixth cervical vertebrae. It is continuous
with the laryngeal part of the pharynx.
It descends downward into superior mediastinum of the thorax. Here, it is situated between the
trachea and the vertebral bodies T1 to T4. It then enters the abdomen by piercing the muscular right
crus of the diaphragm, through the oesophageal hiatus (simply, a hole in the diaphragm) at the T10
level.
The phrenoesophageal ligament connects the oesophagus to the border of the oesophageal hiatus.
This permits independent movement of the oesophagus and diaphragm during respiration and
swallowing.
The abdominal part of oesophagus is approximately 2cm long – it terminates by joining the cardiac
orifice of the stomach at level of T11.
Muscular layers
The oesophagus consists of an internal circular and external longitudinal layer of muscle.
Furthermore, the external longitudinal layer is composed of different muscle types in each third of
the oesophagus:
● Superior third – voluntary striated muscle
● Middle third – voluntary striated and smooth muscle
● Inferior third – smooth muscle
Food is transported through the oesophagus by peristalsis – a rhythmic contractions of the muscles,
which propagates down the oesophagus. Hardening of these muscular layers can interfere with
peristalsis and cause dysphagia, which is difficulty in swallowing.
There are two sphincters present in the oesophagus, known as the upper and lower oesophageal
sphincters. They act to prevent the entry of air and the reflux of gastric contents respectively.
Upper Oesophageal Sphincter

The upper sphincter is an anatomical, striated muscle sphincter at the junction between the pharynx
and oesophagus. It is produced by the cricopharyngeus muscle. Normally, it is constricted to prevent
the entrance of air into the oesophagus.
Lower Oesophageal Sphincter
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The lower oesophageal sphincter is a physiological sphincter located in the gastro-oesophageal

junction (junction between the stomach and oesophagus). The gastro-oesophageal junction is
situated to the left of the T11 vertebra, and is marked by the change from oesophageal to gastric
mucosa.
During oesophageal peristalsis, the sphincter is relaxed to allow food to enter the stomach.
Otherwise at rest, the function of this sphincter is to prevent the reflux of acid
Histology:
The oesophagus has a mucous membrane consisting of a tough stratified squamous epithelium
without keratin, a smooth lamina propria, and a muscularis mucosa.
The muscular layer of the esophagus has two types of muscle. The upper third of the esophagus
contains striated muscle, the lower third contains smooth muscle, and the middle third contains a
mixture of both. Muscle is arranged in two layers: one in which the muscle fibres run longitudinally
to the esophagus, and the other in which
the fibres encircle the esophagus. These
are separated by the myenteric plexus, a
tangled network of nerve fibres involved
in the secretion of mucus and in peristalsis
of the smooth muscle of the esophagus.
The esophagus also has an adventitia, but
not a serosa. This makes it distinct from
many other structures in the
gastrointestinal tract.
Blood Supply:
With respect to its arterial and venous
supply, the oesophagus can be divided
into its thoracic and abdominal
components.
Thoracic
The thoracic part of the oesophagus receives its arterial supply from the branches of the thoracic
aorta and the inferior thyroid artery (a branch of the thyrocervical trunk). Venous drainage into the
systemic circulation occurs via branches of the azygous veins and the inferior thyroid vein.
Abdominal
The abdominal oesophagus is supplied by the left gastric artery (a branch of the coeliac trunk) and
left inferior phrenic artery. This part of the oesophagus has a mixed venous drainage via two routes:
● To the portal circulation via left gastric vein
● To the systemic circulation via the azygous vein.
These two routes form a porto-systemic anastomosis, a connection between the portal and systemic
venous systems.
Nerve supply:
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The esophagus is innervated by the vagus nerve and the cervical and thoracic sympathetic trunk.
Lymphatic drainage:
The lymphatic drainage of the oesophagus is divided into thirds:
● Superior third – deep cervical lymph nodes.
● Middle third – superior and posterior mediastinal nodes.
● Lower third – left gastric and celiac nodes.
61. Stomach- topography, blood supply, lymphatic drainage, nerve supply

(RA)
The stomach is the most dilated part of the digestive tract

It is situated in the abdominal cavity, just below the diaphragm
Topography:
In order to understand the topography of the stomach, we must know the topography of the
abdomen;
● The abdomen is part of the trunk inferior to the thorax. Its musculomembranous
walls surround the abdominal cavity, which is bounded superiorly by the diaphragm
and inferiorly by the pelvic inlet
● The abdominal cavity can:
➔ Extend superiorly up to the 4th intercostal space
➔ Extend inferiorly with the pelvic cavity
● It contains peritoneal cavity and abdominal viscera
4-quadrant pattern: 9-region pattern:
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Topography of stomach:
● In upper part of abdominal cavity, under left

diaphragmatic vault
➔ In the left hypochondriac region
➔ Partly in the epigastric region
● The cardia:
➔ To the left of T10-T11 vertebrae
● The pylorus:
➔ To the right of T12-L1 vertebrae
Blood supply: by arteries of from celiac trunk
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Venous drainage:
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● Venous drainage from the stomach and duodenum is into the hepatic portal vein,
either directly or indirectly via splenic or superior mesenteric vein (SMV)
● The splenic vein usually receives the inferior mesenteric vein and then unites with
the SMV to from the portal vein
● The right and left gastric veins drain into the portal vein
● The short gastric veins and left-gastro omental veins drain into the splenic vein,
which joins the SMV to form the portal vein
● The right-gastro omental veins empties in the SMV
● The prepyloric vein ascends over the pylorus to the right gastric vein
➔ Because this vein is obvious is living persons, surgeons use it for identifying the
pylorus.
Lymphatic drainage:
Lymph vessels and lymph nodes are located on both curvatures and around the pylorus:
● Greater curvature----> splenic + caudal lymph nodes= gastro-omental lymph nodes.
● Lesser curvature----->gastric lymph nodes
● Pylorus-----> pyloric lymph nodes connect the hepatic lymph nodes at the hilum of
the liver
62. Stomach- structure
Most dilated part of gastrointestinal tract

Shape; J-like shape
Region: Intraperitoneal organ which is located in the left epigastric region, umbilical and left
hypochondriac regions.
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Position: between the abdominal oesophagus and the small intestine. Located in the upper
abdominal cavity, just below the diaphragm
Function; storage and breakdown of food, and mixing it with juices secreted by it’s lining-
chemical digestion
Structure: (macroscopic)
4 regions:
1. Cardia
● Part surrounding the cardiac orifice at level of
T10
2. Fundus
● Located in the left hypochondriac region
● Lies inferior to the apex of the heart at the
level of the 5th rib
● The cardiac notch is between the oesophagus
and the fundus
3. Corpus (body)
● Biggest region
● Has greater and lesser curvatures
4. Pylorus
● The pyloric antrum (the wide part), leads into the pyloric canal (the narrow part)
● The pyloric orifice is surrounded by the pyloric sphincter
2 openings:
● Cardiac orifice- opening by which oesophagus communicates with stomach, at level
of T10
● Pyloric orifice- communicates with duodenum. Located just to the right of midline in
a plane that passes through the lower border of vertebra L1 (the transpyloric plane)
2 curvatures:
● Greater curvature - point of attachment for gastrosplenic ligament and greater
omentum
● Lesser curvature- point of attachment of lesser omentum
2 surfaces;
● Antero-superior surface- whole surface covered by peritoneum
● Postero-inferior surface
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Other features;
● Cardiac Notch- creates superior angle when oesophagus meets stomach
● Angular incisure- bend on the lesser curvature
Histology of the stomach:

● Bean-shaped hollow muscular organ of the gastrointestinal tract involved in the
second phase of digestion
● Has 4 anatomical parts; cardia, fundus, body, pylorus
● Has 3 histological parts; cardia, fundus and body, and pylorus
➔ Fundus and body are same histological structure and are sites of gastric glands
releasing acidic gastric juice
➔ The cardia and pylorus are primarily involved with mucous production and are
similar histologically
Layers:
1.) T
unica
mucosa
1.)Lami
na
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epithelium
➔ Simple columnar epithelium
➔ Invaginate into lamina propria forming gastric pits
➔ Tubular gland empty into bases of gastric pits (cardiac glands, funcid glands,
pyloric glands)
➔ Produce mucin which protects themselves from gastric juice
2) Lamina propria
➔ Loose connective tissue, containing many lymphocytes
➔ All gastric glands are located in this lamina
3) Lamina muscularis mucosae
➔ Well developed, usually composed of 2 layers (circular and longitudinal
muscles) .. smooth muscles
➔ Separates the mucosa from the underlying submucosa
2. Tunica submucosa
➔ Loose connective tissue
➔ Contains: Blood Vessels, lymphocytes, macrophages, lymphatics, adipocytes, mast
cells
3. Tunica muscularis
➔ 3 layers:
➔ Innermost sublayers: oblique bundles of smooth muscle cells may occur

➔ Middle sublayers: circularly arranged smooth muscle cells. Well developed
throughout the stomach, especially in the pyloric gland where it forms the sphincter
muscle
4. Tunica Subserosa
Tunica Serosa;
➔ Lamina propria serosae---> loose connective tissue
➔ Lamina epithelium mucosae---> mesothelium
Gastric glands:
They are different in the histological portions;
1. Cardiac glands:
● Located in the cardiac portion
● Simple or branched glands
● The secretory cells resemble the surface mucous cells of gastric pits
● Produce mucin
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2.Fundic Glands:
● Located in the fundus and body
● Several glands open into one gastric pit
● Have segments;
a) Upper segments (neck):

➔ Mucous neck cells- produce mucin
➔ Undifferentiated stem cells
b) Middle and lower segments (principal segment):

➔ Parietal cells- produce HCl: acid philic (pinkish stain)
➔ Chief cells- pepsinogen: basophilic (bluish stain)
➔ Enteroendocrine cells: produce hormones (gastrin etc.)
3. Pyloric Glands
● Located in pyloric portion
● Branched (and coiled) tubular glands with curved end (gastric pits are deeper in
pyloric region)
● Produce mucin and antibacterial lysozyme
● Secretory cells stain slightly
● Enteroendocrine cells also present
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63. Small intestine- duodenum
● The small intestine (4-6m) has 3 parts:

➔ Duodenum, 25-30cm
➔ Jejunum,2/5ths of total length, 2.5m long
➔ Ileum 3/5ths of total length, 3.5m long
● The small intestine is the primary site for absorption and of nutrients from ingested
material
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Histology of small intestine:

The duodenum, jejunum and ileum merge imperceptibly and have the same basic
histological organisation
Anatomical features:
● Circular folds (kerkring’s valve)
➔ Approximately 1cm tall circular folds formed
by relatively short muscle longitudinal layer of
tunica muscularis
Histological features:
● Intestinal villi
● Approx. 1mm finger-like projections of mucous
membrane into lumen
➔ Increasing internal surface
Function of small intestine:
● Molecular breakdown of food
● Adsorption of small molecules
Surface enlargement of small intestine:
● Kerckring's valve approx. 1cm
● Intestinal villi approx. 1mm
● Microvilli approx. 1micromilimetre
Layers:
1.) Tunica mucosa (mucous membrane)
● Intestinal villi-Finger-like projections of tunica mucosa
● Epithelium contains;
➔ Erythrocytes
➔ Goblet cells
➔ Intraepithelial lymphocytes
a)lamina epithelium
● simple columnar epithelium
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b) Lamina propria
● Smooth muscles
● Blood capillaries
● Intestinal gland (Crypts of Lieverkun)
c)Lamina muscularis mucosa
● In the duodenum it discontinues due to duodenal glands (Brunner’s gland)
● In jejunum: continues
● In ileum: discontinues, due to aggregated lymphatic follicle
2.) Tunica Submucosa

● Loose connective tissue
● Submucosal plexus (Meissner’s plexus)
● In duodenum contains duodenal gland (brunner's gland);
➔ Branched tubular glands
➔ Secrete alkaline mucous to neutralise gastric juice
● In ileum contains aggregated lymphatic follicles
➔ Peyer's patch
3.) Tunica Muscularis

● Stratum circulare
● Stratum longitudinal
● Auerbach plexus
➔ Between 2 layers, well visible(pale portion between 2 layers)
4.)
● Tunica subserosa
● Tunica serosa (serous membrane)
➔ Lamina propria serosae- loose CT
➔ Lamina epithelialis serosae- mesothelium,
◆ In retroperitoneal duodenum
Note; Tunica subserosa + tunica serosa= Tunica adventitia
Structural differences of small intestine:

In duodenum; only duodenal glands
In jejunum; only general characteristics
In ilium; only follicles
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Duodenum:
● Makes a C shape around the head of pancreas
● The duodenum starts at the pylorus of the stomach on right side and ends at the
duodenojejunal junction on left side.
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● Junction- at the level of L2, 2-3cm from midline , the duodenojejunal flexure
● Most of the duodenum is fixed by the peritoneum to structures on the posterior
abdominal wall and is considered partially retroperitonial.
● In contrast, the intraperitoneal convoluted parts of the jejunm and ileum are not
seperable microscopic structures and reach distally to the iliocecal valve (BAUHIN’s
valve) at the transition of the large intestine
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Localization and skeletopy:

● Adherent to the posterior abdominal wall entirely above the level of the umbilicus
● Projected into the:
➔ Epigastric region
➔ Umbilical region
● C shaped, enclosing head of pancreas
● Immobile, no mesentery
Bloodsupply:
● Since the duodenum arises from the foregut & midgut it will be supplied 1st by the
celiac trunk, then superior mesenteric artery
Foregut part (before the major duodenal papilla)

● Superior pancreaticoduodenal artery
➔ From gastroduodenal artery of celiac trunk
Midgut part (after papilla)

● Inferior pancreaticoduodenal artery
➔ From superior mesenteric artery
● Both anastomose with each other
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Venous drainage:
Duodenal vein ----> portal vein
Development of the duodenum:

1. Develops from most cranial part of midgut
➔ The junction of the upper and lower duodenum is just distal to the opening of
the common bile duct
2. Forms ansa duodenalis (C-shaped loop) projecting ventrally
➔ As stomach rotates, ansa duodenalis rotates to the right and becomes
retroperitoneal
3. Intraperitoneal portion is attached to liver by hepatoduodenal ligament of lesser
omentum
64) small intestine-

jejunum, ileum
Both intraperitoneal structures

Jejunum:
● Makes up the proximal 2/5 of small intestine
● Begins at the duodenojejunal flexure where the digestive tract resumes an
intraperitoneal course
● Emptier, larger in diameter, and thicker wall than the ileum
● Has circular folds (plicae circulares)
● No peyer's patches (aggregations of lymphoid tissue)
● Has longer straighter arteries (vasa recta) than ileum
Ileum:
● Makes up distal 3/5 of small intestine
● Ends at ileocecal junction- the union of the terminal ileum and coecum
● Longer than jejunum
● Occupies false pelvis in lower right quadrant of abdomen
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● Characterized by the presence of peyer's patches (aggregated lymph nodules), short

circular folds and vasa recta
a. Jejunum
b. Ileum
Mesenteric attachment:
● The mesentery is a fan-shaped fold of peritoneum that attaches the jejunum and
ileum to the posterior abdominal wall
● The root of the mesentery is directed obliquely, inferiorly and to the right
➔ It extends from the duodenojejunal junction on the left side of L2 vertebra to
the ileocolic junction and the right sacroiliac joint
➔ The average breadth of the mesentery from its root to the intestinal border is
20cm
Blood supply:
Artery:
● All midgut= superior mesenteric artery
➔ Make arterial arcades that run within the mesentery of jejuno-ileum
➔ From the arcades come the straight arteries (vasa recta)
Vein:
● Drained by superior mesenteric vein
➔ Joins splenic vein, behind junction between pancreas head/neck, to form
portal vein
➔ Inferior mesenteric vein can drain into superior mesenteric vein, splenic vein,
or junction between the two.
Development of jejunum and ileum:

1. The midgut forms U- shaped loop (midgut loop) that herniates through the umbilical
ring into the extraembryonic coelom (ie. physiological umbilical herniation)
beginning at week 6
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2. The midgut loop consists of a cranial limb & caudal limb

3. Cranial limb forms;
➔ Jejunum
➔ Upper part of ileum
4. Caudal limb forms:
➔ Coecal diverticulum---> caecum & appendix
Rest of the caudal limb forms:
➔ Lower part of ileum
➔ Ascending colon
➔ Proximal ⅔ of transverse colon
5. The midgut rotates a total of 270 degrees anitclockwise around the superior mesenteric
artery and returns to the abdominal cavity, thus reducing the physiological herniation
around week 11
65. Large intestine: caecum, appendix, colon
● Extends from the ileocecal junction to the rectum (about 1.5m long)
● At the lower GI tract of digestive system
● Functions:
➔ Stool formation and defecation
➔ Absorption of fluids and solutes
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➔ Digestion is finished- breakdown of cellulose, waste, mucous
3 anatomical segments:
➔ Cecum
➔ Colon
➔ Rectum
Development of the large intestine:
● Large intestine is derived from 2 embryonic parts
➔ Midgut - until ⅔ of transverse colon
➔ Hindgut- after ⅔ of transverse colon
Development of midgut:
Refer to notes in development of jejunum and ileum above
Development of hindgut:
● The cranial end of hindgut develops into distal one third of the
➔ Transverse colon
➔ Descending colon
➔ Sigmoid colon
● The terminal end of the hindgut is an endoderm lined pouch called cloaca
➔ Contacts the surface ectoderm of the proctodeum to form the cloacal
membrane
Cecum:
● A large cul de-sac
● Lies in the right iliac fossa, under the level of the ileocecal valve
● 6-7cm in length
● Intraperitoneal position, no mesentery
● Vermiform appendix:
➔ A narrow, hollow, muscular tube with large aggregations of lymphoid tissue
in lamina propria and submucosa
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➔ 6-8cm avg length

➔ Suspended from terminal ileum by small mesentery (the mesoappendix)
which contains appendicular vessels
➔ Surface projections:
❖ the base of the vermiform appendix projects onto McBurney’s point- transition
between lateral 3rd and medial ⅔ on a line connecting the umbilicus with the
anterior- superior iliac spine
❖ Tip of the appendix projects onto LANZ’S point- transition between the right 3rd and
left ⅔ on a line connecting both anterior superior iliac spine; (bony surface
projections on hips)
Colon:
Consists of 4 parts:
● Ascending colon- retroperitoneal
● Transverse colon- intraperitoneal
● Descending colon- retroperitoneal
● Sigmoid colon- intraperitoneal
➢ The transverse and sigmoid colon have their own mesenteries; transverse
mesocolon and sigmoid mesocolon
➢ Ascending and transverse colons are supplied by: superior mesenteric artery and
vagus nerve
➢ Descending and sigmoid colons are supplied by; inferior mesenteric artery and
pelvic splanchnic nerves
❖ Taeniae coli; 3 narrow bands of outer longitudinal muscle coat

❖ Haustra and semilunar folds; small pouches/sacculations of the intestinal wall which
give the colon its segmented appearance/crescent-shaped mucosal folds
❖ omental/epiploic appendices; peritoneum-covered sacs of fat, attached in rows
along taeniae
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Microscopic structure- structure of the wall of the large intestine

● Similar to other parts of intestines
● Inner mucosal layer (mucosa)- NO microvilli present in contrast to duodenum
➔ Separated by CT layer.. submucosa
● Muscular layer
➔ Consists of an inner circular layer and outer longitudinal layer(not
continuous and is reduced to 3 bands called taenia
● At the outside, the intraperitoneal parts are covered by visceral peritoneum forming
the serosa
● The retroperitoneal parts are anchored by adventitia in the connective tissue of the
retroperitoneal space
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Histology of large intestine:

● Large intestine constitutes the lower part of the digestive system
● Its divided into 3 main sections: cecum including appendix, colon and rectum with
the anal canal
● Primary function: reabsorption of water and inorganic salts
● Only secretion of any importance is mucus→ acts as a lubricant during transport of
intestinal contents
General histological features:

● Intestinal glands (crypts of Lieverkun) → tubular gland
● No intestinal villi but there are lymphatic follicles present
● Goblet cells more abundant than in small intestine
● Layers much thinner
Blood Supply:
● Blood until distal third of transverse colon is supplied by superior mesenteric artery,
as it is midgut
● After is hindgut. Blood supplied by inferior mesenteric artery
● VEINS FOLLOW THE ARTERIES
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Superior mesenteric artery;

● Cecum→ ileocecal artery (same as ileocolic artery)
● Appendix→ appendicular branch of ileocolic artery
● Ascending colon and proximal ⅔ of transverse colon→ ileocecal and right colic artery
Inferior mesenteric artery;

● Distal third of transverse colon→middle and left colic artery
● Descending colon→ left colic artery, sigmoid artery
● Sigmoid colon→ sigmoid artery
66.Large intestine: Rectum
● The part of the large intestine that extends from the sigmoid colon to the anal canal
and follows the curvature of the sacrum and coccyx
● Slightly S-shaped organ
● Average length 12-15cm
● Ampulla: lower dilated part, located above the pelvic diaphragm
● Has a mucous membrane and circular muscle layer that forms 3 permanent
transverse folds
➔ Houston’s valve
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➔ Appear to support the fecal mass

Through the rectum;
● In males, the prostate and seminal vesicles can be palpated
● In females, the vagina can be palpated
Parts of the rectum:

The rectum can be divided into 3 parts due to its structure:
Superior part:
● Upper third, intraperitoneal
● In females, located near the Douglas pouch
Middle part:
● Middle third, retroperitoneal
Inferior part:
● Lower third, intraperitoneal
Anal canal:
● Lies between pelvic diaphragm and ends at anus
● Divided respectively to mucosa, blood supply, nerve supply
➢ Upper ⅔ (visceral portion)- belongs to intestine
➢ Lower ⅓ (somatic portion)- Belongs to perineum
● Hilton’s white line separates the internal anal sphincter from the external anal
sphincter
➢ Internal anal sphincter muscle: thickening of circular smooth muscle
➢ External sphincter muscle: skeletal muscle
● Pectinate (dentate) line
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➔ Dividing line between visceral and somatic portions
Innervation:
● Inferior hypogastric plexus, pelvic nerves
Histology of the anal canal

Development of the anus and the anal canal
67. Pancreas
● Lies largely in the floor of the lesser sac in the epigastric region and left
hypochondriac regions
● A retroperitoneal organ, except its tail part which lies in the lienorenal ligament
Parts of the pancreas:
● Head: lies within the C shape concavity of the duodenum

● Uncinate process: projection of the lower part of the head to the left side behind the
superior mesenteric vessels
● Neck: Has pancreatic notch
● Body: main part of the pancreas
● Tail: not retroperitoneal
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Function of the pancreas:

● Exocrine gland: produce digestive enzymes
● Endocrine gland: From islets of langerhans, secretes: insulin, glucagon, somatostatin,
etc.
Duct system of the pancreas:
● There are 2 ducts in the pancreas:
a). Main pancreatic duct (duct of Wirsung)
➔ Begins in tail, runs right along entire pancreas
➔ Carries pancreatic juice containing enzymes
➔ Joins the bile duct to form the hepatopancreatic ampulla (ampulla of Vater), before
entering the descending part of duodenum at the greater papilla
b). Accessory pancreatic duct (santorini's duct)
➔ Begins in the lower portion of the head and drains a small portion of the head and
body
➔ Empties lesser duodenal papilla about 2cm above greater papilla
Blood supply:
For head:
➔ Superior pancreaticoduodenal artery
➔ Inferior pancreaticoduodenal artery
For body:
➔ Splenic artery
Venous drainage
Follows arterial supply
Lymph:
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➔ Para aortic lymph node
Innervation:
➔ Celiac ganglion
➔ Vagus nerve
Histology and development

Its primary function is that of an endo and exocrine gland, fulfilled by different cell types:
- Exocrine:
- Closely packed serous acini cells which secrete enzyme rich alkaline fluid into
duodenum via pancreatic duct
- Endocrine:
- Islets of langerhans are clumps of secretory cells surrounded by a delicate capsule.
There are three types of cells:
- Alpha - secrete glucagon
- Beta - secrete insulin
- Delta- secrete somatostatin (another endocrine hormone)
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68. Liver: shape, topography, blood supply, lymphatic drainage, nerve

supply
Blood supply of the liver:

● Receives oxygenated blood from hepatic artery
● Receives deoxygenated blood, nutrient rich, sometime toxic blood from portal vein,
its venous blood drained by the hepatic veins into IVC
Lymphatic drainage:
● Lymphatics originate in the interlobular connective tissues
● The larger lymphatic vessels leave the liver in some pathways:
❖ Via porta hepatis → hepatic lymphatic nodes
❖ Along the hepatic veins → mediastinal lymphatic nodes
❖ In the falciform ligament → parasternal lymphatic node, nodes around the
aorta
Innervations of the liver:
● Celiac ganglion
● Vagus nerve (CN X)
69. Structure of liver
● Largest visceral organ and the largest gland in the body

● Surrounded by peritoneum
Attached to the diaphragm by;
➔ Coronary ligament
➔ Falciform ligament
➔ Right and left triangular ligament (continuation of coronary ligament)
● Has a bare area (lacks peritoneal lining) on the diaphragmatic surface
➔ Limited by layers of coronary ligament but is entirely without peritoneum
● Divided based on hepatic drainage and blood supply into left and right lobes by the
fossae for the gallbladder and IVC
Parts:
Left lobe:
In epigastrium and left hypochondriac region
Right lobe:
In the right hypochondrium
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Quadrate lobe:
● Anterior to the porta hepatis, between the fissure for ligamentum teres and fossa for
gallbladder
● Receive blood from left hepatic artery and drains bile into left hepatic duct
Caudate lobe:
● Posterior to the porta hepatis, between the fissure for ligamentum venosum and the
groove for vena cava
● Receives blood from right and left hepatic arteries, and drains bile into both right
and left hepatic ducts
Fissures and ligaments of the liver:

The liver has H shaped group fissures on the inferior/posterior surface
1) Crossbar of H
● Porta hepatic
➔ This transverse fissure on the visceral surface of liver between visceral and
caudate lobes lodges;
❏ Common hepatic duct
❏ Hepatic portal vein
❏ Hepatic artery proper
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2) In the left posterior hand

● Fissure for ligamentum venosum
3) In the left anterior hand
● Fissure for ligamentum teres hepatis
4.) The right posterior hand

● Fissure for IVC
5.) In the right anterior hand

● Fossa for the gallbladder
Function of liver:
➔ Production and secretion of bile
➔ Detoxification (filtering blood to remove bacteria, foreign substances)
➔ Storage of CHO’s as glycogen
➔ Protein synthesis
➔ Production of heparin and bile pigaments
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70. Bile ducts. Gall bladder
Gall bladder:
● Located at the junction of the 9th costal cartilage, and lateral border of rectus
abdominus
● Pear-shaped sack lying on the inferior surface of the liver in a fossa
● Contact with duodenum and transverse colon
● Peritoneum attachments
Parts:
● Fundus: rounded, blind-end
● Body: major part
● Neck: narrow part
● Cystic duct: spiral valves (heister’s valves)
Function:
● Receive bile, concentrate, store and also
release it.
● Contracts to expel bile as a result of
stimulation by CCK hormone
Blood supply:
Artery:
● Cystic artery
● Hepatic portal proper
Vein:
● Cystic vein
● Hepatic portal vein
Lymphatic drainage:
● Lymph nodes of porta hepatis
Duct system for bile passage:
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71. The Peritoneum
The Peritoneum is a continuous transparent

membrane which lines the abdominal cavity and
covers the abdominal organs. It supports the
abdominal organs providing a pathway for vessels
and lymph.
The peritoneum develops from the mesoderm of

the embryo, specifically the lateral plate
mesoderm, which splits into two layers to form the
visceral and parietal layers of the peritoneum.
The peritoneum is a serous membrane that

consists of two layers, the Parietal peritoneum and
Visceral peritoneum, both of which consists of
simple squamous epithelium called mesothelium.
The parietal peritoneum lines the surface of the

abdominopelvic wall and can be seen as the
outside of the peritoneum. It is innervated by the relevant intercostal nerves and vasculated by the
relevant intercostal arteries.
The Visceral peritoneum invaginates in order to cover the many abdominal viscera. It is derived from
splanchnic mesoderm in the embryo. It is innervated and vascularized by the same supply as the
viscera it surrounds.
The visceral peritoneum forms two sets of ‘double folds’ within the body and we give these double
foldes different names, where the double fold attaches the stomach and other organs is called the
Omenta. There is both a greater and inferior Omentum. Where the visceral peritoneum forms a
double layer of visceral peritoneum which attaches to the GI tract it is called a Mesentery.
Between the Parietal Peritoneum and the Visceral peritoneum sits the Peritoneal Cavity consisting
of a small amount of lubricating fluid.
Within the body there are Intraperitoneal organs and Retroperitoneal organs. Intraperitoneal organs
are completely covered in visceral peritoneum and include the Stomach, liver and spleen. While The
Retroperitoneal organs are only covered in the peritoneum on their anterior surface. These can be
primary retroperitoneal (Oesophagus, rectum and Kidneys) or secondarily (become retroperitoneal
through the embryogenesis). A mnemonic to recall abdominal viscera retroperitoneal is SAD
PUCKER:
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- S = Suprarenal Glands
- A = Aorta
- D = Duodenum (parts 2-4)
- P= Pancreas (Head and Body)
- U = Ureters
- C = Colon (Not Sigmoid colon
- K = Kidneys
- E = (o)esophagus
- R= Rectum
If you consider a longitudinal cross section of the body the Peritoneal cavity is divided into a A
Greater (Ventral) and Lesser (Dorsal) sac by the Greater and Lesser Omentum (the doubling up of
the visceral peritoneum which attaches the Stomach to things).
Have you ever considered how the visceral organs stay in place? It’s via ligaments, but not normal
bone ligaments, Peritoneal ligaments, we will consider these here.
- Liver
- Falciform ligament - separates right and left lobes, attaching to rectus sheath
- Round ligament - at base of falciform ligament, attaching to the umbilicus
- Coronary ligament (Upper) - runs laterally across the superior anterior aspect of the
liver, attachment for peritoneal reflexes off the diaphragm
- Coronary ligament (Lower) - runs laterally across the superior posterior aspect of
the liver, attachment for peritoneal reflexes off the diaphragm
- Triangular ligament is at the corners where the Upper and Lower Coronary
ligaments meet
- Hepatoduodenal ligament - liver to first part of duodenum (contains bile duct,
proper hepatic a. And portal v.)
- Hepatogastric ligament - liver to lesser curvature of stomach
- Stomach
- Gastrolienal ligament - attaches greater curvature with stomach with hilum of
spleen
- Gastrocolic ligament - attaches greater curvature of the stomach with transverse
colon
- Gastrophrenic ligament - attaches fundus of stomach with left side of diaphragm.
- Gastrosplenic ligament - attaches greater curvature of the stomach with hilum of
spleen
- Spleen
- Lienorenal Ligament - attaches spleen to kidney
When considering the structure of the Peritoneum it helps to consider it in relation to a number of
different structures. We will look at these structures from superior to inferior, working down the
abdomen.
Lesser Omentum
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- Double layer of visceral peritoneum that extends from the porta hepatis to the lesser
curvature of the stomach, via the hepatogastric ligament, and the first part of the
duodenum, via the hepatoduodenal ligament.
- This double layer then splits around the stomach to completely enclose the stomach. This
double layer then meets again at the greater curve of the stomach and ‘hangs down’ over
the intestinal loops forming the Greater Omentum.
Greater Omentum
- The greater omentum hangs over the intestine loops and then attaches to the Transverse
colon
- Behind the Greater and Lesser omentums is where the Lesser sac of the peritoneum sits.
Mesentery
- As the greater omentum double loop reaches the Transverse colon, as with the lesser
omentum the folded surround the transverse colon. From here they come together at the
superior aspect of the transverse colon and reform in a double fold to create the mesentery.
This double layer mesentery then splits with a superior and inferior inflection, the superior
going to the liver and the inferior going to the duodenum.
- This Mesentery which attaches the Transverse colon to the posterior abdominal wall is
called the Transverse mesocolon.
- As we follow the peritoneum inferiorly there is another Mesentery which attaches to the
small intestine. This is called the Mesentery of the small intestine which wraps around the
small intestine, suspending it in the peritoneal cavity.
- Further Down is the Sigmoid Mesocolon
These Mesenteries, along with the Greater and Lesser Omentums cary vascular and lymph supply to
the viscera.
Recap:
- Ontogenesis (including embryogenesis)
- Parietal layer from lateral plate mesoderm, Visceral layer from splanchnic
mesoderm.
- Topography
- Macro- and microscopic structure
- Double layer, important structures include greater and lesser omentum and
mesentery. Along with greater and lesser sac.
- Serous membrane with thin CT layer covered with simple squamous epithelium
called mesothelium.
- Histology and Physiology
- Mesothelium has microvilli on their surface along with elastic CT. The mesothelial
cells are also responsible for producing peritoneal fluid.
- Blood supply
- From relevant intercostal arteries for parietal. From arteries that supply organ for
visceral.
- Nerve supply
- From relevant intercostal nerves for parietal. From nerves that supply organ for
visceral.
- Lymphatic drainage
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- Space drains via the subdiaphragmatic lymphatic system. Space also provides lymph
pathway for other organs.
- Anomalies
Lesser Sac
- Sits behind the stomach and spleen.
- The Lesser and greater Sac communicate via the Epiploic foramen/Foramen of Winslow.
This is just a small hole between the two sacs.
72. Respiratory system - overview and development
An overview of the respiratory system:

- Fundamental for gas exchange via negative pressure breathing, consists of a conduction
portion (respiratory tract) and a respiratory portion (lungs).
- Also involved in voice
formation (larynx) and
Olfactory (nasal cavity)
- The air passages are:
- Upper respiratory
tract
- Nasal cavity
- Pharynx
- Lower respiratory
tract
- Larynx
- Trachea
- Bronchi
(external
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and internal)
- Bronchioles
-
- Respiratory portion is held within the lungs
and has:
- Respiratory bronchioles
- Alveolar ducts
- Alveolar sacs (composed of
multiple Alveoli)
- Alveoli
In a nutshell, the respiratory system allows us to

bring in O2 and expel CO2. This exchange takes
place between the Alveolus and the capillary reticulum surrounding them.
Embryonic development
Lung developments beings at 4 weeks, with epithelium coming
from endoderm and CT from mesoderm.
At 26 days a small opening of the foregut appears and this then

develops into the laryngotracheal diverticulum (or lung bud). As this
bud grows, a septum develops, this is in effect separating what will
be the trachea out from the developing oesophagus.
Larynx
- Epithelium develops from the endoderm of the foregut
- Cartilages and muscles from splanchnic mesoderm
Trachea
- Epithelium from endoderm of laryngotracheal
- Cartilage and CT from splanchnic mesoderm
Lungs
- Epithelium from Endodermal epithelium
- CT from mesenchyme
The ‘lung bud’ (what will become the trachea) then begins to develop. Lungs properly being to
develop from 4th week. We can look at four stages of lung maturation:
- Embryonic period
- Lung bud periods
- Pseudoglandular period (5-16 weeks)
- All elements of lungs are developed other than alveoli
- Canalicular period (16-26 weeks)
- Alveolar (respiratory epithelium) begin to develop and tissue becomes more
vascular
- Terminal sac period (26 weeks to birth)
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- Terminal alveolar sacs develop, Type I alveolar cells develop, capillary network
develops, from this period gaseous exchange can start to occur.
a. Ontogenesis (including embryogenesis)

- ,
b. Topography
- Upper and lower tracts.
- Includes nose, sinus, mouth, pharynx, larynx, trachea, bronchi, bronchioles and
lungs.
c. Macro- and microscopic structure
- Tubes leading into air sacs of the alveoli.
- Conducting passages lined with ciliated pseudostratified columnar epithelium
- Alveoli lined by simple squamous epithelium to facilitate diffusion
d. Histology and Physiology
e. Blood supply
f. Nerve supply
g. Lymphatic drainage
h. Anomalies
73. Nose. Nasal cavity. Paranasal

sinuses
The nose is both a respiratory and olfactory organ with a role in

forming the timbre of the voice. It includes the External Nose
and Nasal Cavity.
The external nose consists of:

- Base
- Lateral sides (x 2)
- Dorsum
- Root
- Free tip
- Nostrils
- Columella (bit between nostrils)
The Bony and cartilaginous framework is
picture on the R. Note of those the Nasal
bone, Maxilla and Septal cartilage are
unpaired, the remainder are pared.
The movements of the nose are controlled

by muscles connected by superficial nasal
aponeurosis. The muscles are innervated
by Ophthalmic and Maxillary nerves
(Divisions of Trigeminal nerve).
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The internal nose includes:

- Cavum Nasi
- Vestibule (very tip of the nose)
- Nasal cavity proper
- Nasal Septum
- Bony part
- Vomer
- Perpendicular plate
- Ethmoid bone
- Cartilaginous part
- Cartilaginous nasal septum
- Cartilagenous alares majores
- Vomernassal organ/jacobson’s organ (olfactory)
- Kiesselbach’s area
- Membrane part
The Nasal cavity is bordered by a bony skeletal consisting of:

- Hard palate of the floor
- a superior wall formed by the nasal, ethmoid and sphenoid bone
- medial wall of the nasal septum
- lateral wall of the Maxilla, lacrimal, palatine, sphenoid bones and ethmoid labyrinth.
Within the cavity, attached to the lateral wall are Superior, Middle and Inferior concha through
which air passes. Associated with these are the superior, middle and inferior meatuses. (Note, the
Concha are shelves of bone while the meatus are the fleshy structures associated with the bone
shelf). These Conchae increase surface of nasal cavity as well as creating turbulence in air passaging
assisting air conditioning.
The Medial wall (the septum) houses the olfactory and respiratory segments, while the paranasal
sinuses (recessus sphenoethmoidalis, hiatus semilunaris, infundibulum, plica lacrimalis) all open into
the proper nasal cavity (more detail on these later).
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Histology:
- Respiratory region
- First stratified squamous then;
- Respiratory epithelium: Pseudostratified
columnar and ciliated (as per all respiratory
passages)
- Mucus producing goblet cells present
- Lamina propria
- Nasal glands (seromucus, tubular)
- Venous plexus, Tratum cavernosum
- Lymph network
-
- Olfactory segment
- 5-10mm2, yellowish brown
- Olfactory mucosa, tunica mucosa
- Olfactory epithelium
- Receptor cells (with non-motile cilia)
- Supporting cells (secretion of serous glands)
- Basal cells
- Brush cells
- Lamina propria
- Olfactory (Bowman’s) glands
(Histology doc for rest of Q’s

http://www.lab.anhb.uwa.edu.au/mb140/CorePages/Respiratory/respir.htm#NASAL)
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Blood supply (Cavity):

- Fascial a.
- Opthalmic a.
Blood supply (Cavity):
- Respiratory segment by
sphenopalatine artery
(external carotid)
- Olfactory segment by
anterior and posterior
ethmoidal arteries (internal
carotid)
Venous:
- Fascial and opthalmic veins
Lymph
- Deep neck lymph nodes
- Retropharyngeal lymph
Innervation:
Sensory, branches of trigeminal
- Ophthalmic - Nasal nerve
- Maxillary nerve - Infraorbital, infratrochlear, anterior ethmoidal, posterior nasal
Automatic
- Carotid plexus (sympathetic)
- Pterygopalatine (parasympathetic)
Paranasal sinuses
There are four paranasal sinuses, these are:
- Sinus Maxillaris
- Sit inferior to the eyes and are the largest. They sit in the maxillary bone and drains
into middle nasal meatus.
- Sinus frontalis
- Sit superior to the eyes in the frontal bones.
- Drains into middle nasal sinus
- Sinus ethmoidalis
- We have anterior, middle and posterior ‘cellulae ethmoidales’, totalling around 10
separate air cells between eyes and nose.
- Drain into middle nasal meatus, except from posterior which drains to superior.
- Sinus sphenoidalis
- In the sphenoid bone, it is pared.
- Drains to sphenoethmoidal recess
All are lined with respiratory epithelium. Their biological function is not entirely clear but thought to
be related to the reduction of the relative weight of the skull, increasing resonance of voice, helping
to provide physical and immunological defence, and air conditioning.
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i. Ontogenesis (including embryogenesis)

- Develops from the embryological foregut.
j. Topography
- Consists of base, lateral sides (x2), Dorsum, Nostrils and Columella
k. Macro- and microscopic structure
- Cavum Nasi, Nasal septum (bony and cartilaginous part), membrane part
- Respiratory region: Respiratory epithelium, mucous producing goblet cells, lamina
propria
- Olfactory region: Olfactory mucosa (with olfactory epithelium) and Lamina propria
l. Histology and Physiology
m. Blood supply
- Fascial, ophthalmic, external and internal carotid arteries
- Facial and opthalmic veins
n. Nerve supply
- Opthalmic nerve, Maxillary nerve, carotid plexus, pterygopalatine
o. Lymphatic drainage
- Deep neck lymph nodes & Retropharyngeal lymph
p. Anomalies
74. Larynx
The larynx is ...fucking complex….
It is commonly called the voice box and is an organ in the neck. It is found at the level of C3 in men,
slightly higher in Women and Children and lower for older people. It consists of the vocal folds at C5
level with a pre visceral space at the front and attached to the pharynx behind. It sits directly below
the Hyoid bone and above the Trachea.
Average length in males 44mm, females 36mm, transverse diameter 43mm, 41mm, Anterior-
posterior diameter 36mm, 26m, circumference 136mm, 112mm.
Develops from the endodermal lining and adjacent mesenchyme of the foregut via the 4th and 6th
branchial arches.
The larynx is cartilaginous, comprised of nine cartilaginous elements.
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The unpaired cartilages are:

- Thyroid cartilage - forms the laryngeal prominence (Has superior and inferior horn)
- Cricoid cartilage - Hylaine cartilage, sits below Thyroid cartilage and forms inferior wall of
larynx on top of trachea.
- Epiglottis - large spoon shaped elastic cartilage, depressed during swallowing to cover
opening of trachea.
The paired cartilages are:
- Arytenoid cartilages - triangular hylaine cartilage located posterior superior border of cricoid
cartilage, hold folds in place
- Corniculate cartilages - horn shaped elastic cartilage located at the apex of each arytenoid
cartilage
- Cuneiform cartilages - club-shaped elastic cartilage located anterior to the corniculate
cartilages.
The larynx connects to the Hyoid bone above and the Trachea (via the cricoid cartilage) below. It’s
connection to the hyoid bone relies on the Thyroid membrane, medium and lateral thyrohyoid
ligaments. While it’s connection to the trachea (via cricoid cartilage) relies on the median
cricothyroid ligament and conus elasticus ligaments.
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The larynx has two sets of internal paired joints which aid the movement of the vocal cords.
The first are the cricothyroid joints, formed by articulation between cricoid cartilage and thyroid
cartilage. This joint allows the thyroid cartilage to glide and rotate superiorly or inferiorly, changing
the length of the vocal cords.
The second are the cricoarytenoid joints which create movement of the arytenoid cartilage twoards
and away from each other on the lamina of the cricoid cartilage.
The muscles of the larynx can be divided into intrinsic and extrinsic.
The extrinsic muscles are:

- Laryngeal elevators
- Stylohyoid
- Geniohyoid
- Digastric
- Laryngeal detractors
- Inferior pharyngeal constrictor muscle
The intrinsic muscles are:

