introduction to human anatomy ame 102 i. basics of …

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I. BASICS OF ANATOMY

By

INTRODUCTION TO HUMAN ANATOMY

AME 102

PROF. DR. HODA EL AASARPROFESSOR & HEAD OF ANATOMY DEPARTMENT

Faculty of Medicine -MTI PROFESSOR OF ANATOMY - CAIRO UNIVERSITY

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CONTENTS

Page

1) Anatomical terms……………………….…………… 1

2) Skin &Fascia……………………………………………………. 7

3) Skeletal system………………………………………………… 15

4) Muscles…………………………..……………………………

5) Joints……………………………………………………………….

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6) Serous membrane & Tendons ………………………………..

7) Cardiovascular system…………………...………………...

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8) Lymphatic system…………………………..……….. 63

9) Endocrine system……………………………………….. 68

10) Nervous system……………………………………. 71

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Anatomical Terms

Terms of Anatomical Position

❖ Anatomical erect position: The body is standing up, the face looks

forwards, the upper limbs are stretched besides the body, and the palms are

directed forwards.

❖ Supine position: The body lies on its back.

❖ Prone position: The body lies on its front

ILOs:

By the end of the lecture, students should be able to:

• Describe the different anatomical positions of the human body.

• Recognize the meaning of the different anatomical terms

• Explain the meaning of the different movements of the human body

• Differentiate between different anatomical planes used in medicine

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Terms of Anatomical Planes

- Coronal plane: It is a vertical plane that divides the body into anterior and

posterior halves or parts.

- Median (Sagittal) plane: It is a vertical plane that divides the body into equal

right and left halves.

- Horizontal plane: It is a transverse plane that divides the body into upper

(superior) and lowers (inferior) halves or parts.

- Paramedian plane (Lateral sagittal plane): It is a vertical plane that runs

parallel to the median plane dividing the body into two unequal parts.

Anatomical Terms of Locations

• Anterior (ventral): Near to the front of the body.

• Posterior (dorsal): Near to the back of the body.

• Upper (superior, cephalicl): Towards the head.

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• Lower (inferior, caudal): Towards the feet.

• Median: In the median plane.

• Medial: Near to the median plane.

• Lateral: Away from the median plane.

• Middle: Located at equal distance between two fixed points.

• Intermediate: A point located between two fixed points.

• Superficial: Near to the skin.

• Deep: Away from the skin.

• Proximal: Near to the root of the limb.

• Distal: Away from the root of the limb.

• Palmar: Refers to the front of the hand.

• Plantar: Refers to the ventral aspect of the foot.

• External: Near to the surface of a hollow organ.

• Internal: Near to the cavity of a hollow organ

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Anatomical Terms of Joint Movements

• Flexion (bending): Approximation of two flexor or ventral surfaces.

• Extension (Straightening): Approximation of two extensor or dorsal

surfaces.

• Abduction: Movement of the part away from the middle line (in fingers:

from the axis of the middle finger, and in toes: from the axis of the second

toe).

• Adduction: Movement of the part towards the trunk (in fingers towards the

axis of the middle finger, and in toes towards the axis of the second toe).

• Circumduction: Successive combination of flexion, adduction, extension

and abduction.

• Medial rotation: Internal or medial rotation of a part around its long axis.

• Lateral rotation: External or lateral rotation of a part around its long axis.

• Gliding: Sliding with no axial movement.

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Special Movements

• Pronation (in the forearm and the hand): Rotation of the forearm so that

the palm of the hand looks backwards and the thumb looks medially.

• Supination (in the forearm): Rotation of the forearm so that the palm of

the hand looks forwards and the thumb looks laterally.

• Opposition: It is flexion and medial rotation of the thumb so as it gets in

contact with the tips of the medial four fingers.

• Inversion (in the foot): The medial border of the foot is raised up and the

sole looks medially. It is accompanied with plantar flexion of the foot.

• Eversion (in the foot): The lateral border of the foot is raised up and the

sole looks laterally. It is accompanied with some degree of dorsiflexion of

the foot.

• Lateral flexion of the trunk: Bending the trunk to one side.

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Skin & Fascia

Skin

Skin consisted of:

I- Epidermis (outer epithelium):

It if formed of stratified squamous epithelium covered by Keratin layer (horny

layer)

It invaginates the deeper layer (dermis ) to form:

• Sweat gland

• Hair follicle

• Sebaceous glands

2- Dermis:

• Consists of collagen and elastic fibers, blood vessels, lymphatics and

nerves.

• A tiny bundle of Muscle fibers named erectorpili muscle connects the side

of hair follicle to the junction between dermis and epidermis.

Skin pigments: The skin colour is affected by five pigments:

1. Melanin: Brown pigment which protects the skin against damage induced

by the ultraviolet rays.

2. Carotenes: Yellow orange pigment.

3. Reduced hemoglobin: Purple

4. Oxyhemoglobin: Red

ILOs:

At the end of the lecture, students should be able to:

• Recognize layers of the skin and skin appendages

• Describe the structure and function of the superficial fascia.

• Explain the structure and function of the deep fascia in the human body.

• Determine sites of thickening of deep fascia and its importance

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Skin appendages:

I- Hair: there are two types of hair:

a) Primary hair: It is the first hair that appears and covers the whole skin of

the foetus inside the uterus.

b) Permanent hair: It presents everywhere except in palms of hands, soles of

feet, umbilicus and in certain areas of the external genital organs. It

consists of root and shaft. Duct of sebaceous opens into the hair follicle.

