ANATOMY High Yield Points

ANATOMY important points from GENERAL ANATOMY

• Flexion and extension takes place in sagittal section
• Adduction and abduction take place in coronal section
• Dermis is thinner on anterior surfaces of body as compared to posterior surfaces.
• Appendages of skin are nails, hair follicles, sebaceous and sweat glands.
• Hair follicles are invaginations of epidermis into the dermis.
• Arrector pili are the bands of smooth muscles that that connect the undersurface of hair follicle to the superficial part of dermis. Dimpling of skin called gooseflesh is due to the the pull of the is arrector pili muscle. It causes contraction of sebaceous gland and its secretion.
• Sebaceous glands lie within the dermis and pour their secretion, the sebem ONTO the shaft of hairs.

• Sweat glands expand full thickness of dermis and their extremity may lie in superficial fascia. They are the most deeply placed structure of all appandeges.
• Sebaceous glands are not present in lips, palms, sides of fingers, glans penis and clitoris, labia minora and internal surfaces of labia majora, soles, sides of feet and sides of toes.
• Sweat glands are not present on red margins of lips, nail buds, glans penis, clitoris,
• Boil is infection of hair follicle and sebaceous gland.
• Carbuncle is staphylococcal infection of superficial fascia. It usually occurs at nape of neck and starts as infection of hair follicle or group of follicles.
• Sebaceous cyst most frequently occurs at scalp.
• Patient of shock exhibits gooseflesh as a result of overactivity of sympethetics.
• Partial thickness burn heals from the cells of hair follicles, sebaceous and sweat glands and from the cells of edges of burn. A burn that extends deeper than sweat gland heals slowly and only from edges.
• Superficial fascia is devoid of adipose tissue in eyelids, auricles, penis, scrotum and clitoris
• Nerve to muscle is a mixed nerve, 60% is motor and 40% is sensory.
• Primary cartilageonus joints are those n which the bones are united by plate of hayaline cartilage. Examples are union b/w epiphysis and diaphysis and b/w first rib and manubrium.
• Secondry cartilagenou joint are those in which the bones are joined by fibrocartilage and articular surfaces are covered by hyaline cartilage. Example are joints b/w vertebral bodies and the symphesis pubis.
• HILTON’s LAW. Sensory Nerve supplying the joint also supplies the muscles that cause movement on that joint and the skin overlying the insertion of these muscles.
• In syringomylia the pain sensation is lost in joints.
• Tendons invaginate the synovial sheath from a side and are suspended by mesotendons. Mesotendons transmit the blood vessels. In areas where wide range of movement is there these mesotendons remain as vinulae.
• In certain areas of bodies especially the tips of fingers and toes the arteries and vein connect directly without intervention of capillaries. These areas are called arteriovenous anastomosis
• Lymphatic vessels are absent in CNS, eyeball, internal ear, epidermis of skin, cartilage, bone.
• Preganglionic are myelinated adnd type B fibers.
• Postganglionic are nonmyelinated and type C fibers
• Two sympethetic chains end below by joining together to form a single ganglion the GANGLION IMPAR.
• In bone the extracellular matrix is calcified.
• Flat bones are composed of outer and inner layer of compact bone called the TABLES and middle layer of cancellous bone the DIPOLE. Scapula is irregular but is included in flat bones.

ANATOMY important points from UPPER LIMB

• Atrophy of breast after menupause occurs due to absence of ovarian estrogen and progesterone.
• Carcinoma within the breast substance can cause retraction of nipple due to pull on lactiferous ducts
• During redical mastectomy the nerve to serratus anterior and nerve to lattismus dorsi is preserved
• Parts of clavipectoral fascia lies deep to pec major and its fascia. It is pierced by cephalic vein, lateral pectoral nerve, thoracoacromial vessels, lymphatics. It has following parts:
a. Fascia investing the subclavius(posterior lamina is fused to investing layer of deep cervical fascia and axillary sheath)
b. Costocoracoid ligament
c. Fascia investing pec minor
d. Suspensory ligament of axilla
• Radial nerve is the largest branch of brachial plexus
• Subacromial bursitis, supraspinatous tendinitis and pericapsulitis of shoulder joint casues very painful movement in middle range of abduction b/w 50 to 130 degree. This is called painful arc
• Most important ligament for the suspending the upper limb from clavicle and scapula is coracoclaviculer ligament
• Upto 120 degree abduction of arm at shoulder joint: for every 3 degree of abduction of arm, 2 degree occurs in shoulder joint and 1 degree by rotating the scapula. After 120 degree only scapula rotates…
• Median nerve has no branches in upper arm except that of vasomotor branches to brachial artery
• Ulner nerve has no branch in anterior compartment of upper arm
• Bones of hand are cartilaginous at the time of birth. First bone of the hand to be ossified is capitates.
• Compartment syndrome: early signs and symptoms are altered sin sensations, pain disproportionate to injury, pain by passive stretching of muscles. Late signs and symptoms are tenderness and failure of capillary refilling.
• Volar carpal ligament:a superficial slip of flexor retinaculum is attached to pisiform bone. Called volar carpal ligament. Ulner artery and nerve pass deep to it.
• Superficial branch of radial nerve is direct continuation of radial nerve
• Rupture of extensor policis longus tendon occurs after fracture of distal third of radius
• Space of parona. Space b/w flexor digitorum profundus anteriorly and pronatus quadrates and interosseous membrane posteriorly. In case of infection of digital sheath of little finger and thumb the pus may burst thru proximal ends of ulner and radial bursa and enter this space
• Blood supply of epiphysis of distal phalanx of fingers is outside the pulp space. While that of diaphysis is inside the pulp space.. infection causing increased pressure can cause necrosis of diaphysis and epiphysis is spared.