- Cricothyroid - stretching vocal cords
- Posterior crico-arytenoid - broadens vocal slits
- Lateral crico-arytenoid - narrow vocal slits
- Oblique arytenoid - Narrow VS (and subsidiary aryepiglotticus - relaxing VS)
- Thyro-arytenoid - Relaxing VS (and its subsidiary part of the vocalis)
- Thyro-epiglotticus - Broadens vocal slits
- Transverse arytenoid (unpaired) - narrow vocal slits
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Innervation:
Motor
- Vagus nerve (accessory nerve)
- Inferior laryngeal N.
- Superior laryngeal N. (cricothyroideus only)
Sensory
- Vegus N
- Superior laryngeal (the mucosa above glottis)
- Inferior laryngeal (the mucosa below the vocal folds)
Histology
- Vocal folds lined by stratified squamous epithelium and contain
striated skeletal muscle and ligaments to control tension
- The mucosa of the larynx is covered with respiratory epithelium
(columnar ciliated epithelium)
- The epiglottis is covered in statified squamous nonkeratinized
epithelium
Cavity of the larynx

- Divided into three parts
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- Supralottic pace
- Transglottic space (with vocal and ventricular folds)
- Subglottic space
Vessels:
- Blood supply
- Superior laryngeal artery
- Ramus cricothyroideus
- Inferior laryngeal artery
- Venous drainage
- Homonymous veins which drains to Internal Jugular vein
- Lymphatic drainage
- Upper part - Deep cervical lymph nodes
- Middle part - prelaryngeal lymph nodes
- Lower part - Partracheal lymph nodes

- Developes from endodermal lining and mesenchyme of foregut via the 4th and 6th
branchial arches
b. Topography
- Levle of C3 in neck. Medial. 44mmx43mmx36mm male
- Pyramidal in shape
- Paired and unpaired cartridges, joined by ligaments and muscles (both intrinsic and
extrinsic)
- Three cavities (Supraglottic, Transglottic and Subglottic)
- Vocal folds lined by stratified squamous epithelium, mucosa of larynx covered with
respiratory epithelium, epiglottis covered in stratified squamous nonkeratinized
epithelium.
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e. Blood supply
- Superior laryngeal artery, Ramus cricothyroideus and inferior laryngeal artery
f. Nerve supply
- Vagus nerve, superior laryngeal (above glottis) and inferior laryngeal (below vocal
cords)
- Deep cervical lymph, prelaryngeal lymph and pararacheal lymph.
h. Anomalies
75. Trachea. Bronchi
The trachea is a short cartilaginous and membranous tube with a length of 11-13cm; diameter of 2.5
cm. It’s function is to conduct air from the larynx to the bronchi. It begins between C6-C7 and splits
into two (at bifurcatio tracheae) at around Th4-Th5. It is located just in front of the esophagus and
includes 15-20 cartilaginous rings.
Histology:
The trachea consists of:
- Respiratory epithelium (Stratified columnar with cilia creating brush border)
- Lamina Propria with elastic fibers, blood vessels and lymph nodules
- Submucosa with seromucous tracheal glands
- Perichondrium layer
- Hyoid cartilage layer
- Covered with adventitia layer
Blood supply:
- Inferior thyroid artery (Branch of thyrocervical, branch of subclavian)
- Internal thoracic artery (Branch of subclavian)
- Thoracic aorta
Venous drainage
- Paratracheal venous plexus
- Inferior thyroid vein
Lymph vessels
- Deep lateral cervical lymph nodes
- Pre-, paratracheal lymph nodes
Innervation
Nerve supply to the mucous membrane comes from afferent fibers of the vagus and recurrent
laryngeal nerves, also providing parasympathetic fibers. Sympathetic fibers from the upper ganglion
of the sympathetic trunks supply the smooth muscle and blood vessels.
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Bronchi
The principal bronchi arise from the trachea as two terminal branches, the air travels through the
trachea into the bronchi and into the bronchioles which tne evolve into the alveoli. The bifurcation
of the trachea takes place at about Th4-Th5, at an angle of about 55-65 degrees.
The right bronchus is wider, shorter and more vertical and the left, and is about 1 inch long. Before
entering the hilum of the right lung it gives of the superior lobar branch, meaning the superior lobar
branch does not arise inside the lung but outside.
The left bronchus is narrower, longer and more horizontal compared to the right, it is about 2 inches
long. It passes to the left below the arch of the aorta and in front of the esophagus. After entering
the lung it divides into superior and inferior lobar bronchi.
The bronchi enter the lung at the hilum, the same point at which the pulmonary vein and artery also
enter the lung. The Vein enters inferiorly and artery superiorly to the bronchi. Once the bronchi
enter the lung they divide into secondary (lobar) and tertiary (segmental) bronchi.
There are three right lobar bronchi, and two left lobar bronchi, the number of lobar bronchi is
determined by the number of lobus of each lung. Each lobar bronchi then divides into ten segmental
bronchi, supplying each segment of each lobe.
Histology
- Tunica mucosa
- Epithelial layer with respiratory epithelium
- Lamina propria with elastic fiber network, blood vessels and BALT
- Tela submucosa with bronchial glands
- Muscular cartilaginous layer (cartilage proportion decreases further along the bronchi)
- Bronchial cartilage plates
- Bronchial muscle
- Tunica adventitia
Blood supply
- Thoracic aorta
Venous drainage
- Parabronchial venous plexus
- Bronchial veins
Lymph drainage
- Deep cervical lymph nodes
- Pre-, paratracheal and tracheobronchial lymph nodes
Innervation
- Pulmonary branches of vagus nerve for parasympathetic
- Branches from sympathetic trunk for sympathetic
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b. Topography
e. Blood supply
f. Nerve supply
h. Anomalies
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76. Lung - shape, topography, blood supply, lymphatic drainage,

nerve supply & 77. Structure of lung
The lungs are a paired organ responsible for oxygenating blood that enters via the pulmonary artery
and leaves via the pulmonary vein.
The lung has the following basic shape:
- Base that sits on the diaphragm
- Apex that projects above rib I and into the root of the neck
- Two surfaces, costal surface and mediastinal surface (lateral and medial)
- Three borders, inferior, between coastal and base surface, anterior and posterior, between
mediastinal and costal.
The medial surface of the left lung lies against:

- Heart, arch of aorta, Thoracic aorta, Oesophagus
The medial surface of right lung lies against
- Heart, Inferior and superior vena cava, Azygos vein, Oesophagus
Each lung consists of lobes. The right lung has three lobes, while the left has two, each is separated
by fissures within the lung. Each lung also has a hilum, or root, within each hilum is:
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- A pulmonary artery (superior)

- Two pulmonary veins (inferior)
- A main bronchus (posterior)
- Bronchial vessels
- Nerves, and
- Lymphatics
Right lung
Has three lobes and two fissures:
- Oblique fissure, separates inferior lobe from superior lobe
- Horizontal fissure, separates superior lobe from middle lobe
Note the right lung has two bronchi tubes going through it’s hilum as the bronchus to the superior
lobe splits prior to entering the hilum.
Left Lung
Has two lobes and one oblique fissure. The left lung is slightly smaller than the right lung, and the
inferior portion of the medial surface is notched due to the hearts projection into the lung. The left
lung possesses a ‘Lingula’ or lip which curves around the heart.
Bronchial tree
As the bronchi go through the hilum into the lung they split, we shall follow their pathway here.
- Main bronchus
- Lobar bronchi (one to each lobe)
- Several Segmental bronchi for each bronchopulmonary segment
- Divide to form many bronchioles
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- Lead to terminal bronchioles

- Each terminal bronchiole gives off a respiratory
bronchioles known as alveoli, the site of gas
exchange
Bronchopulmonary segments
These are the functional units of the lung, each lung segment is supplied by one segmental (or
tertiary) bronchus, there are ten bronchial segments in each lung (although some fuse in the left
lung).
Left lung segments Right lung segments
- Apicoposterior segment (SI & II)* - Apical segment (SI)*
- Anterior segment (SIII) - Posterior segment (SII)*
- Superior lingular segment (SIV)* - Anterior segment (SIII)
- Inferior lingular segment (SV)* - Lateral segment (SIV)*
- Superior segment (SVI) - Medial segment (SV)*
- Medial basal segment (SVII) - Superior segment (SVI)
- Anterior basal segment (SVIII) - Medial basal segment (SVII)
- Lateral basal segment (SIX) - Anterior basal segment (SVIII)
- Posterior basal segment (SX) - Lateral basal segment (SIX)
- Posterior basal segment (SX)
* slightly different segments names between left and right lung
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A = right lung, B = Left lung

When bronchioles terminate they terminate in alveolar
ducts which in turn end in alveolar sacs. These are small
hollow sacs where gas exchange occurs, a typical pair of
lungs contains about 700 million alveoli with a 70m2
surface area. Each alveolus has a mesh of capillaries that
cover it allowing for exchange.
The histology of alveoli:

Alveoli contain three types of cells:
- Type I - Squamous alveolar cells
- Very thin with low solubility to allow for easy diffusion of gasses
- Type II - Great alveolar cells
- Secrete pulmonary surfactant to lower the surface tension of water and allows
membrane to separate an increase surface area
- Macrophages - just do what macrophages do!
Blood supply of lungs

The lungs are supplied with deoxygenated blood by the paired pulmonary arteries which come
directly from the right ventricle. Meanwhile the pulmonary veins carry vasculated blood out of the
lungs and into the left atrium.
Meanwhile the actual bronchi, lung roots, visceral pleura and other supporting tissues are supplied
by the bronchial arteries (a branch of the descending aorta) and venous drainage comes from the
bronchial vein (drains into azygos vein on the R, hemiazygos on the L).
Innervation
Innervation comes from the pulmonary plexuses, featuring sympathetic, parasympathetic and
visceral afferent fibers:
- Parasympathetic is derived from the vagus nerve, stimulating secretion from bronchial
glands and contraction of bronchial smooth muscle
- Sympathetic from sympathetic trunks, stimulating relaxation of bronchial smooth muscle
- Visceral afferent conducts pain to the sensory ganglion of the vagus nerve.
Lymphatic drainage
Superficial and deep lymphatics of the lung drain into tracheobronchial nodes which sit around the
roots of lobar and main bronchi and along the trachea. The lymph ducts travel through the hilum
and into the posterior mediastinum. The ducts then drain into the right and left bronchomediastinal
trunks.
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See above for development.
69. Pleura. Pleural cavity
The body has two pleural cavities, one on either side of the mediastinum (the central compartment
of the thoracic cavity surrounded by loose CT), surrounding the lungs. The borders of the cavity are:
- Superiorly they extend above rib I to the root of the neck
- Inferiorly they extend to the level just above the costal margin (bottom of ribs)
- Medially they are contained by the mediastinum.
Firstly, we’ll take a look at the pleura membranes themselves, and then the cavity.
The pleura consists of two membranes, the Parietal pleura, which adheres to the thoracic wall, and
the visceral pleura, which adheres to the surface of the lung.
The parietal pleura has sections named in line with the parts of the thoracic wall they are associated
with:
- The pleura attached to the ribs and intercostal spaces is the costal part
- The pleura covering the diaphragm is the diaphragmatic part
- The pleura covering the mediastinum is the mediastinal part
- And the dome shaped layer extending into the cervical region is the cervical pleura.
Important additional features are:
- Suprapleural membrane which attaches the cervical pleura to the first rib and transverse
process of C7.
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- Sleeve like reflection of mediastinum surrounding structures in hilum (root) of lung

- Pulmonary ligament which holds the lung in position, extending to the base of the lung
Innervation of the parietal pleural comes from somatic afferent fibers of phrenic and intercostal
nerves, while blood supply comes from intercostal arteries while venus supply is of the same.
The visceral pleura is continuous with the parietal pleura at the hilum of each lung, and firmly
attached to the lungs throughout.
There are two areas where the space between the visceral and parietal pleura is significant, these
are known as pleural recesses:
- Costodiaphragmatic recess - located between the costal pleura and the diaphragmatic
pleura
- Costomediastinal recess - located between the costal pleurae and the mediastinal pleurae,
behind the sternum (large on left side).
This are simply gaps where the lung does not usually expand to in respiration unless forced to.
The visceral pleura is not sensitive to pain, it's only sensory fibers detect stretch. It receives
autonomic innervation from the pulmonary plexus (derived from sympathetic trunk and vagus
nerve). Arterial supply comes from the internal thoracic arteries (branch of subclavian), which also
supply the parenchyma of the lungs.
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Histologically the visceral pleura consists of:

- Cuboidal mesothelial cells with microvilli and thick glycocalyx to assist gliding
- Vascularized CT
- Under these sit the alveolar walls of the lung
The pleurae derive from the lateral plate mesoderm which splits into the somatopleuric mesoderm,
forming the parietal membrane, and the splanchnopleuric mesoderm, forming the visceral
membrane.
Pleural cavity
The pleural cavity is the space between the visceral and parietal membrane , it helps to regulate
pressure outside the lung and provide lubrication for the lung to move during respiration.
The cavity consists of about 10 mL of fluid which. This fluid a clear plasma fluid that filters through
from the capillaries of the thoracic wall, including Glucose, Albumin and Bicarbonate. This filtration
occurs due to a pressure gradient between the capillaries of the chest wall and the pleural space, the
fluid can then be absorbed by the mesothelial cells of the visceral pleura, or reabsorbed by the
lymphatic system. Differnet parts of the pleura drain to different lymph nodes, as shown below.
The fluid of the cavity allows for mechanical coupling between the lung and the thoracic wall. This
allows for adhesion between the two, while still providing movement.
Where we have too much fluid under pathological conditions, this will ‘break’ the mechanical
coupling and allow the lung to pull away from the thoracic wall. This will reduce the lung’s volume.
This is known as pleural effusion.
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70. Urinary system - overview and development
The urinary system filters blood to remove toxins, metabolic waste and excess ions, excreting it via
urine, while retaining most of the water. In this regarding the Urinary system is also very important
for Osmoregulation (regulation of water levels)
Additionally kidneys regulate the volume of blood and its pH value, while also performing
gluconeogenesis during prolonged fasting. Finally, the kidneys have an endocrine function in
secreting Renin to regulate blood pressure, and Erythropoietin, to stimulate erythrocyte production.
The system consists of:

- The Left and Right Kidney
- The left and right Ureter (kidney to bladder)
- The Urinary bladder
- The Urethra (bladder to external)
The kidneys are the most complex part of the urinary system, they consist of a functional unit known
as the Nephron. Nephrons operate within the parenchyma of the kidneys which filter blood to
remove urea, a waste product formed by the oxidation of proteins, as well as removing excess ions.
Each Nephron consists of:
- Glomerulus (where blood flows in via afferent arteriole is filtered before flowing out via
efferent arteriole)
- Bowman's capsule (with Bowman’s space)
- Proximal convoluted tubule (where absorbance of nutrients takes place before Glomerulus)
- Loop of Henle (where water is reabsorbed)
- Distal convoluted tubule (where ion concentration and pH levels are regulated)
- Collecting tubule (where multiple distal tubes come together)
The urinary system arises from the intermediate mesoderm which forms a urogenital ridge on either
side of the aorta. At about week 4 this ridge then develops into three distinct sets of tubular nephric
structures:
- Pronephros
- Cervical region of embryo, disappear by end of week four
- Mesonephros
- Forms thanks to cellular induction by Pronephros
- Caudally to the pronephros, performs some early kidney function at first, later goes
on to develop into Wolffian ducts
- Produces urine between week 6 and 10
- DOES NOT GO ON TO FORM ANY PART OF MATURE KIDNEY. Instead in females it
degenerates completely while in males it gives rise to efferent ductules of testis, the
epididymis, vas deferens and seminal vesicles.
- Metanephros
- Appears week 5 in the pelvic region
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- Develops from an outgrowth of the mesonephric ducts called ureteric bud

- Gives rise to definitive adult kidney.
The ureteric bood is also responsible for the development of the ureter. See image below.
The simple steps i would use to describe this process are:

- Cellular induction from pronephros induces development of mesonephros
- Mesonephric duct develops ureteric bud
- Ureteric bud develops metanephros which will become the kidney in the adult
The development of the Nephron occurs before birth, but maturation continues post natally.
Nephrons have four developmental stages:
1. Vesicular stage (13-19 weeks)
a. Formation of small circular vesicle
2. S-shaped body stage (20-24 weeks)
a. Vesicle extends out into s-shape
3. Capillary loop stage (25-29 weeks)
a. Capillaries begin to develop
within S-shaped body
4. Maturation stage (infants aged 1-6
months)
a. Continued maturation and
development
Meanwhile, the urinary bladder is formed partly from the endodermal cloaca (this is a structure at
the far end of the hindgut which divides to the rectum, bladder and genitalia) and partly formed
from the ends of the Wolffian ducts. Once the rectum has separated from the dorsal part of the
cloaca the ventral part becomes the urogenital sinus which then divides into the superficial
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urogenital sinus and deeper anterior vesicourethral portion, it is this deeper portion that goes on to
become the bladder and the urethra.
71. Kidney - shape, topography, blood supply, lymphatic

drainage, nerve supply
The kidney is a paired organ with excretory function. They are ‘bean shaped’ and retroperitoneal in
the posterior abdominal region. They sit immediately lateral to the vertebral column, extending from
Thoracic XII to Lumbar III, with the right kidney slightly lower.
The left kidney is longer and more slender than the right kidney, as well as being nearer to the
midline.
Both kidneys have a superior and inferior extremity (basically the top and bottom), and two surfaces
(anterior and posterior) and two margins (lateral and medial).
The kidneys are 10-13 cm long, 6 cm wide and 3 cm thick.
The superior extremity of both is covered by the suprarenal gland. The other relations are as follows:
- Right Kidney
- anterior surface
- Superior half of covered by liver
- Medial part of covered by descending part of duodenum and R colic fissure
- Inferior half of covered by small intestine
- Left kidney
- Anterior surface
- Superior part covered by Stomach, Spleen and pancreas
- Inferior part covered by jejunum
- Lateral part covered by Descending colon
The posterior surface of both left and right covered by the same things:
- Diaphragm superiorly
- Transversus abdominis inferior laterally
- Quadratus lumborum inferior medially
- Psoas major inferior centrally
The kidneys sit within a Renal fascia, that itself encloses the Kidneys, the inferior vena cava and the
abdominal aorta, along with a layer of perinephric fat that sits between these things and the renal
fascia. The anterior and posterior renal fascia come together at the lateral margins of each kidney.
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Each kidney has a hilum on the medial margin through

which renal vessels, lymphatics and nerves enter and
leave the substance of the kidney. This is also where the
ureter exits the kidney.
Each kidney includes an outer renal cortex, and an inner

renal medulla. The renal medulla takes the form of
pyramidal segments, these pyramids project into the
major calyx, attached via the minor calyx. The major calyx
is a chamber which collects the urine and feeds it into the
Renal pelvis and ureter. In between these medulla
pyramids are, obviously, areas of the renal cortex, these
are known as Renal columns.
The regions between the minor calyxes are known as the renal sinuses, these are cavities which
house vessels, nerves and fat.
The functional unit if the kidney is the Nephron. The nephrons span the cortex and the medulla, with
the initial filtering portion in the renal corpuscle which is situated in the cortex, and the renal tubule
which passes from the cortex into the medullary pyramids. The structure of the nephrons is given in
detail in the next question.
Blood supply
Left and right renal arteries supply the kidneys, these branch directly
from the abdominal aorta. Each renal artery then divides further into
anterior and posterior branches as it approaches the hilum, these
become lobar/segmental arteries which penetrate the renal capsule,
supplying 5 renal vascular segments (superior, inferior, anterior
superior, anterior inferior, posterior)
These lobar arteries also each give off 2 or 3 interlobular arteries which
feed into different arterioles that supply the glomeruli (see renal
structure below). Filtration occurs as these arterioles form Glomerular
capillaries in the Bowman’s capsule, and peritubular capillaries around
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the tubules of the nephron. From here The blood travels out in the Renal vein out into the inferior
vena cava.
Lymphatic drainage
The lymphatic drainage of the kidneys is to the lumbar nodes, those are the nodes around the
abdominal aorta and inferior vena cava. There is a Periarterial and Perivenous lymphocytic network
around these two vessels that works to provide lymph drainage.
Nerve supply
Nervous supply of the kidneys comes via the Renal plexus whose fibers follow the renal arteries
course to reach the kidneys. Input form the sympathetic nervous comes from celiac and mesenteric
ganglia which triggers vasoconstriction of the kidney, reducing renal blood flow. Meanwhile
parasympathetic innervation by way of branches of the vagus nerve (Cranial X) have an unclear
function.
Additionally there are somatosensory fibers that come from the Thoracic and lumbar spinal nerves
to provide sensory (pain) receptors.
81. Structure of Kidney
PAIRED, RETROPERITONEAL
Macroscopic structure:
- Bean shaped, 10-12cm in length, 5-6cm in width, 4cm in thickness
- One kidney weighs 120-200g
- Left kidney slightly longer than the right kidney, can weigh more
- 12 lobules
- Smooth anterior surface, posterior surface covered by fibrous capsule
External:
- Enclosed in renal fat and renal
fascia
- Anterior surface of the right kidney
covered with peritoneum only
when in contact with liver, it is
convex and faces slightly laterally
- Posterior surface – flat, lateral
border is convex and faces slightly
to the posterior wall of abdomen
- Upper 2/3 of right kidney in relation
with the liver, upper 1/3 of the left
kidney in relation with the stomach
- 2 borders: the lateral border is
convex, the medial border is
concave
- 3 coverings: Renal fascia, Renal hilum, Renal sinus
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- Renal fascia – covers both kidneys like a huge tent and separates retroperitoneal
structures into 3 parts. Renal fascia divides fat surrounding kidney into two layers:
Inside – perineal fat between capsule of kidney fascia and outside – pararenal fat
- Each kidney as a separate adipose layer – peritoneal fat
- Each kidney has a fibrous capsule – renal capsule (removable)
- Renal sinus – inner cavity leads the hilum of the kidney. Structures that enter/leave
here = renal artery/vein, minor calices, major calices, renal pelvis, lymph vessels,
renal fat, ANS fibres
- Renal hilum – entrance into renal sinus
- Anteriorly - Located the renal vein, artery then ureter
Internal:
- Cortex (5-7cm thick, covers renal columns) – outer part of the kidney and projects
into inner medullary region between renal triangles
- Medulla – subdivided into renal pyramids (10-15cm) according to their shape
- Between renal pyramids there are renal columns, end in renal papilla forming the
minor calyx
- 1 pyramid and an adjacent cortical area form a renal lobe
- The border between 14 lobes cannot be seen in an adult kidney!
- Medial margin – the hilum of the kidney [deep vertical slit – renal vessels,
lymphatics, nerves, substances enter and leave the kidney]
- 3-4 minor calices, 4 major calices
- Major calices join to form renal pelvis and then become ureter
Segments:
- Superior anterior – in front of renal pelvis, includes anterior surface of upper end
and upper portion of middle part of kidney,
lateral margin and part of posterior surface
- Inferior anterior – in front of renal pelvis and
extends to anterior surface of kidney
- Lower segment – lower end of kidney
- Posterior segment – lies behind renal pelvis and
corresponds to posterior surface of kidney
Microscopic:
- Entire parenchyma of kidney – nephrons and
collecting ducts
- Comprised of renal corpuscles and tubular
system
- Renal corpuscles are located in renal cortex, not in
renal medulla
- In renal corpuscles - water and low molecular weight
constituents from plasma filtered into space of
Bowman’s capsule
- Dense fibrous capsule – outer CT layer and inner
layer of smooth muscles
- Smooth muscle fibres penetrate the tissue of the
kidney
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- Glomerulus contains podocytes and a basement membrane allowing water and

certain solutes to be filtered across
- Nephrons: take simple filtrate of blood and modify it into urine, fulfil roles of
filtration, reabsorption, secretion and exert control
- Filtration membrane composed of = fenestrations, podocyte fenestra, fused
basement membrane, filtration slits
- Renal corpuscle: glomerulus are found between afferent and efferent arterioles,
surrounded by bowman’s capsule, outermost part of the bowman’s capsule –
parietal layer w/ simple squamous. Podocytes with pedicles cover the glomerular
capillaries
- Fenestrations prevent the filtration of blood cells and large proteins
- Juxtaglomerular apparatus found outside Bowman’s capsule and glomerulus
- Proximal convoluted tubule: Filtered fluid collected by Bowman’s capsule and enters
into PCT
- Simple cuboidal cells from this tubule with prominent microvilli on luminal surface
form a brush border which increases the surface area
- Loop of Henle: Descending and ascending portions. The descending portions start off
short, thick and then become long, thin. The ascending portions start off short, thin
and then become long and thick. They are both adjacent and parallel to each other
- Distal convoluted tubule: Formed by the simple cuboidal epithelium, shorter than
PCT. Fewer microvilli on apical surface, large amount of mitochondria as ions are
pumped against the concentration gradient
82. Renal Pelvis and Ureter
PAIRED, RETROPERITONEAL
Ontogenesis:
- See development of urogenital organs/kidney*
Topography:
- Arise in abdomen, Ureter is a continuation of renal pelvis
- Renal pelvis communicates with urinary bladder
- Ureter measures 25-30cm (length)
situated bilaterally
- Enter bladder anteromedially, superior
to levator ani muscle
- Crosses bifurcation of common iliac
artery
- 1-2cm lateral to uterus, runs with
uterine artery
- Passes post/inferior to ductus deferens
and lies in front of seminal vesicle before
entering post/lat bladder (male)
- Descends retroperitoneally on lateral
pelvic wall medial to umbilical artery and
obturator artery/vein
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- Terminate in pelvic cavity and drain into bladder
Macroscopic Structure:
- Ureters = muscular tube, divisible into two parts – Abdominal – retroperitoneal
space, Pelvic
- There is also the intramural space – transverses wall of the urinary bladder. Renal
pelvis – funnel shaped
-
Microscopic Structure:
- Wall of ureter is made up of 3 layers: CT
adventitious coat, muscular coat – 3 layers,
mucous coat
- Composed of smooth muscle – contracts to
produce peristaltic waves, propels urine to the
bladder
- CT adventitious coat = Fibrous CT, admixture
of elastic fibres. Nerves and vessels of the
ureter pass in the CT
- Muscular coat = Inner longitudinal, middle
circular, outer longitudinal (with separate
bundles)
- Mucous coat = Longitudinal folds form and so
lumen of the ureter is stellate. Few small
tubule-alveolar glands occur in mucous coat (upper portion of ureter)
Physiology:
- Urine is released from renal pyramids to the renal calyces
- Transport urine from kidney to the bladder
Histology:
Mucosa
o Epithelium = urothelium
● Thick, with cells that change shape
o Star shaped irregular lumen, made by mucosal folds, due to muscular contractions
o
o Note that lumen is
long, narrow and star
shaped, not
circular*like DD
o 3 main cell types of
Epithelium
● umbrella cells
– come in
contact with
urine, and
adjust
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accordingly, can be bi-nucleated, shape change due to actin filaments

● piriform cells – underneath umbrella cells and above basal cells, can also
adjust morphologically
● basal cells – located at lowest layer of stratified epith
o LP = fibroelastic CT, denser near epith –> looser towards muscularis ext, with diffuse
lymph tissue = MALT
o No real muscularis mucosae
Muscularis
o 3 layers:
● inner longitudinal layer
● middle circular layer
● outer longitudinal – but only in last 1/3 of ureter
o smooth muscle responsible for creating peristaltic contractions to convey urine
through ureter (30cm)
Adventia
o 3rd main layer
o ureter = retroperitoneal, so covered w/ adventia
o Connective tissue, arteries, veins and nerves
o adipose
Blood Supply:
- Receive blood from arterial branches of adjacent vessels as they pass toward the
bladder
- Renal artery – upper end
- Abdominal aorta, testicular/ovarian (gonadal) arteries, common iliac artery – middle
part
- Internal iliac artery = pelvic cavity
- Vesicle venous plexus – interior iliac vein
- Abdominal part – renal and testicular/ovarian artery, Pelvic part – superior/inferior
vesical artery
Innervation:
- From renal, aortic, superior hypogastric, inferior hypogastric plexus’ through nerves
follow the blood vessels
- Sensory fibres enter the spinal cord at T11-L2
Lymphatic Drainage
- Upper part of ureter drains to the lateral aortic nodes
- Middle part of each ureter drains to lymph nodes associated with common iliac
vessels
- Inferior part of each ureter drains to lymph nodes associated with external and
internal iliac arteries
Anomalies
- Uretral cancer
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- Kidney stones
- Vesicoureteral reflux
- Hyperectomies
83. Urinary Bladder
UNPAIRED, INFRAPERITONEAL
*Lower in females
*Men – paired anatomical structures are positioned posterior and adjacent to the bladder,
from medial to lateral, dilated part of the ductus deferens, seminal vesicle and ureter,
directly superior to the prostate gland
Topography:
- ‘Bladder bed’
- Anterior – Pubic bone, separated from
anterior abdominal wall and pelvis
(rectopubic space)
- Inferior/Lateral – Obtuartor internal
muscle, levator ani muscle
- Inferior/Posterior – Rectum
- Between Bladder and Rectum – In men:
seminal vesicles, ejaculatory duct, ductus
deferens. In females: uterus, upper
vagina
Vesicouterine Pouch:
- Anterior – bladder
- Posterior - uterus
- Lateral – vesicouterine ligament (folds)
- Enveloped by extraperitoneal fat and connective tissue
Rectovesicle Pouch:
- Anterior – Bladder, seminal vesicle, ductus deferens
- Posterior – Rectum
- Lateral – rectovesicular fold
- Hollow muscular organ, flattened spherical shape
- Located in subperitoneal space
- Parts of the bladder = Apex, Fundus, Neck, Body
- Apex (ant end) – directed towards upper part of symphysis (cresent internal urethral
orifice), origin of median umbilical ligament – remnant of embryonic urachus
- Fundus (post/inf) – contact with rectum in male separated by rectovesicular septum,
in contact with anterior surface of vagina in female. Internal urethal orifice + 2
ureteric orifices make up the trigone (triangle) of the bladder. The ureteric orifices
are 2-3cm apart
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*In men, peritoneum covers fundus reflecting from upper post wall and covers tip of
seminal vesicle
- Neck (lat/post) – urethra originates from bladder, just above = uvula = small
eminence projects into urethra
- Back of orifice, the mucous membrane forms elevation = uvula of bladder (elevation)
continuous with urethral crest
- Bladder filled with urine – Pear shape, in contact with obturator muscles.
- Bladder empty – Saucer shape, in contact with pelvis minor muscle
- Holds about 500-1500ml of urine, urination urge when 250ml-500ml reached
- Wall consists of the internal mucosal layer, followed by 3 layers of smooth muscles
with parasympathetic innervation, external Tunica adventitia or the cranial Tunica
serosa (peritoneum)
- Muscular coat – thick and made
up of 3 layers (outer, middle,
inner) merge
- Detrusor muscle longitudinally
and circularly arranged muscle
fibres
- Sub-mucous – thin layer of
areolar tissue loosely connects
muscular layer with mucous
layer
- Serious – outer layer, parietal
layer derived from peritoneum
- Mucous – stratified transitional
epithelium, innermost layer of
wall of urinary bladder
attached to muscular layer.
Mucosa falls into many folds
known as rugae – bladder
empty/near empty
- Surrounded by paravesicle adipose tissue, stabilised by ligaments
- At the apex: median umbilical ligament – umbilicus (connection), females – bilateral
pubovesical ligament, males – bilateral puboprostitate ligament anchor bladder to
bony pelvis, prostate gland directly under fundus of bladder, intersected by urethra
Physiology:
- During urination, smooth muscles of wall of the bladder contract following
parasympathetic activation
- Striated muscles of pelvic floor relax allowing bladder to descend, smooth muscles
relax
- Temporary store of urine – Bladder: hollow organ, Walls – stretched with a folded
internal lining (rugae) – holds up to 600ml
- Assists in expulsion of urine – during voiding (drainage), musculature of bladder
contracts and sphincters relax
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Histology:
Mucosa
o Epith = urothelium, transitional epithelium

● same cell types as ureter
● up to 10 layers when bladder empty,
number of layers decrease when
bladder is full
o when bladder is full, cells flatten and appear
squamous, & when bladder is empty, cells
became dome shaped
o LP = CT tissue fibers, fibroblasts, a/v, many
layers
● Can either say LP has 2 layers = upper
cell rich, and lower fibrous layer
● Or can say there is a cell rich LP with a
fibrous submucosa
● fibrous layer not present in
bladder trigone
o changes in appearence and cells shapes in
transitional epithelium are from thickened
regions called plaques
● interconnected via interplaque regions
● allow cell membrane to fold – which
disappear when urine flows into bladder
Muscularis Mucosae
o 3 muscular layers: – inner longitudinal, middle circular, outer longitudinal
o not as organized as ureter
● helps regulate urine secretion via relaxation & contraction of muscularis
● controls detrusor m
o Internal urethral sphincter = fromed @ site of entry of bladder –> Urethra
o w/ CT in between, and a/v and capillaries, and occasional n. fibers
Adventia
o Infraperitoneal
o fundus covered by peritoneum
o serosa/ subserosa can be present where peritoneal presented – superiorly –> simple
squamous = mesothelial cells
o SNS n fibers maybe
Blood Supply:
- Superior vesicle artery (interior iliac artery)
- Fundus of bladder: inferior vesical artery in males and vaginal artery in females
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Innervation:
- PNS from pelvic splanchnic nerve (S2-S4)
- It innervates the external urethral sphincter, via the pudendal nerve (S2-S4).
- Sympathetic NS (T12-L2) communicates with bladder via hypogastric nerve, relaxes
detrusor muscle
Lymphatic Drainage:
- Body – external iliac lymph nodes, Fundus – internal iliac lymph nodes, Neck – sacral and
common iliac lymph nodes
Anomalies:
- Congenital urinary bladder anomalies often occur without other genitourinary
anomalies – infection, retention, incontinence, and reflux
- Bladder cancer, stones, cystisis, Hematuria
84. Male and Female Urethra
*From bladder and opens at perineum, urine emptied through it
Topography:
- Begins at the base of bladder, ends at external opening in perineum.
- Lined by stratified columnar epithelium, protected from corrosive urine by mucus
secreting glands
Female (3-5cm)
- Urethra = short (about 4cm long)
- Travels in slightly curved course, passes inferiorly
through pelvic floor into perineum passes via
deep perineal pouch and perineal membrane
before opening in vesitibule lies between labia
minora
- Urethral opening anterior to the vaginal opening
in the vestibule
- Inferior aspect bound to anterior surface of
vagina
- Two small paraurethral mucous glands (Skene’s
gland) associated with lower end of urethra
- Drains via duct that opens onto lateral margin of
external urethral orifice
- Urethralis muscle runs the length of urethra and forms the external urethral
sphincter – under voluntary control of somatic nervous
system, made up of striated muscle fibres
Microscopic structure:
- 3 layers
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- Muscular, thin layer of spongy erectile tissue, mucous layer

- Muscular layer – continuous with muscular layer of bladder, extends full length of
urethra
- Thin layer of spongy erectile tissue – includes vein plexus and bundles of smooth
muscle fibres. Below mucous layer
- Internally continuous with bladder and lined with laminated epithelium transitional
near to the bladder
- The upper part consists of: Paraurethral glands, ducts at external urethral orifice
- The lower part consists of: Transverse perineal wraps around to form urethrovaginal
sphincter. Closely associated with anterior wall of vagina
- Attached via strong CT sheath = urethrovaginal septum between them =
urethrovaginal space
Histology:
*In females, endoderm = epithelium

Female Urethra
o The lumen of the proximal female urethra is lined
with urothelium
o In the middle there is columnar epithelium and
the distal urethra is lined with stratified
squamous epithelium
o Lamina propria is rich in blood vessels especially
in distal urethra
o Numerous glands in lamina propria
o Tunica muscularis consists of smooth and striated
muscles, they build up the sphincter of the
urinary bladder
Physiology:
- The bladder neck
interconnects the
bladder with the
posterior urethra
below. It contains the
internal sphincter
- Internal sphincter
keeps the urine out of
the bladder neck and
out of the posterior
urethra
- Carries only urine, no
semen
Blood supply:
- Interior pudendal, vaginal artrery
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Lymph drainage:
- Sacral/Interior iliac lymphatic node
Nerve supply:
- Pudendal nerve
Anomalies:
- Hypospadias, epispadias – abnormal development of urethra in male
- Urethritis
- Urethral cancer
Male
- Long urethra (about 20cm long)
- Bends twice along its course
- Begins at base of bladder, passes inferiorly through
prostate and passes through deep perineal pouch
and perineal membrane, enters root of penis
- Urethra exits deep perineal pouch, bends forwards
to course anterior into the root of the penis
- Flaccid penis – urethra makes another bend, this
time inferiorly when passing from root to the body
of the penis
- During erection, bends between root and body of
the penis disappears
- Divided into: preprostatic, prostatic, spongy and
membranous
Membranrous (1-2cm) – shortest
- Traverses the pelvic floor
- Narrow and passes via deep perineal pouch
- Surrounded by skeletal muscle of external urethral sphincter
Preprostatic/intramuralis (1 cm)
- Within wall of urinary bladder
- Extends from base of bladder to prostate associated with circular cuff of smooth
muscle fibres (internal urethral sphincter)
- Sphincter contract but there is no retrograde movement of semen to bladder
(ejaculation)
Prostatic (3.5cm)
- Small blind-ended
- Homologue of female uterus
- Traverses the prostate gland
- Ducts that enter = ejaculatory duct (common duct of ductus deferens and seminal
vesicle) on the seminal colliculus and prostatic ducts on both sides and prostatic
utricle
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- The lumen of the urethra marked by longitudinal midline fold of mucosa (urethral
crest)
- Depression of each side = prostatic sinus; ducts of prostate empty into these two
sinuses
Spongy (15cm) - longest
- Embedded in spongy body of Penis, runs to external urethral orifice
- Bulbourethral glands and Littre’s glands (urethral) enter here
- Terminal part dilated to form Navicular fossa
- Surrounded by erectile tissue
- 2 bulbo-urethral glands in deep perineal pouch part of male reproductive system and
open into bulb of spongy urethra
- External urethral orifice = saggital slit at end of the penis
- At sharp angle (1st turn) -> bulb
of penis -> pubic symphysis –
bends downwards (2nd turn) ->
spongy body -> penis tip ->
opens at navicular fossa
Seminal colliculus:
- Lateral to this, prostatic sinuses
and prostate glands open
- 3 small openings: @ midline =
utricle of prostate
- Inferior to this: 2 ejaculatory
ducts
- Secretions of prostate, seminal
vesicle and bulbourethral
glands mixes with spermatozoa
from testis = semen
Histology:
Male Urethra
Mucosa
o Epith = pseudostratified non keratinized
epithelium
● Epithelium changes depend on part of
urethra
● Pars prostatica – urothelium
● Pars membranous – stratified columnar
● Pars spongiosum – stratified columnar –
until navicular fossa – stratified squamous
o LP = thin layer, merges with surrounding corpus spongiosum, cell rich
o lumen is shaped like ureter, glands of Littre
o mucosal folds makes small dips in lumen, and forms lacunae
o lacunae attached to urethral ducts of urethral glands of Littre
● mucus secretions
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● thin basophillic (blue) outer layer with pale interior (mucus)

● duct is more basophillic, with small circular lumen
Corpus spongiosum
o network of cavities lined by simple squamous epith
o artery and vein in between
Outer layer = Tunica albuginea
o thick eosinophillic layer, with smooth m and elastic fibers
Physiology:
Ejaculation:
- It passes semen from its prostatic part into the spongy part. The spongy part is the
one that transverses the penis. It is also called penile urethra. When ejaculation
takes place in the male, semen is released from the seminal vesicle or from the tail
of epididymis into the prostatic urethra in the first phase of ejaculation. The second
phase is controlled by the bulbospongiosus muscle, which assists the penile urethra
to release forcibly its contained semen to the outside, and in reproductive capacity,
into the vagina.
Lymph drainage:
- Interior/exterior iliac lymph node
Blood supply:
- Prostatic branch of inferior vesicle artery and middle rectal artery
Nerve supply:
- Pudendal nerve, Prostatic plexus (inferior hypogastric plexus)
Anomalies:
- Ascending infections of urinary bladder, more common in female – shorter urethra
- Chordee, Epsipadias, Hypospadias, Paraphimosis (similar to above)
85. Male and Female Genital Systems – Overview and development
*The inguinal canal transmits the vas deferens in men and the round ligament of the uterus in
women.
Male Genital System – overview:

- Internal Male Reproductive organs consist of Testis, Epididymis, Ductus deferens,
spermatic cord, accessory sex glands: prostate gland, seminal vesicle and Bulbourethral
gland
- External male reproductive organs consist of the penis, male urethra and scrotum
- The function of the male genital system is for the production, maturation and transport of
spermatozoa and seminal fluid production. The testis produce male sex hormones i.e.
testosterone
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Development of external male reproductive system:

- External genitalia develop from caudal part of sinus urogenital
- Urogenital sinus develops from cloaca of hindgut into the urinary bladder to parts of
urethra
- The ectoderm and connective tissue
(mesenchyme) beneath also
contribute
- First part of development – identical
in both sexes (indifferent gonad)
Urethra:
- Anterior to wall of urogenital sinus
indents to form urethral groove
bordered on both sides by urethral
folds
- Spongy part of urethra develops.
Prostate and membranous part of
the urethra develop further from
urogenital sinus
Penis:
- Lateral to labioscrotal folds, anterior
to groove lie the genital tubercles
- The genital tubercle goes on to
become the penis due to the
influence of testosterone. Genital
folds merge above urethral groove to
form spongy body and head of penis.
Scrotum:
- The labioscrotal folds enlarge and
fuse to form scrotum
Development of internal male reproductive

system:
- Up to week 7, internal genitalia
development is identical in both
sexes
- The primordium of primitive gonads
develops into the testis
- Develops into the lumbar region at
level of mesonephros (connection
between the testis and epididymis)
- Due to longitudinal growth of the
body and testis relocated caudally and remains connected to its vascular structures
Testis:
- Along inferior mesenchymal gubernaculum, a periotoneal pouch if formed and it
reaches down to future scrotum and serves in guiding descent of the Testis, process
completed at birth
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Spermatic cord:
- At birth, peritoneal vaginal process closes and obliterates in area of spermatic cord.
The distal part of vaginal process remains and forms part of the testicular covering
Epididymis, Ductus Deferens and Accessory sex glands:
- Sex hormones of the testis induce final differentiation of Wolffian duct to the
internal male genitalia (Epididymis, Ductus Deferens), seminal vesicles and other
accessory sex glands (prostate, bulbourethral gland) from urogenital sinus
- Anti-Mullerian hormone suppresses differentiation of Mullerian ducts into female
genitalia
Female Reproductive system – overview:

- External female reproductive organs referred to as the ‘Vulva’ – clitoral hood, mons
pubis (layer of fatty tissue), external urethral orifice, major vestibular gland, vulval
vestibule, vaginal orifice, major and minor labia fold
- Vestibular glands enter the vestibule from the lateral
- Clitoris is a sensory organ from sexual arousal
- The clitoral crura are two erectile tissues that join together to form a V shape, they
are attached to the inferior ischiopubic rami and covered by ischiocavernosus muscle
on both sides
- The bulbospongiosus muscle stabilises the bulb of the vestibule
- Vagina pierces the urogenital diaphragm. Bulbus do not unite at the midline and
neither do the genital folds. The urethra is associated with the anterior wall of the
vagina
- Internal Female reproductive organs are vagina, uterus, uterine tube and ovary
- Uterine tube and ovary are paired organs and referred to as the uterine appendages
– reproductive and sex organs
- Ovary serves for maturation of follicles and production of female sex hormones
(oestrogen and progesterone)
- Uterine tube provides place for fertilisation of ova and transports the zygote to the
uterus where embryo/fetus develops and grows during pregnancy
Development of external female reproductive system:

- Ectoderm and connective tissue located beneath the urogenital sinus
- External genitalia develop from caudal part of Urogenital sinus
- Urogenital sinus develops from cloaca of hindgut, urinary bladder and urethra
- External genitalia develop identically in both sexes
- Anterior wall of urogenital sinus indents to form the urogenital groove bordered by
urethral folds. Lateral there are the labioscrotal folds, and anteriorly there is the
genital tubercle
Clitoris:
- Genital tubercle develops into the clitoris due to oestrogen produced from the ovary
Minor and major labium:
- Genital folds and labioscrotal folds do not merge. Genital folds develop into the
minor labia and the labioscrotal folds develop into the major labia
- Major labium fold contains cavernous body of vestibule
- Minor labium fold surrounds the vestibule and continues freely as the frenulum of
the clitoris to the clitoris gland
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Development of internal female reproductive system:

- Develop identically in both sexes – week 7
Ovary:
- The primitive gonad develops into ovary, at the level of the mesonephros at the
lumbar region
- Ovary and uterine tube have an intraperitoneal positional as the longitudinal growth
of the body of ovary is located caudally (near tail) to lesser penis without leaving
peritoneal cavity
Vagina, Uterus, Müllerian ducts:
- Mullerian ducts differentiate into female genitalia
- At the start of Week 12, the Müllerian ducts form the uterine tube. Distal portions
merge and give rise to uterus and upper vagina
- Lower vagina develops from urogenital sinus
- The short female urethra and Bartholin’s glands develop from urogenital sinus
86. Testis
PAIRED GLAND, PERITONEAL
Ontogenesis:
- See internal male organ development
Topography:
- Egg shaped and 4x3cm in size (20-30g). It has a
superior and inferior pole
- Composed of seminiferous tubules and
intersitital tissue surrounded by a thick CT
capsule (tunica albuginea)
- Located within scrotum, left testicle lies lower
than the right
- Suspended from abdomen by spermatic cord
– collection of vessels, ducts, nerves that
supply testis
- On posterior abdominal wall originally –
during embryonic development descend down
abdomen through inguinal canal to reach
scrotum *carry DD with them
- Surfaces: medial and lateral (continuous)
- Border: front and posterior
- Extremity: upper and lower
- Ellipsoid shaped
- 4.5cm in length, 3cm width, 2cm thickness, 25-30g
- Series of lobules, each contain seminiferous tubules (area of sperm development –
sperm collect in rete tesis, transport to epididymis) supported by interstitial tissue
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- Made up of parenchyma enclosed in a dense connective tissue tunica albuginea, the
septa of the testis stretch from it
into the parenchyma and divide
the gland into lobes of testis (100-
250)
- The tunica albuginea is what
surrounds the seminiferous
tubules (70-100cm in length).
When in contact with epididymis
covered in t.albuginea
- 400-600 coiled seminiferous
tubules modified at each end,
become straight tubules which
connect to collecting chamber (rete testis) in thick, ventrically orientated wedge of
CT (mediastinum testis – spongy structure) = upper border of testis
- Up to 18 efferent ductules arise from rete testes (mediastinum), pierce the tunica
albuginea and enter head of the epididymis
- Sides and anterior aspect of epididymis covered by closed sac of peritoneum (tunica
vaginalis – fluid filled) originally connected to abdominal cavity
- Covered by visceral layer directly continuous with parietal layer, apart from gap
between testis and epididymis (entry for nerves and vessels)
- Inner layer corresponds to transversalis fascia of abdomen = internal spermatic
fascia
- Cremaster muscle raises testes, cremaster muscle + internal spermatic fascia are the
coverings of the spermatic cord
- Fascia, muscle and tissue are enclosed by external spermatic fascia – aponeurosis of
external oblique
Physiology:
- Produce spermatozoa (spermatogenesis)
- The initial action is known as Spermatogonia, which yields primary spermatocytes
by mitosis. Following these Meiosis I divides the spermatocytes into two secondary
spermatocytes. Each spermatocyte then divides into spermatids by Meiosis II. These
then mature into spermatozoa (or sperm cells). So the process is:
● Spermatogonia (mitosis)
● Develops spermatocytes which divide by meiosis I
● Spermatocytes produced divide by Meiosis II
● Develop into spermatids which mature to spermatozoa
● This process takes place in the seminiferous tubules of the male testes; the process
is highly dependent on optimal conditions for the process to occur correctly.
- Secrete sex hormones
Histology:
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Seminiferous Tubules
o 1-4 in each lobule
o triangular nucleus
o produce spermatids
o 1st layer = in epith of tubules = Sertoli cells
o Contain spermatogenic cells in 2nd layer –
between sertolis cells and lumen
● regularly replicating and
differentiating
● organized poorly into layers
o 3rd layer = Tunica Propria
● also called peritubular tissue
● myoid cells sit beneath the basal
lamina of Sertoli cells = nursing cells
● contraction of myoid cells create
peristaltic movement
● if thickens in early life —> Infertility
o Basal compartment = spermatogonia, primary
spermacytes
o Lumen = mature spermacytes, spermatids
o surrounded by interstitial tissue
Interstitial Tissue
o arteries, veins
o loose CT
o clusters of epithelial like cells of Leydig
● eosinophillic, round nucleus
● lipid droplets
● crystal of Reifkle = Rectangular, crystal-like inclusions in the interstitial cells
of the testis (Leydig cells) and hilus cells in the ovary.
● elaborate Smooth ER for enzyme production
● testosterone production
Sertoli Cells = tall columnar, non replicating cells that rest on basal lamina, 5 functions
Straight tubules: short narrow ducts, with cuboidal lining epithelium, no spermatogenic cells
Rete Testis: @ mediastinum testis,
o network of tubules with wide lumen
o epithelium goes from simple squamous to low cuboidal to low columnar.
o widen near the efferent ducts
Rete Testis: @ mediastinum testis,

o network of tubules with wide lumen
o epithelium goes from simple squamous to low cuboidal to low columnar.
o widen near the efferent ducts
Blood Supply:
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- Arterial supply via paired testicular arteries from abdominal aorta (Descend down
abdomen into scrotum via inguinal canal contained within spermatic cord)
- Int. pudendal artery from int. iliac artery, ext. pudendal artery from femoral artery,
testicular artery from abdominal aorta, cremasteric artery
- Venous drainage – paired testicular veins from pampiniform plexus (scrotum) – veins
wrapped around testicular artery
- The plexus acts as heat exchanger and cools arterial blood until it reaches testes
- In abdomen, left testicular vein drains into left renal vein, right testicular vein drains
into inferior vena cava
- Right testicular vein -> inferior vena cava
- Left testicular vein -> left renal vein
Innervation:
- Testicular plexus – from renal and aortic plexus
- Receive autonomic and sensory fibres
- Ilioinguinal, pudendal, perineal branch of post. Cutaneous femoral, genital branch of
genitofemoral
Lymphatic Drainage:
- Superior inguinal nodes and lumbar nodes
Anomalies:
- Testicular tumours
- Testicular torsion
- Testicular rupture
87. Epididymis. Ductus Deferens. Funiculus Spermaticus (Spermatic Cord)
Epididymis
PAIRED with testes
Topography:
- Adjacent to superior and dorsal aspect of Testis, and attached to it by the superior
and inferior ligament.
- Not covered by tunica vaginalis
- Formed by twists and turns made by 1 epididymal duct
- Contains main bulk of efferent ducts
- A slit-like sinus
- Head, Body and Tail
- Head: made up of lobules of epididymis, 12-14 efferent ducts from rete testis.
Connective tissue structure found at the head of the epididymis this is called the
apex of the epididymis
- Body: duct of epididymis
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- Tail: continuous with Ductus Deferens (true epididymis enlarges to form tail.
- Blind pouches – ductuli aberrantes lost connection with Ductus Deferens, may be in
epididymis
- Contains a number of small ducts, or ductules within the canal which are responsible
for the transport of spermatozoa through the body prior to ejaculation
- Pseudostratified epithelium
- Inferior ligament, superior ligament, sinus
Physiology:
- Stores spermatozoa until ejaculation, newly produced sperm mature here –> gain
motility and ability to ertilize female oocyte
- Contains fluid which contains glycolipid decapitation factors that bind sperm cell
membranes and block acrosomal reactions and fertilisation abilities until
capacitation at female reproductive tract
- During ejaculation, sperm flow from the lower portion of the epididymis,
transported via peristaltic action of muscle layers within the vas deferens and mixed
with dilating fluids of seminal vesicles prior to ejaculation
Histology:
*Diagram of testes and epididymis

o include efferent ducts and ducts of epididymis
o lined by tunica vaginalis
o simpler glands than the testes, many large
glands
o small blood vessels and veins
o small round stem cells
o 4-6 M long coiled structure
o lined by pseudo stratified columnar
epithelium, with primary cells and basal cells that
have stereocilia
o lymphocytes are also present
Blood Supply:
- Paired Testicular artery from abdominal aorta
- Paired testicular veins
- The right testicular vein drains into the inferior vena cava
- The left testicular vein drains into the left renal vein
- Reinforces DD
Innervation:
- Testicular plexus
- Receive autonomic and sensory fibres
Lymphatic Drainage:
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- Paired lumbar and preaortic nodes at L1 vertebral level
Anomalies:
- Epididymitis, elongated epididymis, cyst of epididymis
Ductus Deferens
Topography:
- Ascends in scrotum as a component of the spermatic cord and passes via the inguinal
canal and inserts into ant. Abdominal wall
- Tail of epididymis ascends with spermatic cord to the inguinal canal into the
retroperitoneal space at the deep inguinal ring, descending to the bladder
- No structure runs between the Ductus Deferens and the peritoneum
- The Ductus Deferens is in front of the interior iliac artery and ureter
- Long muscular duct, pair of dense tubes – 50cm (length), 3mm (diameter), 0.5mm
(lumen). Made up of 4 parts
- 1st part: cylindrical tube (convoluted), 2nd part: component of spermatic cord in
scrotum into inguinal canal, 3rd part (terminal): dilated and called the ampulla of the
DD.
- End part narrows and unites with excretory duct of seminal vesicals and ejaculatory
duct
- Outer adventitious coat, middle muscular coat, inner mucous coat
- Adventitious coat which contains connective tissue with mixture of elastic fibres and
carries vessels and nerve elements of the duct
- Muscular coat – thickest part which contains longitudinal outer and inner layers and
circular layers of smooth muscles
- Mucous coat – gathered in longitudinal folds and covered with double layer
prismatic epithelium lies over Lamina Propria (rich in elastic fibres)
Physiology:
- Transports sperm from epididymis rail (scrotum) to the ejaculatory duct in pelvic
cavity
- Unites with duct of seminal vesicle to form ejaculatory duct
- Terminal portion: ampulla, medial to
seminal vesicle
- Opens lateral to seminal collicus on
posterior wall of prosthetic urethra
Histology:
o tiny narrow irregular lumen, with mucosal

foldings into it = glandular diverticuli.
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o thin mucosa – LP has collagen fibers, and elastic fibers

o THICK muscular layer
Does not have urothelium so do not mistake for ureter or urethra, urethra’s lumen is long,
thin and irregular
o The lumen here is wide, almost circular and irregular
o no submucosa or muscular mucosa
o adventia = no peritoneal relationship
Blood Supply:
- Deferential artery (vein runs with artery)
- Superior vesical artery
- Vesical venous plexus
Innervation:
- Inferior hypogastric plexus
Lymphatic Drainage:
- Exterior iliac lymph nodes
Anomalies:
- Vasectomy
- Cystic fibrosis may cause the absence of the DD, and so this could lead to male
infertility
Funiculus Spermaticus/Spermatic Cord

*Develop from genital folds of embryo; L&R genital folds join to form scrotal raphe on
scrotal sac
PAIRED
Topography:
- Rounded band
- Runs from the deep inguinal ring to posterosuperior testis periphery
- Contains DD, Testicular artery, DD artery, Genitofemoral nerve, lymph vessels and
vaginal process
- 18-20cm long
- Components found in coats of spermatic cord and testis
- Inner layer corresponds to transversalis fascia of abdomen = internal spermatic
fascia
- Cremaster muscle and fascia raises testes on common coat (wraps around spermatic
cord)
- Fascia and muscle and tissue enclosed by external spermatic fascia – aponeurosis of
external oblique
- Cord is enveloped by fibrous tissue
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Physiology:
- Facilitates the passage of the sperm
- Extends and withdraws the scrotum (extends from abdomen to testes)
Histology:
- Sensory nerve fibres are
located in the spermatic cord
- Contains thick walled ductus
deferens
- Blood vessels, nerves,
skeletal tissue
Blood Supply:
- Internal pudendal artery
from internal iliac artery,
external pudendal artery from femoral artery, testicular artery from abdominal
aorta, cremasteric artery
- Pamniform plexus – Acts as heat exchanger, cools arterial blood until reaches testes,
venous drainage of testis, wraps around testicular artery
- As it travels via inguinal canal condenses to form the single testicular vein
- Right testicular vein drains into the inferior vena cava
- Left testicular vein drains into the left renal vein
Innervation:
- Ilioninguinal, pudendal, perineal branch of posterial cutaneous femoral nerve, genital
branch of genitofemoral nerve
Lymphatic Drainage:
- Paraaortic lymph nodes
Anomalies
- Tumours of the spermatic cord
- Torsion of the spermatic cord
88. Seminal vesicles. Prostate. Bulbo-

urethral glands.
Seminal Vesicles
PAIRED, RETROPERITONEAL except tip =
intraperitoneal
Topography:
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- At posterior side of prostate, behind both sides of the base of the bladder, in front of
the rectum
- Located inferior/lateral to ampulla of Ductus Deferens, against fundus of the bladder
- Tip lies posterior to uterus, peritoneum of rectovesical pouch seperates it from
rectum
- Inferior end separated from rectum via rectovesical septum
- Long, blind sacculated tube, 10-15cm approximately, coils down to become 5cm and
is 1cm thick
- Elongated oval ducts
- Excretory ducts and Ductus Deferens combine to form Ejaculatory Ducts which enter
prostatic part of urethra
- Cavity of seminal vesicle = canal with pockets forming a labyrinth
- Wall composed of elastic, smooth muscle and collagen fibres forming a muscular
coat
- Cavity lined by muscular coat forming elevations which fill with lumen
- Each seminal vesicle is enclosed in an adventitious coat
- Gland has honeycombed lobulated structure with mucosa lined by pseudostratified
columnar epithelium
Physiology:
- Secretions of seminal vesicle are the key role in the normal functioning of semen
(70% total volume)
- Produce yellowish, viscous fluid, that contains high amount of fructose, which is
energy for sperm
- Secretions contain: 1) Alkaline fluid – neutralises acidity of male urethra and vagina
which facilitate sperm survival, 2) Fructose – energy source for spermatozoa and
keeps them swimming, 3) Prostaglandins – Suppress female immune response to
foreign semen, 4) Clotting factors – keep semen in female reproductive tract post
ejaculation
- Remainder of semen volume – testicular sperm, prostatic secretions, mucous
(bulbourethral gland)
Histology:
Mucosa
o Epithelium = columnar or
pseudostratified columnar, very
invaginated (similar to lumen of
gallbladder)
o has mucosal crypts, made by infoldings
of the mucosa
o LP
● smooth muscle
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● rich in elastic fibers

● very rich in cells
● goes into the primary mucosal folds
o secondary mucosal folds are the ones that you cannot see open up into epithelium
(look like closed sacs)
Muscular Layer
o Rest on thick layer of smooth muscle continuous w. DD
o Smooth muscle has inner circular and outer longitudinal layer
o Contractions of smooth m. wall during ejaculation pushes substances through
ejaculatory duct
Adventia – no peritoneal covering
Blood Supply:
- Inferior vesicle artery with vein (int. iliac artery)
- Middle rectal artery/branch (int. iliac artery) from artery of DD
- Superior rectal artery
Innervation:
- Hypogastric and Pelvic plexus
Lymphatic Drainage:
- External and Internal Iliac lymph nodes
Anomalies:
- Seminal vesiculitis
Prostate
UNPAIRED
Topography:
- Surrounds urethra in pelvic cavity, below Bladder
- Surfaces: Anterior – pelvic wall, muscle fibres, retroperitoneal fat in front of it,
between it and pubic symphysis. Posterior - seminal vesicles, ductus deferens,
ampulla of rectum. Superior – Bladder, Inferior – urethral sphincter, deep perineal
muscle, urogenital diaphragm, levator ani muscle
Insert diagram
- Inverted round cone, large base
- Right and Left lobe, separated along the surface by indistinct groove and isthmus of
prostate or median lobe
- Transverse diameter – 4cm, vertical diameter of 3cm, anteroposterior diameter of
2cm
- Weighs 20g, complete development at 17
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- Isthmus of the prostate is an area bounded anteriorly by the place of entry of the
neck of the bladder into base of the gland
- Develops 30-50 branching tubuloacinar prostatic ducts, lined in double layer
cuboidal epithelium
- Glandular and muscular tissue (smooth)
- Consists of 4 zones: Central, Transitional, Peripheral, and Anterior. Central –
surrounds ejaculatory ducts, embryonically derived from Wolffian ducts. Transitional
– located centrally and surrounds urethra, embryonically derived from urogenital
sinus. Peripheral - Main body of the gland and located posteriorly derived from
urogenital sinus. Anterior – gland free
- Contains glandular substance and muscular tissue
- Muscular tissue – contains no glandular substance
- Glandular substance – Irregularly arranged in the organ: prevails over the connective
tissue in the direction of the rectum, developed less than the muscular tissue in the
direction of the urethra.
- Secretions from prostate and secretions from seminal vesicles = semen (ejaculation)
- Prostatic capsule – dense CT fibrous capsule
- Prostatic sheath – soft CT capsule around fibrous one – from pelvic fossa continuous
with paraproctum (CT fibres around rectum), paracysticum (CT fibres around
bladder)
Physiology:
- Produce the fluid portion of semen
- The gland cells within prostate produce thin fluid rich in proteins and minerals that
maintain and nourish sperm, this fluid is made continuously. When man sexually
aroused the prostate produces larger amount of fluid, then mixes with sperm and is
ejaculated as sperm
- Plays a role in controlling the flow of urine. The muscle fibres of the prostate are
wrapped around the urethra and are under involuntary nervous system control.
These fibres contract to slow and stop the flow
of urine
Histology:
Epithelium: transitional (urothelium) epithelium

Chiefly glandular
Prostatic Glands
o look like popcorn
o have glandular epith = simple columar
epithelium –> cuboidal
o Tubuloacinar glands lined by
simple/pseuostratified columnar epithelium and
produce fluid
o are small, branched tubulo acinar glands
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o may have circular very pink prostatic stones

● calcifications of cellular debris in the gland
● number increases with age
● Very characteristic of prostate. — LOOK FOR THESE, if you think it is the
prostate.
o between glands = fibromuscular stroma, with loads of smooth m bundles, and
collagen and elastic fibres
o The stroma encircles an area called the seminal collicus, that has no glands
At top of seminal collicus, is located the C shaped urethra, with the utricle underneath.
Ejaculatory ducts open on either side of utricle
*cannot see utricle and ejaculatory ducts in slide, but need to know them theoretically on
the lateral sides of the collicus are the prostatic sinuses (the end of the C), where the ducts
of the glands open into.
Excretory ducts: columnar epithelium stains darker than glands
Blood Supply:
- Inferior vesicle artery, middle rectal artery drained by prostatic venous plexus
(between fibrous capsule and prostatic sheath) into interior iliac vein
- Prostatic arteries from interior iliac arteries
Innervation:
- PNS/SNS to contract smooth muscle
- PNS – pelvic splanchnic nerve (S2-S4)
- SNS – inferior hypogastric plexus
Lymphatic Drainage:
- Drains to obturator and internal iliac lymphatic channels
Anomalies:
- Prostate cancer
- Prostatitis
- Prostatic hyperplasia
Bulbourethral Glands
PAIRED
Topography:
- Found within perineal muscles
- Excretory ducts of lentil-sized glands enter spongy part of the urethra
- Aids in lubrication
- Situated within perineal pouch
- Behind membranous part of urethra at blind end of bulb of penis
- Pea-shaped, yellow/brown
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- Duct of the gland measures up to 6cm in length – passes anterior and slightly
downwards, pierces bulb of penis and opens into the cavity of the urethra
- Each lobule consists of a number of acini, lined by columnar epithelial cells
- Compound tubulo-alveolar glands lined by columnar epithelium
- Ducts of each lobule fuse to form common duct of BU gland surrounded by fibres of
the sphincter urethrae muscle
Physiology:
- Mucus secretion serves as lubricatum during sexual arousal
- Secretions also alkaline and may help reduce residual acidity in male urethra
Histology:
- Composed of mucinous acini arranged in a lobular
pattern with intercalated ducts
- Thin connective tissue membrane separates the
alveoli of the glands and supports the blood vessels
- The tubules and alveoli of the body are lined
by the tall columnar epithelium with small,
flattened nuclei
- Those in the tail by low columnar
epithelium with round basal nuclei
- Epithelium in the secretory state has foamy, slightly basophilic cytoplasm, epithelium
in resting state has granular eosinophilic cytoplasm
- Central excretory ducts, lined by cuboidal epithelium
Blood Supply:
- Artery of bulb of penis – from pudendal artery
Innervation:
- Hypogastric plexus
- Autonomic innervation derived from prostatic plexus
Lymphatic Drainage:
- Drains into internal and external iliac lymph nodes
Anomalies:
- Cowper’s syringocele – enlarged duct of the bulbourethral gland
89. Penis. Scrotum
Penis
UNPAIRED
Topography:
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- Found outside of the pelvic cavity

- Below: dorsal vein in midline, left and right dorsal artery, lateral to it, most lateral is
dorsal nerve
- Formed of erectile tissue
- Goes through perineal membrane, held in back to perineal body with
bulbospongious muscle
- Arranged in the form of 3 bodies: paired cavernous body of penis, unpaired spongy
body of the penis, root of the penis, body of the penis, glans (head/tip) of peins
- Posterior part of penis – immobile area covered by skin of scrotum and attached to
anterior surface of pubis
Root
- Root of the penis = most proximal
- At superficial perineal pouch
between the superior membrane
and the deep perineal fascia
- Made up of 3 types of erectile
tissue: two crura, one bulb
- Crus of penis – covered by
ischiocavernous muscle attached to
margins of pubic arch
- Bulb of penis – covered by
bulbospongiosus muscle between 2
crura
- Urethra passes this body,
transversely reaches corpus spongiosum
- Part of urethra within bulb shows dilation – intrabulbar fossa
Body
- Upper anterior surface called dorsum of the penis
- Lower surface – urethral surface
- Continuous with root of penis
- Made of elongated erectile tissues: corpus spongiosum, corpus carvernosum (right
and left)
- Very little muscular fibres, thin skin, connective tissue, blood and lymph vessels,
fascia, and the corpora filled with blood during sexual excitement -> erection
Corpus cavernosum
- Long rod like structures, arises from posterior end, crus of penis, from the
periosteum of medial border of the inferior pubic ramus and ramus of ischium in
region of sub-pubic angle
- Medial surface – cavernous body fuse anteriorly
- Inferior surface – urethral groove, spongy body attached to dense CT
- Superior surface – groove, transmits dorsal vessels and nerves
- Ends at glans penis
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- Cavernosa is covered by tunica albuginea – longitudinal fibres that enclose capsule

completely at midline and form septum penis
- Trabeculae isolate spaces filled with venous blood = venous spaces of
Corpus spongiosum
- Smaller in bulk than cavernous body, flattened anteroposteriorly
- Posterior end thickened to form bulb of penis
- Two halves are adjoined laterally by ischiocavernous muscles, covered by
bulbospongiosus muscles
- Between and below cavernoosa
- Tunica albuginea thinner, weaker and blends with tunic of cavernosum
- Carries urethra
- Never hardens
Glans:
- Head of penid
- Continuous with foreskin at coronal sulcus and via frenulum
- Separate from the body via corona gland (sulcus) and location of glands that release
pre-ejaculate
- Extension of spongy body and soft in erection
- Covered by foreskin. Fused with tunica albuginea of cavernous body and immobile
Skin of penis
- Very thin, stretchable and dark
- Loosely connected with superficial fascia
- Folded as foreskin at neck, known as prepuce
- Separated from underlying fascia by loose areolar tissue
- Prepuce has two surfaces – inner more delicate and outer, thicker surface
- On lower surface of glans, prepuce forms a longitudingal fold known as the frenulum
of the prepuce
- Space between glans and prepuce is the preputial sac
- On corona glandis, many preputial sacs are found which secrete sigma
- Superficial fascia
- Loosely arranged areolar tissue found
- Few muscle fibres found
- Contains superficial dorsal vein of penis
- *Bulbospongiosus muscle – propelling force of ejaculation
Deep layer of superficial fascia:

- It covers 3 erectile tissues contains – dorsal veins, dorsal arteries, dorsal nerves
- Continuation of deep perineal fascia, continued with fascia covering external oblique
muscle and rectus sheath
Tunica albuginea:
- Dense fibrous layer that envelopes cavernous and spongy body
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- Very dense around cavernous body

- More elastic around spongy body and therefore not turgid during erection, permit
passage of ejaculate
Tunica vaginalis:
- Double serous membrane, peritoneal sac at end of vaginal process
- Covers front and sides of testis and epididymis
- Closed sac derived from abdominal peritoneum (innermost layer – scrotum)
- Parietal layer – adjacent to interior spermatic fossa
- Visceral layer – adherent to testis and epididymis
Ligaments:
- Suspensory (condensation of deep fascia)
– thick elastic fibres
- Pubic symphysis and arcuate pubic
ligament – deep fascia of penis/body of
clitoris
- Lies deep to fundiform ligament
- Fundiform (condensation of
abdominal subcutaneous tissue)
- From linea alba and membranous layer of
superficial fascia of abdomen and splits
into right and left parts, encircles body of
penis and blends with superficial penile
fascia to form the scrotum septum. This
interlaces with dartos muscle
Histology:
- The erectile tissue of the penis
is arranged into a smaller
ventral corpus spongiosum
through which the urethra
runs and two lateral corpora
cavernosa, each bordered by a
layer of dense collagenous
tunica albuginea
- Beneath this you can find
trabeculae consisting of
collagen, elastic fibers, and
smooth muscle surrounding
irregular cavernous veins.
- The corpora contain irregular
vascular spaces, lined by endothelium
Physiology:
- Sexual intercourse, urination
- Erection:
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- Deep artery of penis – branches into helicine artery runs radially and opens into
cavernae into the veins located in periphery of cavernous body, besides the tunica
albuginea
- Helicine artery have smooth muscle valves = Ebner’s cushions, usually closed and
they allow a small amount of blood in and they are drained easily by veins, no blood
is drained and an erection occurs
- At the end of an erection, Ebner’s cushions close, blood flow decrease and vein
compression release and the cavernae empties
Blood Supply:
- Internal pudendal artery branches
- Deep artery of penis runs in the cavernous body
- Dorsal artery of the penis runs deep to deep fascia and supplies glans penis
- Artery of the bulb of the penis supplies bulb of penis and spongy body
- External pudendal artery supplies penile skin
- Femoral artery branches – Superficial external pudendal artery
- Dorsal veins, Superficial veins, Deep veins are all unpaired
- Superficial veins drain into prepuce and penile skin, runs to subcutaneous tissue
- Deep dorsal veins lie deep to Buck’s fascia and receives blood from glans penis and
goes to the midline between the dorsal arteries
- Deep to the suspensory ligament there are right and left branches which connect to
the pudendal veins joining to form prostatic plexus
Innervation:
- Sensory nerve supply: dorsal nerve of penis, ilioinuguinal nerve
- Autonomic nerve supply: pelvic plexus. Splits into sympathetic and parasympathetic
- Sympathetic: vasomotor, branches of pudendal nerve
- Parasympathetic: carried from prostatic plexus, vasodilated S2-S4
- Branches of pudendal nerve
Anomalies:
- Chordee, Epispadias, Hypospadias, Phimosis and paraphimosis
Scrotum
*Structure of the skin and muscles containing the testes with the epididymis and lower
portion of spermatic cords
Topography:
- Anterior part of the perineal region behind the penis
- Skin covering and several layers of epididymis
- Divided internally by the septum, at the outside corresponds to Raphe scrotum of
skin. Between penis and anus
*Quick ontogenesis: the scrotum is derived from genital swellings. During development, the
genital swelligs fuse in the midline – Adults – fusion marked by scrotal raphe – Ridge of the
skin running on midline from root of penis to perineum
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- Fibromuscular cutaneous sac
- Contains 3 major paired structures – Testis, Epididymis, Spermatic cord
- Skin of scrotum in direct continuation (head of each testicle, spermatic cord of skin
of penis, thin, devoid of fat, darker than skin of abdomen and thighs, some hairs
- The scrotal skin is corrugated because of the underlying dartos muscle
- Under skin = dartos muscle continuous with smooth muscle fibres

- The testis and the spermatic cord have the following coverings: skin of scrotum,
dartos tunica – subcutaneous layer with smooth muscles, fascia spermatica externa
– continuation of superficial body fascia, cremaster muscle with cremaster fascua,
internal spermatic fascia – continuation of transveralis fascia
- Testis is covered with tunica vaginalis testes – external lamina parietalis and inner
lamina visceralis
- Both connected by mesorchium (fibrous sheath) and create between them cavity of
scrotum with septum in between
Histology:
- N/A
Physiology:
- Suspended sac containing parts with individual functions, surrounds and protects
testes
- Acts as a climate-control system for the testes because they need to be slightly
cooler than body temperature for normal sperm development
Blood Supply:
- Arterial supply from the anterior and posterior scrotal arteries
- Anterior scrotal artery from external pudendal artery
- Posterior scrotal artery from internal pudendal artery
- Scrotal veins follow major arteries draining into the external pudendal veins
Innervation:
- Genital branch of genitofemoral nerve – derived from femoral plexus and supplies
anterolateral aspect of scrotum
- Anterior scrotal nerves – derived from ilioinguinal nerve and supplies anterior aspect
of scrotum
- Posterior scrotal nerves – from perineal nerve and supplies the posterior aspect of
scrotum
- Perineal branches of posterior femoral cutanerous nerve derived from sacral plexus
and supplies inferior aspect of scrotum
Lymphatics:
- Lymph fluid drains to nearby superficial inguinal nodes
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Anomalies:
- Cysts, scabies, herpes, pubic lice, mumps, inguinal hernia, chlamydia and other sexually
transmitted infections, dermatitis, testicular cancer, genital warts to name a few…
90. Ovary
PAIRED, EXTRAPERITONEAL
Topography:
- Ovarian fossa, posterior part of broad ligament at lateral wall of pelvis, sacroiliac
joint
- From posterior abdominal wall it does not descend down to the inguinal canal, stops
at lateral wall of pelvic cavity
- Ant – medial umbilical ligament, Post – ureter
and interior iliac artery, Superior extremity –
infundibulum of uterine tube, end suspended via
suspensory ligament of ovary, Inferior extremity
– angle of body, uterine tube via proper ligament
of ovary.
- Each ovary is situated transversely on lateral wall
of true pelvis
- Bluish-white, oval organs (flattened) – 2.5-5cm (length), 0.5-1.5cm (thickness), 5-8g
(weight)
- 2 surfaces: medial, lateral
- 2 borders: straight mesovarian border, convex free border
- 2 ends: tubal end facing fimbriae of the tube, infundibulopelvic ligament and uterine
end = sharper
- Free ovary border - complex
- Connects to the posterior side of broad ligament via mesentery known as
mesovarium which is attached to the hilum of the ovary
- Not covered with peritoneum so ovum can fall into the peritoneal cavity and travel
to fallopian tube
Ligaments:
- Ligament of ovary - from ovary to fundus of uterus.
Goes from uterus to connective tissue of major labium
and becomes round ligament of uterus. Terminates
below the uterine tube
- Suspensory ligament of the ovary – Fold of peritoneum
extends from mesovarium to pelvic wall with
neurovascular structures, stretches to psoas major
muscle
- Other ligaments: mesovar +mesosalpinx, propium ovarii
ligament, uteri teres ligament, ovarii suspensory
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ligament, cardinal ligament, uteri latum ligament and rectouterinum ligament
- 3 components: Surface, cortex,
medulla
- Surface – simple cuboidal
epithelium = germinal
epithelium
- Cortex – largely
compromised of
connective tissue – stroma
(cortical substance, glandular
tissue, medullary
substance), supports 1000s of
follicles. Each primordial follicle – oocyte surrounded by single layer of follicular cells
- Medulla – supporting stroma, rich neurovascular network enters hilum of ovary from
mesovarium
- Peritoneal duplicatures covered by Tunica serosa
Physiology:
- Folliculogenesis - Folliculogenesis is the process of ovarian follicle development. In
order to reach the ovulatory stage, an ovarian follicle will pass through the following
stages: primordial (resting), primary, secondary (pre-antral), tertiary (antral), and,
finally, the pre-ovulatory (Graafian) follicle stage.
- Oogenesis - It is the creation of an ovum (egg) and the female form of
gametogenesis. The process of oogenesis is as follows:
● Process starts in germinal epithelium (ovarian surface epithelium) which gives rise to
the ovarian follicles
● These ovarian (or primordial follicles) develop into oocytes in a process known as
oocytogenesis (this is completed before birth)
● These primary oocytes then develop into an ootid via meiosis in a process known as
osteogenesis
● This meiosis process however stops at Prophase I and there is no further
development until puberty
● Once puberty is reached, chromosomal crossover can occur completing Meiosis I,
developing the primary oocyte into the secondary oocyte and first polar body
● After Meiosis I, Meiosis II begins however is halted at metaphase II until
fertilization. If fertilization occurs, Meiosis II will complete and an ootid and another
polar body will have been created.
Histology:
Cortex
o Epithelium = cuboidal germinal epithelium, instead of mesothelium,
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● Therefore, in case of ovulation, rupture of epithelium is possible to release

oocyte.
● The epith can grow and cover the rupture hole.
● Repeated rupturing due to monthly ovulation of a woman leads to a scarred
look on the epithelium.
● There is no mesothelium coverage, because ovary is extraperitoneal, though
is continuous with mesothelium of visceral peritoneum of surrounding areas.
o Beneath that is a layer of dense CT = tunica albuginea.
o Then is the stromal or spinocellular tissue, in which all the follicles are embedded
● also just called stroma
● contains fibrocytes and smooth m cells, that contribute to theca externa
Primoridal follicle: – make about 20/month.

o oocyte surrounded by single layer of follicular cells,
o simple squamous epith
o resting in prophase
o
1st Primary follicle
o follicular cells enlarge and become
cuboidal = now called granulosa cells
these cells later form the corona radiata
o zona pellucida starts to appear – non
cellular layer between corona and oocyte
itself
● Glycoprotein rich zone (ZP 1, 2, 3 )
● Zone of contact and
communication between oocyte
microvilli and granulosa cell
processes.
● Develop gap junctions
o oocyte itself becomes bigger
o
2nd primary follicle –
o zona pellucida is present (very eosinophillic, made of carbs, can be stained by PAS)
follicular epithelium become stratified and becomes known as stroma granulosum.
o
o Theca cells from surrounding
CT begin to be seen. These are
actually stromal cells layering
themselves into two layers
Seconday follicle –
o Clear theca interna and
externa seen, zona
pellucida seen
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o antrum vacuoles start to appear

● with follicular liquor inside, that contains peptides produced by granulosa
cells
● if you see an antrum = secondary follicle
o granulosa cells on one side of follicle surrounds the oocyte to form = cumulus
oophorus
o Between layer of granulosa cells and theca cells is a thin basement membrane
o Theca internata is thicker and very defined inner layer –> produces hormones
o Theca externa is much thinner and interweaves with surrounding CT
Tertiary follicle = Graafian follicle

o Largest ones in slide, usualy closer
to center of slide
o theca interna and theca externa
are thicker
o cresent shapen antrum is now
seen (formed by merging of
previously seen vacuoles)
o corona radiata (communicates
with gap junctions)
o oval within inter cavity, with liquid
inside
o oocyte accentric within follicle (attached to one side)
o granular cells protrude into cavity to produce the cumulus oophorus.
Remember that the corona radiata accompanies oocytes in ovulation, as well as the zona
pellucida.
Within follicle, seconday oocyte has 1 cm diameter.
Medulla
o dense irregular CT, that is connected to the uterus via meso-ovary.
o has many a/v
Blood Supply:
- Ovarian artery – ovarian and tubal branch
- Receive blood from paired ovarian artery from abdominal aorta
- Venous drainage – ovarian veins
- LOV drains left renal vein and ROV drains inferior vena cava
Innervation:
- Pamniform plexus
- Runs via suspensory ligament of ovary with vasculature to enter ovary at hilum
- Ovaries receive sympathetic and parasympathetic nerve fibres from ovarian and
uterine (pelvic) plexuses
- SNS – run with ovarian artery/vein – connections with pelvic plexus - ovarian plexus
- PNS – pelvis splanchnic nerve – same route with ovarian vessels
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Lymphatic Drainage:
- Lymph from ovaries drains into para-aortic nodes (Lumbar/lymph plexus)
Anomalies:
- Ovarian cancer, ovarian cyst, ovarian torsion, premature ovarian failure, ovarian apoplexy
to name a few…
91. Uterine tube
Also called the fallopian tubes.

● Extends from either side of uterus in the Superior border of broad ligament of the
uterus.
● They are 10-18 cm long and opens at its free end through the abdominal ostium into
the abdominal cavity
● The opening of the uterine tube is funnel shaped and is called infundibulum. The
infundibulum of the uterine tube has finger like processes and they are called fimbria.
● Infundibulum is continuous with the Ampula (largest part), which makes up 2/3 rd of
the uterine tube.
● Narrowest part is called isthmus.
● The uterine tube lies intraperitoneally and are connected by mesolpinx to the broad
ligament of the uterus. Up
● The inner surface of the year 20 has a longitudinal musculus folds
Vasculation
● The uterine artery supplies approximately the medial 2/3rd of the uterine tube and
the lateral 1/3rd is vasculated by the all ovarian archery.
● The uterine tubes are drained by the venous plexus
● Innervation
● The Uterine tubes are innervated by the parasympathetic (from sacral plexus) and
sympathetic (from T1-T12 segments) nerves from the superior mesenteric nerve plexus
and the renal plexus.
● The uterovaginal nerve plexus also supplies them.
● Lymphatic drainage:
● Lymph from the ovary drains to the lumbar nodes. Also the lymphatic drainage from
the uterine tube also flows to the internal iliac nodes.
Microscopic structure: -
● The walls of the uterine tubes are up composed of three layers:
● 1) mucosa: -
o inner layer
o Uphas single layer of the columnar epithelium with ciliated and glandular cells.
Also has pig cells which are non-ciliated secreting cells. They waft the ovum
towards the uterus and supply it with nutrients.
● 2)Muscular layer: -
o middle layer
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o has many components, e.g. Subperitoneal layer pop up, perivascular layer and
autochthonus muscles of the tube itself . so the main function of this layer is to
help the spermatozoa and the oocyte to move.
● 3) Serosa
o outer layer
o permits movement against its surrounding
92. Uterus
● Thick wall muscular organ situated near the outer of lesser pelvis between urinary
bladder and rectum
● 7-8 cm long and weighs around 50-70 g
● has 3 parts
● 1) fundus :-some people can’t is part of the body,
● Projects beyond the right uterine wall horn and left uterine horn
● 2) body; - usual site for implantation of the blstocyte
● - has 2 surfaces, anterior and posterior surfaces and 2 lateral borders
● anterior surface = flat and related to urinary bladder its covered with the peritoneum
and forms the posterior wall of uterovesical pouch
● posterior pouch = convex and is related to coils of the terminal ileum and to the
sigmoid colon. Covered with peritoneum to form the anterior wall of the
rectouterine pouch.
● Lateral border = rounded and convex and provides attachment to the broad ligament
of the uterus which connects to lateral pelvic wall.
● 3) cervix: - thin round, lower 1/3rd of the uterus is directly posterior and inferiorly
has 2 regions. 1) Ectocervix and 2) endocervical canal
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● 1) ectocervix = portion that projects into the vagina (called the vaginal part). Which is
lined with Stratified squamous non-keratinized epithelium.
● 2) Endocervical canal: - Also called the supravaginal part of the cervix. Lined by
mucus –secreting simple columnar epithelium.
● Position of the uterus depends on the nearby hallow organs.
● The uterus changes during 3 main time, during:-
● 1) age: - this is when body remains large and the cervix shrinks. Happens when the
woman gets older.
● 2) menstruation: - Uterus is enlarged and is more vascularised
● 3) pregnancy: - uterus becomes enlarged that it extends into the epigastric region.
Microscopic
● Has 3 main tissue layers: -
● 1) Peritoneum: -
o outer layer
o parts of the body and fundus are lined with parietal peritoneum, called
periperitoneum. Which is double layered membrane that is continuous with
abdominal peritoneum
● 2) myometrium
o middle layer
o thickest part of the uterine wall, composed of smooth muscle cells,
connective tissue and vessels.
o Its muscles forms 3-d meshwork that is mostly parallel to surface of the
uterus
o Function is to help to expose the foetus during birth.
● 3) endometrium: inner most layer
o has cells rich in connective tissue with few fibers
o its simple columnar epithelium that has ciliated cells and invaginates to form
the tubular uterine gland.
o Can be further divided into 2 layers
▪ 1) functional layer = undergoes cyclic changes
▪ 2) basal layer = not shed durning menstruation.
Vasculation
● Supplied with uterine artery (part of the internal iliac artery) and partly by the
ovarian artery
● Venous drainage is by the network of the valveless vein that forms uterine
plexus. It drains via the uterine vein into internal iliac vein.
Innervation
● Autonomic innervation via the inferior hypogastric plexus as pelvic splanchnic nerves
(s2-s4), which forms plexus lateral to the cervix with large ganglion cells called
uterovaginal plexus.
Supports of the uterus: -
● by 5 ligaments
1. broad ligament: - peritoneal fold between the lateral margin of the uterus and
lateral pelvic wall. It contains connective tissue, vessels and nerves.
2. Round ligament: - extends from the uterine wall and has smooth muscle cells and
runs through the inguinal canal. Attaches the side of uterus to pelvis.
3. Ovarian ligament: - joins ovaries to uterus
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4. Cardinal ligament: - has condensation of connective tissue that fixes the cervix to
the lateral pelvic wall. Its located at the base of broad ligament. Has uterine
artery and vein in addition it provides support to the uterus.
5. Uterosacral ligament: - extends from cervix to the sacrum. Supports uterus
formed by dense superitoneal connective tissue and nerves of the inferior
hypogastric nerve plexus.
93. Vagina. Female External Genitalia
Vagina: -
● Thin walled, hollow fibromuscular organ
● Extends from the cervix of the uterus to the vaginal orifice in the vestibule of the
vagina
● Anterior to vagina is the bladder and urethra
● Posterior to vagina is the rectum and anus
● Laterally located at the ureter and urinary artery
● Frontal aspect = flattened, and its anterior and posterior walls Touch, making an “H”
shape.
● Posterior wall = 1.5 -2 cm longer than the anterior wall
● Vaginal fornix is the superior end of the vagina and that surrounds the cervix of the
uterus. It has a flat anterior part, deep posterior part and lateral part
● Vaginal fornix = widest part of the vagina
● Vagina mucosa contains transverse fold called vaginal rugae, as well as the
longitudinal folds called vaginal columns. Which are produced by the Bell developed
venous plexus in the wall of the vagina
Functions:-
1. Act as an organ of sexual intercourse
2. Channel of drainage of cervical secretion and menstrual blood
3. During childbirth, it is the last and most distal portion of the birth canal
Histology: -
1. Stratified non-keratinised squamous epithelial lining: - provides protection
and lubricated by cervical mucus. It is glycogen rich, no glands present,
produces the vagina fluid; which is slightly acidic (4.0-4.5ph) due to
formation of lactic acid which is produced by glycogen breakdown
2. Elastic lamina properia:- dense connective-tissue layer, which project papilla
into the overlying epithelium . als upo has larger veins
3. Fibromuscular layer:- has to lose a smooth-muscle
1) inner circular
2) outer Longitudinal layer
4. Adventitia: - fibrous layer, providing strength to the vagina.
Vasculation: -
● supplied by the vaginal branches from the uterine artery and branches of
the inferior vesicle arteries and internal pudenal arteries.
● It is drained by the vaginal Venus plexus, which drains into internal iliac vein
by uterine vein.
Innervation: -
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● Autonomic innovation= uterovaginal nerve plexus