II- Nails: It develops from epidermis. It is formed of root body and free border.

III- Sebaceous gland: It is located in the angle between hair follicle and the hair

erector muscle. Their ducts open in the hair follicles.

IV- Sweat glands: It is simple coiled tubular glands open on the surface of the

skin.

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Epidermis

Dermis

Root Body Free border

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Fascia

It is formed of sheets of fibroareolar C.T. lies deep to the skin and passes

between muscles and organs. It is divided into:

A- Superficial fascia:

It lies beneath the skin and contains variable amount of fats.

*Functions of superficial fascia:

• Retains warmth of the body.

• Acts as a reservoir of fat.

• Facilitates movement of skin.

• In the upper part of chest, it contains mammary gland.

• Acts as a soft bed for passage of vessels and nerves to skin.

* Superficial fascia contains sheets of muscles in certain sites in

the body:

(a) In the face (muscles of expression).

(b) In neck (platysma)

(c) In the palm (palmaris brevis)

Superficial fascia

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B- Deep fascia:

* Structure:

- It is a dense white fibrous layer that lies deep to the superficial fascia.

- It covers the muscles or passes between the muscles to form intermuscular

septa.

- Almost absent in the face and the anterior abdominal wall.

* Function of deep fascia:

1) Keeps the underlying structures in position.

2) Binds the muscle into groups and extends between them as

intermuscular septa.

3) Helps circulation in veins and lymphatics, when muscle contract

against their fascia, they compress veins and lymphatics.

4) It forms interosseous membranes that bind bones together.

5) In certain areas it forms tubular sheathes around vessels and nerves, eg.

Carotid sheath in neck, femoral sheath in the thigh.

6) Formation of fibrous sheaths around flexor tendons of hands and feet.

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*Sites of condensation of the deep fascia

Deep fascia

Superficial fascia

Interosseous membrane

Intermuscular

septum

Intermuscular septum Fibula

Tibia

Muscle group

Muscle group

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• Sites of condensation of the deep fascia:

1- At wrist and ankle joints to form flexor and extensor retinaculae holding the

tendons of the long muscles in place to prevent their bowing during

contraction of their muscles.

2- At the palm of the hand forming palmer aponeurosis to protect the

underneath vessels and nerves.

3- At the sole of the foot forming planter aponeurosis to protect the underneath

vessels and nerves.

4- At the lateral side of the thigh forming iliotibial tract giving an attachment to

strong muscles of the lower limb helping the lower limb to act as one stick in

standing position.

Iliotibial

tract

Fibrous sheath of the flexor

tendon of ring finger

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Formative assessment

Q1- Explain the function of the superficial fascia.

Q2- one of the following is a function of the deep fascia:

a) It retains warmth of the body.

b) It Binds the muscle into groups

c) It acts as a reservoir of fat.

d) It facilitates movement of skin.

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The skeletal system

It consists of:

• Cartilage.

• Bones

I- Cartilage

General properties:

• It is modified form of connective tissue.

• It is firm, flexible and avascular.

• It gets its nutrition by diffusion from the blood vessels of perichondrium.

• It has no nerves or lymphatics.

• It consists of mature cartilage cells (chondrocytes), fibers and matrix.

• It resists compression forces and friction.

It can be subdivided into three types:

1- Hyaline Cartilage:

• Properties

ILOs:

At the end of the lecture, the student should be able to:

• Describe the general criteria of cartilage.

• Differentiate between different types of cartilage.

• Describe the three types of cartilage and mention their sites.

• Recognize the general features and functions of bones in man.

• Differentiate between different types of bones according to their developmental

origin, type of ossification, and shape.

• Explain blood supply and growth of bones.

• Describe the layers and functions of periosteum.

• Identify the direction of nutrient foramina and the growing end of long bones

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a) Translucent,

b) Minimal amount of collagenous fibers.

c) Rich in cartilage cells (single or in groups, cell nest)

• Sites:

1. Articular cartilage

2. Cartilage of respiratory passage as nose, Larynx, trachea

3. Costal Cartilages

4. Skeleton of fetus and epiphyseal plate

Articular

cartilage

Thyroid cartilage of Larynx costal cartilage

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2- Yellow Elastic Fibrocartilage

• Properties:

Contains yellow elastic fibers in the matrix with abundant cartilage cells

• Sites:

1. Ear pinna, External auditory meatus, Eustachian tube.

2. Some laryngeal cartilage as epiglottis.

3- White Fibrocartilage

• Properties:

It is rich in dense white collagenous fibers with few number of cartilage cells

• Sites:

1. Intervertebral disc.

2. Laberum glenoidal and laberum acetebulare

3. Symphysis Pubis

4. Semilunar cartilage of knee and meniscus

Elastic fibers Epiglottis

Elastic fibers Epiglottis

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II- Bones

It is formed of calcified C.T. with hard matrix, it is formed of 206 separate bone.

❖ Classification of Bones

1- According to their position in the body

They are divided into:

a) Axial skeleton:

Skull, vertebral column, sternum & ribs

b) Appendicular skeleton:

Bones of the upper limb and lower limb.

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2- According to the structure:

There are two types of bones: compact (ivory) as the cortex of the shaft of long

bones and cancellous (spongy) formed of bone trabeculae as in vertebrae.