ANATOMY important points from THORAX

• Superior wall of thoracic cavity is formed by suprapleural membrane
• Cervical rib arises from ANTERIOR tubercle of transverse process of 7th cervical vertebra
• After rib incision the rib regenerates from osteogenic layer of periosteium
• Thoracic outlet syndrome: most of the symptoms are caused by pressure on the LOWER trunk of brachial plexus
• Anterior intercostal membrane replaces the external intercostals at the level of costal cartilage
• Posterior intercostal membrane replaces the internal intercostals at the level of angle of ribs
• The 10th and 11th intercostals nerves pass directly into the abdominal wall coz the ribs are floating
• First intercostal nerve has no anterior cutaneous branch
• For the intercostal nerve block the needle is inserted near the lower border of the rib instead of upper border
• Supraplerural membrane is thickening of endothoracic fascia. It is triangular and attached to medial border of 1st rib latterly(base) and tip of transverse process of C7 medialy(apex).
• Some of muscle fibers of Right crus of diaphragm pas upto the left and surround esophageal orifice like a sling…
• Most commonly fractured ribs are 5 to 10. Rib 1 to 4 are protected by clavicle, pecs, and scapula. 11 and 12 move along the force.
• Diaphragm is also a weight liftin muscle
• In most posterior part of intercostals space the neurocascular bundle lies in the middle of the space.. it comes along the lower border of rib above at the level of angle of the rib
• Accessory phrenic neve is branch from nerve to subclavius (C5)
• Clavicle is subcutaneous thru its whole length
• Apex beat is produced by streightning of aorta by the force of blood during vent contraction. This causes pushing of heart forwards producing apex beat.
• First spine of vertebrae is of C7
• Cardiac notch is present in upper lobe of Left lung
• Hydrostatic pressure is greater in capillaries of parietal pleura than in visceral pleura. So pleural fluid is absorbed in visceral pleura
• Presence of 300 ml of fluid in costodiaphragmatic recess is sufficient to be detected clinically
• During expiration the bifurcation of trachea moves up by one vertebral level.. during deep inspiration it moves down as far as T6
• Sensory nerve suplly of trachea is from vagi and recuurent laryngeal nerves. Sympathetics supply the trachialis
• Mucosa or trachea is supplied by recurrent laryngeal nerve and in the region of bifurcation by pulmonary plexus
• Bronchoscope can reach upto 1st segmental bronchus
• Females rely mainly on the movement of ribs rather than descent of diaphragm during inspiration.
• Pericarditis is inflammation of serous pericardium
• Floor of fosa ovalis represents persistant septum primum. Annulus of fosa ovalis represents septum secundum
• Cusps of heart valves are formed by folds of endocardium wth some connective tissue in core
• SA node lies right to the SVC
• Right border of heart is formed by RA. Right border of mediastinum in the Xray is formed by right brachiocephalic vein, SVC, RA, and sometimes the IVC.