● Inferior side innervated by the pudendal nerve
Lymphatic drainage: - iliac nodes up and superficial inguinal lymph nodes.
External genitalia: -
● Has six components
● It’s also called Vulva
● Function :- 1) is to act as an sensory tissue during sexual intercourse
● 2) to assist in micturition, by directing flow of urine.
● 3) defend the female reproductive tract from infection
list of structure and its function: -
1) mons pubis: - skin covered fat pad overlying pubic symphysis, which is covered in
pubic hair after puberty
2) Labia majora:- two hair-bearing external folds, it’s derived from labio scrotal
swellings. Fuse posteriorly and extends anteriorly to the mons pubis.
3) Labia minora: - thin folds of the skin that are devoid of fat, below the vestibule of
vagina.
1) anteriorly it tapes into 2 folds form the frenulum of the clitoris
2) has thin epidemial covering overlying connective tissue and sebaceous glands.
4) Vestibule: - Area between and surrounding labia. Has vestibule glands around it
which secretes mucoid discharge
5) Bartholins gland: - located either side of vaginal orfice, these glands secrete
lubrication mucus from small ducst during sexual intercourse.
6) Clitoris: - Located unde the prepuce and derived from the genital tubercle
● Is and erective, sensory organ
● Made up of crus, body and gland of clitoris
Vasculation: -
Branches of internal pudendal artery
Venous drainage by internal pudendal vein, external pudendal veins and deep posterior vein
of clitoris.
Innervation: - innervated by branches from the pudendal nerve, ilioinguinal nerve and
genitofemoral nerve.
Lymphatic drainage: - Lymph from the external genitalia that drains into the inguinal nodes.
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94. Perineum- Muscles and fasciae
● Region between anus and the Scrotum/Vulva

● Diamond shaped
● Transverse perineal muscles are the Superficial and deep muscles
● The perineum has 2 triangles, that makes up the diamond shape.
1. Anal triangle: - Posterior half of the perineum
● Bounded by the coccyx, sacrotuberous ligament
2. Urogenital triangle :- anterior half of the triangle
● Bounded by the pubis symphasis, ischiopubic rami
Superficial Perineal muscles
Muscles Origin Insertion Action

Ischiocavernousus ● Medial Inserted by an Helps maintaining
surface aponeurosis into the erection of the penis by
of Ischial sides and under compressing the crus
ramus surface of the
behind anterior part of the
the crus crus
● Posterio
r part of
perineal
membra
ne
Bulbospongiosus ● Perineal ● Posterior 1. helps in ejecting
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body fibers = the last drops of

● Median perineal the urine
raphe membranes 2. middle fibers =
over the ● Middle fibers assist in erection
bulb of = bulb and of the corpus
penis corpus spongiosum penis
spongiosum, by compressing
and the raphe the bulb
on their upper 3. anterior fibers=
surface. erecting penis by
● Anterior fibers compressing the
= Raphe on deep dorsal vein of
the dorsal penis.
surface of the
penis.
Superficial Medial surface Perineal body where Steadies the perineal

trsansversus of the root of it interlaces with body.
perinei ischial ramus other converging
muscles.
Deep perineal muscles
Muscles Origin Insertion Action

Sphincter ● Transverse Perineal body 1. Helps in
urethrae perineal (in females, the ejecting last
ligament decussate drop of urine
● Membranous between the 2. Helps in
urethra urethra and ejaculation
vagina, and are
also inserted on
the walls of
vagina)
Deep transversus Arises from the fascial Perineal body Steadies the perineal
perinei sheath of the pudeanal body
vessels
● The, perineal branch of the Pudendal nerve innervates all of the superficial and deep
muscles.
● Vasculation occurs in this muscles by the Internal Pudendal artery
● The perineal fascia consists of superficial and deep layers. The superficial perineal
fascia again can be divided into superficial fatty layer and deep membranous layer.
● The superficial fatty layer (Camper fascia) is continuous with the fat in the region of
anal triangle (or ischiorectal fossa), the superficial fascia of the thighs and the fatty
superficial layer of abdominal wall. In male, it is replaced in scrotum with smooth
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dartos muscle.
● The membranous layer (Colles’ fascia) is attached posteriorly to the posterior end of
perineal membrane and the perineal body. On each side it is attached to the margins
of pubic arch and to the deep fascia i.e. fascia lata of the uppermost part of the thigh
on medial aspect. Anteriorly, the membranous layer is continuous with dartos fascia
and with the similar layer of abdominal wall i.e. Scarpa’s fascia.
● The deep perineal fascia (investing or Gallaider’s fascia) tightly invest the
ischiocavenous, bulbospongiosus and superficial transverse perneal muscles. The
deep perineal fascia is fused with the suspensory ligament of the clitoris in females
and the deep fascia of the abdomen in males.
95. Breast
● Epithelial derivatives containing connective tissue stroma

● Female breast maybe hemispherical, disk or coned shaped.
● Lies on either side of the body on the body of the pectoral fascia between the 3 rd and
7th rib midway between the sternum and axillae.
● There is a thin layer of interstitial connective tissue between breasts and fascia.
Which allows movement of breast against the anterior wall of thorax.
● Fixed in its posterior by collagen fiber bundle called suspensory ligaments of the
breasts.
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● Nipple: - located in the centre of the breast, measuring 10-12 mm in diameter and
points lightly superiorly and laterally and is surrounded by areola.
● Tip of the nipple is unpigmented
● Periphery of areola ace 10-15 usually circulatory arranged nodular elevation called
areolar glands.
● The areolar glands has apocrine and eccrine sweat gland and sebaceous glands. And
it keeps the moist during lactation .
● Breast is developed near the end of the first embryonic nodes a bundles
condensation of epithelium called the mammary streak froms on either side of the
trunk between the brachial arch region of the tail.
● Then mamas streak develop into mammary ridge at like 6th week of embryonic life.
● The group of apocrine glands starts to forms during 3 rd gestational month
Vasculation: -
● media aspect = internal thoracic artery
● Lateral part= lateral thoracic and thorocoacromial branches , lateral mammary
branches and mammary branches.
● Corresponds with the arterie and drains into the axillary and internal thoracic vein.
Lymphatic: - 3 group of lymph nodes
1) Axillary node
2) Parasternal node
3) Posterior intercostal nodes.
Innervation: - by anterior and lateral cutaneous branches of the 4th-6th intercostal nerves.
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Endocrine glands
1) Development
2) Topography
3) Macro- microscopic structure
4) Blood supply
5) Histophysiology
96. Pituitary gland or Hypophysis
Development
● Pituitary gland is formed by mixture of 2 Tissues.
● Early Gestation finger of ectoderm grows upwards from the roof of the mouth
(Known as Rathke’s Pouch). This later develops into Anterior Pituitary gland
(Adenohypophysis)
● Another ectodermal Finger evaginates ventrally from the growing diencephalon. This
extension of ventral brain becomes the posterior Pituitary gland (Neurohypophysis)
Topographic
● Weighs 600-900 mg and rests in the hypophyseal fossa of the sella Turcica of the
Sphenoid bone.
● Divided into adenohypophysis, an epithelial structure and neurohypophysis.
● Position:
● Anteriorly – sphenoid sinus
● Posteriorly :- posterior intercavernous sinus, basilar artery and pons
● Superiorly: - diaphragm sellae and optic chiasm
● Inferiorly: - sphenoid sinus
● Laterally: - cavernous sinus
1) Adenohypophysis: - Anterior lobe
● Consists of : -
1) Pars distalis: - responsible for hormone secretion and makes up most of the
glands
2) Pars tuberalis: - covers anterior part of the infundibulum and tuber cinereum
3) Pars intermedia : -forms a narrow intermediate zone
2) Neurohypophysis: - Posterior lobe
● Contains only unmyelinated axons, axons terminal, glial cells and wide lumen
capillaries.
● Connected to hypothalamus by the infundibulum
● Upon stimulation, the posterior lobe secretes 2 hormones ADH and Oxytocin.
● Consists of : -
a) Pars nervosa - Bulk Portion of Posterior pituitary gland
b) Median Eminence - Upper section of Neurohypophysis
c) Infundibular stalk - Stem connected pars nervosa and base of the brain
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Vasculation: -
● anterior lobe is vasculated by the superior hypophyseal artery
● posterior lobe is vasculated by 3 arteries:
1) superior hypophyseal artery
2) infundibular artery
3) inferior hypophyseal artery
● The Anterior and posterior hypophyseal veins drain both of the lobes respectively.
Histophysiology
Anterior lobe: -
A) Acidophils/Alpha-cells: - About 43%
1) Somatotrophs: secretes Growth Hormone (GH)
2) Lactotrophs: - Secretes Prolactin Hormone
3) Corticotrophs: - Secretes ACTH (Adrenocorticotropic hormone)
B) Basophils/beta-cells, about 7% of cells
1) Thyrotrophs: secretes TSH (Thyroid stimulating hormone)
2) Gonadotrophs: Secretes FSH (Follicle Stimulating Hormone)
3) Luteotrophs: Secretes LH (Luteinizing hormone) and ICSH (Interstitial cell
stimulating hormone)
c) Chromophobic cells - 50% represents the non-secretory phase of the other cell types, or
their precursors
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Posterior lobe:-
1) Contains Pituicytes
2) Large number of Non-myelinated fibres-Hypothalamic-Hypophyseal tracts arises
from the neurons of supraoptic and paraventricular nuclei of hypothalamus
The hormones related to this side of the Pituitary gland are: -
A. Vasopressin (ADH) -Acts on Kidneys Tubules
B. Oxytocin - Promotes constriction of the uterine and mammary smooth muscle.
97. Pineal gland or epiphysis
● About 10 mm long and weighs about 160 mg

● Pine-cone in shape
● Lies between habenular commissure and the posterior commissure, on the posterior
wall of the 3rd ventricle
● Secretes Indole and peptides, especially alpha-melanocyte- stimulating hormone and
Melatonin
● Derived from the Neuroepithelium of the diencephalon in the roof of the 3 rd
ventricle and remains connected to the other parts of the brain via the habenulae
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● During phylogenesis, the pineal gland undergoes a complex transformation, from

originally functioning as a photosensory organ to Neuroendocrine gland.
● It is made up of the Parenchymal pinealocytes , which are embedded in a stroma of
astrocytes processes.
● The parenchymal pinealocytes are divided into lobules by connective tissue septa
● The gland also has Glial cells, which are formed by fibrous astrocytes and act like
supporting cells.
● Innervation: -
● By sympathetic nerves whose cell bodies are located in the superior cervical
ganglion.
Vasculation: - Posterior choroidal artery is the main supply. It is drained by the internal
cerebral veins.
98. Thyroid gland

Development
● Develops from the epithelium of the floor of the mouth. It descends down the neck
to lie in its adult anatomical position ( between C5 –T1).
● Has 2 lateral lobes, the right and left lobe. Which lies either side of larynx and
trachea and are connected by the isthmus of the thyroid gland
Topographic
● It is dark brownish in colour and weighs around 18-60g in adults.
● Lobes = 4-8 cm long; 2-4 cm wide and 1.5-2.5 cm thick in the middle. The 2 lobes are
connected by isthmus
● Bound by the pretracheal fascia, which is between hyoid bone and thorax.
1) isthmus: - measures 1.5-2.0cm wide and 0.5-1.5 cm thick.
● It has pyramidal lobe, which is long projection from cranial border
2) Fibrous capsule of the thyroid gland – consists of 2 layers
1) internal capsule – thin and sends vascularised connective tissue septa into
the interior of the gland.
2) External capsule: - tougher and part of pretracheal layer
● Space between the internal capsule and external capsule is filled with
loose connective tissue.
Vasculation: - Superior thyroid artery, supplies the superior, anterior and lateral parts of the
thyroid gland
● While the inferior thyroid artery supplies the inferior, posterior and
medial part of the gland.
● The superior thyroid vein empty into the internal jugular vein
● The inferior thyroid vein empty into the brachiocephalic vein.
Innervation: - Branches from sympathetic trunk, reaches via postganglionic fibers derived
from superior cervical ganglion and cervicothoroco ganglion of the sympathetic trunk
● Parasympathetic supply is from the superior laryngeal nerve and recurrent laryngeal
nerve.
Histophysiology: -
● Consists of epithelial cells arranged to form approx. 3 million closed follicles.
● Made up of 2 components:
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1) Thyroid follicles: - large walls (50-900 micrometres in diameter), spherical or

tubular folds.
● Epithelial cells are float or columnar or even tall columnar during
secretion.
● Fine connective tissue fibers and a dense network of fenestrated
capillaries surround the surface.
2) Para follicular or c cells: - lies in the interfollicular connective tissue.
● Contains abundant Golgi apparatus and membrane enclosed granules
with a diameter of 100-180nm.
● Derived from the neural crest during embryological development and
so are of neuroectoder marginal origin.
Hormones produced: - Thyroid gland produces Thyroxin (T4) and Triiodothyronine (T3), as
well as calcitonin. Thyroxin and Triiodothyronine stimulates the cellular metabolism and are
essential for mental and physical development.
● T4 and T3 are produced in a series of steps.
● Firstly they bind to thyroglobulin, which is a product of the follicular epithelial cells.
Then iodide is taken up from the blood and turned into iodine in presence of H2O2.
● The resorption of follicle content is stimulated by the Thyrotropin (TSH), which is
secreted by the pituitary gland. The vesicles are transported by endocytosis and
they fuse with lysosome, which sever the bond between the hormone and
thyroglobulin. The hormone is when released into the blood by Diffusion.
99. Parathyroid gland
● 4 yellow/reddish-brown parathyroid glands. 2 are superior parathyroid and 2 are

inferior parathyroid glands.
● Derived from the endodermal epithelium of the posterior diverticula of the 3 rd and
4th pharyngeal pouches.
● Weighs about 120-160 mg in total
● Located in at the level of caudal margin of the caudal cartilage.
● The superior parathyroid gland is derived from the 4th pharyngeal pouch
● The inferior parathyroid gland is derived from the 3rd pharyngeal pouch.
● The inferior parathyroid gland is located at the base of the lateral lobes at the level
of the 3rd and 4th tracheal cartilages.
● Parathyroid gland are enclosed in a connective tissue capsule
● They have granular epithelium, which has connective tissue fibers and adipose cells
and is permeated by a dense network of fenestrated capillaries.
● 2 main cells types may be distinguished
1. Chief cells : - production of the parathyroid hormones (PTH), PTH mobalizes
calcium from the bone, by increasing osteoclast activity and so increase in bone
resorption, which results in increase in the calcium ion concentration in the
blood.
● Also promotes the phosphate excretion by kidneys.
2. Oxyphil cells: no known function
Vasculation:
● Collateral circulation is derived by the
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1) Superior thyroid arteries

2) Thyroid ima artery
3) Laryngeal, tracheal and oesophageal arteries.
● Inferior thyroid arteries, which changes into the parathyroid artery.

● Parathyroid glands are drained into the thyroid plexus of veins.
100. Suprarenal glands. Paraganglia
Suprarenal glands: -
● Also known as Adrenal glands
● Paired retroperitoneal endocrine gland, situated over the medical aspects of the
upper poles of each kidneys
● Forms a compact organ and it is surrounded by a common connective tissue capsule
● Mesodermal part = outer adrenal cortex. This surrounds the ectodermal part and
posterior coelom cavity to form adrenal medulla
● The gland weighs 4.2 – 5.0g
● Posteriorly there is hilium, hilium allows the veins and lymphatic vessels to exit and
nerves and arteries to enter.
● When viewed from anterior side, the right adrenal gland is triangular in shape with a
distinct apex.
● Base lies directly on the superior pole of the kidney
● Lateral portion lies against the medial crus of the diaphragm, overlying both greater
splanchnic nerve and right part of the celiac ganglia
● Anterior surface = covered by the right lobe of the liver and partly by the inferior
vena cava
● Left = more crescent shaped
● Does not have apex and lies on the upper medial margin of the kidney.
● Anteriorly, it covers greater splanchnic nerve and is in close contact with omental
bursa and posterior wall of the stomach.
Vascualtion: -
● By 3 arteries,
1. Superior adrenal artery
2. Middle adrenal artery
3. Inferior adrenal artery
● Right and left adrenal veins drain the gland into the inferior vena cava.
Histophysiology:
● Basal laminae and a reticular fiber network surround a glandular epithelium of
the adrenal cortex. It is rich in lipids and appears yellow.
● The adrenal cortex consists of 3 layers: -
1. Zona glomerulosa – composed of small, round cells. Has abundant
SER, scattered lysosomes and lipid droplets
● Produces and secretes Mineralocorticoids such as aldosterone.
2. Zona Fasciculata: - Cells lies in parallel cord and sheets
● Rich in lipids, cholesterin, and cholesterol ester and also in vitamin
a and c.
● Produces and secretes corticosteroid such as cortisol
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3. Zona reticularis: - arranged in network or clusters

● Contains few lipids
● With advancing age, the lipofusin granules accumulate
● Produces and secretes androgens e.g. DHES and small amount of
corticosteroid
Medulla: - Contains cells, which secretes catecholamines. For fight or flight response and
also secretes enkephalins, which is used for pain control.
● The medulla is derived from neuroectodermal sympathoblasts.
Paraganglia: - glomus organ

● Nodular, pea seized epithelium structure
● Contains clusters or cords of chromaffin cells secreting catecholamines
● Arises from neural crests
● Largest Paraganglia are aortic Paraganglia, which are irregularly dispersed in the
retroperitoneal space.
101. Endocrine pancreas. Gastro-entero-pancreatic endocrine

system
Endocrine Pancreas: -
● Lying within or near the margin of the lobules of the exocrine pancreas are the islet
of Langerhans
● About 0.5-1.5 million islets
● 100-200 micrometers and weighs 2-5g
● consists of columns of epithelial cells
● 5 different endocrine cells types:
1. Alpha cells – 15-20% of islet of Langerhans
● Lies periphery of the islets
● Produces hormone glucagon. Glucagon.
2. Beta cells: - 70% of the islet

● Produces insulin. Insulin stimulates glycogen synthesis and reduces blood
sugar level
3. Delta cells: - 5% of the islets cells
● Has homogenous secretory granules, which are filled with somastostem,
which inhibits secretion of insulin and glucagon.
4. PP cells – produces pancreatic polypeptides, this is an antagonis of cholecystokinin
and inhibits secretion of exocrine pancreatic cells.
5. D1 cells: - Contains vasoactive intestine polypeptide, which dilates blood vessels.
Vasculation : -Fed by the Arteriole, which arises from islet capillary network
● Drained by the pancreatic vein, into the hepatic portal vein.
Gastro-entero-pancreatic endocrine system : - Don’t quite know what they are asking for
and mr google doesn’t recognise this as well…
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Section 3: Cardiovascular System

Cardiovascular System
For the blood vessels, knowledge on the location, branches (tributaries) and
essential collateral pathways, and for the lymphatic system - on the regional
lymph nodes and the lymphatic drainage, are required
Overview on Cardiovascular system: -

As the word suggests, cardio meaning heart and Vascular meaning something that involves
arteries and veins. This system is one if not the most crucial system of the body, involving:
Heart, arteries and veins. So the main function of the cardiovascular system is that it
transports nutrients, hormones, Oxygen ETC Via help of the red blood cells.
102. Heart (Cord. Development, topography and external

relief)
● Heart is a fibromuscular, hollow organ. Located in midastrenum. The apex is

directed towards the left, inferiorly and anteriorly. While the base is directed
right, superiorly and posteriorly.
● It is rounded, conical and 3-d pyramidal in shape
● Size of the heart depend on sex, age and fitness level of an individual.
● The function of the heart is to pump the blood throughout the body.
● The heart has 4 chambers and 4 valves.
● Located inside a membrane sac, called pericardium.
● The wall of the heart has 3 layers (talk about in greater detail on question
105):
1. Epicardium
2. Myocardium
3. Endocardium
● Has 3 surfaces
1. Sternocostal
2. Mediastinal
3. Diaphragmatic
● Has 4 borders
1. Right border = Right atrium
2. Inferior border = Left ventricle and Right ventricle
3. Left border = Left ventricle
4. Superior border = Right and left atrium and the big vessels.
Development
● The heart forms from an embryonic tissue called Mesoderm at around 18-19
days after fertilization and starts pumping blood at around 21-22 days after
fertilization
● The order in which this happens is: -
1. The heart begins to develop near the head of the embryo in a region
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Anatomy 2017 - Cardiovascular system
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called cardiogenic area.

2. Following signals from the underlying endoderm, the cardiogenic area
begins to form 2 layers called cardiogenic cords.
3. As the cardiogenic cord develops, a lumen starts to develop. This is
called Endocardial tubes.
4. The 2 tubes migrate together and fuse to form one primitive heart
tube.
● The primitive tube quickly forms 5 regions: -
1. Truncus Arteriosus, which gives rise to Ascending aorta and the
Pulmonary trunk
2. Bulbus Cordis, which gives rise to the right ventricle
3. Primitive Ventricle, which gives rise to the left ventricle
4. Primitive atrium, which gives rise to the anterior portion of both left
and right atriums and the 2 auricles.
5. Sinus Venosus, which gives rise to the posterior portion of the right
atria, SA node and coronary sinus.
● At around 23-28 days after fertilization. The primitive heart tube elongates
and it begins to fold within the pericardium. Eventually forming an s shape
and places the chambers and major valves into alignment similar to the adult
heart.
● End of 5th week, 2 major things happens:
1. Septa, valves, remodelling of the chamber occurs
2. Partitioning of atria and ventricles also occurs.
3. 5th to 8th week, the atrioventricular (Tricuspid) valves forms.
4. 5th to 9th week, the Semilunar (Bicuspid) valves forms.
Topography: -
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103. Heart chambers, Cardiac valves.
● The heart consists of 4 chambers. 2 atriums and 2 ventricles.

● Basics of how the heart work is that. The blood returning to the heart enter
the Atrium, and then the valves open and due to the pressure, the blood is
forced into the Ventricle and then due to increase in pressure in the
ventricles the blood is pushed through into the artery.
● From the left ventricle, the blood is passed through to the aorta and it enters
the Systematic circulation.
● From the Right ventricle, the blood is passed into the Pulmonary artery and it
enters the pulmonary circulation.
● Between the 2 atriums, there is a septum called, Interatrial Septum
● Between 2 ventricles, there is a septum called, Interventricular septum
Right Atrium
● Receives Deoxygenated blood from the superior and inferior Vena cava and
the Coronary vein and pumps it though Atrioventricular Valve (Tricuspid
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valve) into the Right Ventricle

● Inferior surface of the right Atrium can be divided into 2 parts, each with
Distinct Embryological origin.
● These 2 parts are separated by Cristae Terminalis, which is a muscular ridge:
-
1. Sinus Venarum (Sinus of the Vena cava) : -
● Coated posterior to cristae Terminalis
● Receives blood from superior and inferior vena cava.
● Has smooth muscles, which are derived from embryonic sinus
venous.
2. Atrium Proper (True Atrium and true Auricle)
● Anterior to the Cristae Terminalis
● Derived from primitive atrium, has rough, muscular arch
formed by Pectinate muscles.
Left Atrium
● Receives oxygenated blood from the 4 pulmonary veins and pumps I through
Mitral (Bicuspid) valves into the Left Atrium.
● Smaller than right atrium
● Left atrium forms the posterior border of the heart.
● Left atrium is continuous anteriorly with the left auricle, which contains small
Pectinate muscles that projects into its lumen.
● Near the Interatrial septum dividing, there is a valve from the Foramen Ovale,
which is produced by the oval fossa of the right atrium.
Interatrial septum
● Solid muscular wall that separated the right and left atria.
● The septal wall in the right atria is marked by a small oval-shaped depression
called the fossa ovalis. In the foetus it is open, however it closes with the first
breath of the newborn.
Right ventricle
● Receives blood from the right atrium and pumps it into the pulmonary artery
● Divided into 2 muscular ridges. The supraventricular crest and septomarginal
trabecular. Which forms the inflow tract and the outflow tract. The inflow
tract, is localised Posteroinferiorly of the ventricle. While the outflow tract, is
localised Anterosuperiorly of the ventricles.
● Inflow tract =
● Covered by series of irregular muscular elevation known as trabeculae
carnae.
● Trabeculae carnae can be grouped into 3 main types: -
1. Ridges: - Attach along their entire length on one site to form ridge
along the interior surface of the ventricle.
2. Brides: - Attached to ventricles at both ends, but free in the
middle
3. Pillars (Papillary muscles) : - Anchored by base of the ventricles.
Their apices are attached to fibrous cords (Chordae tendinae)
● Outflow tract =
● Funnel shaped Conus Arteriosus (Infundibulum)
● Located in the Superior aspect of the ventricles.
● Derived from the embryonic bulbus cordis
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● Visibly different from the rest of the right ventricle as if it has smooth walls
and no trabeculae carnae.
Left ventricle
● Inner space is conical In shape and it is divided into an inflow tract, with
jagged trabeculae carneae and a smooth walled outflow tract.
● Receives oxygenated blood from left atrium and pumps it into the aorta.
● Anatomically, left ventricle forms apex of the heart, as well as the left and
diaphragmatic border.
● Inflow tract: -
● Bicuspid valve
● Lined by trabeculae carnae
● 2 papillary muscles present which attach to the cusps of the mitral valve.
● The papillary muscle consists of the anterior papillary muscle and
posterior papillary muscles.
● Anterior Papillary muscles, arises from the sternocostal surface of the Left
Ventricle
● Posterior Papillary muscles arise from the diaphragmatic surface.
Outflow tract: -
● Known as Aortic Vestibulae
● It is smooth-walled with no trabeculae carnae
● Derived from Bulbus Cordis.
Interventricular septum
● Separates the 2 ventricles
● Composed of a superior membranous part (1mm thick) and inferior muscular
part (Roughly 1.2 cm thick)
● Septal leaflet of the tricuspid valve arises from membranous part.
Cardiac valves
● 4 valves.
1. 2 atrioventricular valve , which are
a. Tricuspid valves.
b. mitral valves.
● The Atrioventricular valves Located between Atrium and Ventricle
2. Semilunar valve, which are
a. Pulmonary valve and
b. Aortic valve.
● The semilunar valves are Located between ventricle and corresponding
arteries.
● Function of the valves: - to ensure blood flows in one direction only.
● Composed of connective tissue and endocardium.
1. Atrioventricular valve: -
● Closes during systole
● Each AV valve consists of a flap of connective tissue that is covered on
both sides by endocardium and is devoid of blood vessels
● Atrial surface of the flap is smooth, while the Chordae tendinae arises
from its free margin and inferior surfaces.
a. Tricuspid valve: -
● Located between right atrium and left atrium
● Has 3 cusps (Anterior, posterior and septal)
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● Base of the cusp is held by Chordae tendinae.

● In between 3 large cusps there are small intermediate
segments that do not reach the fibrous ring.
b. Bicuspid valve: -
● Located between left atrium and ventricle
● Has 2 cusps – Anteromedial and posterolateral cusps.
● The short and thick chordae tendinae are attached to an
anterior and posterior papillary muscle in such a way that each
papillary muscle supports adjacent sides of the both valve
leaflets.
2. Semilunar valves
● Valves of pulmonary trunk and aorta
● They close at the beginning of ventricular relaxation (Diastole)
● Each consisting of 3 nearly equal sized valves, the semilunar cusps
which are formed by folds of endocardium
● The attachment of the semilunar cusps is curved and the artery walls
near the valves are thin and bulging.
● In the middle of free margin of each valve is the nodule of semilunar
cusps.
● Either side of this nodule, running along the valve margin, that is thin
and crescent-shaped rim called lunule of semilunar cusp
a. Pulmonary valve: -
● Between right ventricle and pulmonary trunk
● Consists of anterior semilunar cusps, right semilunar cusp
and left semilunar cusps.
● The wall of the pulmonary trunk opposite the valve
protrudes to form a shallow sinus.
b. Aortic Valves: -
● Located between ascending aorta and left ventricle
● Has 3 cusps, right, left and posterior
● Near the valve hall of aorta bulges outward, forming aortic
sinus
● Left coronary artery arises from aortic sinus of the left
semilunar cusp and the sum for right coronary artery.
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104. Structure of the cardiac wall. Fibrous skeleton of the

heart
● Wall of the heart is made up of 3 layer

1. Epicardium
2. Myocardium
3. Endocardium
● The thickness of the heart, is determined by the myocardium
1. Epicardium: -
● Outer surface of the myocardium
● Lined with shiny smooth epicardium and simple squamous epithelium cells.
● Formed by mesothelium, a thin layer of connective tissue and thick
subepicardial layer of fat. The connective tissue secretes small amount of
lubricating fluid to the pericardial cavity.
2. Myocardium
● Myocardium is composed of cardiac muscle. Which is a large involuntary
striated muscle surrounded by framework of collagen. It is responsible for the
contraction of the heart.
Atrial muscle
● The atrial myocardium can be divided into superficial and a deep layer.
1. superficial layer: - Extends over both atria and is thicker along its
anterior aspect compared to the posterior aspect.
2. Deep layer: - Contained looped fiber or annular fibers that passes to
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the respective atrioventricular orifice of surrounding opening of the

veins.
Ventricular muscle
● Wall of the ventricle contains highly complex arrangement of myocardial
fibers with morphologically distinct subepicardial, middle and
subendocardial layer.
a. Subepicardial layer: - Runs horizontally about the surface of the right
atrium. The left atrium runs longitudinally towards the diaphragmatic
surface. At the apex both ventricle subepicardial muscle forms a
vortex of the heart. They curve around and forms the inner
subendocardial layer.
b. Middle: - Present in left ventricle and Interventricular septum
c. Subendocardial layer: - Contributes to formation of the trabeculae
carneae and papillary muscles.
3. Endocardium
● Inner surface of myocardium is lined with endocardium

● Consists of Endothelial cells, which are simple squamous epithelial tissue
layer and a thin layer of Loose connective tissue
● Lines the cavity and valves of the heart
● Also regulates contraction and aids in cardiac embryological development
Fibrous skeleton of the heart
● Also known as Cardiac skeleton
● High-density single structure of connective tissue that forms and anchors the
valves and influences the force exerted through them.
● The thickest area of condensed connective tissue is found at a site where the
aortic valve, tricuspid valve and bicuspid valve meet. This area is called right
fibrous trigone
● Aortic and bicuspid valve meet is called the left Fibrous trigone
● Pulmonary valve is not anchored by any considerable extend of the cardiac
muscle.
105. Pericardium. Pericardial activity
● Encloses the heart and portion of the great vessel near its base
● Consists of 2 components, outer fibrous pericardium and inner serous
pericardium
● The pericardium is covered on its right and left side by pleura
● Passing between pleura and pericardium is the phrenic nerve
● Bilaterally, accompanying the pericardiacophrenic artery and
pericardiacophrenic vein.
1. Fibrous pericardium: -
● Conical sac folded by collagenous connective tissue with dense fiber
that surrounds the heart without actually being connected to it.
● At various places, it anchors the heart into the thorax
● Caudal portion is joint to the central tendon of the diaphragm
● Anterior portion is attached by the sternopericardial ligaments
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● The rigidity prevents overfilling of the heart.

2. Serous pericardium: -
● Have 2 layers, parietal and visceral.
● Outer layer is called parietal layer. It lines the internal surface of the
serous pericardium.
● Inner is the visceral layer, which forms the outer layer of the heart.
Each layer is made up of single sheet of epithelial cells, called
mesothelium.
Innervation and Vasculation
● Innervation = Phrenic nerve, vagus nerve and sympathetic trunks
● Vasculation = Pericardiacophrenic artery and it is drained by the
Pericardiacophrenic Vein.
Pericardial cavity
● Cavity between the serous layer and fibrous layer of pericardium
● Is filled with pericardial fluid. This fluid is similar to the Cerebrospinal fluid.
● Function: - reduce friction between the pericardium by lubricating the
epicardium surface allowing membrane to glide over each other with each
heartbeat
106. Blood supply of the heart – arteries and veins
● Coronary artery vessels are the vessels that supplies the heart.
Coronary arteries
● 2 main stem that artery straight of the aortic valve
● right and left coronary artery. They both arises from the aortic sinus within
the aorta
● when the heart is relaxed the back flow of the blood fills the valve pocket,
therefore allowing the blood to enter the coronary artery.
Right coronary Artery
● Initially covered by right auricle
● After distributing branches to the right atrium and anterior surface of the
right ventricle, and giving off right marginal artery, it travels posteriorly in
the coronary sulcus to posterior Interventricular sulcus and gives off
posterior Interventricular artery
● RCA supplies right atrium, conducting system, greater proportion of the
right ventricle, posterior part of the intervertebral septum and adjacent
diaphragmatic surface of the heart.
Left coronary artery
● Short stem passes between pulmonary trunk and left auricle before dividing
into the anterior Interventricular artery
● Interventricular artery travels caudally in the anterior Interventricular sulcus
and the circumflex artery, which runs posterior in the coronary sulcus.
● LCA supplies most of the left ventricle, anterior portion of the Interventricular
septum, part of the right ventricle and sternocostal surface of the heart and
the left atrium.
Veins
● 5 tributaries that drain the venous blood into the coronary sinus.
1. Greater cardiac vein: - Originates from apex of the heart and follows the
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anterior Interventricular groove onto coronary sulcus.

2. Small cardiac vein: - Located in the anterior surface of the heart. Passes
around the right side of the heart to join the coronary sinus
3. Middle cardiac vein: - Drains the right side of the heart, located on the
posterior surface of the heart.
4. Left marginal veins:- drains the left posterior side
5. Left posterior ventricular vein: - located in the centre. It runs along the
posterior Interventricular sulcus to join the coronary sinus.
107. Conducting system of the heart
● Hearts conducting system consists of 4 components: -

1. SA node
2. AV node
3. Bundle of his
4. Purkinje fibers
● The specialised cardiac muscles cells generate and conduct spontaneous
rhythmic impulses that stimulate the beating of the heart.
● Cluster of cells are found in 2 sites, where they form nodular structure
known as Sinoatrial node and Atrioventricular node.
● Most of the cells are arranged into bundles, which are divided into
atrioventricular bundle, the right bundle and left bundle.
1. SA node: - Excitation of the signal (Action potential)

● Lies beneath Epicardium on the posterior surface of the right
atrium, near the opening of the vena cava in the sulcus
Terminalis cordis.
● 10 mm long, spindle shaped and also known as the cardiac
pacemaker.
● Spreads around atria, causing them to contract.
2. AV node: - About 5 mm long, located in the Interatrial septum
between the coronary system and the septal cusps of the tricuspid
valve (this location is also called triangle of Koch)
● Receives impulses from the atria, allows them to spread to the
ventricles and delays the spread of the impulse so that the
atria can contract fully and empty.
3. Bundle of his: - Directs continuation from the AV node
● Penetrates the cardiac skeleton as it travels towards the
ventricles
● Carries impulses from the node to the purkynje fibers. Which
allows the waves to spread through the ventricles.
● Splits into 2 branches called right and left bundle branch
● Right bundle, curves downwards and enters the septomarginal
trabeculae to reach the anterior papillary muscle.
● Peripheral branches of the right bundle is the subendocardial
branch, which forms the subendocardial plexus
● Left bundle, fans out in flat bundle along the Interventricular
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septum.
● Divided into 2 major branches, which proceeds to the sum of
the papillary muscles, branch off to form subendocardial
network.
4. Purkinje fibers: - Modified cardiac muscle fibers and hear
accumulation of glycogen in the central portion of the cell.
● Arises from the bundle branches and fascicle from the bundle
of his.
● Spreads the impulse into the ventricular myocardium.
108. Features of the arterial and venous part of the vascular system
NAVID IS DOING IT
109. General structure of the wall of blood vessels. Arteries,

veins and capillaries
● Vessel wall: - Consists of 3 layer

1. Tunica Interna (Intima):-
● Has layer of longitudinally flat arranged flat endothelial cells (Simple
epithelium) that usually rest on basement membrane
● Underneath that them is subendothelial layer (Small amount of connective
tissue)
● Arterial wall additionally has fenestrated elastic membrane called internal
elastic membrane.
2. Tunica Media (Media)
● Middle layer
● Muscular layer and consists of nearby concentric flat spirals of smooth
muscles cells, as well as interwoven elastic fibers
● Thicker in arteries than veins
● It can adjust the luminal diameter of the vessel, which is handy when
the vessel wall changes shape due to pressure of the blood.
3. Tunica Externa (Adventitia)
● Outermost layer
● Consists of connective tissue which in the wall of vein is accompanied by
smooth muscle cells. These cells are arranged in longitudinally also with
collagen and elastic fibers.
Capillaries
● Has thin wall, made up of only endothelial cells
● Very small, measures 5-7 micrometres in width.
● Forms connection between vein and artery.
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110. Vessels and functional properties of the pulmonary

circulation
● It’s a portion of the Circulatory system which carries the deoxygenated blood
from the heart to the lungs for it to get it oxygenated and then brings it back
to the heart and pumps it throughout the body.
● The vessels that are involved in this are
1. Pulmonary artery
2. Pulmonary Vein
3. Capillaries.
● Firstly, Superior and inferior vena cava bring the deoxygenated blood from
the body into the heart, more specifically the right atrium. Later this blood is
pumped through the atrioventricular valve into the right ventricle. Once the
right atrium is filled with blood, it contracts and pushes the blood through
the pulmonary valves (part of the mitral valve) into the Pulmonary artery.
Now, this blood is taken to the lungs where there is a strong capillary
network around a structure called alveoli, this is where the gas exchange
happens. So, here the deoxygenated blood is oxygenated. Now this
oxygenated blood travels from the capillaries into the pulmonary vein, which
brings the oxygenated blood from the lungs to the left atrium. Now this blood
is pushed into the Left ventricle by the bicuspid valve and then from the
ventricle it is pushed to the aorta through the aortic valve and from there, to
the rest of the body.
* Not too sure is this detail is enough, not sure if they also want me to talk about the fetal
circulation. So if anyone has idea, please add in. ☺
111. Aorta – overview
● Rises from the left ventricle of the hear

● Has 3 sections
1. Ascending aorta: - gives rise to the right and left coronary artery
2. Aortic arch: - Gives rise to 3 vessels which supplies the head, neck and arms.
● Arises from the right side as 2-3 cm called brachiocephalic trunk. It
ascends obliquely to the right over the trachea and divided into right
subclavian artery and right common carotid artery.
● Along the left side of the mediastinum, the left common carotid
artery and the left subclavian artery emerges from the aortic arch.
3. Descending aorta: -
● Distal to the subclavian artery
● Tapers slightly to become aortic isthmus, forming junction with
descending aorta
● Divided into thoracic aorta, which extends as far as the aortic hiatus
of the diaphragm and abdominal aorta
● Thoracic part: - gives rise to parietal branch segmentally that passes
as the posterior intercostal artery in the thoracic space of 3-11.
Giving of
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1. subcostal artery
2. smaller, visceral branches
3. Superior phrenic artery
● Abdominal aorta: -
● 1. Parietal branches are given of by abdominal aorta. E.g. Inferior
phrenic artery, lumbar artery and medial sacral artery
● 2. Visceral branches includes celiac trunk, which gives of left gastric
artery, common hepatic artery, splenic artery, Superior Mesenteric
artery, inferior mesenteric artery middle suprarenal artery, renal artery
and ovarian/testicular artery.
112. External carotid artery
The external carotid artery is a major artery of the head and neck.
It arises from the common carotid artery which bifurcates into the external and
internal carotid at the level of the fourth vertebra, within the carotid triangle of the
neck. It’s branches are generally responsible for vasculation of external portions of
the head, as shown below.
It’s branches are:

- Superior thyroid (Supplies thyroid)
- Hyoid, Sternocleidomastoid, Superior laryngeal, Cricothyroid
- Lingual (supplies Genioglossus)
- Sublingual, Deep lingual
- Facial (supplies superficial face)
- Ascending palatine, tonsillar, submental, glandular, inferior labial,
superior labial, lateral nasal, angular (terminal branch)
- Ascending pharyngeal (Pharynx)
- Occipital (supplies scalp and occipital bone)
- Posterior auricular (supplies scalp posterior to auricle and the auricle itself)
- Maxillary (supplies deep structures of the face)
- 16 branches, supplying tympanic, deep auricular, meningeal, deep
temporal, infraorbital and others.
- Superficial Temporal (supplies temple and scalp)
- Transverse facial, middle temporal, anterior auricular, frontal, parietal
Remember: Some Ladies Found Out About P MS
Artery beings at the upper border of thyroid cartilage and curves back, behind
posterior belly of digastric and stylohyoid muscle, and into the space behind the neck
of the mandible where it begins to branch.
113. Internal carotid artery
The internal carotid artery is a major artery of the head and neck.
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It arises from the common carotid artery which bifurcates into the external and
internal carotid at the level of the fourth vertebra, within the carotid triangle of the
neck. It’s branches predominantly supply the brain.
The artery is divided into four parts:

- Cervical segment
- Begins at upper border of thyroid at the carotid bifurcation and runs
up in front of the transverse processes until it enters the carotid canal
in the skull, anterior to the jugular foramen
- Petrous segment
- Enters the canal i the petrous part of the temporal bone, ascends and
then curves forward and medially, and enters the cavity of the skull.
- Cavernous portion
- Here the artery is between the layers of the dura mater forming the
cavernous sinus. This portion of the artery is surrounded by filaments
of the sympathetic nerve
- Cerebral portion
- Having perforated the dura mater on the medial side of the anterior
clinoid process, the artery passes between the optic and oculomotor
nerves where it gives off terminal branches
It’s branches are:

Petrous part
- Caroticotympanic
- Enters tympanic cavity and anastomoses with anterior tympanic
branch of internal maxillary and stylomastoid artery branch of posterior
auricular
- Artery of pterygoid canal
- Passes into pterygoid canal and anastomoses with branch of internal
maxillary
Cavernous part
- Cavernous arteries
- Numerous which supply hypophysis, semilunar ganglion and walls of
cavernous and inferior petrosal sinus
- Hypophyseal
- One or two minute vessels supplying hypophysis
- Semilunar
- Small vessels to semilunar ganglion
- Anterior meningeal
- Passes over wing of sphenoid to supply dura matter of anterior cranial
fossa, anastomoses with meningeal branch of posterior ethmoid artery
(branch of opthalmic artery)
- Opthalmic
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- Enters orbital cavity through optic foramen, below and lateral to optic
nerve, and divides to frontal and dorsal nasal terminal branches.
Gives off a shed load of branches in the meantime, not going there.
Cerebral part
- Anterior cerebral artery
- Passes above the optic nerve, and connects to the anterior
communicating artery and anastomoses with posterior cerebral
arteries Gives of Anterior, posterior, inferior and middle branches.
- Middle cerebral artery
- Largest branch of internal carotid, runs laterally in the lateral cerebral
fissure and then backward and upwards where it divides into branches
to supply the lateral surface of the cerebral hemisphere.
- Posterior communicating artery
- Runs backward from internal carotid and anastomoses with posterior
cerebral, a branch of the basilar, a branch of the vertebral artery.
- Choroidal
- Small, arises near posterior communicating, enters inferior horn of
lateral ventricle and ends in choroid plexus.
The image on the Left is a schematic drawing of the circle of Willis. This shows the
arteries of the brain and brainstem (excluding the middle cerebral arteries). This a
good way of viewing the supply of blood to the brain from the internal carotid.
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114. Ophthalmic artery
The ophthalmic artery has already been mentioned above, it arises from the internal
carotid, just as it emerges from the cavernous sinus. It’s branches supply all of the
structures of the orbit as well as some of the nose, face and meninges.
The branches of the ophthalmic artery are:

- Central artery of retina
- First branch, turns superiorly and penetrates the optic nerve, entering
the eye to supply the inner retinal layers
- Lacrimal artery
- One of the largest branches, branches just as OA enters the orbit and
supply the lacrimal gland, eyelids and conjunctiva
- Posterior ciliary
- Anywhere between 1 and 5 arteries, which perforate the sclera (white
of the eye) posteriorly, near the optic nerve. There are both Long and
short posterior ciliary arteries.
- Muscular branches
- Supplies the extraocular muscles
- Supra-orbital artery
- Passes over optic nerve, through supraorbital foramen to supply
muscles and skin of forehead
- Ethmoidal arteries (Posterior and Anterior)
- Enter the nose via the posterior ethmoidal canal and supplies the
posterior ethmoidal sinuses and then enters skull to supply meninges.
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- Terminal branches
- Supratrochlear
- Forehead and scalp vasculation
- Dorsal nasal
- Forehead and scalp vasculation
115. Maxillary artery
The maxillary artery is the large of the two terminal branches of the external carotid
and arises from behind the neck of the mandible. It is firstly imbedded in the parotid
gland, and then passes between the ramus of the mandible and the
sphenomandibular ligament. From here it passes between the two heads of the
pterygoid muscle through into the pterygoid fossa where it gives off its terminal
branches.
The maxillary artery is divided into three parts:

- Mandibular part (winds around neck of mandible)
- Pterygoid part (travels between two heads of lateral pterygoid muscle)
- Pterygopalatine part (in the pterygoid fossa)
Interestingly, each part gives five branches, the middle five all being branches to soft
tissue so do not course through bony foramina.
The branches are, from the mandibular part:

- Deep auricular
- runs up towards ear and is superficial to the tympanic membrane to
supply blood to external acoustic meatus of ear
- Anterior tympanic
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- also courses near tympanic membrane but is deep to it, through

petrotympanic fissure to middle ear to anastomose around the
tympanic membrane
- Middle meningeal
- passes straight up to foramen spinosum to joint two roots of
auriculotemporal nerve and supplies skull and dura mater
- Inferior alveolar
- passes down towards inferior alveolar nerve, runs anteriorly in the
mandible supplying the pulps of the teeth and the mandible.
Meanwhile its mental branch runs through the mental foramen and
supplies the lip and skin of the region
- Accessory meningeal
- supplies blood to trigeminal ganglion. Passes through foramen ovale
to supply dura mater of the floor of middle fossa and trigeminal cave
Pterygoid part
- Masseteric artery
- runs with lingual nerve and supplies masseter muscle
- Pterygoid artery
- supplies lateral and medial pterygoid muscle
- Deep temporal
- bifurcates into anterior and posterior running between temporalis and
pericranium respectively. Anterior part communicates with lacrimal
artery which then perforates zygomatic bone and great wing of
sphenoid.
- Buccinator artery
- runs between pterygoideus internus and insertion of temporal muscle
to the outer surface of buccinator muscle which it supplies. Also
anastomoses with infraorbital artery, from there it descends down the
nose, anti=parallel to the facial artery.
Pterygopalatine part
- Sphenopalatine artery
- supplies nasal cavity by passing through sphenopalatine foramen into
nose cavity.
- Descending palatine artery
- divides into greater and lesser to supply hard and soft palate
respectively. Descends through greater palatine canal with branches
of pterygopalatine ganglion, the terminal branches anastomose with
the sphenopalatine artery.
- Infraorbital artery
- passes through inferior orbital fissure to emerge with infraorbital nerve
on face
- Posterior superior alveolar artery
- supplies maxillary teeth and posterior wall of maxilla
- Middle superior alveolar
- supplies pharynx and roof of nose
- Artery of pterygoid canal
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- Runs through pterygoid canal, supplies upper part of pharynx and

parts of tympanic cavity
DAMn I AM Piss Drunk, Bu
t St upid Dr unk I Prefer, Must Phone Alcoholics
Anonymous
Maye come up with better, this is a bit dum...)
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116. Subclavian artery
The subclavian arteries are paired major arteries of the thorax that sit just below the
clavicle. The right subclavian is a branch of the brachiocephalic (itself a branch of the
aortic arch) while the Left subclavian comes directly off the aortic arch.
From its origin the subclavian passes between the anterior and middle scalene
muscles, this contrasts to the subclavian vein which is anterior to the anterior
scalene. As the artery crosses the lateral border of the first rib it becomes the axillary
(see Q 117).
The subclavian can be separated into three sections, each with its own branches, the
Thoracic region, the section medial to the scalenus anterior muscle, the muscular
region, the area behind the anterior scalene muscle and the cervical region, the part
lateral to the scalene muscle but before the border of the first rib is crossed.
Thoracic region branches:

- Vertebral artery
- Ascends until it reaches vertebral column at the transverse foramen of
C6, continues through transverse foramen until C1 where it then
enters foramen magnum to supply the brainstem and anastomose
with the internal carotid.
- Internal thoracic
- Descends, behind the sternum and costal cage and branches into
- Superior epigastric (anterior part of abdominal wall, some
diaphragm)
- Pericardiophrenic (supplies pericardium)
- Musculophrenic (supplies diaphragm)
- Thyrocervical trunk
- Ascends and gives off four branches
- Suprascapular (supraspinatus, sternocleidomastoid,
subclavius)
- Transverse cervical (Trapezius, sternocleidomastoid)
- Inferior thyroid (Thyroid gland)
- Ascending cervical (anastomoses with ascending pharyngeal +
occipital)
Muscular region
- Costocervical trunk
- Supreme intercostal artery (supplies upper two intercostal spaces,
deep neck, back, skin of back and vertebral canal)
- Deep cervical artery (supplies deep neck musculature)
Cervical region does not have any branches
Mnemonic:
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Very Tired Individuals Sip S

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117. Axillary and brachial arteries
The Axillary artery travels through the axilla and is responsible for vasculating the
upper limb and parts of the musculocutaneous elements of the scapula and upper
thorax.
The Axillary sits within a neurovascular bundle formed by the artery and the cords of
the brachial plexus, all enclosed by the axillary fascia.
The artery is a continuation of the subclavian, beginning at the outer border of the
first rib. It passes through the axilla with the lateral, posterior and medial cords of the
brachial plexus and ansa pectoralis muscle anteriorly.
The axillary is divided into the first, second and third segments by the pectoralis
minor muscle. Each segment gives of one, two and three branches respectively. The
axillary artery becomes the brachial artery at the inferior border of teres major.
The branches are:

- Superior thoracic
- Acromiothoracic
- Lateral thoracic
- Subscapular
- Anterior circumflex humeral
- Posterior circumflex humeral
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Brachial artery
This is a continuation of the Axillary artery which becomes the brachial artery at the
inferior border of teres major. It continues down the brachial region until the popliteal
fossa at the elbow where if bifurcates into the radial and ulnar arteries.
It is the main blood supply for the brachial region and runs along with the median
nerve and brachial vein.
It maintains a superficial course, just below the deep fascia. It lies upon the lateral sie
of biceps brachii throughout. At its most distal it moves more central, anterior to the
humerus. It gives off four branches, plus its terminals, these are:
- Profunda brachii
- Passes posteriorly to supply posterior part of the arm, terminates in
radial and middle collateral arteries. These anastomose with the Ulnar
collateral arteries.
- Humeral nutrient artery
- Superior ulnar collateral
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- Inferior ulnar collateral

- And its two terminal branches (Ulnar and Radial arteries)
118. Radial and ulnar arteries
The radial artery is the main artery of the lateral aspect of the forearm, arising from
the bifurcation of the brachial artery in the cubital fossa, running along the anterior
portion of the radius.
The artery runs under brachioradialis and then lies lateral to flexor carpi radialis
tendon in the distal forearm. Once in approaches the wrist it winds around the lateral
aspect of the radius and crosses the floor of the anatomical snuff box, passing
through between the heads of the first dorsal interosseous muscle.
The radial artery gives off three branches:

- Radial recurrent artery
- Travels superiorly to anastomose with the radial collateral artery
around the elbow joint
- Palmar carpal branch
- Near border of pronator quadratus
- Runs across the wrist and anastomoses with the palmar carpal branch
of ulnar artery to help supply carpal bones and joints
- Superficial palmar branch
- Enters hand passing through the thenar muscles (medial) and
anastomoses with the superficial palmar arch.
- This is the terminal branch
- Deep palmar branch
- Contributes to deep palmar arch
Supplies thumb, and lateral part of the indix finger (1 ½ digits)

The ulnar artery is the main artery in the medial part of the forearm. It arises from the
bifurcation of the Brachial artery in the cubital fossa. From here it runs down the
anteromedial part of the forearm.
Ulnar artery
During its course it is covered by flexor digitorum superficialis, pronator teres and
flexor carpi radialis. It lies on top of brachialis and flexor digitorum profundus. It
continues to descend down the ulnar side of the arm, passing superficially to the
transverse carpal ligament, as such it is not part of the carpal tunnel. It does however
pass through its own tunnel known as Guyon's canal, along with the ulnar vein and
nerve.
Guyon’s canal is about 4cm in length and is formed by the:

- Roof: Superficial palmar carpal ligament
- Medial border: pisiform
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- Lateral border: hamate

- Floor: pisohamate ligament
The ulnar artery runs with the ulnar vein and ulnar nerve.
It’s proximal branches are

- Anterior ulnar recurrent
- Posterior ulnar recurrent
- emerges just after the bifurcation and move upwards to anastomose
with the ulnar collateral branch of deep brachial artery,
surrounding the elbow joint
- Common interosseous
- Anterior interosseous
- Descends, anastomosing with the dorsal
interosseous artery at the distal end of the
forearm.
- Posterior interosseous
- Passes back through oblique cord and upper
border of interosseous membrane.
- Anastomoses with dorsal carpal network at
lower part of the forearm.
It’s distal branches are:
- Palmar carpal branch (contributes to superficial palmar arch)
- Dorsal carpal artery (terminal) (contributes to deep palmar
arch)
These distal branches supply the dedial 3 ½ digits of the hand.
The superficial palmar arch gives rise to three common palmar digital arteries, which
in turn give rise to the proper palmar digital arteries which supply the medial 3 ½
digits.
The deep palmar arch lies at the base of the metacarpals and it gives off 3 or 4
palmar metacarpal arteries that supply the lateral 1 ½ digits.
119. Aortic arch. Thoracic aorta
The aortic arch is a portion of the main artery that leaves the heart. It is part of the
aorta between the ascending and descending aorta.
The ascending aorta leaves the heart via the left ventricle, located on a level with the
lower border of the third costal cartilage, behind the left half the the sternum. It
passes upward, forward and to the right. At the point of the second right costal
cartilage, when the vessel enters the mediastinum, it is considered the aortic arch.
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The arch itself runs upwards, backwards and towards the left side of the body, in
front of the trachea. The arch can ascend as high as the
midlevel of the manubrium of the sternum.
The arch consists of three branches:

- Brachiocephalic trunk
- The first and largest, to the right and
anterior of the other branches
- Goes on to give rise to the Right common
carotid and Right subclavian
- Left common carotid
- Ascends along the left side of the
trachea through the superior
mediastinum before splitting into internal
and external carotid.
- Left subclavian artery
- Ascends, with left common carotid
through superior mediastinum before
moving laterally.
The arch has a normal diameter of 30mm.
Thoracic aorta
The thoracic aorta is part of the aorta located in the thorax. It is the continuation of
the descending aorta and is contained in the posterior mediastinal cavity.
It beings at the lower border of T4, where the aortic arch ends. It continues until the
aortic hiatus in the diaphragm where it becomes the abdominal aorta.
As it starts it sits on the left of the vertebral column, moving medially as it descends,
and enters the abdomen dead centre, in front of the vertebral column. It has a radius
of approximately 1.1 cm (110mm).
Behind the thoracic aorta is the vertebral column with the hemiazygos vein. To the
right is the azygos vein and thoracic duct (the largest lymph vessel in the system). To
its left sits the left pleura and lung and in front of the thoracic aorta lies the root of the
left lung, pericardium, esophagus and the diaphragm.
The thoracic aorta gives off a number of paired branches, in descending order these
are:
- Bronchial arteries
- Supply the Bronchi
- Mediastinal arteries
- Supply the lymph glands and loose areolar tissue
in the posterior mediastinum
- Esophageal arteries
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- Four or five in number, arise from the front of the aorta, passing down
the esophagus, anastomosis to supply the esophagus with nutrients.
- Pericardial arteries
- Supplies the pericardium
- Superior phrenic arteries
- Supplies the diaphragm
Meanwhile throughout the length of the posterior aspect of the thoracic aorta the
posterior intercostal arteries branch off.
Ben Made Every Person Suffer
120. Abdominal aorta - paired branches 121. Unpaired

branches
The abdominal aorta is the largest vessel in the abdominal cavity, it is a continuation
of the descending (thoracic) aorta. The abdominal aorta starts at the aortic hiatus of
the diaphragm and continues until it bifurcates into the left and right common iliac
arteries at the level of L4.
It travels down the posterior wall of the abdomen, directly anterior to the vertebral
column, following the curvature of the lumbar vertebrae (convex). It runs parallel to
the inferior vena cava which runs to the right.
It is clear to see, if the abdominal aorta runs just anterior to the vertebral column
down to L4, it will be posterior a range of organs as it runs through the abdomen. It is
dividd into two segments, the paravisceral segment, off which the visceral branches
arise and the infrarenal segment, where no branches arise.
We have been told to address the paired and unpaired branches separately, but we
shall look at them in conjunction, differentiating between the two as we go! (Although
we will have separate mnemonics).
……………….
122. Common iliac artery. Internal iliac artery
The common iliac arteries arise from the aortic bifurcation at 4th lumbar. They end in
front of the sacroiliac joint, where they bifurcate into the Internal and external iliac.
They are 4cm long, running along the medial border of psoas muscles, along with
two common iliac veins which lie posteriorly to the right. All blood to the lower limb
flows through these arteries.
The internal iliac arteries are paired and supply the pelvis, buttock, reproductive
organs and the medial part of the thigh. It is about 3 to 4cm in length. Following
biforcation of CIA it passes downard to the upper margin of the greater sciatic
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foramen, dividing into an anterior and posterior trunk. It lies posterior to the ureter,
anterior to the internal iliac vein and runs between external iliac vein and psoas major
muscle.
Branches are:
- Posterior
- Iliolumbar
- Lumbar and Iliac branches
- (supply Psoas major, quadratus lumborum, iliacus)
- Lateral sacral
- Superior and inferior branches
- (runs through anterior sacral foramina, supplies skin
and muscles on dorsum of sacrum, anastomosis with
gluteal)
- Superior gluteal artery
- (runs through greater sciatic foramen, supplies gluteal
muscle)
- Anterior
- Obturator artery
- Anterior and posterior
- (runs through obturator canal, supplies obturator
externus muscle, medial compartment of thigh, femur)
- Inferior gluteal
- (supplies gluteus maximus, piriformis and quadratus
femoris muscles)
- Umbilical artery
- Artery to vas deferens and superior vesical artery
- (supply deoxygenated blood to the placenta or vas
deferens depending on gender. Becomes medial
umbilical ligament)
- Vaginal artery/inferior vesical artery
- (supplies vagina and/or base of bladder)
- Middle rectal artery
- (supplies rectum)
- Internal pudendal artery
- Inferior rectal, perineal artery, posterior labial/scrotal, artery to
bulb of vestibule/penis, dorsal artery of clitoris/penis, deep
artery of clitoris/penis
- (runs throgh greater sciatic foramen. Supplies anal
canal, labia/scrotum, bulb of vestibule/penis, clitoris)
123. External iliac artery. Femoral artery
The external iliac is the corresponding artery to the internal iliac. Proceeds along the
anterior and inferior of the psoas major muscle following bifurcation and exits the
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pelvic girdle posterior and inferior to the inguinal ligament. Once it passes the
inguinal ligament it is known as the femoral artery.
The External iliac has three branches, the inferior epigastric (anastomosing with
superior epigastric), deep circumflex and the terminal branch, the femoral artery.
The femoral artery enters the thigh from behind the inguinal ligament. In the first few
cm it is sheathed in the femoral sheath with the femoral vein, passing behind the
sartorius muscle and medially to the femoral nerve. It can be generally considered
to supply the Anterior compartment of the thigh.
Its branches are:

- Superficial circumflex iliac artery (Runs up to anterior superior iliac spine)
- Superficial epigastric artery (runs into umbilicus, belly button, region)
- Superficial external pudendal artery (supplies skin of scrotum/labium majus)
- Deep external pudendal artery (supplies skin of scrotum/labium majus)
- Profunda femoris (arises 4cm below inguinal ligament, enters medial fascial
compartment of thigh, giving of arteries to supply the muscle compartment)
- Descending genicular artery (supplies knee joint)
124. Popliteal artery. Arteries of leg and foot
The popliteal artery is the continuation of the femoral artery after it passes through
the adductor hiatus (the gap between the adductor magnus muscle). It passes
through the popliteal fossa, ending at the lower border of the popliteus muscle where
it branches into anterior and posterior tibial arteries.
The Popliteal artery runs close to the joint capsule, with five perforating branches
supplying the joint (superior lateral, superior medial, middle, inferior lateral and
inferior medial). These form the genicular anastomosis surrounding the joint capsule
of the knee.
Other than its terminal branches and five genicular arteries, the popliteal provides the
Sural artery which are two large branches that supply the gastrocnemius, soleus and
plantaris muscles.
Arterial supply to the foot is delivered vi the Dorsalis Pedis (a continuation of the
anterior tibial) and the Posterior Tibial.
Dorsalis Pedis begins as the anterior tibial enters the foot, passing over the dorsal
aspect of the tarsal bones, moving inferiorly, dividing into the first dorsal metatarsal
artery and deep plantar artery. The deep plantar artery then anastomoses with the
lateral plantar artery to form the deep plantar arch.
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The posterior tibial artery enters the sole of the foot through the tarsal tunnel where it
splits into lateral and medial plantar arteries, supplying the plantar side of the foot
and contributing to the deep plantar arch.
125. Superior vena cava. Veins of head and neck
The superior vena cava is 24mm in diameter and the vein that returns venous blood
from the upper half of the body into the right atrium of the heart. It is formed by the
left and right brachiocephalic veins which in turn collect blood from the head, neck
and arms.
The SVC is located in the anterior right part of the superior mediastinum.
The brachiocephalic veins are formed by the jugular vein (from the head) and the
subclavian vein (from the arm). Furthermore, the internal thoracic, inferior thyroid and
left superior intercostal vein all drain into the brachiocephalic veins.
- Venous drainage of the brain and meninges is supplied by the dural venous
sinuses.
- Venous drainage of the scalp and
face is supplied by veins
synonymous with the arteries,
which then drain into the jugular
veins.
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- Venous drainage of the neck is carried out be the jugular veins.
The dural venous sinuses are the spaces between the periosteal and meningeal
layers of dura mater. They collect venous blood that drains from the brain and skull,
and ultimately drain into the internal jugular vein.
There are three jugular veins, External, Internal and Anterior.

- The Posterior auricular and Retromandibular vein drain the scalp and face
respectively, these two come together at the angle of the mandible to form the
external jugular vein. The external
jugular then passes underneath the
clavicle and drains into the
subclavian.
- The internal jugular vein beings in
the cranial cavity as a continuation of
the sigmoid sinus, known as the
superior bulb. The vein exits the skull
via the jugular foramen. In the neck
the vein descends through the
carotid sheath, forming the inferior
bulb just prior to joining the
subclavian vein. It also receives
blood from the facial, lingual,
occipital, superior and middle thyroid
veins.
- The anterior jugular veins drain the anterior part of the neck, communicate via
the venous arch and empty into the subclavian vein.
126. Veins of the thoracic wall, the upper part of the

abdominal wall and vertebral column
The anterior aspect of the thorax is drained by the internal thoracic vein, into the
brachiocephalic vein.
The posterior aspect is drained by the azygos system into the Superior Vena Cava.
- 1st intercostal space drained by highest intercostal vein into brachiocephalic
- The right side is drained by azygos system into SVC
- The left side is drained by the Hemiazygos (lower thorax) or accessory
hemiazygos (higher thorax)
Some important veins to note

- The azygos vein runs up the right side of the thoracic vertebral column,
collecting from the posterior walls of the thorax and abdomen, draining into
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the SVC. It is formed by the union of ascending lumbar veins and right
subcostal veins.
- The hemiazygos does a similar job the the azygos, just on the left side. It
collects from the left intercostal veins and drains into the azygos vein at the
level of T9.
- Accessory hemiazygos vein is on the left side and drains 5th-8th intercostal
spaces on the left side of the body.
- Intercostal veins run between each of the veins, numbers 2-4 drain into the
superior intercostal vein, the remainder drain into the azygos vein on the right
and the hemiazygos/accessory azygos on the left.
- The internal thoracic vein collects from the superior epigastric vein and
drains into the brachiocephalic vein.
The vertebral column is drained by venus plexuses formed by veins that run along
the column, both inside and outside the
canal. The two plexuses are the internal
vertebral plexus and the external vertebral
plexus.
The spinal veins are found in the pia

mater. There are longitudinal and lateral
veins:
- Two median longitudinal veins
- Anterior and posterior
- Two pairs of lateral veins
- Enter the vertebral column
with the roots of the nerves
The longitudinal channels drain into the

internal vertebral plexus in the epidural
space, which then drains into the azygos
system in the thorax.
Additionally, there are veins that perforate into the body of the vertebrae itself, these
are known as Basivertebral veins.
127. Inferior vena cava. Veins of the pelvis and lower part
of abdominal wall
The inferior vena cava carries blood from the lower part of the venous system into
the right atrium. It is formed by the joining of the left and right common iliac veins at
the 5th lumbar level. It sits retroperitoneally in the abdominal cavity, running
alongside the right side of the vertebral
column. It passes through the diaphraghm
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at the caval opening, T8. Its key tributaries are:

- L5- common iliac
- L1-L5 lumbar veins
- L2 - Right gonadal
- L1 - Right suprarenal and renal veins
- T8 - hepatic, infra phrenic veins
There are three main veins in the pelvis:

- External iliac
- Continuation of femoral vein, starts at crossing of inguinal ligament
- Receives inferior epigastric and deep
circumflex veins
- Internal iliac
- Responsible for majority of pelvic
drainage, formed near greater sciatic
foramen
- Tributaries correspond with branches of
internal iliac, receiving blood from
superior and inferior gluteal, internal
pudendal, obturator, lateral sacral,
middle rectal, vesical uterine and vaginal
veins.
- Common iliac
- Formed at upper margin of pubic
symphysis by union of internal and
external iliac
- Additionally receives iliolumbar and
middle sacral veins.
The lumbar veins drain the posterior abdominal wall,

draining into the IVC, while the anterior abdominal wall
is drained by a collection of veins including the
epigastric veins (superior, inferior and superficial) and
the two circumflex iliac arteries. These all feed into the
IVC.
The diagram on the right shows a shcematic representation of the azygos, caval and
vertebral systems of veins.
128. Anastomoses between the systems of both venae

cavae (cava-caval anastomoses)
The thoracoepigastric vein (I think this

is what this question relates to) is a
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vein that runs along the lateral aspect of the trunk between the superficial epigastric
vein and the lateral thoracic vein, establishing connection between the femoral and
axillary vein.
Consider that the axillary drains into the SVC, while the femoral drains into the IVC,
as such the thoracoepigastric vein is providing communication between the two VCs,
offering a unique link between the two. Additionally, the Thoracoepigastric vein is
attached to the portal system via the paraumbilical vein, serving as portocaval
anastomosis as well.
129. Superficial and deep veins of limbs
Upper limb:
- Axillary
- Cephalic (runs down lateral side of arm to hand to form )
- Brachial
- Basilic (runs down medial side)
- Median cubital - courses crease of elbow connecting
cephalic and brachial veins
- Both basilic and cephalic help to drain hand via dorsal
and palmar arches.
- Both additionally interlinked with perforating veins down
forearm
The deep veins of the lower limb, we’ll start top down:
- External iliac vein
- Deep vein of thigh
- Femoral vein
- Popliteal vein
- Fibular vein
- Posterior tibial vein
- Anterior Tibial vein
The dorsal and plantar venous arches of the feet drain into the anterior and posterior
tibial veins.
There are two superficial veins, these are the great saphenous
vein, formed by the dorsal venous arch of the foot and the dorsal
vein of the big toe. It goes up the medial side of the leg, massing
anteriorly to the medial malleolus at the ankle, and posterior to the
medial condyle of the knee. It terminates by draining into the
femoral vein just before the inguinal ligament
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The small saphenous vein is formed by the dorsal arch of the foot and the vein of the
little toe, it runs as a up the posterior part f the leg, draining into the popliteal vein in
the popliteal fossa.
130. System of of hepatic portal vein. Porto-caval

anastomosis
So the portal venous system, is fucking genius!!!!
All of the venous blood from the digestive tract

gets collected by veins in the portal system and
feeds the portal vein. The portal vein then feeds
into the liver which is responsible filtering the
blood. So let's look at the portal system in some
more detail.
Portal vein is made up by the following:

- Splenic vein
- Gastric vein (drains fundus of
stomach)
- Left gastro-omental vein (drains curvature of stomach)
- Pancreatic veins (drain the pancreas)
- Inferior mesenteric (drains large intestine)
- Superior mesenteric vein
- Right gastro-omental (drains curvature of stomach)
- Anterior and posterior inferior pancreaticoduodenal (drains pancreas &
duodenum)
- Jejunal vein (drains jejunum)
- Ileal vein (drains ileum)
- Ileocolic (drains ileum, colon and cecum)
- Right colic (drains ascending colon)
- Middle colic (drains transverse colon)
Anastomosis between the systemic venous system and portal venous system is
known as porto-cava anastomosis. Locations of anastomoses are:
- Esophageal - Esophageal branch of left gastric vein with esophageal branch
of Azygos vein
- Rectal - superior rectal vein with middle and inferior rectal veins
- Paraumbilical - paraumbilical vein with superficial epigastric vein
- Retropernal - splenic vein with renal vein
- Intrahepatic - left branch of portal vein with inferior vena cava
Liver cirrhosis which causes portal hypertension can cause damage to these regions,
as such we use these sites of anastomosis for liver cirrhosis indicators.
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131. Fetal blood circulation. Changes in vascular system at

birth
The umbilical cord receives deoxygenated blood from the iliac arteries of the fetus
and returns oxygenated blood to the fetus liver via the inferior vena cava. The
circulatory system of the fetus looks like this:
- Oxygenated blood arrives via the umbilical vein
- ⅓ of the blood enters the inferior vena cava directly, via ductus venosus, the
remainder is mixed with deoxygenated blood in the liver.
- From the inferior vena cava, blood moves from right atrium direct to left atrium
via foramen ovale.
- The ductus arteriosus connects the aorta with the pulmonary artery, further
moving blood away from lungs. Blood then enters systemic circulation.
- Blood from the descending aorta then enters the umbilical arteries, where it
goes back to the placenta
At birth a number of changes take place to the vascular system:

- With the activation of breathing, the lungs become distended and the capillary
network in the lungs have their resistance drastically reduced. This means
blood flow can take place in these capillaries (previously the resistance was
too high so no blood passed through the pulmonary capillaries)
- This pressure change in the lungs results in the dropping of right atrial
pressure, as such foramen ovale becomes closed, creating fossa ovalis.
- The cutting of the placenta sees an increase in peripheral resistance, as such
the higher aortic pressure sees the ductus arteriosus turned around, and after
a few months it is obliterated and the remnants known as ligamentum
arteriosus.
- Similarly, the severing of the umbilical cord leads to the transformation of the
umbilical vein into ligamentum teres hepatis.
132. Lymphoid system. Overview. Structure of the wall of

the lymphatic vessels. Main lymphatic vessels
The lymphatic system is a network of tissues and organs that help the body remove
toxins and other unwanted material. The primary function is to transport lymph, a fluid
rich in white blood cells, throughout the body.
There are hundreds of lymph nodes, where the lymph is filtered, connected by lymph
vessels. The lymphatic system will take up interstitial fluid within these vessels and
transport it to the lymph nodes, where the lymph is monitored and cleaned as it filters
through. There are also specific lymph organs (such as the Tonsils, Thymus and
Spleen) which either provide a specific site for tacking down pathogens, or are where
leukocytes can be developed.
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Lymph vessels run through capillary beds, collecting approximately 3 liters of

interstitial fluid each day. Lymph capillaries are made of loosely overlapping
endothelial cells which allow for the movement of fluid in, but not out. Lymph vessels
work similarly to veins with a thin layer of smooth muscle, and valves to prevent back
flow.
The main lymph vessels in the body are the Right lymphatic duct (collects from right
arm and head) and thoracic duct (collects from left side, head, torso and lower body),
which drain directly into the right and left subclavian veins respectively.
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133. Lymph node - structure
Lymph nodes are ovoid structures of which there are about 600 of in the body, with
clusters found in the underarms, groin, neck, chest and abdomen. They are linked by
lymphatic vessels and are major sites of T and B lymphocytes as well as other white
blood cells.
Their size is up to 1cm long, surrounded by a fibrous capsule, with indentations

known as Trabecula. The node is divided into the outer cortex and inner medulla.
The cortex consists of B cells in the outer layer and T cells in the inner layers. The
cortex also includes a germinal centre which is the point of mature B cell proliferation.
The medulla contains predominantly macrophages along with plasma cells, and B
cells as well as sinuses for the lymph to flow into.
The junction of the efferent vessel and the node is known as the hilum, where the
lymph first flows out off.
134. Tonsils - structure
The term ‘Tonsils’ covers the adenoid tonsil, two tubal tonsils, two palatine tonsils
and the lingual tonsil. They are an example of Mucosal associated Lymphatic Tissue
(or MALTS). The palatine tonsils are the obvious one that hangs down either side at
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the back of the throat. The tonsils act to cover the aerodigestive tract as one of the
first lines of defence.
The adenoid tonsils contain respiratory epithelium, with small folds, it is found at the
roof of the pharynx.
The tubal tonsils contain respiratory epithelium, found at the roof of the pharynx.
The palatine tonsils contain non-keratinized stratified squamous epithelium, with a

network of pits storing B cells. It is located to the sides of the oropharynx.
Lingual tonsils contain non-keratinized stratified squamous epithelium, with a network

of pits, it is located behind the terminal sulcus.
All tonsils have a surface specialized with M cells to capture antibodies and alert the
underlying B cells and T cells. B cells are proliferated in the germinal centers of the
tonsils, these centers are where B memory cells are created and secretory antibodies
produced.
135. Thymus
The thymus can be seen as both an endocrine gland and associated with the
immune system. It offers a role of training and developing T-lymphocytes.
It i about 5cm by 4cm and 6cm thick. It enlarges in children and atrophies at puberty,
being barely distinguishable in old age. It consists of two lateral lobes close to the
midline, extending from the fourth costal cartilage upwards toward the lower border of
the thyroid gland, overlying the sternum with the pericardium below.
Each lateral lobe is surrounded by a fibrous capsule and consists of multiple lobules,
held together by areolar tissue. Each lobule is made up of nodules (solid, elevated
areas of tissue or fluid) or follicles
Follicles are irregular in shape and less fused together, each consists of a medulla
and cortex.
The function of the Thymus is to develop T cells to ensure

they only attack foreign cells. T cells first go to the cortex
where they come into contact with epithelial cells
presenting antigens. Those that respond correctly survive
and migrate to the medulla where they are presented with
the body's own antigens to test for autoimmunity.
Note image on right shows Hassall’s corpuscle, these are

eosinophilic type VI epithelial reticular cells which nobody
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knows what they do. WHO WANTS A NOBEL PRIZE FOLKS ;)
Thymus blood supply comes from the internal thoracic, superior and inferior thyroid
arteries.
136. Spleen
The spleen is a lymphatic organ that filters and stores blood to protect the body from
infections and blood loss. It sits between the stomach and left hypochondriac region
of the abdominal cavity. It is approximately 4 inches long and well vasculated by the
splenic artery.
The spleen has two surfaces, diaphragmatic and visceral. And includes a Hilum,
superior, inferior and intermediate border with two poles. It is intraperitoneal and
surrounded by the following peritoneal ligaments:
- Gastrosplenic
- Splenorenal
- Phrenicocolic
The spleen is covered with a tough CT capsule with two other tissue components:
- White pulp
- Lymph nodules, arranged around a central arteriole called the
Malpighian capsule, contains B and T-lymphocytes
- Red pulp
- Collection of cells in between the sinuses of the spleen, it contains
lymphocytes, blood cells as well as fixed and free macrophages.
The red pulp provides the important function of phagocytosis.
The white pulp helps activate immune response through humoral and cell mediated
pathways.
Furthermore, RBCs are stored in the spleen while they are actually created during
gestation.
137. Bone marrow
There are two types of bone marrow. Red bone marrow, red due to an abundance of
blood and hemopoietic cells. and Yellow bone marrow, filled with adipocytes and
essentially excludes hemopoietic cells.
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As we age bone marrow generally transfers from red to yellow. Red bone marrow
is mainly found in flat bones such as the pelvis, sternum, cranium etc, and the
spongy material at the epiphyseal ends of long bones.
We use the term stroma to indicate which is bone marrow tissue not related to
hematopoiesis. Much of this is made up by yellow bone marrow. The stroma is a
meshwork of specialized fibroblastic cells with supporting hematopoietic cells.
The cells that make up red bone marrow are:

- Myelopoietic cells
- Erythropoietic cells
- and Other cells (plasma, reticular, lymphocytes, monocytes, megakaryocytes)
In addition bone marrow consist of hematopoietic stem cells which give rise to
Leukocytes, erythrocytes and platelets.
The matrix of the bone marrow also consists of the same substances as bone
(collagen type I, proteoglycans, fibronectin and laminin).
Bone marrow has important hematopoietic properties:

- All blood cells, both Red and White, originate from bone marrow, developing
from hemocytoblast cells found in the bone marrow.
- Additionally, all granulocytes develop from the
bone marrow, and re directly released into the
bloodstream.
- Finally B cells are produced in their immature
phate prior to being released to lymphoid tissue
where it matures and waits to be called into action.
138. Lymphatic vessels and regional

lymph nodes of head and neck
The ever lyrical gray’s anatomy states “a discussion of the

lymphatics of the neck becomes a summary of the lymphatics of the head and neck”,
so let's have a look at the two together. Superficial and Deep lymph nodes supply the
region, the superficial ones hug the external jugular vein, while the deep ones form a
chain along the internal jugular vein.
Superficial
- Occipital nodes
- Mastoid nodes
- Parotid nodes
- Submandibular nodes
- Submental nodes
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The first two of these nodes (occipital and mastoid) drain into superficial nodes along
the external jugular vein. The remainder drain into the deep jugular nodes along the
internal jugular vein.
Deep cervical
The deep cervical nodes include the Jugulodigastric node and jugulo omohyoid node,
both are connected by the deep cervical lymph chain.
139. Lymphatic vessels and regional lymph nodes of limbs
All lymphatics from the upper limb drain into lymph nodes in the axilla. The axillary
nodes also receive drainage from the adjacent trunk, including regions of the upper
back, shoulder, lower neck, chest and upper abdominal wall. There are generally
some 20-30 lymph nodes in this region. They are divided into group based on
location:
- Humeral (lateral) nodes - posteromedial to the axillary vein, most of the
drainage from upper limb
- Pectoral (anterior) nodes) - occur along inferior margin of pectoralis minor,
drainage from abdominal wall, chest and mammary gland
- Subscapular nodes (posterior) - on posterior axillary wall with subscapular
vessels, drain from back, shoulder and neck
- Central nodes - embedded in axillary fat, receive from humeral, subscapular
and pectoral nodes
- Apical nodes - most superior, drai all other nodes in the region as well as from
cephalic vein and superior region of mammary gland.
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Superficial lymphatic vessels arise from the lymphatic plexus on the skin of the hand
which then ascend up the arm shadowing the basilic vein (run medial to it) and the
cephalic vein. Both vessels terminate in apical nodes.
Deep lymphatic vessels follow the deep veins (i.e. radial, ulnar and brachial)
terminating in the humeral axillary lymph nodes.
140. Thoracic lymphatic vessels and lymph nodes
Lymph nodes in the thorax are either parietal or visceral. These include:
- Parasternal - placed at the end of intercostal spaces by the internal thoracic
artery, drain into bronchomediastinal trunk
- Intercostal - found in intercostal spaces, receive deep lymphatics from the
postero-lateral aspect of chest, drain into right lymphatic duct or thoracic duct
- Superior diaphragmatic - receie lymph from diaphragm, surface of liver and
connected to lumbar lymph (anterior, middle and posterior respectively)
drains into ??
- Anterior, middle and posterior
- Trachea and bronchi - collects from lungs, bronchi, heart and trachea, drains
into bronchomediastinal trunk.
- Superior, inferior, bronchopulmonary, paratracheal and
intrapulmonary.
Main vessels are:

- Thoracic duct
- Longest lymph vessel. Starts at T12 and extends to root of neck.
Drains into angle of left subclavian and internal jugular vein at start of
brachiocephalic vein. Collects from most of the body other than right
thorax, arm, head and neck which are drained by right lymph duct.
- Right lymphatic duct
- 1.25cm in length along medial border of scalenus anterior at root of
neck. Drains into right subclavian and internal jugular vein angle at
start of brachiocephalic vein. Collects right side of thorax, arm, head
and neck.
- Bronchomediastinal lymph trunk
- Combination of tracheobronchial, internal mammary and anterior
mediastinal lymph vessels come together to form bronchomediastinal
lymph vessel. It can be through to as the chest and thoracic wall
collector, which then feeds into Right lymph or thoracic duct.
141. Abdominal lymphatic vessels and lymph nodes

Go onto this wikipedia page (or indeed any lymph page) look at the bottom, it has a
little table with all of the nodes and vessels divided by region, else you’ll be looking in
greys for years!
https://en.wikipedia.org/wiki/Bronchomediastinal_lymph_trunk
142. Pelvic lymphatic vessels and lymph nodes
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Section 4: Nervous System

143. General principles of organization of the nervous system
The nervous system is responsible for sending and receiving signals throughout the body
and is responsible for all movement. We can divide the nervous system as follows.
Nervous tissue consists of non-excitable tissues (supportive cells) and excitable tissue
(Neurons). Non-excitable are:
- Neuralgia - Present in CNS (secrete myelin and create myelin sheath, as well as
passing on nutrients and getting rid of waste)
- Schwann (secrete myelin) and satellite cells (surround neuron cell bodies) - present
in PNS
144. Development of the nervous system

When looking at the development of the nervous system we must first consider the
evolutionary development and then the embryonic development.
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Early invertebrates (such as hydras and jellyfish) had a “nerve net” or reticular nervous
system Later, worms, insects and mollusks developed a ganglionic system where two
parallel nerve ganglion, with attaching nerves, ran along the body like a ladder, with a
primitive ganglion at the front in the head.
Vertebrate nervous systems are ‘tubular’ and the subphylum Vertebrae are all part of the
Chordate Phylum. By definition animals in the Chordate phylum develop a dorsal nerve cord.
The development of the nervous system of different class of animals varies, as summed up
below:
- Primitive vertebrates - fish
- Hindbrain - the largest regional
- Cerebellum well developed for swimming and balance
- Small midbrain
- Small forebrain
- Amphibians - frogs
- Hindbrain - more enlarged
- Cerebellum reduced in size
- Forebrain - still small
- Reptiles and birds
- Cerebellum and midbrain enlaged
- Forebrain regions more developed
- Mammals (incl humans)
- Cerebellum increased
- Telencephalon well developed
Embryogenesis
The nervous system comes from the Ectoderm layer, specifically the
neuroectoderm. Neurulation is the term given to the formation of the
neural tube from the ectoderm of the embryo and it follows the
gastrulation phase in all vertebrates. Neurulation is triggered by the
notochord (a flexible rod shaped body that runs along the back of the
embryo formed from the mesoderm). At the third week the notochord
sends signals to the ectoderm stimulating neurulation.
- The first stage is the formation of the neural plate, which is the
origin of the entire nervous system.
- The neural plate folds outwards to form the neural groove, along
with the tops of the folds now being known as neural crests. The
neural crests in turn close together to form the neural tube.
- The spinal cord forms from the lower part of the neural tube,
with the wall consisting of neuroepithelial cells which
differentiate into neuroblasts, which in turn form nerve cells.
Late in the fourth week brain formation beings. The three primary brain
vesicles are:
- Prosencephalon
- Mesencephalon
- Rhombencephalon
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In the fifth week the brain continues to divide and we can see five separate brain vesicles,
these are.
- Telencephalon (Procephalon origin)
- Diencephalon (Procephalon origin)
- Mesencephalon
- Metencephalon (Rhombencephalon origin)
- Myelencephalon (Rhombencephalon origin)
As mentioned above, the neural tube contains neuroepithelial cells which in turn go on to
make the tissues of the nervous system. Neuroepithelial cells are the undifferentiated ‘stem’
cells of the nervous system and can differentiate down numerous different pathways.
Their development begins by non-specific self proliferation. At the stage of brain

development neuroepithelial cells begin to give rise to non-stem cell progenitors.
Neuroepithelial cells can divide into the following:
- Apolar neuroblast
- Bipolar neuroblast
- Multipolar neuroblast (from which nerve cells develop)
- Glioblast
- Oligodendrocyte
- Protoplasmic astrocyte
- Fibrillar astrocyte
- Ependymal cell
In the wall of the neural tube the cells divide and the neuroblasts begin to move along to find
their final position in the brain. They migrate with the support of Radial glia which support
and guide the migrating neurons.
Every nerve cells then reaches its respective area and developes a long outgrowth, this
outgrowth then feels out which neurons it should make the synapse with. Those cells which
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are able to form synapses live, those which do not undergo apoptosis and die. Most of the
nerve cells at this point die. This process is genetically regulated, but environmental factors
are also very important.
145. General principles of the histophysiology of the nervous system
The nervous system is made up of Nerve cells

(neurons) and glial cells (neuroglia).
Nerve cells:
- Cell body
- Axon - carry signal away from soma
- Dendrites - carry signal towards soma
- Neuron types include
- Pseudo unipolar
- Bipolar
- Multipolar
- Neurons provide Sensory or Motor impulses
Glial cells
- Astrocytes (nutrients to nervous tissue as well as other jobs)
- Oligodendrocytes (secrete myelin CNS), schwann cells (secrete myelin PNS)
- Microglia (resident macrophages in CNS)
- Ependymal cells (produces CSF in CNS)
Nerve cells function by passing action potentials through their axons which are then
transmitted across synapses by electrical or chemical synapses. For more detail review the
Physiology notes on this topic.
Synapses consist of:

- Synaptic terminal
- With presynaptic membrane and synaptic vesicles
- Synaptic cleft
- Postsynaptic membrane
- With neurotransmitter receptors
Synapses can be:
- Axodendritic, axosomatic, axoaxonic or others depending on where the axon meets
the other neuron
- Electrical or chemical types. Chemical types utilize neurotransmitters while electrical
types rely on the direct change in polarity transmitted via gap junctions.
- Excitatory and inhibitory, depending on the neurotransmitter
Review Physiology notes, questions 8 and 9, they cover this in excruciating detail!!!
146. Spinal cord - shape, topography, blood supply

The spinal cord extends from the foramen magnum to L1/LII. There are some key
topographic elements to be aware of.
- Cervical enlargement
- The cervical region of the spinal cord is widened
- Lumbar enlargement
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- The lumbar region of the spinal cord is widened

- Conus medullaris
- The cone shaped ending of the spinal cord
- Filum terminale
- A filament of connective tissue running from the conus medullaris down to the
coccyx
Furthermore, be aware that the final lumbar spinal nerves have roots that descend inferiorly
forming the cauda equina (horse's tail) structure, where the roots of the final spinal nerves
descend down the canal to exit out of the correct transverse foramen. More on this below.
When considering the surface structure of the cord itself, there are some elements to be
aware of:
- Anterior median fissure
- A fissure that extends the anterior length of the cord, housing the anterior
spinal artery
- Posterior median sulcus
- This is a groove that extends along the posterior surface of the cord
- Two Posterolateral sulci
- Grooves on the posterior surface that house the posterior spinal arteries, and
are where the posterior roots of the spinal nerves attach.
The cross section of the spine also consists of two basic elements:
- Gray matter - rich in nerve cell bodies, forming longitudinal columns along the cord.
This forms a characteristics H (or butterfly) shape.
- White matter - surrounds the gray matter, rich in nerve cell axons which forms large
bundles (tracts)ascending and descending in the cord to
carry information up and down the cord.
The blood supply for the cord comes from two sources:
- Longitudinal vessels
- Anterior spinal artery
- Originates from within cranial cavity as the
union of the two vertebral arteries
- Posterior spinal arteries (there are two)
- Each vertebral artery gives off a posterior
inferior cerebellar artery, which in turn
gives off a posterior spinal artery.
- Transverse vessels
- These are feeder arteries that enter the vertebral
canal through the intervertebral foramina at every level.
- These are branches of the vertebral and deep cervical arteries in the neck,
posterior intercostal arteries in the thorax and the lumbar arteries in the
abdomen.
- These vessels watch the course of the spinal nerve roots, also supplying their
blood supply.
147. Gray Columns of spinal cord. Spinal laminae

The gray matter of the spinal cord is divided into three columns:
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- Anterior gray column (or anterior horn)

- Posterior gray column (or posterior horn)
- And Lateral gray column (or lateral horn)
This question will discuss the content of each of these horns.
The anterior gray column is responsible for efferent signals to skeletal muscles and
comprises of three different types of neurons:
- Large alpha motor neurons
- Innervate skeletal muscle, responsible for muscular contraction
- Medium gamma motor neurons
- Innervate skeletal muscle that serves as specialized sensory organs for
proprioception (the recognition of where your arms and legs are). Have
smaller bodies than alpha neurons
- Small, interneurons
- Not well understood, both excitatory and inhibitory
The posterior grey column is the insertion point of the posterior, afferent, spinal nerve roots.
It is divided into several spinal laminae, different laminae are for different types of sensory
information. Importantly, the posterior grey column houses six of the ten spinal laminae, as
we’ll deal with all of these later we’ll leave this here.
The lateral grey column is part of the sympathetic nervous system and receives input from
brainstem, organs and hypothalamus. It is only present in the thoracic and upper lumbar
segments. It contains neurons supplying nerves to the muscles of the limbs, preganglionic
cell bodies of the autonomic nervous system, as well as sensory and relay neurons
Laminae
Lamina I
- Also known as marginal nucleus of spinal cord, the neurons here receive input from
lissauer’s tract (see tracts of white matter), relaying information relating to pain and
temperature via the spinothalamic tract on the opposite side of the cord.
Lamina II
- Substantia gelatinosa of
Rolando, found at the apex of
the grey column, and gets
information from the
spinothalamic tract as well as
dorsal columns. It receives
information about both painful
and nonpainful stimuli. The
information is then sent to
laminae III and IV.
Lamina III and IV
- Termed Nucleus proprius,
adjacent to substantia
gelatinosa, it carries touch and
proprioception information, relaying it to areas of the brainstem, brain and other
laminae.
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- Lamina III and IV make up the Nucleus proprius (NP).