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3- According to the shape

The bones are divided into:

a) Long (tubular) bones: Each has a medullary cavity, a shaft called

diaphysis and two ends called epiphyses. The area of junction between the

shaft and epiphysis is called metaphysis e.g. humerus and femur.

b) Short bones: Each is formed of a mass of spongy bone covered with a

thin layer of compact bone e.g. carpal and tarsal bones.

c) Flat bones: Each is formed of two tables of compact bone with a thin

mass of spongy bone in between e.g. skull bones, scapula and ribs.

d) Irregular bones: They are similar, in structure, to short bones but they

have multiple processes e.g. vertebrae.

e) Pneumatic bones: They are similar to flat bones but with absorption of

the middle layer of cancellous bone. Their cavities are lined with mucous

membrane and they contain air as they communicate with the nasal cavity.

They constitute the paranasal sinuses e.g. maxillary, frontal, sphenoid,

ethmoid and mastoid air sinuses. They have the following functions:

1. Resonance of voice.

2. Lightening of the weight of the skull.

Compact bone (ivory) Cancelluos bone

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3. Protection of the brain.

4. Conditioning of air.

f) Sesamoid bones:

They are more or less rounded nodules of bones embedded in certain

tendons and usually related to articular surfaces

• Function:

1. Modify pressure exerted on tendons as they pass on bone.

2. Diminish friction between the tendon and the underlying bone.

3. Occasionally, alter the direction of pull of muscle.

• Examples:

a) Patella: Largest sesamoid bone embedded in the tendon of

quadriceps femoris

b) Pisiform: It is embedded in flexor carpi ulnaris tendon.

c) Fabella: it is located in tendon of origin of gastrocnemius.

4- According to the methods of ossification:

a. Membranous bones: A connective tissue membrane is transformed into a

bone e.g. clavicle, skull cap and some facial bones.

b. Cartilaginous bones: A model of cartilage is replaced by bone e.g. long

bones of the limbs, the scapula, vertebrae, and ribs.

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Function of bones:

1- Act as a central axis.

2- Support of the body and transmit body weight.

3- Give form of the body.

4- Protect the underlying structures.

5- Give attachments to muscles.

6- Form joints that allow locomotion.

7- Form blood cells in the red bone marrow.

8- Store of calcium and phosphorus.

diaphysis

Long bone

Short bone

Irregular bone Pneumatic bone

Flat bone

Scapula: flat bone

Pisiform

Sesamoid

Carpal

bones

Epiphysis

Medullary

canal

Metaphysis

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❖ Blood Supply of Long Bones

Long bones are supplied by:

1- Nutrient artery: Reaches the medullary cavity and divides into

ascending and descending branches, which reach the metaphysis at the

upper and lower end of the shaft. It supplies the bone tissue and bone

marrow.

2- Epiphyseal arteries: They are numerous and enter the bone through its

two epiphysis to supply them.

3- Metaphyseal arteries: They enter the bone through its two metaphyses

to supply them.

4- Periosteal arteries: They come from the periosteum covering the shaft

of the bone. They supply the cortex of the shaft and communicate

freely with the nutrient vessels in the cortex.

❖ Nerve supply of bones:

Sensory supply comes from surrounding nerves for both bone and

periosteum

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❖ Bone Marrow

it is a soft connective tissue situated in medullary cavities of the long bones and

between trabeculae of the cancellous bone.

Types and distribution:

1- From birth till 2 years the whole bone marrow is red

2- During childhood fatty tissue (yellow marrow) gradually replaces the red

marrow in the medullary canal of long bones

3- In older children and adults, red marrow is restricted to axial bones as

well as clavicles and scapulae.

4- The yellow marrow in the long bones has the potential for conversion to

active haemopoiesis in response to severe haematologic stresses.

1.

2

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❖ The Periosteum

It is rough fibrous sheath surrounding the bone except the articular surfaces.

It consists of 2 layers

a) Superficial white fibrous layer.

b) Deep layer of elastic fibers and osteoblasts, which is responsible for bone

formation.

Function:

1- Growth of bone in width.

2- Forming new bone in case of fracture.

2- Its blood supply supplies also the underlying bone.

Superficial layer

Deep layer

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❖ Growth of bones

A- Increase in length

• This occurs at the epiphyseal plates of cartilages (called metaphysis)

intervening between the epiphysis and diaphysis of the bone.

• The epiphyseal plate is responsible for growth of bone in length by

proliferation of its cells. When the bone becomes mature, the epiphyseal

plate stops division and ossifies resulting in bony fusion between

epiphysis and diaphysis.

• The epiphyseal plate at one end of the shaft of long bone ossifies earlier

than that at the other end, which continues adding bone to the shaft for

another 2 to 3 years before it undergoes ossification as well. This end is

called the growing end.

• Fusion of the epiphysis and diaphysis is under hormonal control. It occurs

in females earlier than males by about 2 years.

B- Increase in width: This is achieved by the osteoblast of the periosteum

which is capable to form new bone even after removal of bone without

removing the periosteum.

Epiphyseal plate

periosteum

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❖ Location of the growing end in the long bones

• The growing ends of UL: It is located at the upper end of humerus and the

lower end of ulna and radius

• The growing ends of LL: It is located at the Lower end of the femur and

the upper end of tibia and fibula.