ANATOMY important points from PELVIS

• Sciatic notch is converted to foramin by sacrospinous and sacrotuberous ligament… posterior boundry of pelvic outlet includes only sacrotuberous ligament. Lateral boundry of outlet contains both sacrospinous and sacrotuberous ligaments
• Contents of sacral canal:
a. Anterior and post roots of lumber sacral and cocygeal nerves
b. Filum terminale
c. Fibrofatty tissue
d. Subacrachnoid space
• Sacral hiatus forms due to failure of fusion of lamina of 5th (sometimes 4th )sacral vertebra…
• The visceral pelvic fascia around the cervix and vagina is called perametrium
• Iliolumber ligament connects the tip of fifth lumber transverse process to iliac crest
• In sacroiliac disease pain is extreme in rotation of vertebral column and is worst at the end of forward flexion.
• Volvulus of sigmoid colon occurs in counterclockwise more commonly
• Neck of blader is held in position by puboprostatic ligament in males and by pubovasical ligament in females
• Only anatomic cause of urinary retention in females is inflammation around urethera eg herpes
• Anterior lobe of prostate contains no glandular tissue
• BPH is due to enlarged median lobe
• Prostatic secretions are alkaline
• Prostatic urethra is the widest and most dilatable part of whole urethra
• Germinal epithelium in ovaries is a misnomer. It donot give rise to ova.
• Uterus has no submucosa. Endoderm is directly applied to muscles
• The subcutaneous and deep part of external anal sphincter have no bony attachment. Superficial part does not completely encircle anal canal
• Superior rectal vein is most dependent part of portal circulation and is valveless
• Contents of hemorhoids : fold of mucous membrane, submucosa, vericosities of superior rectal vein, terminal branch of superior rectal artery
• Most important part of sphincteric action of anal canal is anorectal ring
• The body of penis is supported by two condensation of deep fascia that extend downward from the linea alba and symphesis pubis to be attached to the fascia of penis.. this is called fundiform ligament.

ANATOMY important points from ABDOMEN

• Posterior border of external oblique is free while that of IO and transverses abdomen is attached to vertebra by lumber fascia
• Conjoined tendon has lateral free margin
• Rectus sheath: contents are 2 muscles, lower 6 thoracic nerves, sup and inf epigatric vessels, lymphatics. Above the costal margin the anterior wall of rectus sheath is formed by apponeurosis of EXTERNAL OBLIQUE and The posterior wall is formed by thoracic wall.
• Anterior wall of rectus sheath is firmly attached to rectus abdominis by tendinous sheath but posterior wall is not attached to the muscle.
• Hematoma of rectus sheath occurs most frequently on Right side and from inf epigastric vein
• Dartos muscle is smooth muscle
• In the newborn the inguinal canal is shorter(not absent)
• Pampiniform venous plexus becomes single vein at the level of deep ring
• Testes take their final position in the scrotum by the end of 8th month
• Abdominal vessels lie within the fascial lining of abdominal wall while main nerves lie outside the fascial lining.femoral sheath is extension of this adominal lining so fascial nerve lies outside it.
• Strangulation is common problem in these hernias
a. Indirect inguinal,
b. Femoral
c. Paraumblical
d. Spigelion hernia
e. Internal hernia
• Others abdominal hernia have less chances of strangulation
• Spigelian hernia: hernia of linea semiluneris. It occurs thru apponeurosis of transverses abdominis just lateral to lateral edge of rectus abdominis
• Transpyloric plane: (L1) pyloris of stomach, duodenojejunal junction, neck of pancrease, hila of kidney, fundus of gall blader, first part o duodenum
• Right kidney can be palpated but not the left one
• Structures that can easily be palpated
a. Right kidney
b. Ascending and descending colon
c. Cecum
d. Aorta
• Spleen lies along the long axis of left 10th rib
• Peritoneal fluid is produced by peritoneum and is absorbed by subperitoneal lymphatics
• Whatever the position of body the peritoneal fluid moves towards diaphragm above in normal persons. Inflamed fluid follows the gravity
• Inferior mesenteric vein lies at anterior wall of paraduodinal recess
• In Partial gastrectomy the gastrin bearing ANTRUM is removed
• Anterior wall ulcers of stomach: perforation goes to greater sacright lateral paracolic gutter right iliac fossa and it adheres to liver
• Posterior wall ulcers of stomach erode splenic artery
• Small bowel contents have normal pH and produce little or no irritation of peritoneum
• Cecum is completely covered by peritoneum but has no mesentry
• Most common intussuption are iliocolic
• Ligament of treitz is fibromuscular structure and is remnant of dorsal mesentry
• Right and left gastric vein and cystic vein drain directly to portal vein
• Paraumblical vein connects the LEFT branch of portal vein to veins of anterior abdominal veins
• Right lobe of liver receives blood mostly form intestine. Left lobe, caudate and quadrate lobe receive blood from stomach and spleen. This explains the distribution of secondry malignant deposits in liver
• Left vagus gives a direct branch to liver which donot pass thru celiac plexus
• Liver Is mainly supported by hepatic veins.. peritoneal ligaments and tone of abdominal wall play a minor role
• Gangrene of gall blader is a rare phenomenon coz instead of cystic artery it also receives blood from vessels from the surface of liver
• Structures having direct contact to kidneys without peritoneum: Left side duodenum, colon, suprarenal. Right side pancrease, suprarenal, colon
• Renal transplant: iliac fossa in the posterior abdominal wall is the site. Renal artery is anastomosed end to end to internal iliac and renal vein is anatomosed end to side with external iliac.
• Right suprarenal is pyramidal and left is cresenteric.