Lamina V
- Neck of the dorsal horn, the neurons here are involved with processing sensory
stimuli from cutaneous, muscle and joint mechanical nociceptors as well as visceral
nociceptors.
Lamina VI
- Has a medial and lateral section.
- Medial layer gets input from muscle spindles regarding level of muscle stretch
- Lateral layer gets information from the brain and brainstem via descending
tracts
- The neurons in this layer send information to the cerebellum and motor neurons in
the anterior horn.
- Direct communication between the motor neurons and laminae VI mean VI is
responsible for spinal reflexes
Lamina VII
- Most prominent between C8 and L2, also known as dorsal nucleus of Clarke.
- Receive lower extremity position and sensory information and then pass that
information to the cerebellum via the dorsal spinocerebellar tract
- Furthermore, Sympathetic and parasympathetic preganglionic neurons for the
visceral organs sit in Lamina VII, these neurons are responsible for flight or fight and
rest and digest.
Lamina VIII
- This lamina obtains information from the reticulospinal (maintains tone in muscle
flexors) and vestibulospinal (maintains tone in muscle extensors) tracts.
- This layer takes this competing information and helps to modulate movement and
muscle tone
Lamina IX
- Contains alpha, beta and gamma
motor neurons of the cord. These are the
neurons responsible for muscle
movement.
- The neurons in this lamina closer to the
centre of the cord control axial
muscles and those towards the
periphery control the muscles of the
limbs. Similarly, those neurons
responsible for movement of the
posterior parts of the body are
posteriorly located and those
responsible for movement of the anterior parts of the are anterior.
Lamina X
- Nobody's entirely sure what happens here, but these neurons surround the spinal
canal.
Please Penny, TaP, Sally More Exuberantly To Acheive Unknown
148. White substance of spinal cord. Roots. Propriospinal tract

The white matter of the spinal cord surrounds the gray matter. It consists of the myelinated
axons of neurons, whose cell bodies sit in the gray matter. It acts as a relay and coordinates
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communication between different regions of the brain. It’s colour is derived from the myelin
which is made of lipid tissue that appears white. It is worth noting that white matter also
contains lots of glial cells.
Spinal white matter does not contain dendrites, which are only found in grey matter. The
white matter consists of different kinds of tracts. Tracts are bundles of axons that connect
one part of the brain or spinal cord to another. There are three types of tracts within the
white matter:
- Projection tracts
- These extend vertically between higher and lower parts of the CNS, carrying
information between the cerebrum and the rest of the body.
- Commissural tracts
- These cross from one cerebral hemisphere to another via bridges called
commissures.
- Association tracts
- Connect different regions within the same hemisphere of the brain
The white matter of the spine consists of a number of

projection tracts, both ascending and descending,
these are covered in detail in the two questions
below.
Roots
Spinal nerves have Dorsal and Ventral roots that
stem from the Dorsal and Ventral horns of the spines
grey matter. The dorsal root contains afferent signals
while the ventral root contains efferent signals.
These then come together in the spinal nerve

ganglion where the nerve fibers combine and then
resplit to form the dorsal and ventral rami of the
spinal nerves.
The roots emerge from the intervertebral foramen

between adjacent vertebrae (except for the first pair
(C1) which emerges from between occipital bone
and atlas, this is why the cervical region has 8 spinal
nerves, not 7).
Note how the dorsal root has a dorsal root ganglion,

this is where the bodies of the nerves feeding into the spinal cord are situated. The dorsal
root fibers segregate into lateral and medial divisions. The lateral divisions contain mostly
unmyelinated and small myelinated axons with information regarding pain and temperature,
for laminae I, II and IV. Meanwhile the medial division consists of myelinated axons
conducting sensory information from skin, muscles and joints, entering the posterior column.
Propriospinal tract
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Propriospinal tracts are collections of nerve fibers (of any direction) that connect various
levels of the spinal cord. They are located in the white matter of the spinal cord, and
generally broken into three categories based on location within the cord:
- Ventral propriospinal tract
- Dorsal propriospinal tract
- Lateral propriospinal tract
For details on the specific tracts within these regions see the below two questions.
149. Ascending tracts in spinal cord

The ascending tracts of the spinal cord are sensory tracts carrying information up from the
spinal cord to the brain. Note, the namings of the spinal cord are based on their origin and
termination (e.g. spinothalamic tract goes from spine to thalamus). The ascending tracts
are:
- Lateral spinothalamic
- Pain, temperature and crude touch
- Anterior spinothalamic
- Light touch & pressure
- Posterior spinocerebellar
- Unconscious proprioception and muscular co-ordination
- Anterior spinocerebellar
- Unconscious proprioception and muscular co-ordination
- Fasciculus gracilis
- Fine touch
- Fasciculus cuneatus
- Fine touch
1st, 2nd and 3rd order neurons.

Each consciously processed tract has three types of neurons, first, second and third. These
are distinguished based on their origin and their termination.
- 1st order - primary afferent neuron
- These always remain ipsilateral (same side of the body)
- Arise from sensory receptors of the body
- Enter the white matter and end at the substantia gelatinosa
- 2nd order
- Synapse with 1st order as they enter substantia gelatinosa
- Cross across to the other side of the spinal cord
- Are responsible for decussation to the opposite side of the body
- Enters the ventral posterolateral nucleus of the thymus
- 3rd order
- Arise from the thymus and are carried into the somatosensory cortex
Now we have looked at the neuron types involved we will consider these ascending tracts in
turn.
Spinothalamic tract:
- This is a sensory pathway from the skin to the thalamus, obviously via the spinal
cord.
- Information comes from the spine into the ventral posterolateral nucleus of the
thalamus, then to the somatosensory cortex of the postcentral gyrus.
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- This tract has what is known as somatotopic organization, that is to say each point of
the tract relates to a specific part of the body, the bigger the part, the greater the
sensitivity of the area.
- The pathway decussates at the spinal cord level. This occurs via the anterior white
commissure, usually 1-2 spinal nerve segments above the point of entry.
Fasciculus gracilis and Fasciculus cuneatus

- Fine touch, proprioception and vibration
- Cuneatus carries fibers from upper limb, gracilis from lower limb.
- The cuneatus is lateral to the gracilis within the spinal cord cross section.
Spinocerebellar tract (Subconsciously processed information therefore don’t have three

neuron setup described above)
- Axonal fibers that originate in the spinal cord and terminate in the ipsilateral
cerebellum.
- This tract conveys information about length and tension of muscle fibers
- Information obtained by Golgi tendon organs (nerves around tendons) and muscle
spindles (nerves around muscles).
- The sensory neurons enter the gray matter and synapse in an area known as
Clarke’s nucleus (Laminae VII). These neurons then send axons up the spinal cord
where they remain on the same side.
NB! It is worth reiterating, the laminae that are talked about above are the cross sectional
view of these tracts! So each laminae is describing the tracts at a cross sectional view.
150. Descending tracts in spinal cord

So descending tracts carry information from the brain out to the body. We can divide these
tracts into Pyramidal and Extrapyramidal. Those which are pyramidal pass through the
medullary pyramids, those that are extra-pyramidal, surprise surprise, do not.
Pyramidal
- Corticospinal tract
- Divided into Lateral and anterior.
- These tracts carry voluntary movement commands from the brain to the body
- Lateral tract carries signals for the limbs, anterior tract signals for the body
Extrapyramidal (involuntary movement)
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- Rubrospinal tract
- Originates in the magnocellular red nucleus (midbrain)
- Decussates in the brain
- Travels through lateral funiculus of the spinal cord, largely terminating in the
cervical region.
- Primarily responsible for involuntary flexion of upper limb
- Tectospinal tract
- Originates in the superior colliculus and crosses over the midline immediately
- Runs through the anterior funiculus of the spinal cord and majority of fibers
terminate in the upper cervical levels.
- Thought to be involved in reflex movement of the head
- Vestibulospinal tract
- Lateral and Medial
- Originates in the vestibular nucleus (lateral and medial).
- Lateral courses through brainstem and then anterior funiculus of the spinal
cord, remaining ipsilateral.
- Medial splits into two and courses bilaterally through brain stem via medial
longitudinal fasciculus, exits at or above T6.
- Are involved in postural adjustments and head movement, as well as overall
body balance.
- Reticulospinal tract
- Medial and Lateral
- Descends from reticular formation of the brain
- Primarily involved in posture control and muscle tone
- Remain ipsilateral throughout
Note! See above image for placement of tracts.
151. Meninges and blood supply of spinal cord

The spinal cord has three membranes known as meninges with accompanying spaces,
these are:
- Dura matter on the outermost membrane
- Superiorly it is continuous with the inner meningeal layer of cranial dura mater
at the foramen magnum
- Inferiorly it narrows at SII to form a sheath for the filium terminale. This then
attaches to the coccyx
- Spinal nerves and their roots are surrouned by tubular sleeves of dura matter
which then merge with the neural covering (the epineurium).
- Arachnoid mater
- Is a thin membrane that is against but not attached to the deep surface of the
dura matter
- Ends at the level of SII
- Between arachnoid mater and Pia mater is the Subarachnoid space with CSF
- Pia mater
- Is firmly adhered to the surface of the spinal cord, extending into them median
fissure and reflecting around the roots of the spinal nerves
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- The pia mater also forms 21 denticulate ligaments on either side of the spinal
cord which attach it to the arachnoid and dura mater. This functions to anchor
the spinal cord to the three meninges.
Or, PAD (inner to outer)
The spinal cord is supplied by:

- Longitudinal arteries
- Anterior spinal artery
- Two posterior spinal arteries
- Horizontal arteries
- Anterior and posterior reticular arteries
The two longitudinal arteries are branches of the vertebral arteries, themselves branches of
the subclavian. These arise from within the cranial cavity at the level of the medulla
oblongata.
As the vertebral arteries arise from the subclavian the pass through the transverse foramen
of the cervical vertebrae, moving up towards the brain. After traveling through the foramen
magnum they then anastomose to form the basilar artery, which gives off the anterior spinal
artery. The posterior spinal arteries come directly off the vertebral arteries, splitting prior to
the formation of the basilar artery.
The horizontal arteries come from segmental arteries. These enter the vertebral canal
through intervertebral foramen and arise from different vessels depending on the segment of
the body. Divided segmentally, the origin of the various arteries are:
- Cervical region
- Vertebral artery
- Deep cervical artery
- Thoracic region
- Posterior intercostal arteries (a branch of the thoracic aorta)
- Abdominal region
- Lumbar arteries (a branch of abdominal aorta)
In each segment, as the segmental spinal artery enters the canal via the intervertebral
foramen it gives of anterior and posterior reticular arteries, these follow the path of the nerve
roots, supplying them with blood. Some segments also give a segmental medullary artery,
these anastomose with the longitudinal vessels and supply additional arterial blood.
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The venous drainage of the spinal cord follows a similar trend with anterolateral and
posterolateral spinal veins running longitudinally, either side of the spinal roots, along with an
anterior and posterior spinal vein, running medially, front and back, of the spinal cord.
These veins then drain into the internal vertebral venous plexus which sits inside the
extradural space which drains to the external vertebral venous plexus which then drains into
the ascending lumbar and azygos veins.
152. Encephalon (Brain) - Overview and development

The thing to first get your head around regarding the brain is the multiple ways you can
divide up sections of the brain. In this question we will address these in depth as a good
understanding of the overview will be important for the like, loads of the questions.
Understand this and we’re well on our way to understanding a big chunk of this topic,
consider this high yield.
Division by ‘age’
The human brain has evolved over time and has three layers:
- Brain stem
- Sits in the posterior part, joining the spinal part to the rest of the brain, it is
structurally not dissimilar to the spinal cord.
- Includes the medulla oblongata, the pons and the midbrain
- Provides main motor and sensory innervation to the face and neck via cranial
nerves. Of the 12 cranial nerves 10 originate from the brain stem.
- Cerebellum
- Sits at the posterior base of the brain
- Responsible for motor control and some cognitive functions
- Damage to this region leads to disorders in fine movement, equilibrium,
posture and motor learning.
- Cerebrum
- The newest, associated with higher brain function
- It is the cerebrum that is divided into lobes and hemispheres
- Includes the hippocampus, basal ganglia, olfactory bulb and cortex
Division by hemisphere
We can divide the cerebrum into the Left and Right hemisphere. These are connected by the
Corpus Callosum. The structure of the left and right hemispheres are mirrors of one another,
what is in one is in the other.
Info point: Corpus Callosum

A major tract of white matter (that is axon tracts) composed of both myelinated and
unmyelinated axons. This acts to transmit messages between hemispheres. Remember
the Left hemisphere controls the right side of the body, right hemisphere the left side of
body.
Lobular division
There are four lobes in each hemisphere, each is responsible for different functions:
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- Frontal
- Movement
- Coordination
- Information (problem solving, planning etc..)
- Parietal
- Touch perception
- Object manipulation
- Sensory processing
- Temporal
- Hearing
- Memory acquisition
- Emotion
- Language
- Wernicke's and Broca’s area
- Occipital
- Visual input and perception
This next section probably goes beyond the scope of this specific question, however it
seems both logical and simpler to go into detail about each section here rather than in the
slightly piecemeal way offered by going by syllabus question.
The brain stem - parts and functions

The brainstem, as we’ve said, includes three key structures, the Medulla, Pons and
Midbrain. It connects the Cerebrum and Cerebellum, and most of the cranial nerves come
from here.
The Midbrain itself is then divided into three parts, these are
- Tectum, which forms the ceiling
- Comprised of the superior and inferior colliculi which are the principle
midbrain nucleus of the auditory pathway, receiving input from peripheral
brainstem nuclei as well as the auditory complex
- Tegmentum, which forms the floor
- It is ventral to the cerebral aqueduct (a pocket filled with CSF), with several
nuclei, tracts and reticular formations in here.
- Ventral tegmentum
- Composed of paired cerebral peduncles that transmit axons of upper motor
neurons.
The
153. Medulla oblongata

The brain stem
The brain stem consists of the Medulla oblongata, pons and midbrain. All of the cranial
nerves stem from the brain stem, as well as it having a complex matrix of neurons, known as
the reticular formation, within which some specific nuclei exist. The overall structure sees the
Medulla oblongata inferior, moving up to the Pons and then to the Midbrain. We shall first
consider the surfaces, borders and development of the brain stem.
A - Ventral surface:
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On the ventral surface sit longitudinal columns, the pyramids, running on either side of the
ventral medial fissure can be found on the medulla. Lateral to the pyramid lies an elongated
elevation, the olive, within which sits the inferior olivary nucleus. As we move up o the pons
and Midbrain we see the majority of the cranial nerves appearing, and the Mammillary
bodies underneath the mamillary bodies.
B - Dorsal surface:
Covered by the cerebellum with a median sulcus running along it. It contains four paired
elevations, the superior and inferior colliculi, parts of the visual and auditory systems
respectively. The trochlear nerve emerges immediately caudal to the inferior colliculus. On
the pons sit three sets of cerebellar peduncles, the superior, middle and inferior. As we move
up to the superior portion of the midbrain the Thalmus can be found resting on it.
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Medulla Oblongata
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The medulla oblongata is in the hindbrain and is shaped, it is the pathway between the Pons
and the spinal cord, responsible for:
- Cardiac function
- Respiratory function
- Vomiting
- And Vasomotor centers
It receives its blood supply from the anterior spinal artery, posterior inferior cerebellar artery
and vertebral artery. It forms from the myelencephalon, with final differentiation seen in week
20 gestation.
The medulla itself can sometimes be split into three, we shall look at each section, and
importantly the internal nature of each section, below:
- Caudal medulla
- Rearrangement of grey and white matter
- Ventral horn becomes more attnuated and dorsal horn replaced by caudal
part of trigeminal sensory nucleus
- The trigeminal sensory nucleus travels all along the caudal medulla
into the pons where the trigeminal nerve attaches
- Mid-medulla
- Dorsal columns consist of first order sensory neurons, with the cell bodies in
the dorsal root ganglia of spinal nerves whose axons pass through the caudal
medulla. These axons terminate in the nucleus gracilis and cuneatus upon
the cell bodies of second-order neurons.
- Rostral medulla
- This is the most caudal/superior aspect, has the pyramids on the ventral
surface, along with the inferior olivary nucleus.
Major tracts:
- Pyramidal
- Fibers pass from cortex in dorsolateral direction, crossing the midline from the
decussation of the pyramid, and pass down into the spinal cord
- Medial lemniscus
- Orginates from the dorsal column nuclei, pass short distance and are second-
order somatosensory, massing to the oposite side of the medulla .These
function to transmit information associated with conscious proprioception and
vibratory stimuli to the thalamus
- Medial longitudinal fasciculus
- In dorsal medial position with ascending and descending axons. Ascending
axons arise from lateral, medial and superior vestibular nuclei and project to
pons and midbrain. They provide information on the position of the head to
cranial nerve nuceli which help mediate position and movement of eyes.
- Descending fibers arise from medial vestibular nucleus and pass caudially to
cervial levels of the cord, often called vestibulospinal tract. Helps to adjust
changes in the position of head.
- Descending tract of Trigeminal nerve
- Descends caudally as far as second cervical segment. Is present the entire
length of the medulla, extending from the level of the lower pons. These are
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first order axons which mediate somatosensory inputs from the head to the
brain.
Key nuclei:
- Reticular Formation
- The core of the brainstem contains many complex neuronal groups
collectively referred to as the reticular formation. This formation is involved in
modulation of sensory transmission to the cortex, regulation of motor activity,
autonomic regulation, circadian rhythms and modulation of emotional
behaviour
- Major nuclei of the medulla
- In the lower levels of the medulla the nuclei receive first-order pain and
temperature signals from the head.
- In the upper levels of the medulla, numerous nuclei exist include:
- Spina nucleus
- Cochlear nuclei - receives first-order auditory
- Vestibular nuclei - receives first order vestibular
- Additional cranial nuclei
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The Medulla is often seen in two levels, the closed medulla with the pyramidal decussation
and decussation of the medial lemniscus. And the Upper, open, medulla which contains the
inferior olivary nucleus (A and B respectively).
At the level of the pyramids the structure is largely similar to the spinal cord, notable
differences are the pyramidal cross over to the contralateral side as the tracts travel down
from the brain to the spinal cord. Additionally, there is the presence of the spinal nucleus of
the trigeminal nerve, replacing the substantia gelatinosa, that is situated in the dorsolateral
aspect of the medulla.
Slightly rostral to the pyramidal decussation, a second decussation called the medial
lemniscus is present, involving fibers from sensorimotor cortex involved in motor functions.
https://www.youtube.com/watch?v=Jg9qTzchy6E Internal structure of Medulla oblongata
154. Pons.
The pons is situated between the Mesencephalon and the Medulla oblongata, acting as a
relay station between the two, in front of the cerebellum. It is about 2.5 cm in lenght, rostral
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to the medulla. It contains two pairs of cerebellar peduncles that connect the cerebellum to
the pons.
The pons contains nuclei that relay signals from the forebrain to the cerebellum, as well as
having nuclei that deal with sleep, respiration, swallowing, bladder control, hearing,
equilibrium, taste, eye movement, facial expressions, facial sensation and posture.
The pons contains a number of neural tracts and nuclei that we need to be aware of.
Lower (caudal) half:

- Abducens nucleus of CN VI
- Facial nucleus of CN VII
- Superior and lateral vestibular nuclei
- Auditory relay structures of trapezoid body
- Superior salivatory nucleus gives rise to parasympathetic axons of CN VII
- Nuclei and fibers of reticular formation project to many areas of CNS
Upper (Rostral) half

- Main sensory (trigeminal nucleus) CN V
- Motor nucleus for CN V
- Nucleus locus ceruleus with norepinephrine neurons projecting to group sin the
brainstem
- Mesencephalic nucleus of CN V receives muscle spindle afferents from jaw and
related areas
- Superior cerebellar peduncle communicates midbrain and thalamus to cerebellum
and forms lateral wall of fourth ventricle
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155. Cerebellum - body of cerebellum and internal features

- Main role is to control general muscle contraction and balance
Connects to the brainstem via the superior, middle and inferior peduncles. These peduncles
allow for afferent and efferent communication.
- Superior peduncle
- Provides feedback to the cerebellum, connecting the mesencephalon to the
cerebellum
- Middle peduncle
- Conveys impulses of voluntary movements from the cerebrum through the
pons and cerebellum
- Inferior peduncle
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- Communicates both incoming vestibular and proprioceptive as well as

outgoing motor fibers from cerebellum to medulla oblongata.
Note, the original impulse for the motor signal comes from
the cerebrum, but it is mediated by the cerebellum, which
provides a blueprint for how best to communicate
movement.
The cerebellum achieves its function of ‘fine motor’

movement via three main mechanisms:
- Relay of motor plan
- Receiving position sense
- Sending feedback to cerebral cortex
The cerebella sits in the cerebellar fossa in the cranial

cavity. First we will look at gross anatomy, then the vermis,
then some detailed functional anatomy.
The cerebellum have multiple grooves known as the

cerebella folia, designed to increase the surface area. This
results in a very high density of neurons.
The cerebellum is divided into the left and right hemisphere, connected by the Vermis.
Fissures and lobes of the cerebellum

- Primary fissure
- On the superior surface
- Separates anterior and middle/posterior lobe
- Horizontal fissure
- Located posteriorly within the middle lobe
- Uvulo-nodular fissure
- Located on the inferior surface
- Separates the middle lobe from the flocculo-nodular lobe
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We can also divide the cerebellum by phylogentic (origin) and function

- Vestibulocerebellum (Flocculonodular lobe)
- Regulates balance and eye movements with vestibular input from
semicicrular canals and vestibular nuclei
- Receives visual input from superior colliculi and visual cortex (latter via
pontine nuclie)
- Spincerebellum (vermis)
- Regulates body and limb movment
- Receives proprioception from dorsla columns and trigeminal N. Sends fibers
to deep cerebellar nuclei, which in turn project to cerebral cortex and
brainstem.
- In essence it provides movmeent modulation, and creates ‘mental map’ of
where body parts are
- Cerebrocerebellum (lateral parts of hemispheres)
- Involved in planning movement and evaluating sensory information for action
- Receives input from cerebral cortex (via pontine nuclie) and dentine nucleus
(in cerebellum)
- Sends fibers to ventrolateral thalamus, which projects to premotor cortex and
primary motor area of cerebral cortex, as well as red and olivary nuclei.
The vermis which divides the left and right hemispheres of the cerebellum, consists of
multiple additional parts (of course it fucking does!).
These parts are:

- Nodule
- Uvula
- Tonsil
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- Pyramid
- Tuber
- Folium
- Declive
- Culment
- Lingula
- Superior medullary velum
The cerebellum has four deep cerebellar nuclei embedded in the white matter in the center,
these are:
- Dentate
- Receives incoming signals from premotor cortex and motor cortex, via
pontocerebellar system. Meanwhile, outgoing signals travel via the superior
cerebellar peduncle through the red nucleus to the contralateral ventrolateral
thalamus
- Emboliform
- Globose
- The Globose and Emboliform nuclei combine to form the interposed nuclei. It
receives afferent supply from anterior lobe of the cerebellum and sends
output to the contralateral red nucleus through the superior cerebellar
peduncle.
- Fastigii
- Receives afferent from vermis, and efferent via the inferior cerebellar
peduncle to the vestibular nuclei.
The function of all of the nuclei is inhibitory.
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156. Afferent and efferent cerebellar connections

Afferent connections
- Superior cerebllar peduncle
- Spino-cerebellar ventral tract - Kinetic constiutnet of the proprioception from
the contralateral lower limb
- Middle cerebellar peduncle
- Pontocerebellar tract - provides information on body position
- Inferior cerebellar peduncle
- Bulbo-cerebellar tract - Proprioception from all limbs
- Cuneo-cerebellar tract - Proprioception from upper limgs
- Olivo-cerebellar tract - information about the current commands for execution
of a motion
- Vestibulo-cerebellar tract - information about the position and movement of
head.
- Reticulo-cerebellar tract - information about the intended movement from
other structures including limbic system
Efferent connections
- Superior cerebellar peduncle
- Cerebello-thalamic tract - provides information about planned movment from
cerebellum to the cortex prior to movement
- Cerebello-rubral tract - information sent to the brain stem motor systems
- Cerebello-reticular tract - information to the brain stem motor systems
- Middle cerebellar peduncle
- None
- Inferior cerebellar peduncle
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- Cerebello-vestibular tract - muscle tone adjustment and coordination of the

axial muscles
- Cerebello-reticular tract - information to the brain stem motor circuits
157. Fourth ventricle

The ventricles of the brain are a communicating network of cavities filled with CSF within the
parenchyma. It consists of 2 lateral ventricles, the 3rd ventricle, the cerebral aqueduct and
the 4th ventricle. The ventricles also include the Choroid plexuses, at network of blood
vessels that produces CSF.
The fourth ventricle has a diamond shape in cross section and is found within the pons and
upper medulla. CSF enters through the cerebral aqueduct (from the third ventricle) and exits
to the subarachnoid space of the spinal cord through two lateral apertures and a midline
median apeture.
The fourth ventricle has a roof and a floor.

- The roof is made up by the cerebellum, at the back of the brain
- The floor is made up of the rhomboid fossa, a depression in the pons.
- The floor contains the facial colliculus (part of facial nerve), sulcus limitans
(horizontal groove at top of rhomboid fossa, represents border between alar
plate and basal plate in neural tube) and the obex (narrowing of the ventricle,
where the fourth ventrical becoms the central canal of the spinal cord)
- Floor additionally contains median sulcus, stria medullaris (derived from
arcutate nuclei), medial eminence (elevations medial on the floor) and a few
others….it’ll be fine….
The fourth ventrical developes from the central canal of the neural tube.
158. Mesencephalon (Midbrain)

The mesencephalon connects the Pons and cerebellum to the diencephalon (thalamus and
hypothalamus). It consists of:
- Tectum
- Inferior and superior colliculi
- These integrate sensory visual information and certain auditory
reflexes.
- Four lobes help decussate fibers of the optic nerve, although some
fibers stay ipsilateral.
- Fibers are projected to the medial geniculate body, the auditory relay
nucleus of the thalamus.
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- The trochlear nerve comes out of the posterior surface of this region
- Cerebral peduncle
- Midbrain tegmentum
- Three types of fibers
- Red nucleus
- Large structure located centrally involved in the
coordination of sensorimotor information. Fibers
originating in the cerebellum are received and project to
the thalamic nuclei which have access to primary motor
cortex
- Periaqueductal gray nucleus
- Made up of grey matter, surrounding cerebral aqueduct
(which runs between 3rd and 4th ventricle). Functions
in pain suppression, a result of high concentrations of
endorphins.
- Substantia nigra
- Consists of Pars reticulata and pars compacta.
Compacta contains neuromelanin which synthesizes
dopamine and inputs this to the basal ganglia circuit
(subcortical nuclei through the based of the forebrain).
- Pars reticulata projects outputs from the basal ganglia
to numerous structures, particularly the striatum
(subcortical brain structure), to other locations including
the thalamus, superior colliculus and other caudal
nuclei.
- Crus cerebri
- Contains tracts made up of neurons that connect to the cerebral
hemispheres to the cerebellum.
159. Diencephalon (Interbrain): thalamus, epithalamus, subthalamus

The Diencephalon is the caudal part of the embryological forebrain. It consists of the
Thalamus which in turn has four parts; the epithalamus, dorsal thalamus (or just thalamus),
hypothalamus and the subthalamus (or prethalamus).
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The thalamus is in the forebrain, superior to the midbrain, near the center of the brain, with
projecting nerve fibers out to all aspects of the cerebral cortex.
It is a symmetrical structure of two halves, the medial surface forming the lateral walls for the
third ventricle.
The parts of the thalamus are:

- Epithalamus - most superiorly
- Dorsal thalamus - centrally
- Subthalamus - ventrally
- Hypothalamus - inferiorly
The Thalamic parts are all Vasculated by

posterior communicating and posterior
cerebral artery. We will now consider each
of the Thalamic parts in turn, reviewing
the nuclei present.
Epithalamus
- Includes habenula, mass of nerve cells associated with the pineal gland, with
interconnecting fibers of the habenular commissure and the stria medullaris.
- Anterior and posterior paraventricular nuclei.
- Its main function is to connect the limbic system to the other parts of the brain as well
as secretion of hormones from pituitary gland and regulation of emotions.
Subthalamus
- Composed of several nuclei and associated white matter structures
- Subthalamic nucleus - glutamate neurons which excite globus pallidus and
substantia nigra (both basal ganglia of telenchphalon)
- Zona incerta - continuous with thalamic reticular nucleus receiving inputs from
precentral cortex
- Subthalamic fasciculus - formed by fibers that connect globus pallidus (basal
ganglia of telencephalon) with the subthalamic nucleus
- Three white matter areas known as Fields of Forel, or H fields
- H1 = horizontal tract composed of ansa lenticularis, lenticular
fasciculus and cerebellothalamic tracts, between subthalamus and
thalamus.
- H2 = synonymous with lenticular fasciculus, made up of projects from
globus pallidum (basal ganglia of telencephalon) to thalamus
- H3 = mixed grey and white matter from pallidothalamic tracts of
lenticular fasciculus and the ansa lenticularis which combine in an
area in front of red nucleus.
Thalamus
The thalamus is ovoid, near 4cm long. It has two poles (anterior and posterior) and four
surfaces (medial, lateral, superior and inferior). The anterior pole forms the posterior
boundary of the interventricular foramen (foramen of Monro, between 2nd and 3rd
ventricles), while the posterior pole is known as pulvinar.
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Superior border
- Directly superior, the surface is covered in white matter called stratum zonale
- Medially the superior surface is separated from the fornix by the choroid fissure with
the tela choroidea within.
- Laterally the superior surface is marked by the stria terminalis, over which lies the
thalamostriate vein, separating the thalamus from the body of the caudate nucleus.
- Sheet of white matter known as the external medullary lamina, separating the body of
the thalamus from the reticular nucleus.
- Further lateral to this, the precursor to the internal capsule lies between the thalamus
and the lentiform complex (putamen and globus pallidus basal ganglia).
Medial border
- Surface fors upper part of lateral wall of 3rd ventricle
- Surface connected to other thalamic half by interthalamic adhesion
Inferior surface
- Related to hypothalamus anterior and subthalamus posteriorly. Subthalamus
separates thalamus from midbrain tegmentum
Lateral surface
- Covered by myelinated fibers called extra medullary lamina. These lamina separate
lateral surface with reticular nuclei.
Nuclei of the Thalamus can be divided into the Anterior, Medial, Midline, Intralaminar and
Posterior groups.
-
- All of these nuclei project to the cortex, also receiving from the same part of
the cortex where they project to.
- There are three types of thalamic nuclei, relay, association and nonspecific.
Relay pass information to areas of the cortex, Association receive information
from the cerebral cortex and project back to the cortex in the association
areas where they help to regulate activity, and the nonspecific project broadly
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through the cortex, they may be involved in general functions such as alerting
the brain to danger and activating flight or fight response.
The Thalamus is divided from the Hypothalamus by the Hypothalamic sulcus.
160. Diencephalon - hypothalamus

The hypothalamus sits below the Thalamus with a number of nuclei with different functions.
Most importantly the hypothalamus links the endocrine system to the nervous system via the
pituitary gland.
It forms the ventral part of the diencephalon, and in humans is about the size of an almond.
It controls body temperature, hunger, attachment behaviors, thirst, fatigue, sleep and
circadian rhythms.
Borders and connections:

- Rostrally, the hypothalamus extends from the anterior commissure, lamina terminalis
and optic chiasm.
- Caudally, the hypothalamus extends to the periaqueductal gray matter of the
midbrain.
- Superiorly, the hypothalamus is divided from the thalamus by a groove in the lateral
wall of the third ventricle, the hypothalamic sulcus.
- Laterally, the surface is connects with the thalamus and subthalamus, bordered by
the internal capsule and optic tracts
- Medillay, it is bound by the 3rd ventricles ependyma (a membrane of glial cells lining
all the ventricles).
The nuclei of the hypothalamus are divided as follows:

- Anterior
- Preoptic nucleus
- Medial nuclei
- Medial preoptic - regulates gonadotropic hormones and
thermoregulation
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- Paraventricular nucleus - oxytocin, vasopressin and somatostatin

release
- Supraoptic nucleus - vasopressin and oxytocin release
- Anterior hypothalamic nucleus - thermoregulation
- Suprachiasmatic nucleus - Circadian rhythms
- Lateral
- Lateral nucleus - primary source of orexin neurons for arousal,
wakefulness and appetite
- Tuberal
- Medial nuclei
- Dorsomedial hypothalamic nucleus - BP, Heart rate, GI stimulation
- Ventromedial nucleus - Satiety (fullness), neuroendorcrine control
- Arcuate nucleus - growth hormone releasing hormone, feeding and
dopamine mediated prolactin (milk production) inhibition
- Lateral nuclei
- Lateral tuberal nuclei
- Posterior
- Medial
- Mammillary nuclei (part of mammillary bodies) for memory
- Posterior nucleus - increase BP, pupillary dilation, shivering,
vasopressin release
- Lateral
- Lateral nucleus - as above, source of orexin neurons
- Tuberomammillary nucleus - wakefulness, feeding, learning, memory,
sleep
The hypothalamus is heavily connected to the brainstem and its reticular formation (the
interconnected nuclei of the brainstem). It also connects to other limbic structures including
the amygdala and septum, while receiving inputs from the nucleus of the solitary tract (purely
sensory nuclei forming vertical column of grey matter in medulla oblongata), locus coeruleus
(nucleus in pons involved with response to stress and panic) and ventrolateral medulla.
161. Third ventricle

The third ventricle sits in the middle of the anterior and inferior horns of the second
ventricles. It is connected to the anterior horn by the intraventricular foramen, with CSF
draining into the fourth ventricle via the cerebral aqueduct.
The third ventricle has the following boundaries:

- Bounded by thalamus and hypothalamus on left and right sides
- Floor is formed by hypothalamus
- Anterior wall formed by lamina terminalis
- Roof formed by ependyma
Inferiorly, the third ventricle communicates with the fourth ventricle via the cerebral
aqueduct.
There are two anterior and two posterior protrusions. These are:
Anterior:
- Supra-optic recess (above optic chiasma)
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- Infundibular recess (above pituitary stalk)

Posterior
- Suprapineal recess (above pineal gland)
- Pineal recess
Additionally, running through the third ventricle is the interthalamic adhesion which contains
thalamic neurons and fibers connecting the two thalami.
162. Reticular formation

The reticular formation is a collection of connected nuclei throughout the brainstem. Its
primary function is the maintenance of arousal and consciousness, in a modulatory and
premotor capacity.
The formation can be divided into three separate columns:

- Gigantocellular (good name!) reticular nuclei (Medial, larger cell size)
- Raphe nuclei (median)
- Parvocellular reticular nuclei (lateral, smaller cell size)
The Raphe nuclei form a central ridge within the pons, it is the site of serotonin synthesis,
important in mood regulation. It is surrounded directly by the Medial reticular formation of the
Gigantocellular reticular nuclei.
Meanwhile the lateral column, the Parvocellular reticular nuclei, surround the nuclei of many
cranial nerves, modulating their function.
The Lateral and Medial formations send projections into the medulla and mesencephalon.
The gigantocellular column is involved in motor coordination, and the parvocellular column
regulates exhalation.
In essence, these columns form over 100 small neural networks, with a range of functions,
including;
- Somatic motor control - with some motor neurons sending axons to the formation to
form the reticulospinal tracts of the spinal cord. . Alos relay eye and ear signals to
cerebellum to help coordinate movement.
- Cardiovascular control - formation includes cardiac and vasomotor centers of
medulla
- Pain modulation - origin of descending analgesic (pain reducing) fibers, as well as
ascending fibers to cortex transmit pain signals.
- Sleep and consciousness - projects to thalamus and cerebral cortex that allow it to
modulate signals that reach cerebrum.
- Habituation - controls what we notice!
The formation also produces a number of additional neurotransmitters which are involved in
regulation of brain activity throughout the brain, including;
- Dopamine producing area in the ventral tegmental area
- Noradrenergic producing neurons of the locus ceruleus
- Serotonin releasing raphe nuclei
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- Acetylcholine producing pedunculopontine and lateral tegmental nuclei
163. Telencephalon (Cerebrum, Endbrain) - sulci and gyri

Telencephalon is the embryological term that relates to the part of the embryonic brain that
becomes the cerebrum. The cerebrum itself is made of the following;
- Cerebral cortex
- Hippocampus
- Basal ganglia (from ventral portion)
- Olfactory bulb
Another way of saying this is that The cerebrum constitutes two cerebral hemispheres and
their cortices (outer gray matter layers), and subcortical structures. The cerebrum consists of
two hemispheres, separated by the longitudinal fissure, connected by the corpus coliseum.
Each hemisphere has bilateral control, the left controlling the right etc.
The cerebrum, along with the cerebellum controls all voluntary actions of the body.
Cerebral cortex
The cerebral cortex makes up the majority of the cerebrum. It has a grey outer cortex and a
white inner matter (more below). It is divided into four lobes:
- Frontal
- Separated from parietal by central sulcus
- Separated by temporal by lateral sulcus
- Parietal
- Separated from frontal by central sulcus
- Separated from occipital by parieto-occipital sulcus
- Temporal
- Separated from frontal and parietal by lateral sulcus
- Occipital
- Separated from parietal by parieto-occipital sulcus
If we break the brain down into it’s lobes, it is relatively simple to remember the sulci
and gyri. This list organised working from the top of each lobe downards.
Frontal:
- Central Sulcus
- Precentral gyrus
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- Precentral sulcus
- Superior frontal gyrus
- Superior frontal sulcus
- Middle frontal gyrus
- Middle frontal sulcus
- Inferior frontal gyrus
Can Peter Please Sleep Soundly Mildred, Mildred = Incontinence
Temporal
- Lateral sulcus
- Superior temporal gyrus
- Superior temporal sulcus
- Middle temporal gyrus
- Inferior temporal sulcus
- Inferior temporal gyrus
Last Sunday, Sally Made Idaho Immaterial
Parietal
- Central sulcus
- Postcentral gyrus
- Postcentral sulcus
- Superior parietal lobule
- Intraparietal sulcus
- Inferior parietal lobule
Can Peter Please Suck Ilene’s Innards
Occipital
- Parietooccipital sulcus
- Lunate sulcus
- Transverse occipital sulcus
PLT = Private limited company
Hippocampus
The hippocampus looks like a sea horse (apparently)
with its curved structure. It is paired, and part of the
limbic system, involved in the consolidation of short
term memories. It is subcortical, and found in the
medial temporal lobe.
The hippocampus has two parts:

- Hippocampus proper (Ammon’s horn)
- Dentate gyrus
The other two structures of the telencephalon

(Hippocampus and Basal nuclei) are dealt with
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below, so not covered here.
164. Structure of cerebral cortex. Cytoarchitectonics

IT’S BRODMANN AND HIS AREAS! Brodmann identified 52 regions of the cerebral cortex
with distinct cellular architecture.
So, what are Brodmann areas. Simply put, Brodmann stained slides of the cerebral cortex
with Nissl method and whacked them under a slide. He observed 52 different types of
organisation.
………………………………………………….https://en.wikipedia.org/wiki/Brodmann_area
165. Cortical areas. Localization of the functions in the cerebral cortex

Two types of functional areas:
Sensory areas
- Primary sensory cortex
- Association areas - give meaning/associations with a sensation
- Multimodal association areas - make associations between different stimuli
Motor areas
- Premotor cortex - plans movement and used for fine movements
- Primary motor cortex - sends signals to generate movements
- 2 special motor cortices - Frontal eye field, Broca’s areas
Some useful general points to make, there are in fact 52 different regions of the brain, known
as brodmann's regions, we will not look at these all, just look generally.
Additionally, it is useful to note, the association areas are required for actual identification of
objects. I.e. damage to these areas can result in an individual known what a car consists of,
knowing it has four doors, windows, wheels, etc, but being unable to recognise a car, despite
being able to see it.
We can see there are sensory areas for each of the bodies main types of senses. Somatic,
Taste, Vision, Hearing and Olfaction. Logic and more complex thoughts are hard to pin down
to a specific region of the cortex as they vary for so many individuals. Emotions and feelings
exist in the limbic system, separate to the discussion here.
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A.P.M.S.A.V
So, let’s break down the above:
- Motor areas
- Primary motor cortex = Precentral gyrus
- Frontal eye field = Part of frontal lobe
- Premotor cortex with Broca’s area for speech generation = Part of frontal
lobe, not restricted to a gyrus.
Each part of the primary motor cortex controls a different part of the body, we will review this
below in the homunculus.
- Sensory areas
- Primary somatosensory = Postcentral gyrus
- Primary visual cortex = occipital apex
- Sensory Association area (visual and somatic) = Parietal and occipital
lobes
- Primary Auditory cortex = Superior temporal gyrus
- Auditory Association = Superior temporal gyrus
- Wernicke’s area - speech understanding = Supramarginal gyrus
- Olfactory cortex = Medial aspect of temporal lobe in the Uncus
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Take a look at the first two images in this section (Functional Areas of Cerebral Cortex), take
away these general points:
- The light blue areas are areas which each primary sensory area projects to in order
to give meaning to a particular sense.
- The lavender areas are multimodal association areas which receive multiple different
sensory messages. These are important for the combination of sensory information,
there are three areas
- Posterior: Visual + Auditory + Somatosensory
- Give spacial awareness, very strong in dancers and athletes. Alos has
Wernicke's area that deals with reading, naming and understanding
language and done
- Anterior: Prefrontal cortex + info from posterior association area
- Helps to combine the information from posterior area with past
experience. Helps us to make judgment and understand what is
socially acceptable
- Limbic: Limbic feelings + Motor response.
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- Located on medial side of frontal lobe and helps form memories that
translates to actions. Important for social interactions.
So we have already spoken a little bit about the motor cortex, however, as well as knowing
generally where this sits within the brain, it is important to also know which bits of the cortex
correspond with which bits of the body. As such, damage to that particular part of the cortex
can result in disability in that particular part of the body.
This image shows the pre and post central gyrus, with motor and sensory aspects
respectively.
Working in to out, the list goes:
Sensory Motor
- Genitals - Genitals
- Toes - Toes
- Foot - Foot
- Knee
- Knee
- Hip
- Leg - Trunk
- Hip - Shoulder
- Trunk - Elbow
- Neck - Wrist
- Head - Hand
- Arm - Fingers
- Thumb
- Elbow
- Neck
- Forearm
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- Hand - Brow
- Fingers - Eye
- Thumb - Face
- Lips jaw
- Eye
- Tounge
- Nose - Swallowing
- Face
- Lips
- Teeth and gums
- Tounge
- pharynx
166. Myeloarchitectonics of the telencephalon. Corpus callosum.