• Accordingly, the direction of bone growth in length, which is represented

by the direction of the nutrient foramina, follows the following statement:

from the knee I flee to the elbow I go.The growing ends of bones are the

reverse of the above mentioned statement.

Direction of bone growth

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External Features of Bones

Articular surfaces:

• Articular surface: is the part of bone that shares in the formation of a

joint.

• Facet: is a small articular surface.

• Condyle: is a knuckle-shaped articular surface.

• Epicondyle: is a small projection on a condyle giving attachment to a

collateral ligament for the joint in which the condyle is involved.

• Trochlea: is a pulley-shaped articular surface.

• Caput (head): is the expanded end of a long bone.

• Capitulum: is a small head.

Projections:

1. Process: is a bony projection of a considerable size.

2. Spine: is a pointed process.

3. Hamulus and cornu (horn): are slender curved processes.

4. Styloid process: is a pencil-shaped process.

Elevations:

• Tubercle, tuberosity, and trochanter: are localized roughened bony

elevations of variable sizes.

• Line, ridge: are elongated (linear) elevations of variable sizes.

• Crest: is an elongated (linear) bony projection with a flat surface having

two lips.

Depressions:

• Fossa: is a rounded depression on a bony surface.

• Notch (incisura): is a rounded depression on a bony border.

• Groove and sulcus: are elongated (linear) depressions. The sulcus is

deeper than the groove.

Defects (gaps):

• Foramen: is a hole in a bone.

• Canal: is a foramen of some length.

• Aperture: is a large foramen.

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• Meatus: is a canal with a one closed end.

• Fissure: is a cleft in a bone or between two bones.

Sex Differences in Bones:

Female bones are lighter, shorter, and smoother in features than male bones.


MCQ:

1- One of the following bones is a flat bone:

a. Scapula

b. Clavicle

c. Humerus

d. Carpal bone

2- The hayaline cartilage:

a. Contains large amount of elastic fibers.

b. Rich in cartilage cells

c. Forms the intra-articular disc

d. Forms the ear pinna

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Muscles

The muscles form about ½ of body weight and they have contractile ability.

They are classified into three types:

1- Smooth muscles:

• Plane and spindle in shape.

• Supplied by autonomic fibers i.e. involuntary.

• Sites:Wall of blood vessels and viscera.

2- Cardiac muscle fibers:

• Striated but branched.

• Found in the heart.

• Supplied by autonomic fibers i.e. involuntary

3- Skeletal muscles :

• Striated, not branched, voluntary.

• Have bony attachments; an origin and insertion.

• Supplied by at least one somatic nerve and receive blood supply from

surrounding blood vessels.

ILOs:


• Differentiate between different types of muscle fibers.

• Classify skeletal muscles.

• Explain types of the muscle action.

• Discuss the nerve supply of skeletal muscles.

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❖ Types of striated muscles

1- Pale fibers:

• Rapid contraction and rapid fatigue.

• Located in prime mover muscles which start the movement.

1- Smooth muscles 2- Cardiac Muscles 3- Skeletal muscles

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2- Red fibers (high myoglobin content):

• Slow contraction but sustained.

• Located in antigravity muscles where continuous contraction is needed to

maintain the posture of the body.

Examples:

The gastrocnemius muscle is rich in pale fibers which is needed for rabid

performance of movement.

The soleus muscle is rich in red fibers where maintenance of the movement is

required (maintenance of posture).

❖ Muscle Attachments:

The muscle is attached at its both ends where in contraction, one of the ends is

fixed (the origin, usually the proximal end) and the other end is approximated to

it (the insertion, usually the distal end).

Origin

Insertion

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❖ Types of Muscle Attachments

1. Attachment to bone: It is the commonest type. A muscle may be attached

to bone either directly by fleshy fibres or by a tendon.

2. Attachment to a fibrous raphe: It is a band or septum of fibrous tissue

through which 2 muscles fuse together e.g. mylohyoid muscle.

3. Attachment to deep fascia e.g. tensor fascia lata

4. Attachment to aponeurosis, which is a flat expanded tendon e.g. external

oblique muscle.

5. Attachment to skin: A muscle is inserted into the dermis of the skin and

by its contraction it could move the skin, e.g. facial muscles.

6. Attachment to an intermediate tendon: A muscle may have 2 fleshy

bellies and an intermediate tendon in between; the bellies are inserted

into this tendon; e.g. digastric muscle.

7. Attachment to cartilage: As in the muscles of the larynx e.g. cricothyroid

muscle.

Aponeurosis

Deep fascia

Iliotibial tract

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Form

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Form of the Skeletal Muscles

The form of the skeletal muscles are divided according to the direction of the

muscle fibers in relation to the line of pull into:

a) Parallel fibers ( parallel to the line of pull):

1. Strap like: Sartorius

2. Quadrate: Quadratus femoris

3. Fusiform: Palmaris longus

4. Tendinous intersection: Rectus abdominus

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b) Oblique fibers (oblique to the line of pull):

1- Pennate fibers (feather like):

• Unipennate: Fibers attached to one side of the tendon: flexor pollicis

longus

• Bipennate: Fibers at 2 sides of tendon: rectus femoris

• Multipennate: Series of bipennate: deltoid.

• Circumpennate: The fibers attached all around the tendon: tibialis

anterior muscle.

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2- Oblique non pennate:

• Triangular as temporalis

• Spiral as latissimus dorsi.

• Cruciate as masseter

• Circular as Orbicularis oculi

Muscle Action

It is a range of contraction which produces a definite movement.

❖ Factors affecting the action:

1- Length of the muscle fibers.

2- Number of fibers

3- Direction of the muscle fibers

Triangular

Circular

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NB.

• Not all the muscle fibers contract at the same time so that the Maximum power of

contraction achieved when all fibers of the muscle contract.

• The contracted muscle shortened by 2/3 of its original length.

• Tone of the muscle means the length shorter than distance.

• There is coordination and harmony during movements of different group of muscle.

❖ Types of muscle actions:

A. Prime movers (agonist): Start and maintain the movement e.g.

brachialis to produce flexion of the elbow.

B. Antagonistic muscles: Oppose the action of agonist e.g triceps should

relax in elbow flexion.

C. Synergists: Support the agonists preventing unwanted movement.

Sometimes the prime mover muscle crosses many joints before it reaches

its insertion. So its contraction will move the desired joint (at the

insertion) as well as the other joints crossed by the prime mover. In this

case, other muscles called synergistic muscles will contract to eliminate

the unwanted movements at the crossed joints. Therefore the action of

the prime mover on the desired joint becomes maximal.

D. Fixator muscles: Stabilize the origin of the agonist so it can act

efficiently e.g. to abduct the arm, the short muscles around the shoulder

joint stabilize it during the contraction of the prime mover

❖ Blood supply of muscles:

• Derived from muscular branches of nearby arteries.

• When the artery to a muscle is accompanied by its nerve supply, they

form what is called “neurovascular bundle”.

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❖ Nerve supply of muscles:

• Each receives one or more motor nerve supply.

• When a muscle derived from several myotomes, it has multiple nerve

supply.

• Many muscles, especially those concerned with posture, have also

sensory nerve supply which carries proprioceptive sensation to CNS.

Formative Assessment

Q1 : Enumerate the types of muscle forms with examples.

Q2: Explain the types of muscle actions.

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Joints

Definition: is a meeting between two or more bones.

Classification of Joints

I- Fibrous Joints

Bones are bounded together by fibrous tissue.

1. The joints are almost immobile.

2. No cavity between articular surfaces.

❖ Types of fibrous joints:

1. Sutures: As in skull where the adjacent bone linked by sutural

ligament: serrate, plane or squamous

2. Syndesmosis: The adjacent bones are linked by interosseous ligament

e.g. inferior tibiofibular joint.

3. Gomphosis: Between teeth and adjacent bones (sockets) where the

collagen fibers of the periodontal ligament run between tooth and

socket.

ILOs:

At the end of the lecture, student should be able to:

• Describe the criteria of each type of the joints and giving examples for each one.

• Determine the movements allowed at different types of joints.

• Identify the factors that limit excessive movement of joints.

• Recognize the factors that stabilize the joints.

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II- Cartilaginous Joints:

1. The articulating bones connected together by cartilaginous tissue.

2. Very limited degree of mobility may be allowed.

3. No cavity in this type of joints.

❖ Types of cartilaginous joints

a) Primary cartilaginous joints: It is temporary joint and disappears at

certain age. No movement allowed e.g. epiphyseal cartilage between

epiphysis and diaphysis of long bones.

b) Secondary cartilaginous joints: the bones are connected by a fibro-

cartilaginous disc and it is permanent. Limited degree of movement is

allowed. e.g. intervertebral discs and symphysis pubis.

III- Synovial joints:

Suture (fibrous

joint)

Symphysis pubis

(secondary cartilaginous

joint)

Primary cartilaginous

joint

Syndesmosis

(Fibrous joint)

Gomphosis

(Secondary cartilagenos joint)

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III- Synovial Joints

❖ They are characterized by:

1. Articular surfaces: Is covered by hyaline cartilage and separated from

each other.

2. Joint cavity: It a Potential space.

3. Fibrous capsule: It covers the joint and is perforated by blood vessels,

nerves and synovial membrane.

4. Synovial membrane: It lines the inner aspect of the capsule and non-

articular parts inside the joint. It secretes synovial fluid.

5. Synovial fluid: It fills the joint cavity. It is secreted by the synovial

membrane.. It has the following functions:

a. Lubrication of the articular surfaces.

b. Nourishment of the articular cartilage.

c. Phagocytosis of debris and foreign particles as it contains macrophages

6. Ligaments: They enforce the capsule from outside

7. Intra-articular structures: May be present, for example:

a. Articular disc.

b. Menisci

c. Ligaments

d. Tendons

8. Movements: They are freely mobile with variable grades.

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❖ Movements of the synovial joints:

Joints are classified according to their axes of movements into plane and axial

joints:

A- Plane joints

Plane surfaces are in apposition and moves against each other permitting

gliding movement, e.g. joints between articular processes of vertebrare and

intercarpal and intertarsal joints

B- Axial joints: where the articulating bones move around axis.