Commissure. Capsula interna
This section on Myeloarchitectonics, I assume relates to the six cellular layers of the
neocortex, however I can’t be certain. But let’s take a look.
So, we already know from the above that the Telencephalon consists of more than just the
cerebral cortex, but most sources when discussing cytoarchitecture deal with the cerebral
cortex, so we shall mirror this.
The cerebral cortex consists of the neocortex and the allocortex, the neocortex being by far
the largest. The allocortex is phylogenetically older, consisting of the medial temporal lobes,
involved with olfaction and survival functions such as visceral and emotional reactions.
The allocortex consists of the paleocortex and archicortex:

- Paleocortex = piriform lobe, specialized for olfactory and entorhinal cortex
- Archicortex = Hippocampus - three layered cortex dealing with encoding declarative
memory and spatial functions.
The neocortex has six layers containing up to 14 billion neurons, let's look at these layers:
- Layer I
- Molecular layer with very few neurons
- Layer II
- External granular layer
- Layer III
- External pyramidal layer
- Lots of pyramidal cells
- Layer IV
- Internal granular layer
- Granular, or Stellate, cells are most prominent here
- Layer V
- Internal pyramidal layer
- Lots of pyramidal cells
- Layer VI
- Multiform/fusiform layer
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These six layers can also be functionally divided. The supragranular layers consist of layers I
to III. These are the origin and termination of intracortical connections, both associational
(within the same hemisphere) or commissural (opposite hemisphere). It is this supragranular
layer that permits intracortical communication.
The internal granular layer, IV, receives thalamocortical connections from thalamic nuclei. It
is largest in the primary sensory cortices.
The infragranular layers, V and VI, connect cerebral cortex with subcortical regions. These
are most developed in motor cortical areas. Layer V gives rise to all of the cortical efferent
projections to the basal ganglia, brainstem and spinal cord, while layer VI, projects to the
thalamus.
The precise cellular structure varies between different regions of the brain, indeed there are
52 distinct cytoarchitectural regions, identified by Brodmann, which we call Brodmann's
areas, more on this in different question (Not sure which one….add in number later).
Corpus Callosum
This connects the left and right hemispheres, it is the brains
largest white matter structure with up to 250 million
contralateral axonal projections.
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Anatomically it consists of the:

- Rostrum (at the front)
- Genu (the bend at the front)
- Truncus (body)
- Isthmus (just before the splenium)
- Splenium (at the back)
Rachel Got Trever In Shit
The white fibers of the Corpus Callosum project to various parts of teh cortex, those from the
Rostrum and Genu curve towards the frontal lobe, forming the forceps anterior. White those
curving backwards to to the occipital lobe form the forceps posterior. Between forceps
anterior and posterior sit the main body of fibers known as the tapetum, extending to the
temporal lobes.
Interestingly, the size of the Corpus Callosum seems to increase in ambidextrous people,
while those of us with dyslexia tend to have smaller corpus callosums.
Commissure. Capsula interna

Commissure simply means to connect. In the brain there are five Commissures, these are:
- Anterior
- Connects two temporal lobes of cerebral hemisphere
- In front of fornix, majority of fibers travel through the corpus callosum
- Plays a key role in pain sensation along with some olfactory fibers.
- Posterior
- White fibers that cross the dorsal aspect of the upper end of the cerebral
aqueduct
- Interconnects precentral nuclei, responsible for mediating pupillary light reflex
- Corpus callosum
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- See above
- Hippocampal (commissure of fornix)
- The lateral portions of the body of the fornix help form the commissure of the
fornix.
- Habenular commissure
- Sits in front of pineal gland, connecting habenular nuclei
Note, in this image ‘Hippocampal’ commissure is marked ‘Middle’

commissure
Capsula interna is a white matter structure located inferomedially in

each cerebral hemisphere, carrying information past the basal
nuclei, separating the caudate nucleus and thalamus from putamen
and globus pallidus (lentiform nucleus). It contains ascending and
descending axons, coming and going to and from the cortex.
A large part of the white matter is made up from fibers that will
become the corticospinal tract. Look at the image below. See how
the fibers of the internal capsule descend to become the Geniculate
fibers, then the decussation of the pyramids, before finally forming
the anterior and lateral cerebrospinal tracts.
The capsula has a number of anatomical structures within it, these

are:
- Bend known as the ‘Genu’
- Anterior limb - between the head of caudate and lentiform
nucleus
- Posterior limb - behind genu, between thalamus and lentiform
- Retrolenticular portion - caudal to the lentiform nucleus
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- Sublenticular portion - beneath the lentiform nucleus
Blood supply comes from the middle cerebral, anterior cerebral, anterior choroidal and
interal carotid arteries.
167. Basal nuclei of the telencephalon

The Basal nuclei are cell bodies embedded in the white matter of
the cortex. The main ones are:
- Striatum
- Dorsal
- Caudate nucleus
- Putamen + Globus Pallidus(also below)
- Ventral
- Accumbens
- Olfactory
- Globus and Ventral pallidum
- Substantia nigra
- Subthalamic nucleus
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A = Cortex
B = Extreme Capsule
C = Claustrum
D = External Capsule
E = Lentiform nucleus
- E1 = Putamen
- E2 = Globus Pallidus
F = Thalamus
G = Internal Capsule
H = Caudate Nucleus
Striatum
- Critical component of motor and reward system with glutamatergic and dopaminergic
inputs
- Projects to the rest of the basal ganglia nuclei
- Separated from caudate nucleus and putamen by internal capsule
- Coordinates aspects of cognition including planning, decision making, motivation and
reward perception
Globus and ventral pallidum

- The Globus Pallidus can be divided into internal and external
- Visually indistinct, but histologically different
- GPe receives inputs from striatum, projecting to subthalamic nucleus
- GPi receives input from striatum via direct and indirect connections, they
inhibit by not firing when they get inhibited by striatum.
- Ventral pallidum is a small ventral extension which projects to thalamic nuclei.
Striatum Nigra
- Two parts, Pars compacta, pars reticulata
- Pars compacta produces dopamine for maintaining balance
- Pars reticular works with GPi to inhibit thalamus.
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Subthalamic nucleus
- Produces excitatory glutamate
- Stimulates SNr-GPi complex, part of indirect pathway.
- Receives input from external part of globus pallidus and excites
GPi
Probably worth learning how all these work together.
168. Olfactory bulb and other olfactory structures

169. Limbic system
The Limbic system is a series of structures located either side of the thalamus. It is not a
single structure, rather a collection. The primary ones it includes are:
- Hypothalamus
- Regulates autonomic nervous system (Fight and Flight vs Rest and
Digestion)
- Amygdala
- Responsible for feelings of Anger, fear, anxiety and violence. When
destroyed, we mellow out.
- Thalamus
- Sensory relay station (excepting sense of smell)
- Hippocampus
- Helps to convert short term to long term memory
- Limbic Lobe
- This is the cortical part of the limbic system, formed of parts of the anterior,
parietal and temporal lobes.
- It is made up of the Cingulate and Parahippocampal Gyri
- The basal ganglia
- Caudate, Putamen and globus pallidus are all involved in the limbic system
- Associated with rule-based habit learning, motor planning, predictive control
etc..
-
(Think of a Hippopotamus wearing a Large Blue HAT )
All these structures in the limbic system are involved in motivation, emotion, learning and
memory. It is where the subcortical structures meet the cerebral cortex and it functions by
influencing the endocrine and autonomic nervous system.
It is the region involved in sexual arousal, and where pleasure is derived from from many
drugs.
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https://www.youtube.com/watch?v=z8rE7Z5ud-g
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(probably more detail required, but for this coll this should do)
170. Lateral ventricle

The ventricles of the brain are a communicating network of cavities filled with CSF within the
parenchyma. It consists of 2 lateral ventricles, the 3rd ventricle, the cerebral aqueduct and
the 4th ventricle. The ventricles also include the Choroid plexuses, at network of blood
vessels that produces CSF.
Lateral ventricles are the two largest,

consisting of a central portion and three
lateral horns. The central part is within the
parietal lobe.
Anterior horn:
- Floor formed by Rostrum of corpus
callosum
- Medialy bound by part of the septum
pellucidum
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- Laterally bound by head of caudate nucleus

Posterior horn:
- Roof is formed by corpus callosum
- Medially bound by the calcar avis
Inferior horn
- Roof is formed by tapetum of corpus callosum
- Medially bound by tail of caudate nucleus and hippocampus
Functional location of the cortex
Body
- Medially bound by septum pellucidum
- Laterally bound by caudate nucleus
- Roof is corpus callosum
- Floor is thalamus and choroid plexus
The lateral ventricles are then connected to the third ventricle by the foramen of Monro, or
the interventricular foramen.
171. Cranial dura mater. Dural venous sinuses

Cranial dura mater
The dura mater is a thick outer membrane surrounding the brain and spinal cord derived
from mesoderm. It surrounds and supports the dural sinuses, carrying blood from the brain
back to the heart.
It has two layers:

- Lamellae/periosteal - superficial layer
- Meningeal layer - covers spinal cord
It includes the following:
4 Dura matter projections

- Falx Cerebrum (sagittal top of head, meets TC)
- Falx cerebelli (sagittal, up from bottom of occipital bone to meet with TC)
- Diaphragma Sellae
- Tentrom ceribelli (Horizontal at cerebellum level, both Falx meet here)
Periosteal layer attached at sutures and foramen magnum.
- Tentorium cerebelli
- Separates cerebellum and brainstem from occipital lobes of the cerebrum
- Anterior border is free, attached posteriorly to transverse ridges of on the
inner surface of the occipital bone
- Attached to Falx cerebri and Falx cerebelli at its midline
- Anterolateral margin attaches to superior part of petrous part of temporal
bone
- Falx Cerebrum
- Descends through the longitudinal fissure of the brain from the top of the
head
- Attached anteriorly at the crista galli and the cribriform plate
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- Posteriorly attached to the tentorium cerebelli and internal occipital

protuberance.
- Falx cerebelli
- Sits between the two cerebellar hemispheres
- Attached to the vertical crest on the inner surface of the occipital bone
- Attaching superiorly to the tentorium cerebelli
- Diaphragma Sellae
- Flat piece of dura with circular hole allowing passage of pituitary stalk
- Sits upon sella turcica
Arterial supply by:

- Anterior dura = anterior meningeal (branch of ethmoidal)
- Middle dura = Middle and accessory meningeal (branch of maxillary)
- Posterior dura = posterior and accessory meningeal artery (branch of ascending
pharyngeal a)
Innervation by
- Anterior dura = meningeal branches ophthalmic n.
- Middle dura = meningeal branches maxillary and mandibular n.
- Posterior dura = meningeal branches first and second cervical n.
Dural venous sinuses

The space between the dural layers form the venous sinuses. They are endothelial lined.
All the sinuses then drain into the internal jugular vein
1. Superior sagittal sinus
a. Follows superior border of falx cerebri
b. Receives blood from superior cerebral, diploic and emissary veins
2. Inferior sagittal sinus
a. Follows inferior border of fal cerebri
b. Receives blood from cerebrum and falx cerebri
3. Straight sins
a. Follows at the junction of the falx cerebri and the tentorium cerebelli
b. Receives blood from inferior, great cerebral vein, posterior cerebral v,
superior cerebellar veins from falx cerebri
4. Occipital sinus
a. In falx cerebelli against the occipital bone
b. Communicates with the vertebral plexus of veins
ALL THESE MEET AT THE CONFLUENCE OF SINUS
5. Confluence of sinuses
a. At the internal occipital protuberance
b. This is drained by the left and right transverse sinuses
6. Transverse sinus (Left and Right)
a. These are horizontal downward extensions of the confluence of sinuses
b. Collects form Confluence of sinuses, becomes sigmoid sinus
i. Right receives from superior petrosal sinus
ii. Left receives from straight sinus
7. Sigmoid sinus (Left and Right)
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a. This is a continuation of the transverse into the internal jugular veins (also
receives from diploic and emissary veins)
1. Sphenoparietal sinus (paired)

a. paired on inferior surface of lesser wings
b. Drains into cavernous sinuses
c. Receives diploic and meningeal veins
2. Cavernous sinus (paired)
a. Sits either side of the sella Turcica
b. Receives from cerebral, ophthalmic v. sphenoparietal sinuses, emissary veins
from pterygoid plexus of veins
c. Connected by intercavernous sinus
d. Drains into superior and inferior petrosal sinus
3. Superior petrosal sinus (paired)
a. Superior margin of the petrous part of the temporal bone
b. Receives from Cavernous sinus, cerebral and cerebella veins
4. Inferior petrosal sinus
a. Groove between perous part and occipital bone
b. Ending in internal jugular vein
c. Receives from Superior petrosal and cavernous and cerebella veins and
veins from internal ear and brain stem
Both proposals then feed into the sigmoid sinus which then feeds internal jugular
5. Basilar sinus
- Found on the clivus which is posterior to the sella turcica
- Connects the two inferior petrosal sinuses and communicates with the vertebral
plexus
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172. Arachnoid mater and pia mater. Cerebrospinal fluid circulation

Arachnoid matter has subarachnoid space with Cerebral spinal fluid. It includes Arachnoid
villi and cisternae. The arachnoid villi protrude into the venous sinuses and allow CSF to exit.
Subarachnoid cisterns are openings in the subarachnoid space, caused by the separation of
Dura and Pia matter. Important named ones are:
- Cisterna magna (between cerebella and medulla oblongata)
- Pontine cistern (surrounds the ventral aspect of the pons
- Cerebellopontine angle cistern (lateral angle of cerebellum and pons)
- Interpeduncular cistern (base of brain between two cerebral peduncle of midbrain
and dorsum sellae)
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- Superior cistern (dorsal to midbrain, around the midbrain)

- Crural cistern (around ventrolateral aspect of midbrain)
- Carotid cistern (between carotid artery and ipsilateral optic nerve)
- Insular/Sylvian cistern (between fissure of frontal and temporal lobes)
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173. Blood supply of the brain - arteries and veins

Arteries
All arteries come together in circle of Willis, the circle is supplied by internal carotid, vertebral
and anterior spinal arteries. The branches, starting anteriorly are:
- Anterior cerebral
- Middle superior
- Posterior communicating
- Posterior cerebral
- Superior cerebral
- Basilar
- Pontine
- Anterior inferior cerebellar
- Vertebral
- Posterior inferior cerebellar
Venous drainage
Divided into external and internal cerebral veins.
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Internal:
There are two internal cerebral veins that run parallel with one another between the layers of
the tela choroidea. The tela choroidea is a triangular process of the Pia Mater that sits in the
third ventricle (kind of).
Each vein is formed near the interventricular foramen by the coming together of the choroid
veins (veins of the eye), and they drain into the great cerebral vein which drains to the
straight sinus.
External:
- Superior cerebral
- Between 8 and 12 superior cerebral veins drain the superior, lateral and
medial surfaces of the hemispheres, found in sulci. All drain to superior
sagittal sinus
- Inferior cerebral
- Drains the undersurface of the cerebral hemispheres and drains into the
cavernous and transverse sinuses
- Middle cerebral
- Superficial middle and deep middle.
- Superficial beings on lateral surface of hemisphere, running through
lateral sulcus and drains into cavernous sinus
- Deep runs lower part of lateral sulcus, draining into cavernous
174. Exteroceptive system for mechanoreception

First some definitions for this slightly wordy question.
- Exteroceptive = relating to external stimuli
- Mechanoreceptor = sensory receptor that responds to pressure or distortion
So, this question is asking about touch sensation.
Physical mechanical stimulation occurs, the message of which is then transmitted to the
brain. The overall steps are as follows:
- Mechanical stimuli
- One of four mechanoreceptors
- Nerve pathway
- Spinal ganglion
- Spinal cord
- Sensory nucleus, Fasciculus Gracilis or Fasciculus Cuneatus
- The brain
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Let’s break this down a little more:

Receptors
There are four types of receptors:
- Merkel cell nerve endings
- Found in basal epidermis and hair follicles
- React to low vibrations and deep static touch (such as edges)
- Mostly used in areas like fingertips
- Myelinated
- Tactile corpuscles
- Found in dermal papillae
- React to moderate vibration and light touch
- Respond in quick action potentials, found in lips and fingertips
- Lamellar corpuscles
- Gross touch and distinguishing rough and smooth substances
- Large receptive fields that only react to sudden stimuli
- Bulbous corpuscles
- React slowly to sustained skin stretch
- Responsible for feeling of object sloping and play role in finger movement
- Myelinated
Neural, Spinal cord and Nucleus
Afferent nerve fiber sends information to spinal cord via the dorsal column, which then
ascends via gracilis (T7 and below) or cuneatus (T6 and above).
Brain
Information sent to the postcentral gyrus with its primary somatosensory cortex (Brodmann
1, 2 and 3), collectively called S1. Travels via the Thalamus, the relay hub for sensory
information.
……..
175. System for pain and temperature

The spinothalamic tract is responsible for sensory pathway from skin to thalamus.
Specifically, the lateral spinothalamic tract is responsible for pain and temperature, while the
anterior pathway carries information regarding crue touch (see above).
Pain is a physiological response associated with tissue damage. It is generally understood

that the activation of certain nerve fibers, Nociceptive fibers, are what elicits pain. Different
types of Nociceptors will elicit different types of pain (e.g. Heat Nociceptors for burning,
chemical for chemical burns, mechanical for mechanical injuries).
When an area is injured, this causes vasodilation, which causes reddening of the skin and
swelling. This is known as the triple response. This inflammation causes pain, as well as
making the region much more sensitive to painful stimuli in the short term future. This is
known as primary and secondary hyperalgesia (maybe also primary and secondary pain).
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The nerves that supply Nociceptors are A and C fibers. These then synapse on the Dorsal
root ganglion, before decussating into the lateral spino-thalamic tract. From here the
secondary afferent ascends to the thalamus, from where it synapses to the ventrobasal
complex and posterior nuclear group on the thalamus, before going to the Somatic Sensory
areas of the cortex via their 3rd order neuron.
There are two types of thermoreceptors, one for response to cooling and one for response to
warming. These thermoreceptors are bare nerve endings, the cold ones innervated by
A myelinated afferents, while the warm receptors are innervated by C fibers.
Such receptors respond to change in temperature with an increase or decrease in firing rate,
the cold receptors show a maximal rate of discharge at about 30 degrees C, while warm
receptors have a maximal rate of about 40 degrees C. Thermoreceptors also then feed into
the lateral spinothalamic tract.
Spinothalamic tract:
- This is a sensory pathway from the skin to the thalamus, obviously via the spinal
cord.
- Information comes from the spine into the ventral posterolateral nucleus of the
thalamus, then to the somatosensory cortex of the postcentral gyrus.
- This tract has what is known as somatotopic organization, that is to say each point of
the tract relates to a specific part of the body, the bigger the part, the greater the
sensitivity of the area.
- The pathway decussates at the spinal cord level. This occurs via the anterior white
commissure, usually 1-2 spinal nerve segments above the point of entry.
176. System for proprioception

Proprioception is the body's ability to sense where its own limbs are.
Sensory information is provided by proprioceptors (muscle spindles) in skeletal striated

muscles and tendons (golgi tendon organs) and the fibrous capsules of joints. The nerves
that carry this information are A-alpha, A-beta, A-delta and C.
The information is then predominantly passed to the Dorsal column systems and medial
lemnisci to the cerebral cortex. Additionally, there are other pathways that ascend to the
cerebellum as well as other areas of the cerebral cortex. The dorsal column has three
neurons, the first order neurons in the dorsal root ganglia which send their axons through the
gracile fasciculus and cuneate fasciculus. These sinapse with the second order neuron at
the cuneate nuclei in the lower medulla. The third order axons ten take over in the thalamus,
taking information to the postcentral gyrus.
177. Motor system. Pyramidal, oculomotor and corticonuclear systems
The motor system consists of the pyramidal and extrapyramidal system.
The pyramidal system (or corticospinal tract) starts in the cerebral motor cortex. There are
upper and lower motor neurons.
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Impulses originate in the giant pyramidal cells of the motor areas, the axons of these then
descend through the following pathway:
- internal capsule,
- the peduncles of the midbrain
- the belly of the pons.
- Pyramids of medulla oblongata (Pyramidal decussation)
- Move posterior to the posterolateral funiculi of the
spinal cord
- Synapse in the anterior horn cells to lower
motor neurons
Understand therefore that the pyramidal tracts control the contralateral side of the body.
Somatic motor movements are triggered by the motor cortex. Each area of the motor cortex
signals a different part of the body.
The oculomotor system is the part of the nervous system relating to eye movements. There
is both voluntary and involuntary eye movements that effect the six extraocular muscles. The
nerves and the muscles they affect are as below:
- Lateral rectus (Abducens)
- Medial rectus (oculomotor)
- Inferior rectus (oculomotor)
- Superior rectus (oculomotor)
- Superior oblique (Trochlear)
- Inferior oblique (oculomotor)
Voluntary eye movements occur in jumps known as saccades.
Voluntary horizontal movements are mediated by the Frontal Eye Fields of the cerebral
cortex (FEF). Projections from the FEF go to the contralateral paramedian pontine reticular
formation, either directly or via the superior colliculus. From here, the signal is passed to the
abducens nucleus. The abducens nucleus then triggers both the abducens nerve and fibers
that communicate with the oculomotor nucleus, helping to trigger conjugate (simultaneous)
lateral movement of the eyes.
Voluntary vertical gaze follows a different pathway. Diffuse areas of the cortex project to the
rostral interstitial nucleus of the medial longitudinal fasciculus. From here, there is bilateral
projection to the oculomotor and trochlear nuclei, with fibers passing through the posterior
commissure.
Pathway for voluntary horizontal movement:

- Frontal eye field
- Contralateral paramedian pontine reticular formation
- Abducens nucleus
- Abducens nerve + oculomotor nuclei then oculomotor nerve
Pathway for voluntary vertical movement:
- Diffuse areas of cortex
- Rostral interstitial nucleus of medial longitudinal fasciculus
- Bilateral projection to oculomotor and trochlear nuclei (via posterior
commissure)
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- Oculomotor and trochlear nerve stimulation
The vestibulo-ocular reflex produces eye movement in response to changes in head

position. Effectively, the movements of the head detected by the vestibular portion of the
vestibulocochlear cranial nerve mediate eye movement. As head movement is detected,
projections from the vestibular nucleus feed the abducens and oculomotor nucleus via the
paramedian pontine reticular formation. This triggers the stimulation of the relevant muscles
and results in eye movement.
In eye tracking we observe smooth movement rather than movement in saccades. This
requires some impact from the vestibulo-ocular reflex pathway, and some visual input to the
occipital cortex to allow for locking of the eyes to the target. Effectively, we can see this as
the combination of the Vestibulo-ocular reflex and the Occipital eye field., which connects
indirectly, via the pontine cerebellar fibers, to the pontine nuclei.
Eyes also perform vergence, referring to the convergence or divergence of eyes. This
requires the occipital lobes, and a pathway that involves the rostral midbrain reticular
formation, adjacent to the oculomotor nucleus.
The pupillary light reflex is the bilateral constriction of pupils in response to light,
contralateral axons from the optic nerve terminate in the pretectal nuclei, which triggers
bilateral projections from this nucleus to the edinger-estefall nucleus, resulting in pupillary
constriction.
The Corticonuclear tract is a two neuron white matter pathway that connects the motor
cortex to the medullary pyramids. It is responsible for carrying the motor functions of the
non-oculomotor cranial nerves. To put it another way, any motor function by a cranial
nerve, that is not eye movement, is mediated by the corticonuclear tract.
The pathway originates in the primary motor cortex of the frontal lobe, descends through the
corona radiata and genu of the internal capsule, passes into the midbrain, where it becomes
the cerebral peduncles, specifically the middle ⅓ of crus cerebri. The neurons then synapse
to the lower motor neurons of the cranial nerves at the appropriate level.
178. Motor system. Extrapyramidal system

The extrapyramidal system is the element of the motor system responsible for involuntary
movements. These tracts are primeraly found in the reticular formation and target lower
motor neurons in the spinal cord involved in reflexes, locomition, complex compound
movmeents and postural control. The movements are modulated by other aspects such as:
- Basal ganglia
- Cerebellum
- Vestibular nuclei
- Sneory areas of cerebral cortex
The tracts of the extrapyramidal system include:

- Rubrospinal tract
- Originates in the magnocellular red nucleus (midbrain)
- Decussates in the brain
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-Travels through lateral funiculus of the spinal cord, largely terminating in the
cervical region.
- Primarily responsible for involuntary flexion of upper limb
- Tectospinal tract
- Originates in the superior colliculus and crosses over the midline immediately
- Runs through the anterior funiculus of the spinal cord and majority of fibers
terminate in the upper cervical levels.
- Thought to be involved in reflex movement of the head
- Vestibulospinal tract
- Lateral and Medial
- Originates in the vestibular nucleus (lateral and medial).
- Lateral courses through brainstem and then anterior funiculus of the spinal
cord, remaining ipsilateral.
- Medial splits into two and courses bilaterally through brain stem via medial
longitudinal fasciculus, exits at or above T6.
- Are involved in postural adjustments and head movement, as well as overall
body balance.
- Reticulospinal tract
- Medial and Lateral
- Descends from reticular formation of the brain
- Primarily involved in posture control and muscle tone
- Remain ipsilateral throughout
179. Limbic functional system

The limbic system is important in instinctive, hormone driven responses, helping to feed the
hypothalamus neuronal information, which in turn feeds the pituitary, providing a neuro-
endocrine link. Its general functions are seen as:
- Motivation
- Emotion
- Learning
- Memory
It is highly interconnected with nucleus accumbens, playing a role in exual arousal. Also
heavily linked to basal nuclei of telencephalon.
Below we will summarise the relationship between different parts of the limbic system and
then evaluate their function.
- Cingulate Gyrus
- Hippocampal formation
- Fornix
- Amygdala
- Stria terminalis
- Ventral amygdalofugal pathway
- Septum
- Medial forebrain bundle
ALL THEN FEED TO HYPOTHALAMUS
Functions:
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- Amygdala
- Temporal pole of hippocampus
- Receives afferents from inferior temporal association cortex, septum and
olfactory tract
- Projects to stria terminalis
- Responsible for emotions of anger
- Septum
- Lies below rostral part of corpus callosum, connecting amygdala and projects
to hypothalamic
- Hippocampal formation
- Includes hippocampus, dentate gyrus, parts of parahippocampal gyrus
- It is thought to have a role in the control of attention
- Cingulate gyrus
- Continuous with parahippocampal gyrus
- Projects to parahippocampal gyrus and is responsible for linking with papez
circuit.
180. General principles of organization of the peripheral nervous system.

Ontogenesis
The nervous system is divided in into CNS and PNS. The PNS consists of:
- Sensory neurons
- Motor neurons
- Interneurons
The nervous system is responsible for:

- Sensory input
- Stimulus causes an intensity graded receptor potential within cells sensory
zone. If stimulation great enough, action potential is stimulated (see other
questions for receptor types)
- The body is divided into segmental organization from which we can see
where different nerves have sensory input
- We see 30 pairs of spinal nerve roots that provide sensory information
around the body
- And 3 branches of the trigeminal on the face
- Motor output
- May be Somatic (voluntary) or Autonomic (involuntary)
With the processing element of the NS being performed by the CNS.
The autonomic nervous system is divided, both anatomically and functionally into the
Sympathetic and Parasympathetic divisions.
The Sympathetic nervous system originates from the Thoracolumbar region (T1-T2), while
the parasympathetic region originates from cranio-
sacral regions (CN III, VII, IX, X and Sacral 2-4).
The autonomic nervous system (both Sympathetic

and Parasympathetic) have pre- and post-
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ganglionic synapses. This in comparison to the Somatic nervous system which does not
have such ganglion.
Those in the Sympathetic NS have their ganglion in the paravertebral ganglia. Those in the
Parasympathetic NS have their ganglion in or near the target organ.
The preganglionic neuron are always myelinated, while the postganglionic are not. Within
the Sympathetic chain, the preganglionic neurons are short, while the postganglionic
neurons are long, while the opposite is true in the parasympathetic NS, which has long
preganglionic neurons and short postganglionic ones.
Let us now consider the neurotransmitters of both autonomic divisions.
The somatic system generally uses Acetylcholine as its neurotransmitter.
The Sympathetic system and Parasympathetic both use Acetylcholine as the

neurotransmitters for their preganglionic neurons. However, the sympathetic division goes
on to use Noradrenaline when synapsing to target organs (sweat glands excluded). The
parasympathetic postganglionic fibers continue to use Acetylcholine.
Also consider that the major endocrine organ, the adrenal medulla, is directly innervated by
presynaptic fibers of the sympathetic NS. This sympathetic fiber causes the adrenal medulla
to directly release adrenaline and noradrenaline into the circulation.
Let us now consider the receptors of the two branches. The parasympathetic division,
primarily using acetylcholine, utilizes two types of receptors, muscarinic and nicotinic
cholinergic. There are five types of muscarinic receptors
- M1 - in the NS system
- M2 - in the heart, act to bring the heart back to normal actions
- M3 - located through the bod including endothelial cells and lungs
- M4 - postganglionic cholinergic nerves
- M5 - possible effects on the CNS
There are two types of nicotinic receptors:
- N1 - muscle type (mostly for somatic motor neurons, not autonomic system)
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- N2 - primarily for autonomic nervous system
The sympathetic nervous system meanwhile uses adrenergic receptors, these fall into three
groups:
- Alpha - located in arteries
- Beta 1 - located in the heart
- Beta 2 - located in bronchioles of the lungs and skeletal muscle vessels.
In regards to functions, remember that Sympathetic is Fight and Flight, while

Parasympathetic is Rest and Digest (or remember that Parasympathetic, with a parachute,
slows, and chills you out).
The Sympathetic:
- Dilates pupils
- Dilates bronchi
- Accelerates heart rate
- Constricts arterioles
- Inhibits stomach
- Inhibits intestinal motility
- Constricts bladder
The parasympathetic:
- Constricts pupil
- Simulates tear and salivary glands
- Inhibits heart rate
- Dilates arterioles
- Constricts bronchi
- Stimulates stomach and intestinal motility
- Releases bladder
181. Somatic and autonomic (vegetative) nerves. Regional and segmental

nerve supply of skin and muscles
The Somatic NS consists of efferent nerves responsible for stimulating contraction. It
controls all voluntary muscular systems and mediates involuntary reflex arcs. It is composed
of:
- Spinal nerves
- Cranial nerves
- Association nerves
The autonomic system acts as a control system, affecting heart rate, digestion, respiratory
rate, salivation, perspiration, pupillary dilation, urination and sexual arousal. The autonomic
system is divided into sympathetic and parasympathetic as described above.
The main neurotransmitter for somatic nerves is Acetylcholine. While the Autonomic uses
Acetylcholine for its preganglionic fibers, Noradrenaline for the sympathetic part and then
acetylcholine again for the parasympathetic part.
Neural supply of the various parts of the body is not so complicated. Where we are
considering the limbs, we can see plexuses formed by different spinal nerves. These
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plexuses see the coming together of nerves to form additional nerves which then travel down
the limbs to innervate muscles and skin.
On the body, we see segmental arcs, formed by the thoracic portion of the spinal cord, with
each area of both cutaneous and muscular innervation corresponding to the particular
vertebral level.
182. Spinal nerves - formation, spinal ganglia, reflex arch
There are 31 pairs of spinal nerves that, with the exception of C1, have ventral and dorsal
nerve roots exiting through the intervertebral foramen. These stem from the Dorsal and
Ventral horns of the spines grey matter. The dorsal root contains afferent (sensory) signals
while the ventral root contains efferent (motor)
signals.
These then come together in the spinal nerve ganglion where the nerve fibers combine and
then resplit to form the dorsal and ventral rami of the spinal nerves.
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The roots emerge from the intervertebral foramen between adjacent vertebrae (except for
the first pair (C1) which emerges from between occipital bone and atlas, this is why the
cervical region has 8 spinal nerves, not 7).
Note how the dorsal root has a dorsal root ganglion, this is where the bodies of the nerves
feeding into the spinal cord are situated. The dorsal root fibers segregate into lateral and
medial divisions. The lateral divisions contain mostly unmyelinated and small myelinated
axons with information regarding pain and temperature, for laminae I, II and IV. Meanwhile
the medial division consists of myelinated axons conducting sensory information from skin,
muscles and joints, entering the posterior column.
The Sympathetic chain consists of 22 ganglion that runs along the cervical, thoracic,
lumbar and cervical part of the spinal cord. The ganglia interacts with the anterior rami of the
spinal nerves via the rami communicantes. The trunk allows for preganglionic fibers of the
sympathetic system to spread throughout the body.
Observe in the image below how preganglionic fibers travel out of the lateral horn, through
the ventral root of the spinal nerve, via the white communicans and synapse with the
postganglionic fibers of the sympathetic chain in the ganglion.
Meanwhile the Dorsal ganglion (also known as spinal ganglion, so this may be what they’re
actually asking in this question), is a cluster of nerve cell bodies in the dorsal root of the cell.
Remember, the dorsal root consists of sensory neurons, these are basically pseudo-unipolar
type neruson (with two branches that act as a single axon) and a body that sits in the dorsal
root ganglion.
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Of course, the ventral root does not need this, as their neuron bodies sit in the gray matter of
the ventral horn of the spinal cord.
Reflexes are mediated via the reflex arc. Reflex arcs are simply neural pathways that bypass
the brain. A sensory neuron receives a signal, enters the dorsal horn of the spinal cord. In a
Monosynaptic reflex arc, this synapses directly with the motor neuron which passes out to
the effector. In a polysynaptic reflex arc, this synapses with an interneuron which then
pases the action ptoential to a motor neuron. The efferent motor neuron then pases out of
the spinal cord, causing a physical reaction.
Reflex arcs can be autonomic (affecting inner organs) and somatic (affecting muscles). It
should also be noted, that some of the autonomic reflexes are mediated by the brain more
than the spinal cord.
The patellar reflex is an important medical reflex, used to identify damage to the L3 and L4
neurons. It is a Monosynaptic arc.
183. Posterior or dorsal rami of spinal nerves

The dorsal root of spinal nerves are mixed nerves, with motor and sensory fibers. They
emerge after the nerve emerges from the intervertebral foramen.
Once formed the nerve travels backwards, dividing into medial, intermediate and lateral
branches.
- Lateral branches
- Supply iliocostalis muscle
- And skin lateral to the muscles on the back
- Intermediate branches
- Supply spinalis muscles and longissimus muscle
- Medial branch
- Innervation to the transversospinalis, intertransversarii, interspinales and
splenius
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- And Zygapophyseal joints
Posterior rami remain distinct from one another, each innervating a narrow strip of skin and
muscle along the back at the level that the ramus leaves the spinal nerve.
184. Cervical plexus

The cervical plexus is formed of the anterior rami of C1 to C4 which then give branches
supplying the Head and Neck.
There are Muscular and Sensory branches which we will look at. Using the image below we
will look at each nerve, it’s path, and it’s function.
Muscular branches
Ansa cervicalis
- A looping nerve arising from spinal nerves C1-C3. It is the ‘handle’ of the neck. It has
an inferior and superior root. It gives rise to the following nerves for the strap
muscles:
- The nerves to the superior and inferior omohyoid belly
- Nerve to the Sternohyoid muscle
- Nerve to the Sternothyroid muscle
C1 root
- Nerve to geniohyoid
- Nerve to Thyrohyoid
Phrenic nerve
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- Arises from anterior rami of C3-C5, passes around the lateral side of the anterior
scalene muscle, winding around anteriorly between the subclavian artery and vein,
entering into the thorax via the superior thoracic aperture and then down the side
of the pericardium to the diaphragm where it splits to left and right to innervate the
diaphragm.
In addition we have the following small nerves that come off the plexus:
C1
- Communication to vagus nerve
- Nerve to Rectus capitis lateralis
- Nerve to longus capitis
- Nerve to Rectus capitis anterior
C2 & C3
- To longus capitis and longus colli muscles
C3 & C4
- To Scalene and Levator scapulae muscles
Sensory branches
- Lesser occipital nerve
- Derived from C2 and supplies cutaneous innervation to posterior superior
scalp + communicates with Greater auricular nerve
- Passes behind sternocleidomastoid muscle and ascends up the posterior
border
- Greater auricular nerve
- Derived from C2 and C3 and supplies innervation to external ear and to skin
over parotid gland
- Transverse cervical nerve
- Derived from C2 and C3 and innervates anterior skin portion of the neck
- Curves around posterior sternocleidomastoid around to the front of the
muscle.
- Then pierces deep cervical fissure and gives branches that supply parts of
the upper sternum
- Supraclavicular nerve
- Derived from C3 and C4 and innervates skin that overlies the suprascapular
fossa and also to the upper thoracic region and sternoclavicular joint
- Passes behind sternocleidomastoid
185. Brachial plexus - formation. Branches of the supraclavicular part.*
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A ‘Nerve Plexus’ is when nerve fibers from multiple spinal segments intermingle and then
segregate to travel to a region of the body. The brachial plexus includes nerve fibers from
C5-T1.
Each point (C5-T1) gives off a root, we need to track what happens to these roots and
understand how the terminal nerves are derived from them. We shall review each root in
turn:
Roots
C5
C6
C7
C8
T1
Dorsalscapular nerve splits off C5

Long Thoracic nerve splits off C5-C7
Trunks
C5 + C6 = Upper Trunk
C7 = Middle Trunk
C8 + T1 = Inferior Trunk
Suprascupluar nerve splits off upper trunk

Subsclavius nerve splits off upper trunk
Devisions
Each trunk now divides into two, Anterior and Posterior. The Anterior divisions of Upper
Trunk and Middle Trunk join to form the Lateral Cord, while all of the Posterior divisions
from all three trunks come together to form the Posterior Cord. The Anterior division of the
Lower trunk stays separate as the Medial Cord.
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Anterior divisions go on to innovate muscles of the Anterior (Flexor) group, and Posterior
divisions go on to innovate muscles of the Posterior (extensor) group.
No nerves split off divisions
Cords
Lateral Cord - Anterior divisions of upper and middle trunk
Posterior Cord - Posterior divisions of upper, middle and lower trunk
Medial Cord - Anterior division of lower trunk
NB! The terms lateral, posterior and medial relate to the cords orientation to the Axillary
artery.
Lateral Pectoral nerve splits off from Lateral cord

Upper, middle and lower subscapular nerve split off from Posterior cord
Medial Pectoral nerve splits off from Medial cord
Medial brachial cutaneous nerve splits off from Medial cord
Medial Antebrachial cutaneous nerve splits off from Medial cord
Terminal branches
The three cords go on to form five terminal branches, these are:
Lateral cord = Musculocutaneous Nerve + ½ Median nerve (lateral root)
Posterior cord = Axillary Nerve and Radial Nerve
Medial cord = Ulna Nerve and ½ Median nerve (medial root)
Best video for this: https://www.youtube.com/watch?v=5YJJkK4Kw88

186. Median nerve*
Nerve roots - C6 - T1
Motor Function:
- Anterior compartment of the forearm, except flexor carpi ulnaris
- Thenar muscles
- Lateral two lumbricals of hand
Sensory Function:
- Palmar cutaneous innervating lateral palm
- Digital cutaneous innervating lateral three fingers on palmar surface
Course:
- From medial and lateral cords of brachial plexus
- Descends down arm lateral to brachial artery before crossing over to be
situated medially
- Enters anterior compartment of the forearm via cubital fossa
- In forearm travels between flexor digitorum profundus and
flexor digitorum superficialis
- Enters hand via carpal tunnel
Terminal branches
- Anterior interosseous nerve
- Palmer cutaneous nerve
187. Ulnar nerve*

Spinal roots - C8-T1
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Motor functions:
- innervates muscles of hand (apart from thenar muscles and lateral two lumbricals)
- Flexor carpi ulnaris
- Medial half of flexor digitorum profundus
Sensory functions:
- Innervates the anterior and posterior surface of the medial 1 ½ fingers
- And associated palm area
Course
- Continuation of medial cord
- Descends down medial side of brachial region
- At elbow passes posterior to medial epicondyle of humerus
- Peirce's two heads of flexor carpi ulnaris in antebrachial
region, traveling alongside ulna
- Travels superficially to flexor retinaculum, entering
hand via ulnar canal.
Branches:
- In antebrachial region
- Muscular branch
- Palmar cutaneous branch
- Dorsal cutaneous branch
- Terminal in hand
- Superficial
- Deep
188. Radial nerve*

Roots - C5 - T1
Motor:
- Innervates Triceps brachii
- Extensor muscles of forearm
Sensory:
- Posterior side of forearm
- Dorsal surface of lateral side of palm
- Lateral 3 ½ digits
Course
- Continuation of the posterior cord of brachial plexus
- Starts posterior to axillary artery
- Descends into the radial groove of the humerus, wrapping around the
humerus laterally, accompanied by deep brachial artery
- Enters the forearm traveling anterior to lateral epicondyle
through cubital fossa
- Bifurcates into two in antebrachial region
Branches:
- Terminal
- Deep branch (motor)
- Superficial branch (sensory)
189. Axillary nerve. Musculocutaneous nerve*
Axillary Nerve
Roots - C5 and C6
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Motor functions:
- Teres Minor
- Deltoid muscles
Sensory functions:
- Superior lateral cutaneous nerve of arm which innervates skin over lower deltoid
Course:
- Continuation of posterior cord of brachial plexus
- Lies posterior to axillary a. And anterior to subscapularis
- Descends to inferior border of subscapularis and exits axilla
posteriorly via the quadrangular space along with posterior circumflex
- Gives off terminating branches
Branches:
- Terminal
- Posterior terminal branch (mixed, motor Terres)
- Anterior terminal branch (motor deltoid)
Musculocutaneous nerve
Roots: C5-C7
Motor:
- Innervates anterior compartment of arm
Sensory
- Gives rise to lateral cutaneous n. Which innervates skin on lateral surface of forearm.
Course:
- Arises from lateral cord of brachial plexsus
- Leaves axilla and pierces coracobrachialis
- Passes down arm anterior to brachialis, deep to biceps brachii
- Emerges lateral to biceps tendon and continues into
antibrachila region as lateral cutaneous nerve
Branches
- Terminal
- Only lateral cutaneous nerve
190. Intercostal nerves*