According to the number of axes, these joints are classified into:

1- Uniaxial:

a. Hinge joint: It is characterized by:

1. Moving around transverse axis

2. Has strong collateral ligaments.

3. Allowing flexion and extension only

❖ Examples: elbow, ankle and interphalangeal joints

b. Pivot joint: It is characterized by:

1. Moving around longitudinal axis

2. Allowing rotatory movements

Joints between the articular processes Intercarpal joints

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❖ Examples: superior and inferior .radio-ulnar and atlanto-axial joints

2- Biaxial

These joints move around two axes perpendicular to each other allowing

flexion, extension, adduction and abduction. According to the shape of the

articular surfaces, there are 3 types:

a. Condylar: It consists of either 2 separate convex surfaces (condyles), which

articulate with 2 concave surfaces, e.g. knee joint (bicondylar) or one

condyle articulating with one concave surface e.g. temporomandibular joint

(unicondylar).

b. Ellipsoid: It consists of one convex oval surface articulates with elliptical

concave surface, e.g. wrist and metacarpo-phalangeal.

c. Saddle: each surface is concave in one direction and convex at the

perpendicular one, e.g. carpometacarpal of thumb.

Pivot joint (Atlanto-axial) Hinge joint (Elbow)

48

3- Multiaxial joints:

The movements occurs around axes. The articular surface consists of a global

rounded head articulates with a concave cup-shaped cavity. They are called

ball and socket joints and are the most freely mobile joints in the body, e.g.

the shoulder & hip joints.

Saddle shaped joint: carpometacarpal joint of thumb

49

❖ Factors maintaining stability of the joints

1. Bony (skeletal) element: Shape and fitting of articulating surfaces.

2. Ligamentous element: Position and strength of ligaments as well as

thickness and elasticity of the capsule

3. Muscular element: Strength of the surrounding muscles which are in

direct contact with the joint capsule.

4. Intra-articular pressure: positive atmospheric pressure and negative

intra-articular pressure help keeping the articulating surfaces in contact

with each other.

❖ Arterial and nerve supply (Hilton’s law) Blood vessels cross the flexor aspect of joints to avoid stretching and tear

of blood vessels.

Hilton's Law: The nerve supply to a muscle acting on a specific joint gives a

branch to supply this joint and another branch to supply the skin covering the

same joint.

Shoulder joint (ball & socket)

Shoulder joint

50


MCQ:

One of the followings is a hinge joint:

a. shoulder

b. Elbow

c. Knee

d. wrist

51

Serous Membranes

Structure

It is formed of a closed sac lined with a single layer of sequamous cells. It

contains fluid for lubrication.The serous membrane is formed of:

a. Visceral layer: Inner layer covering the organ or the part.

b. Parietal layer: Outer layer is reflected from the visceral layer.

c. Potential space: Between the 2 layers where thin film of serum-like fluid

is present to facilitate the movement.

Function

a. It facilitates movement of the structure lined by it.

b. It minimizes the friction between the mobile organ and the surrounding

structures.

Sites

1. Synovial sheath: Around the tendons of the muscles.

2. Synovial membrane: It is a serous sac inside the synovial joints to

facilitate the movement of the joint.

3. Pericardium: Serous sac around the heart.

4. Pleura: Serous sac around the lungs.

5. Peritoneum: Serous sac lining the abdomen viscera.

6. Bursae:

• They are definite sacs, their walls are identical in structure to the

synovial membrane of the joints.

ILOs:

Br the end of the lecture, students should be able to:

• Locate the sites of serous membranes.

• Describe the function of the serous membranes.

52

• They occur where skin, ligament or tendon move over bony surfaces

under conditions of pressure, to provide free movement and diminish

friction between surfaces.

• Most bursae lie close to the joints, and sometimes communicate with

synovial membrane of the joints.

53

Subdeltoid bursa

54

Tendons • They are tough whitish cords formed of parallel bundles of collagen

fibres connected together by fibroareolar tissue. • The tendon connects the muscle with the bone. • Friction between it and the bone is minimized by a synovial sheath

present around the tendon or by a bursa.

Aponeurosis

▪ It is a flat expanded tendon usually of a flat muscle e.g. anterior abdominal

wall muscles.

▪ It is poor in vasculature. Sometimes a non-flat muscle has an aponeurosis e.g.

biceps brachii muscle which has bicipital aponeurosis.

55


Q. Mention the sites and function of synovial membranes.

56

Cardiovascular System

It is formed of two main structures:

A) Heart

B) Blood vessels.

A- Heart

- It is Formed of 4 chambers:

1. Right atrium: It receives the deoxygenated blood from all parts of the

body by 2 large veins; the superior vena cava (SVC) and the inferior

vena cava (IVC). It sends its blood to the right ventricle through the

tricuspid valve.

2. Right ventricle: It sends the deoxygenated blood through the pulmonary

valve to the pulmonary trunk which divides into 2 pulmonary branches

(right and left), one for each lung where oxygenation of the blood

occurs.

3. Left atrium: It receives the oxygenated blood from both lungs through 4

pulmonary veins and pumps it to the left ventricle via mitral valve.

4. Left ventricle: It pumps its oxygenated blood to all parts of the body

through the aortic valve, to the aorta and its branches.

- The right 1/2 of the heart contains deoxygenated (venous) blood and the Left

1/2 of the heart contains oxygenated (arterial) blood.

- The heart is enclosed within 2 layers of serous pericardium surrounded by

ILOs:


• Recognise the three main circulations of the human body.

• Describe types of arterial anastomoses and their sites.

• Determine the sites of end arteries and its significance.

• Explain the importance of the arterio-venous shunt.

.

57

the fibrous pericardium.

- The heart pumps about 70 C.C. of blood/beat and 5 liters/minute.

Blood Circulation

Blood circulates in a closed circuit:

From heart----large arteries----smaller arteries----arterioles-----smaller arterioles-

-------capillaries----venules----small veins-----large veins---- back to heart.

Types of blood circulations:

The body contains 3 circulations:

1- The Pulmonary circulation (lesser circulation)

2- The Systemic circulation(greater circulation

3- The Portal circulation

Direction of circulation of blood within the chambers of the heart

58

1- The pulmonary circulation:

it is the passage of deoxygenated blood from the right ventricle to

pulmonary arteries then to the lungs for gas exchange and its return from

the lung, as oxygenated blood, to the left atrium via 4 pulmonary veins.

2- The Systemic Circulation (Greater circulation):

The oxygenated blood is carried from the left ventricle through the aorta

and its branches to all parts of the body for cell respiration. Then, the

deoxygenated blood is collected and return to the right atrium by means of

the superior and inferior venae cavae.

3- The Portal Circulation: The venous blood from stomach, spleen,

pancreas and intestine is collected into portal vein which ends in the liver

and not in the heart. The blood carried is rich in digested food substances

and it is poured into the liver sinusoids (venous vessels) to be processed.

Then the blood is drained into the hepatic veins to the inferior vena cava.

Therefore, the portal circulation begins and ends by veins.

59

B- The Blood Vessels

I. Arteries:

They Are vessels carrying blood away from the heart. They give branches all

over the body. They carry oxygenated blood except the pulmonary and

umbilical arteries, which carry deoxygenated blood.

Systemic circulation

60

❖ Classification of arteries:

1- Large sized arteries: The tunica media of their wall is rich in elastic

fibers, e.g. aorta

2- Medium sizes arteries: Muscular supplying limbs and organs

3- Small sized arteries: Muscular and arise from medium sized ones and

goes more peripheral.

4- Arterioles: they arise from small arteries having thick wall and narrow

lumen. They have projections into the lumen from their muscle layer

called pre-capillary sphincter. They are the main source of peripheral

resistance to blood flow to capillaries.

❖ Special types of arteries:

1- End arteries: no precapillary arteriolar anastomosis between adjacent

arteries. Their interruption, due to any cause, results in death of the

supplied organ.

The following arteries are end arteries

a. Splenic

b. Renal

c. Pulmonary

d. Metaphyseal

e. Central artery of the retina.

2- Tortuous arteries:

They supplied movable organs to give a way during different

movements of the organ as:

a. Lingual

b. Facial

c. Splenic

d. Uterine

3- Coronary arteries:

Blood supply to the heart is called coronary arteries. They contain

elastic fibers in the 3 tunics to prevent closure of the coronaries during

heart contraction.

4- Cerebral arteries: They resemble veins in having wide lumen, very

thin wall as well as well-developed internal elastic lamina.

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❖ Arterial Anastomosis

The arteries unite with each other. The frequency of arterial anastomosis

increases with increase distance from the heart i.e. the smaller arteries

anastomose more frequently than the larger ones

- Importance

1. The anastomosis can provide alternative routes for blood flow to

maintain the blood supply to the area where its main arterial supply is

interrupted for any reason as in accident or disease.

2. It equalizes pressure in the communicating arteries

Large

sizes

artery

Muscular

artery

Arterioles

Facial artery (tortuous)

Splenic artery (tortuous

artery)

62

❖ Types of anastomosis: 1- End to end anastomosis (actual): The two ends of two arteries are

connected together forming an arch.

Example: palmar arches and stomach arteries. Cutting the anastomosis

results in bleeding from both sides.

2- By terminal arterioles (potential): It occurs between side branches

(collateral branches) of the main arteries. Sudden occlusion of the main

arteries results in death of the supplied part while gradual occlusion

gives chance to the collateral circulation to open and maintains the

blood supply to the tissues beyond the level of obstruction e.g.

Coronary arteries, and anastomoses around joint.

NB.:

• Blood supply to the wall of the arteries is called Vasa Vasorum, which is derived from

neighboring arteries.

• Nerve supply of the arteries: arises from sympathetic fibers to produce vasoconstriction.

Anastomosis around elbow Arterial palmar arches

63

II- Veins

❖ Properties:

• They are blood vessels carrying blood from peripheries to the heart and

usually carry deoxygenated blood, except the pulmonary and umbilical

veins which carry oxygenated blood.

• The veins have thin wall and bigger calibers than the corresponding

arteries for slower rate of blood flow.

• Venous pressure is much less than the arterial one and they do not pulsate.

• They are divided into superficial and deep veins. Deep veins usually

accompany arteries while the superficial ones do not.

• In both hand and foot, the venous return is by the way of the dorsum to

escape the pressure of the palm and sole which may constrict the veins.

• The large veins have a dead space around them to allow for great

dilatation that takes place during increased blood flow e.g. femoral vein.

• Most of the veins especially those of the lower limbs contain valves

formed by two cusps inside their lumena, which prevent back flow of the

blood by gravity.

• Some veins have no valves:

1. SVC & IVC

2. Dural sinuses

3. Vertebral veins

4. Cardiac veins

5. Pulmonary veins

6. Hepatic & portal veins

7. Ophthalmic veins

8. Pelvic veins

❖ Factors helping venous return:

• In limbs:

1- Muscular contraction within the osteofascial compartments helps to

squeeze veins pumping the blood towards the heart.

2- Valves prevent back flow of blood towards the periphery.

Venous

valve

64

3- Arterial pulsation of the arteries accompanied the veins.