These are the anterior rami of the first 11 thoracic spinal nerves, with the anterior ramus of
12th thoracic being the subcostal.
The first two nerves supply fibers to upper limb as well as thoracic branches, the next for
tribute to the walls of the thorax, the final five the walls of the thorax and abdomen.
Each enters the intercostal space between the posterior intercostal membrane and the
parietal pleura. The nerves run along the intercostal groove on the inferior of the rib.
Each gives off the following branches:

- Lateral cutaneous
- Anterior branches
- Posterior
191. & 192 Lumbar plexus* & Sacral plexus - formation and branches*
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Mnemonic: I (twice) Get Laid On Fridays

2 from 1, 2 from 2, 2 from 3.
The lumbar plexus forms in the psoas muscle. All other than Genitofemoral (anterior) and
Obturator (medial) all of the nerves emerge lateral to the psoas muscle.
Nerve Segment Innervated muscles
Iliohypogastric T12-L1 - Transversus abdominis

- Abdominal internal oblique
Ilioinguinal L1
Genitofemoral L1, L2 Cremaster (in males)
Lateral Femoral Cutaneous L2. L3
Obturator L2-L4 - Medial compartment of thigh

- Obturator externus
- Adductor longus
- Adductor brevis
- Gracilis
- Pectineus
- Adductor magnus
Femoral L2-L4 - Anterior compartment of thigh

- Iliopsoas
- Pectineus
- Sartorius
- Quadriceps femoris
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Sacral plexus
The key branches from the sacral plexus are the

Superior gluteal, inferior gluteal, Sciatic, posterior
femoral and pudendal nerves. These then branch to
help innervate the leg.
The key nerves running down the lower limb are:

- The Sciatic nerve which runs posteriorly down
the humerus and splits at the top of the tibia
into:
- The Tibial nerve - which then runs
down the posterior of the Tibia and
enters the foot at the tarsal tunnel
supplying the majority of the muscles of
the foot.
- Common Peroneal nerve
- Common Peroneal nerve divides
into superficial and deep nerves
- The Sural nerve comes from branches of

the Tibial and Common Peroneal nerve
- Femoral nerve - largest branch of lumbar
plexus, passes through psoas major muscle,
splits anteriorly and posteriorly.
- Saphenous nerve is a branch of the
femoral nerve runs down the medial side of the leg.
- Obturator nerve - emerges out of psoas major medially
- Splits into anterior and posterior divisions
- Gluteal nerve
- Gluteal superior
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- Gluterioral inferior
193. Ischiatic nerve*

Nerve roots: L4 - S3
Motor:
- Innervates posterior thigh
- Hamstring portion of adductor magnus
- Terminal branches innervate muscles of lower leg and foot
Sensory:
- Indirect (via terminal branches)
- Skin of lateral leg
- Heel
- Dorsal and plantar surfaces
Course:
- From formation leaves pelvis and enters gluteal region via greater sciatic foramen,
emerging inferiorly to piriformis
- Crosses posterior surface of superior gemellus, obturator internus, inferior
gemellus and quadratus femoris. Enters thigh, passing deep to long head of
biceps femoris
- When sciatic reaches apex of popliteal fossa it terminates, bifurcating.
Branches:
- Tibial
- Passes through popliteal fossa and innervates gastrocnemius, popliteus,
soleus and plantaris, as well as what will become the cutaneous sural nerve
- Itself gives off
- Medial plantar
- Lateral plantar
- Common peroneal
- Innervates short head of biceps femoris and gives sensory innervation to skin
over the upper third of lateral calf.
- Gives off
- Articular branches (x3, around the knee)
- Lateral sural cutaneous nerve
- Motor branches
- Superficial and deep, innervating lateral and anterior
compartment of the lower leg respectively, along with intrinsic
muscles of the foot.
194. Oculomotor (III), trochlear (IV) and abducens nerves (VI)

Oculomotor
Nuclei:
- Somatic efferent found on the midbrain
- General visceral efferent (Edinger westphal nucleus)
Innervation:
- Motor
- Extraocular muscles (not abductor or superior oblique)
- Parasympathetic
- Supplies sphincter pupillae and ciliary muscles of eye
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Course:
- Stards midbrain, passes along the lateral wall of the cavernous sinus and divides into
inferior and superior division before passing through common tendinous ring.
Trochlear
Nuclei:
- Somatic efferent found on midbrain at level of inferior colliculus
Innervation
- Motor
- Extraocular muscle - superior oblique
Course
- Passes between cerebellar arteries, under the surface of cerebelli, along the lateral
wall of cavernous sinus and superior to the orbital fissure, lateral to the tendinous
ring.
Abducens Nerve
Nuclei:
- Somatic Efferent nucleus found in pons, deep facial colliculus on floor of 4th ventricle
(Rhomboid fossa)
Innervation
- Motor
- Extraocular muscle - lateral rectus
Course
- Fibers descend ventrally through the pons, through Arachnoid and Dura Mater,
through Petrosal and Cavernous sinus, through sup. Orbital fissure and common
tendinous ring.
195. Trigeminal nerve (V) - nuclei, branches and regions of nerve supply
Nuclei:
- One motor
- Branchial efferent - found in upper pons
- Three sensory
- Somatic efferent - mesencephalic nucleus in midbrain for proprioception of
muscles of mastication, face, tongue and orbit
- Main sensory - upper pons, responsible for touch from trigeminal area
- Spinal nucleus - lower pons, medulla and upper cervical spinal cord for pain
and temperature
Branches:
- Ophthalmic
- Sensory for nose and forehead (nasal cavity, skin of forehead, upper eyelid,
eyebrow and nose)
- Maxillary
- Sensory for eye and mouth (lower eyelid, upper lip, gums, cheek, nose palate
and pharynx
- Mandibular
- Sensory for Lower part of mouth (lower gums, teeth, lips, palate and tongue)
- Motor for Temporalis and masseter muscles (muscles of mastication)
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Just note, although it should be obvious, that the Trigeminal is responsible for sensory
innervation throughout the whole face. If your patient is unable to feel a touch on the face,
you’re looking a damage to one of the trigeminal branches.
196. Ophthalmic nerve

Nuclei
- Sensory neurons - Pons
Innervation
- Sensory for nose and forehead (nasal cavity, skin of forehead, upper eyelid, eyebrow
and nose)
- Parasympathetic for lacrimal
Course
- From Trigeminal Ganglion, via lateral wall of cavernous sinus. Divides into
Nasociliary, Frontal and Lacrimal N. Nasociliary divides into five, Frontal into
supraorbital and supratrochlear.
Branches
- Nasocillary
- Sensory root of ciliary ganglion
- Posterior ethmoidal nerve
- Long ciliary nerve
- Infratrochlear nerve
- Anterior ethmoidal nerve
- Lacrimal nerve
- Frontal nerve
- Supratrochlear and supraorbital nerves
197. Maxillary nerve

Nuclei
- Sensory - Originates from Trigeminal ganglion (ganglion found in trigeminal
impression near apex of petrous part of temporal bone)
Innervation
- Sensory for eye and mouth (lower eyelid, upper lip, gums, cheek, nose palate and
pharynx
- Parasympathetic - Lacrimal and Nasal glands
Course
- From trigeminal ganglion via lateral wall of cavernous sinus and through Foramen
Rotundum into pterygopalatine fossa. Divides to Post. Superior Alveolar,
Zygomatic, Infraorbital (then through infraorbital foramen) and Pterygopalatine
ganglion. From Pterygopalatine ganglion divides into six.
Branches
- In cranium
- Middle meningeal nerve
- From pterygopalatine fossa
- Zygomatic nerve
- Nasopalatine nerve
- Posterior superior alveolar nerve
- Greater and lesser palatine nerves
- Pharyngeal nerve
- In infraorbital canal
- Middle and anterior suprior alveolar nerve
- Infraorbital nerve
- On the face
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- Inferior palpebral nerve

- Superior labial nerve
198. Mandibular nerve
Nuclei:
- Motor neurons found in upper pons
- Sensory nucleus
Innervation
- Motor
- Muscles of mastication (Temporalis and masseter)
- Sensory
- Sensory for Lower part of mouth (lower gums, teeth, lips, palate and tongue)
- Parasympathetic
- Submandibular and Sublingual glands
- Parotid gland
Course
- From Trigeminal ganglion through foramen ovale, divides into Anterior and
Posterior division. Posterior then divides to Auriculotemporal, lingual and inferior
alveolar which goes through Mandibular foramen.
Branches
- From main trunk
- Muscular branches for each masticatory muscle (motor)
- Meningeal (sensory)
- Anterior division
- Masseteric nerve (motor)
- Deep temporal nerves (motor)
- Buccal nerve (sensory)
- Lateral pterygoid nerve (motor)
- Posterior division
- Auriculotemporal (sensory)
- Lingual (sensory)
- Inferior alveolar
199. Facial nerve (VII). Intermediate nerve
Nuclei:
- Branchial efferent - facial nerve nucleus, found in the pons for muscles
- General visceral efferent - the superior salivatory nucleus adjacent to facial nucleus
- Branchial afferent - nucleus of tractus solitarius, lateral to dorsal vagal nucleus in
upper medulla
Innervation
- Senroy
- Taste from anterior ⅔ of tongue
- Motor branches
- Branches before parotid gland
- Nerve to stapedius
- Posterior auricular nerve
- Nerve to posterior belly of digastric
- Nerve to mylohyoid muscle
- Branches once facial enters parotid
- Temporal (frontalis, orbicularis oculi and corrugator supercilii)
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- Zygomaticus (orbicularis oculi)

- Buccal (orbicularis oris, buccinator + zygomaticus muscles)
- Mandibular (mentalis)
- Cervical (platysma)
- Parasympathetic
- Carried by two separate nerves
- Greater petrosal - feeds mucous glands of oral cavity, nose, pharynx
and lacrimal gland
- Chorda Tympani - supplies submandibular and sublingual salivary
glands
Course
- Starts at lower border of pons above olive and with inferior cerebellar peduncle.
Passes through internal acoustic meatus and facial canal.
- Along Medial wall of tympanic cavity and through facial canal and then through
Stylomastoid foramen, into parotid gland.
- From there splits out into five nerves having already given off Nerve to stapedius,
intracranial branches and Extracranial branches.
The intermediate nerve is part of the facial nerve located between the motor part of the facial
and the vestibulocochlear nerve. It contains sensory and parasympathetic fibers of the facial
nerve, once in the facial canal it joins with the motor root of the facial nerve at the geniculate
ganglion.
- In essence, half of intermediates stems from nucleus salivatorius (parasympathetic)
and half from the external auditory meatus, with sensory information that terminates
in the glossopharyngeal nuclues.
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200. Cochlear nerve of the vestibulocochlear nerve (VIII). Auditory sensory

system
The cochlear and vestibular nerves of the vestibulocochlear nerve are functionally discrete
and arise from different parts of the brain;
Nuclei:
- Cochlear component arises from ventral and dorsal cochlear nuclei in inferior
cerebellar peduncle
Innervation
- Cochlear detects magnitude and frequency of sound waves
- Inner hair cells of the organ of corti activate ion channels in response to vibrations of
basilar membrane
- AP then travels through cochlear nerve to inferior cerebellar peduncle
Course
- Combines with vestibular nerve to form full nerve.
- Emerges from brain at cerebellopontine angle and exits the cranium via internal
acoustic meatus
- Nerve then splits inside internal acoustic meatus, with cochlear nerve traveling to
cochlear of inner ear and forming spiral ganglia
201. Vestibular nerve of the vestibulocochlear nerve. Vestibular sensory

system
The cochlear and vestibular nerves of the vestibulocochlear nerve are functionally discrete
and arise from different parts of the brain;
Nuclei:
- Vestibular component arises from vestibular nuclei complex in the pons and medulla
Innervation
- Detects changes in the position of the head in relation to gravity
- Vestibular hair cells are located in the otolith organs (utricle and saccule) to detect
linear movement of head, along with the three semicircular canals where they
perform the same function.
- The cell bodies of these hair cells sit in the vestibular ganglion which is in the outer
part of the acoustic meatus
Course
- Combines with cochlear nerve to form full nerve.
- Emerges from brain at cerebellopontine angle and exits the cranium via internal
acoustic meatus
- Nerve then splits inside internal acoustic meatus, with vestibular nerve traveling to
the vestibular system of the ear
202. Glossopharyngeal nerve (IX)

Nuclei:
- Branchial efferent - nucleus ambiguus in upper medulla
- General visceral efferent - inferior salivatory nucleus
- General and Special afferent- nucleus of tractus solitarius for taste, baroreceptors
and chemoreceptors of carotid body
Innervation
- Motor
- Muscles of the pharynx and tongue (speech and swallowing)
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- Sensory
- Taste from posterior ⅓ of tongue, pharynx, posterior tongue, chemoreceptors
and baroreceptors
- Parasympathetic
- Saliva production and salivation
Course
- Starts surface of Medulla (b/w Olive and inferior cerebellar) passes through Jugular
foramen and splits to superior and inferior ganglion.
- Sup to Tympanic branch, Plexus then lesser petrosal nerve through foramen
Ovale to Parotid gland.
- Inf. provides pharyngeal, pharynx, tonsillar, lingual and carotid branches.
Branches
- Tympanic
- Stylopharyngeal
- Tonsillar
- Nerve to carotid sinus
- Branches to posterior ⅓ tongue
- Lingual branches
- Communicating branches with vagus
203. Vagus nerve (X)

Nuclei:
- Branchial Efferent - nucleus ambiguus in upper medulla (palate, pharynx, larynx +
esophagus)
- General visceral efferent - Dorsal motor nucleus of vagus (cardiac and visceral
muscles)
- General and special visceral afferent - nucleus of tractus solitarius for taste, heart,
lungs, abdominal viscera, baro and chemoreceptors
- Somatic afferent - spinal nucleus of trigeminal for skin of ext acoustic meatus, auricle,
mucous membrane of larynx and pharynx.
Innervation
- Motor
- Swallowing, coughing, voice via pharyngeal muscles
- Sensory
- Skin at back of year, external acoustic meatus, part of tympanic membrane,
larynx, trachea, esophagus, thoracic and abdominal viscera, baroreceptors,
chemoreceptors, taste from epiglottis and pharynx.
- Parasympathetic
- Smooth muscle contraction of abdominal viscera, visceral gland secretions,
relaxation of airways and decreased heart rate
Course & Branches
- Starts surface of Medulla b/w olive and inferior cerebellar peduncle.
- Fibers run laterally through reticular formation, through jugular foramen forming
superior than inferior ganglion.
- From here gives off seven branches:
- Recurrent laryngeal, Sup & inf cardiac, Ant & Post Bronchial, Esophageal,
Gastric, Celiac and Hepatic.
204. Accessorius nerve (XI). Hypoglossal nerve (XII)

Accessorius
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Has too roots, from two nuclei:

- Branchial Efferent - nucleus ambiguus for cranial part, muscles of pharynx and plate
- Second branchial efferent - anterior horn of upper ⅚ cervical segments for spinal part
- sternocleidomastoid and trapezius muscle
Innervation
- Motor
- Swallowing and head movements, via trapezius and sternocleidomastoid
Course
- The two roots come together as the spinal root passes up through the foramen
magnum and they join to go through jugular foramen.
- They then split again forming cranial and spinal nerve to inferior vagal ganglion and
neck muscles respectively.
Hypoglossal
Nuclei
- Somatic efferent nucleus - hypoglossal N. in upper medulla
Innervation
- Motor
- Speech and swallowing via muscles of the tongue
Course
- Fibers from nucleus, originating from Medulla b/w pyramid and olive, pass through
Hypoglossal canal. Then gives off nerves to inf. Vagal ganglion, dura and lingual
muscles. Then joints with sup.root of Ansa cervicalis.
206. - 208 General principles of organization of the autonomic (vegetative)

nervous system. Autonomic reflex arch; Parasympathetic part of the
autonomic (vegetative) nervous system; Sympathetic part of the autonomic
nervous system. Overview
The autonomic nervous system is divided, both anatomically and functionally into the
Sympathetic and Parasympathetic divisions.
The Sympathetic nervous system originates from the Thoracolumbar region (T1-T2), while
the parasympathetic region originates from cranio-
sacral regions (CN III, VII, IX, X and Sacral 2-4).
The autonomic nervous system (both Sympathetic

and Parasympathetic) have pre- and post-
ganglionic synapses. This in comparison to the
Somatic nervous system which does not have
such ganglion.
Those in the Sympathetic NS have their ganglion

in the paravertebral ganglia. Those in the Parasympathetic NS have their ganglion in or
near the target organ.
The preganglionic neuron are always myelinated, while the postganglionic are not. Within
the Sympathetic chain, the preganglionic neurons are short, while the postganglionic
neurons are long, while the opposite is true in the parasympathetic NS, which has long
preganglionic neurons and short postganglionic ones.
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Let us now consider the neurotransmitters of both autonomic divisions.
The somatic system generally uses Acetylcholine as its neurotransmitter.
The Sympathetic system and Parasympathetic both use Acetylcholine as the

neurotransmitters for their preganglionic neurons. However, the sympathetic division goes
on to use Noradrenaline when synapsing to target organs (sweat glands excluded). The
parasympathetic postganglionic fibers continue to use Acetylcholine.
Also consider that the major endocrine organ, the adrenal medulla, is directly innervated by
presynaptic fibers of the sympathetic NS. This sympathetic fiber causes the adrenal medulla
to directly release adrenaline and noradrenaline into the circulation.
Let us now consider the receptors of the two branches. The parasympathetic division,
primarily using acetylcholine, utilizes two types of receptors, muscarinic and nicotinic
cholinergic. There are five types of muscarinic receptors
- M1 - in the NS system
- M2 - in the heart, act to bring the heart back to normal actions
- M3 - located through the bod including endothelial cells and lungs
- M4 - postganglionic cholinergic nerves
- M5 - possible effects on the CNS
There are two types of nicotinic receptors:
- N1 - muscle type (mostly for somatic motor neurons, not autonomic system)
- N2 - primarily for autonomic nervous system
The sympathetic nervous system meanwhile uses adrenergic receptors, these fall into three
groups:
- Alpha - located in arteries
- Beta 1 - located in the heart
- Beta 2 - located in bronchioles of the lungs and skeletal muscle vessels.
In regards to functions, remember that Sympathetic is Fight and Flight, while

Parasympathetic is Rest and Digest (or remember that Parasympathetic, with a parachute,
slows, and chills you out).
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The Sympathetic:
- Dilates pupils
- Dilates bronchi
- Accelerates heart rate
- Constricts arterioles
- Inhibits stomach
- Inhibits intestinal motility
- Constricts bladder
The parasympathetic:
- Constricts pupil
- Simulates tear and salivary glands
- Inhibits heart rate
- Dilates arterioles
- Constricts bronchi
- Stimulates stomach and intestinal motility
- Releases bladder
Autonomic reflexes
Remember, all reflex arch consists of receptors, sensory neurons, maybe an interneuron
and an effector. In somatic reflexes the effector is muscle, in autonomic reflexes the effector
is cardiac muscle, smooth muscle or glands (endocrine or exocrine).
Let’s look at one example of blood pressure, the baroreflex.

- The baroreceptors in the aortic arch sense the blood pressure in the body
- This information travels to the solitary nucleus of the brainstem via the vagus nerve
- The Solitary nucleus then modulates the sympathetic and vagal neurons of the
medulla, which in turn regulate autonomic control of the heart and blood vessels
- Where there is low arterial pressure (i.e. low b.p.), we see decreased
baroreceptor firing, increased sympathetic activity, and decreased vagal
activity, which work to increase heart rate and vessel constriction.
Organ Nerves Spinal column Respective

origin functions
Somatch PS: Anterior and Stimulation of gastric

posterior vagal juices and motility
trunks
S: Greater T6-T10 Antagonistic

splanchnic nerves
Duodenum PS: Vagus nerve Stimulation of gastric

juices and motility

splanchnic nerves
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Jejunum and ileum PS: Posterior vagal Stimulation of gastric

trunks juices and motility

splanchnic nerves
Spleen S: Greater T6-T8 Unclear, however

splanchnic nerves thought to maintain
splenic immunology
functions.
Gallbladder and PS: Vagus Stimulates digestive

Liver secretions,
increases
gluconeogenesis
S: Celiac plexus and T6-T9 Antagonistic

Right phrenic nerve
Colon PS: Vagus and Increases motility

Pelvic splanchnic and secretions
nerves
S: Lesser and Least T10 - L3 Antagonistic

splanchnic nerves
Heart PS: Vagus Slows down heart

rate
S: Intermediolateral T1 - T5 Increases heart rate

fibers
Lungs PS: Vagus Bronchoconstriction
S: Sympathetic T2-T4 Bronchodilation

fibers to lung
Pancreatic head PS: Vagus Increases

stimulation of alpha
and beta cells
S: Thoracic T8, T9 When acetylcholine

splanchnic binds to a2 receptors
decreases beta
secretion, increases
alpha. When binds
to B2 increases
secretion from Beta
cells.
Vermiform appendix S: superior T10

mesenteric plexus
Kidneys and Ureters PS: Vagus Increases urine

production
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S: Thoracic and T11, T12 Decreases urine

lumbar splanchnic production
nerves
209. Cranial and cervical part of the sympathetic part of the autonomic
nervous system !!!!! QUERY - DO NOT UNDERSTAND!!!!
The notes below relate to the parasympathetic action of cranial nerves, there is no
sympathetic action of these nerves that I can detect. There is a mistake here
somewhere, I just don’t know where! :D
The cranial nerves with parasympathetic action are:
- Oculomotor
- Facial
- Glossopharyngeal
- Vagus
The first of these three arise from specific CNS nuclei and synapse at one of four
parasympathetic ganglia; ciliary, pterygopalatine, otic or submandibular. From these four
ganglia the parasympathetic nerves complete their journey to target tissues via trigeminal
branches (ophthalmic, maxillary or mandibular nerves).
The vagus nerve does not participate in these cranial ganglia, instead it targets the organs of
the thoracic or abdominal viscera.
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210. Thoracic, lumbar and pelvic part of the sympathetic part of the
autonomic nervous system
211. Sensory receptors - free nerve endings and encapsulated endings

Mechanoreceptors
These are sensory receptors that respond to mechanical pressure or distortion. There are
the following types in hairless mammalian skin:
1. Lamellar corpuscles (Pacinian corpuscles)
a. Detect rapid vibrations
b. Transient responses, but with large receptive fields.
2. Tactile corpuscles (Meissner corpuscles)
a. Detect light touch and adapt to changes in texture (low frequency vibrations)
b. Rapidly adapting receptor - small receptive fields with transient responses to
the onset and offset of stimulation
3. Merkel nerve endings (Merkel's discs)
a. Detect sustained pressure
b. Slow Adapting type 1 receptor - small receptive fields
4. Bulbous corpuscles (Ruffini endings)
a. Detect tension deep in skin and fascia
b. Slow adapting type 2 receptor - large receptive fields
Additionally, the following are mechanoreceptors in slightly different contexts
5. Free nerve endings
a. Not true ‘receptors’ but these detect touch, pressure and stretching
6. Baroreceptors
a. Found in blood vessels, not skin, excited by stretch in blood vessel.
7. Hair follicle receptors
a. Receptors on the root of hair follicles detect movement in hair.
Additionally, there are four types of mechanoreceptors in ligaments, Types I - IV, with low,
medium and up to very high pain thresholds respectively.
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Thermoreceptors
There are two types of thermoreceptors, one for response to cooling and one for response to
warming. These thermoreceptors are bare nerve endings, the cold ones innervated by
A myelinated afferents, while the warm receptors are innervated by C fibers.
Such receptors respond to change in temperature with an increase or decrease in firing rate,
the cold receptors show a maximal rate of discharge at about 30 degrees C, while warm
receptors have a maximal rate of about 40 degrees C.
Nociceptors
A nociceptor is a sensory receptor that responds to damaging stimuli by sending pain to the
spinal cord and brain. They are found in any area of the body that can sense dangerous
stimuli, either external (such as the skin, cornea and mucosa) or internally (such as the
muscle, joint, bladder and gut).
Nociceptors can be:

- Thermal
- Mechanical
- Chemical
- Sleeping/Silent
- Activated with the onset of inflammation to the surrounding tissue
- Polymodal
- These are neurons that perform multiple nociceptor functions (e.g. Thermal
and mechanical)
Nociceptors also take the form of free nerve endings.
212. Olfactory organ. Olfactory sensory system

Nasa Cavity
Medial wall
- Anterior = Septal nasal cartilage
- Posterior = Vomer, perpendicular plate of ethmoid
Floor
- Soft tissue of external nose
- Upper surface of palatine process of maxilla and
horizontal plate of palatine bone. Together these =
hard palate.
Roof
- Cribriform plate of ethmoid bone
- Anterior = Nasal spine of frontal and nasal bone as
well as lateral process of septal cartilage and major
wing cartilages of external bone
- Posterior = anterior surface of
sphenoid, wing of vomer and
adjacent sphenoidal process of
palatine bone and vaginal process of
medial plate of pterygoid process.
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Lateral wall
- Maxilla
- Palatine bone
- Medial pterygoid plate
- Ethmoid bone
- Includes three nasal concha
Nasal function
Smell is the product of the conversion of a chemical signal into a electronic one. Particles
are sucked up into the nasal cavity where they dissolve into the mucosal lining of the nasal
cavity. Olfactory receptor cells are embedded into the epithelium that detect these odor
molecules and transmit this information into the CNS. The receptor cells function by virtue of
the cilia they have, which bind to molecules, causing an increase in intracellular cAMP,
opening selective cation channel, leading to depolarization of the olfactory receptor. This
electrical response then spreads through the receptor cells to the olfactory nerve fibers at
the back of the nasal cavity.
From the olfactory sensory neurons

the signal is passed, through the
cribriform plate, to the tufted and mitral
cells. These cells help to form the
olfactory bulb. From the olfactory bulb
the signal is passed to the Uncus of
the brain which houses the olfactory
cortex. The olfactory cortex includes
the piriform cortex, amygdala, olfactory
tubercle and parahippocampal gyrus.
From here the Olfactory tubercle

connects with a range of different parts
of the brain, including the Thalamus,
Hypothalamus, Hippocampus,
Brainstem and others. This is why
odors can produce such a strong wider
response, by virtue of the
interconnection of the olfactory cortex with the rest of the brain.
213. Gustatory organ. Gustatory Sensory system

Taste is our ability to take chemical signals from our mouths and understand the taste in our
brains. There are five flavours:
- Salty
- Sour
- Sweet
- Bitter
- And Umami (meaty, savoury taste)
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Tastes are detected by taste buds, of which there are three types:
- Fungiform papillae, mushroom-shaped, located at tip of tongue
- Foliate papillae, ridges and grooves at back of the tongue
- Circumvallate papillae, circular shaped and
located in a row just in front of the end of
the tongue.
Each taste bud consists of supporting and
gustatory cells. They contain pores at the surface
which are the site of sensory transduction. All taste
buds can respond to all tastes.
Different tastes are transduced via different

mechanisms, we have laid out the steps below:
- Salty
- Increased extracellular Na+, leads to
increased Na+ conductance leads, resulting in depolarization of taste cell.
- Secretion of neurotransmitter by taste cell and excitation of gustatory afferent
nerve fiber
- Sour
- Increased extracellular H+ increases Na+ and decreases K+ conductivity
- Results in cellular depolarization, neurotransmitter release, and excitation of
gustatory afferent nerve fiber
- Bitter/Sweet/Umami
- Dissociation of G-protein causes activation of phospholipase C, increasing
IP3 levels.
- This increases intracellular Ca2+, prompting secretion of neurotransmitter and
therefore excitation of gustatory afferent nerve fiber.
The anterior ⅔ of the tongue send afferent fibers to the CNS via the chorda tympani branch
of the facial nerve, while the posterior ⅓ is supplied by the glossopharyngeal nerve. All fibers
converge on the rostral part of the ipsilateral nucleus of the solitary tract in the pons. From
the solitary tract, fibers project to the thalamus, and then to the parietal cortex and insular
cortex.
- Tounge
- Solitary nucleus
- Thalamus
- Postcentral gyrus/Insula
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214. - 219 Eye - overview and

development; Fibrous layer of eyeball;
Vascular layer of eyeball; Retina. Optic
nerve. Visual sensory system; Chambers of
eyeball; Extraocular muscles. Eyelids;
Blood supply of the eye; Lacrimal
apparatus. Conjunctiva
Eye formation begins at approximately 3 weeks,

formed from mesodermal and ectodermal cells.
Specifically, from neuroepithelium.
The eye consists of three concentric layers:
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- External fibrous layer (sclera and cornea)

- Middle, Vascular layer (choroid, ciliary body and Iris)
- Inner layer of nerve tissue (Retina)
The fibrous (outer layer) is formed from the:

- Sclera
- This is the white of the eye
- opaque , fibrous, protective outer layer with collagen and elastic fibers
- Continuous with dura mater and cornea
- Attachment for extraocular muscles
- Four layers
- Episclera
- Stroma
- Lamina fusca
- Endothelium
- Cornea
- Transparent front part of the eye
- With the anterior chamber and lens, refracts light (accounts for ⅔ of
refraction)
- Unmyelinated nerve endings, no blood vessels.
- Five layers
- Anterior corneal epithelium
- Bowman’s layer
- Corneal Stroma
- Descemet’s membrane
- Endothelium
Vascular layer of the eye includes:

- Iris
- Coloured, thin circular structure responsible for controlling the diameter and
size of pupil, thus the amount of light reaching the eye
- Front area is known as stroma, back known as pigmented epithelial cells
- Stroma connects to sphincter pupillae and dilator pupillae for constriction and
dilation
- Has a central pupillary zone and a more lateral ciliary zone.
- Controlled by long and short ciliary nerves
- Ciliary body
- Part of the eye that includes ciliary muscle which controls shape of lens and
includes ciliary epithelium which produces aqueous humour.
- It is a ring-shaped thickening of tissue inside the eye, dividing posterior
chamber from vitreous body.
- Choroid
- Containts connective tissue, lying between retina and sclera.
- Provides oxygen and nourishment to the outer layers of the retina.
- Structure divided into four layers
- Haller’s layer (outermost)
- Satter’s layer
- Choriocapillaris
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- Brunch’s membrane (innermost)
Retina
- The retina consists of Cone and Rod cells that are light-sensitive, causing a cascade
of chemical and electrical events that ultimately trigger nerve impulses.
- Ten layers
- Inner membrane
- Nerve fibre layer
- Ganglion cell layer
- Inner plexiform layer
- Inner nuclear layer
- Outer plexiform layer
- Outer nuclear layer
- External limiting membrane
- Layer of rods and cones
- Retinal pigment epithelium (closest to choroid)
Optic Nerve
- The nerve that carries impulses from cones and rods into the brain
- This forms a blind spot in the eye.
- Goes to optic chiasm, and from there continues to lateral geniculate nucleus of
Thalamus, precentral nuclei and finally superior colliculus. This then inputs into
primary visual cortex.
Visual sensory system

We know from the above that the signals is carried from the photoreceptive cells to the
bipolar, and ganglion, the optic nerve. But what happens from here?
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The optic nerve projects back into the brain, and partially decussates. Those fibers
originating from the medial half of the retina decussate via the optic chiasm, while those from
the medial half remain ipsilateral. From here the fibers progress to the lateral geniculate
nucleus of the thalamus.
The axons of the optic tract can terminate either here, in the lateral geniculate nucleus, or in
one of three other locations:
- Superior colliculus of mesencephalon - for control of eye movement
- Pretectum of the midbrain - for control of the pupillary light reflex
- Suprachiasmatic nucleus of the hypothalamus - for control of diurnal rhythms and
hormonal changes
- And of course the lateral geniculate nucleus of the thalamus - for visual perception
Those that terminate in the thalamus, synapse with optic radiating neruson which then send
the information to the visual cortex found in the occipital lobe of the brain. The Lateral
geniculate body of the thalamus contains 6 separate layers, each of which has a slightly
different function depending on the level of synapse.
When it comes to understanding images, certain neurons in the visual cortex are responsible
for firing at specific times. For instance, some neurons respond to dark objects while soe
respond to light. As signals are passed into the primary visual cortex, they are then sent on
to secondary visual areas, including visual association cortex, responsible for analyzing the
visual information, parallel channels for 3D position, gross form and motion as well as colour
analysis.
Chambers:
- Anterior chamber
- Front part of the eye between the cornea and iris
- Posterior chamber
- Between the irs and the lens
- Vitreous chamber
- Between the lens and the back of the eye
- Blood vessels travel along the optic nerve and enter through the back of the
eye
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Aqueous humour liquid fills the anterior and posterior chambers while the vitreous chamber
is filled with a clear gel with high phagocytic content.
Extraocular muscles
- Superior rectus - oculomotor - elevation
- Inferior rectus - Oculomotor - Depression
- Lateral rectus - Abducens - Abduction
- Medial rectus - Oculomotor - Adduction -
- Superior oblique - Trochlear - intorsion
- Inferior oblique - Oculomotor - extortion
And then Levator palpebrae superioris (oculomotor) retracts and elevates eyelid.
All blood supply is by virtue of the ophthalmic artery.
Eyelids
Skin that covers and protects eye. Controlled by levator palpebrae superioris muscle. Has
eyelashes on front margin. Has several layers:
- Skin
- Subcutaneous tissue
- Orbicularis oculi
- Orbital septum
- Ptarsal plates
- And palpebral conjunctiva
Innervation:
- Sensory = branches of ophthalmic and trigeminal
- Infratrochlear
- Supratrochlear
- Supraorbital
- Lacrimal
Blood supply
- Anastomoses of lateral and medial palpebral arteries, branching from lacrimal and
ophthalmic artery respectively.
Blood supply of the eye

Blood supply by ophthalmic artery, first branch of internal carotid. Ophthalmic provides
orbital and ocular group.
Orbital group:
- lacrimal artery which feeds lacrimal gland,
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- supraorbital artery which supplies upper eyelid

- Posterior ethmoidal which supplies posterior ethmoidal sinus
- Anterior ethmoidal which supplies frontal ethmoidal sinus
- Medial palpebral artery
Optical group
- Long posterior ciliary - arteries to supply ciliary muscles where they further divide
- Short posterior ciliary - arteries to supply back of eye with sclera and choroid and end
up by ciliary process
- Anterior ciliary arteries - terminate in the circulus arteriosus major, surrounding the irs
- Central retinal artery - sends branches over the internal aspect of retina
Lacrimal apparatus
Lacrimal apparatus are a group of organs responsible for production and drainage of tears
(you’ve been using them while learning anatomy!). It includeS:
- Lacrimal gland
- Secretes tears to eye
- Superior lacrimal canaliculi
- Lacrimal sac
- Inferior lacrimal punctum
- Nasolacrimal duct
- These four help to secrete fluid into the
nose
- A = lacrimal gland
- B = superior lacrimal punctum
- C = lacrimal canal
- D = lacrimal sac
- E = inferior lacrimal punctum
- F = inferior lacrimal canal
- G = nasolacrimal canal
It is innervated by the lacrimal and zygomatic nerves,
and vasculature by the lacrimal artery.
Conjunctiva
The conjunctiva is a mucous membrane that covers the front of the eye and lines the inside
of the eyelids. It is composed of non-keratinized, stratified squamous epithelium with goblet
cells and stratified columnar epithelium.
- Artery = Lacrima and anterior ciliary artery
- Nerve = supratrochlear nerve
Has three parts, palpebral, bulbar and fornix conjunctiva parts for lining, covering of eyeball,
and the junction of the two respectively.
220. - 226. External ear. Tympanic membrane, Middle ear - tympanic cavity,
Auditory ossicles. Auditory (pharyngotympanic) tube, Internal ear - bony
labyrinth, Internal ear - membranous labyrinth. Vestibular labyrinth, Internal ear
- cochlear membranous labyrinth. Cochlear duct. Spiral organ (organ of Corti)
Let's take a look at the core elements of the ear, along with their functions:
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- Pinna (auricle)
- Responsible for collecting and sound and
helping to funnel it into the auditory canal.
- Includes Helix, Scapha, Antihelix,
Concha and Lobule
- Extrinsic muscles are helicis major,
helicis minor, tragigus, antitragigus,
transerse and olbique.
- Intrinsic muscles are Anterior, superior
and posterior auricular muscles
- External auditory canal
- About 2.5cm, extending from pina to eardrum
- Tympanic membrane (eardrum)
- Cone shaped membrane that transmits sound from air to the ossicles in the
middle ear
- Three layers
- Cutaneous
- Fibrous
- Mucosal
- Two parts
- Pars flaccida (upper)
- Pars tensa
- Nerve supply via auriculotemporal N, branch of mandibular.
- 10 mm in size.
- Malleus attaches to umbo area
- Malleus, Incus and Stapes
- Middle ear auditory ossicles that take the vibrations of the tympanic
membrane and transmit to the oval window, amplifying by mechanical
movement as a result of their angle of formation.
- Stapes inserts on Oval window, transmitting vibrations at higher order.
- Movement controlled by two muscles (tensor tympani and stapedius) that
help to protect the ear from excessive noise.
- Sit in tympanic cavity with medial, lateral, anterior, posterior roof and
floor, made by oval window, tympanic membrane, carotid canal, mastoid
process, tegmen tympani and fundus tympani respectively.
- Eustachian tube (auditory tube)
- Links nasopharynx to middle ear, approx 3.5cm long, helps to equalise
pressure.
- Has bony ⅓ and cartilaginous ⅔.
- Four muscles, Levator veli palatini, salpingopharyngeus, tensor tympani,
tensor veli palatini.
- Vestibular apparatus
- Three semicircular canals responsible for balance (see below)
- Cochlea with Organ of Corti
- Bony tube with organ for hearing, examined below.
Internal ear - bony labyrinth, Internal ear - membranous labyrinth, Internal ear -
cochlear membranous labyrinth. Cochlear duct. Spiral organ (organ of Corti)
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From the oval window, the vibration is transmitted into the fluid filled cochlea. The cochlea is
a bony tube filled with fluid, within it sits the Organ of Corti, the sensory organ of hearing.
The Organ of Corti is separated into three sections, the Scala vestibuli, Scala media and
Scala Tympani. Scala vestibuli and Tympani are filled with Perilymph while media is filled
with endolymph.
The vibrations of the oval window cause displacement of fluid in the Scala vestibuli, and in
turn cause displacement in the Scala Media. The waves of fluid displacement cause
movement of the basilar membrane of the organ of corti, which causes movement of the
stereocilia which project from the surface of hair cells.
The movement of these hair cells, modulated by the tectorial membrane, then triggers
depolarization in the nerve fibers of the cochlear nerve. These stereocilia are linked to one
another by protein ‘Top Links’ which help to control opening of ion channels. The bending of
the stereocilia prompts the depolarization of the cells, thanks to the opening of K+ channels.
As the endolymph they are bathed in has high K+ levels, rapid depolarization is achieved.
Different parts of the organ of Corti are most sensitive to different sound frequencies, with
the hair cells closest to the apex most sensitive to low frequency waves.
The displacement of the fluid, and the energy contained within it, is then displaced by
vibrations of the Round window, which sits along Scala Tympani.
Vestibular Apparatus
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Balance is achieved by the integration of Sensory information, including Visual,

Proprioceptive and Vestibular. We will look here at Vestibular.
The vestibular apparatus are located in the labyrinth of the inner ear. It contains three
semicircular canals located at right angles to one another. The three canals are located
horizontally, posteriorly and superiorly. These canals work with the Utricle and Saccule
within the vestibule which respond to changes in the position of the head.
The semicircular canals are filled with endolymph, as we rotate our heads the fluid in the
semicircular canals moves, and it, in turn, moves the hair cells that sit within these canals.
The movement of these hair cells triggers depolarization of the hair cells, and in turn triggers
an AP in the vestibulocochlear cranial nerve.
Meanwhile, within the Utricle and Saccule are Otoconia crystals. As we change speed, or
move our head position, these crystals move. The movement of these crystals then move
the underlying otolithic membrane, kinocilium and stereocilia that are attached to hair cells.
These stereocilia are responsible for the transducing the movement of the cilia into an action
potential. This ability, to detect this kind of movement, is known as Detection of Linear
Acceleration.
221. Skin. Epidermis and dermis

222. Skin glands. Hairs and nails.
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Section 1: Bones, Joints and Muscles

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Section 1: Bones, Joints and Muscles

2. Bones of the vertebral column

General points, all vertebrae have:

An anterior body - Corpus vertebrae

Anterior tubercle - on Anterior arch

Axis Anterior view

3. Ribs and sternum

a. Head, neck, tubercle at posterior part

4. Clavicula, scapula and humerus

The ​Clavicle ​is a paired s-shaped bone.

Parts Faces Borders

Shaft Superior face Anterior edge

Key Features Inferior view

Shoulder bone, pared, triangular in shape.

Parts Faces Borders Angles

Spine Infraspinous fossa Superior border Inferior angle

Proximal end Anterior medial Anterial

Trochlea - think medial condyle

5. Radius and ulna

Parts Faces Borders

Proximal end Anterior Anterior

Parts Faces Borders

Proximal end Anterior Anterior

S​ome - Scaphoid - Looks like a spoon

Metacarpal and Phalanges

7. Bones of pelvis: sacrum and hip bone

Key Features Ilium, Lateral view

Ischium, Lateral view

Obturator foramen - hole between wings of pubis and Ischium

Acetabulum, Medial view

Parts Faces Borders

Proximal Medial surface Anterior

Parts Faces Borders

Apex Medial Anterior

Lateral Malleolus - lump at distal end

- Articular facet of lateral malleolus

Talus - proximal, medial to calcaneus

Metatarsals and Phalanges

There are ​Proximal, Middle ​and D

Each Metatarsal and Phalangeal has a ​Base, Shaft ​and

On the Distal Phalangeal there is a Tuberosity.

10. Calvaria (cranial roof). Frontanelies

- Frontal crest Inferior View

The Fontanelle (soft spot), is the part of the infant

11. Cranial base, external surface.

Cranial base, external surface

Neck of Condylar process

12. Cranial base, internal surface

13. Lateral surface of the cranium. Temporal fossa,

15. Bony nasal cavity

16. Joints system. Boney joints: synarthrosis, cartilaginous

Structural Class Structural Types Mobility

Fibrous Adjoining bones 1. Structure (short 1. Immobile

Cartilaginous Adjoining bones 1. Synchondrosis 1. Immobile

Synovial Adjoining bones 1. Plane Freely movable

- Non-moving e.g. cranial sutures

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The Clavicle is a paired s-shaped bone.

Some - Scaphoid - Looks like a spoon

There are Proximal, Middle and D

Each Metatarsal and Phalangeal has a Base, Shaft and

Symphyses joints - Two bones separated by cartilage

Manubriosternal joint - joint between manubrium and body of sternum

Costochondrol joints - joint between rib and its cartilaginous aspect

It joints the mandibular condyles with the m

The joint uses three ligaments:

The ligaments involved are:

The ligaments of this joint are:

There are five ligaments involved in this joint:

The ligaments that support this joint are :

It is a synovial plane joint allowing

Pubic symphysis joint lies anteriorly

Synovial hinge allowing dorsiflexion and plantar flexion.