4- Deep fascia surrounding the muscle groups.

• Near thorax:

The negative intra-thorathic pressure helps the venous return from the

abdomen.

• In head and neck:

The force of gravity helps the venous return.

III- Connections between arteries and veins

1- Capillaries: They have narrow uniform diameter. They are found in all

parts of the body except epidermis of skin, cornea and cartilage.

2- Sinusoids: they have wide irregular diameter and many pores. They are

located in certain areas of the body e.g. liver, bone marrow, pituitary and

parathyroid glands.

3- Arteriovenous shunt:

❖ Characteristics

• It exists between smaller arteries and corresponding veins

• Straight or coiled

• Proximal to capillary bed

• Thick muscular wall

• Has sphincter rich sympathetic supply.

• Capable of complete closure, in this case circulation passes in the

capillary bed as usual.

• When patent, the blood passes directly from the artery to vein by

passing capillary bed.

• Poorly developed in newly-born infants.

• They develop rapidly in early years of life

• Undergo atrophy and sclerosis in old age.

❖ Sites of arterio-venous shunt

• Exposed parts of the body

• Mucous membranes of alimentary canal

65

• The erectile tissue of the penis

❖ Significance of arteriovenous shunt

1. Regulation of body temperature via the cutaneous arterio-venous

anastomosis.

2. Facilitate the process of absorption where the aretio-venous

anastomosis was closed during active absorption, the slow blood flow

through the ordinary capillary bed gives enough time for active

absorption.

3. Has role in erection



MCQ:

Which of the followings is a character of the sinusoids:

a. Narrow lumen

b. Uniform diameter

c. Located in most of the parts of the body

d. Presence of pores

66

The Lymphatic System

The lymph is an intercellular fluid.

❖ The lymphatic system is formed of: 1. Lymphatic vessels

2. Lymphoid tissues: As lymph nodes, spleen, tonsils and thymus gland.

3. Free cells (lymphocytes): including B- and t- lymphocytes.

1- Lymph Vessels:

- Formation

• It starts as network of lymph capillaries in the intercellular spaces where

excess fluid is drained by "the lymph capillaries which is collected into lymph

vessels. The lymph vessels are interrupted along their course by lymph nodes,

which is a small bean-shaped bodies. There are 2 types of lymph vessels:

a. Afferent lymph vessels: They open into the periphery of the lymph nodes

at their convex borders and carry lymph to them.

b. Efferent lymph vessels: They emerge from the hilum of the lymph nodes

and carry the lymph away from them.

• The lymph vessels unite to form ultimately 2 main lymph trunks, thoracic

duct and right lymphatic duct, open in the venous system at the root of

neck.

• There are no lymphatics in certain tissues such as:

a. Nervous system

b. Bone marrow

c. Spleen

d. Eye

ILOs:

By the end of the lecture, the student should be able to:

Describe the types and characters of lymph vessels.

Discuss the shape, structure, sites and functions of lymph nodes

Explain factors helping lymph drainage.

67

e. Avascular structures e.g. cartilage, cornea and hair.

- Characteristics of lymph vessels

• The superficial vessels follow veins while the deep ones follow arteries

except the tongue.

• They have a thin irregular wall, which absorbs substances of high

molecular weight (colloids) through wide pores in their walls.

• They have many valves, which make the flow of lymph in one direction.

• They drain a colorless fluid except intestinal lymph vessels, which drain

milky lymph rich in fat, hence called lacteals.

❖ Factors helping Lymphatic return 1. Filtration pressure of capillaries.

2. Contraction of surrounding muscles and valves prevent passage of

lymph to peripheries.

3. Pulsation of nearby artery

4. Intrathoracic negativity

5. May be by smooth muscles in the walls of large lymph trunk.

6. Peristaltic movement of the intestine

2- Lymph Nodes

- Shape: Lymph nodes are oval or kidney-shaped small bodies.

68

- Structure: Each lymph node consists of cortex and medulla.

a. Cortex: Contains lymph follicles. It receives lymph via afferent vessels.

b. Medulla: Devoid of follicles and leads to the hilum of the node. The

lymph leaves the hilum by passing through an efferent vessel.

- Site: They are located along the course of lymph vessels in groups in fixed

sites:

a. At the limb roots: axillary (in upper limb) and inguinal (in lower

limb).

b. In the neck: on both sides and at its junction with the head.

c. In the chest: close to the trachea and bronchi and in the chest wall.

d. Close to the abdominal and pelvic organs: near the big vessels.

e. Around abdominal aorta and blood vessels of pelvis.

- Function of lymphatic system

A- Lymph vessels: absorption of colloids from tissue spaces.

B- lymph nodes:

1. Filtration of lymph from bacteria and foreign bodies.

2. Formation and production of lymphocytes

3. Defense mechanism: They form the sites of interaction between micro-

organisms (antigens) and phagocytes and lymphocytes.

69

3- Thymus Gland

• It's a lymphatic organ and has endocrine function as it secretes thymosine

hormone.

• It's formed by two lobes and present in the thorax just behind the sternum.

• The size of the thymus continues to increase in size until the age of puberty, and

then it decreases in size with advance of age.

70

4- Spleen

• Site: It is a hemolymphatic organ present in the upper left part of the

abdominal cavity beneath the left dome of the diaphragm, behind the

stomach and protected by the 9th, 10th, and 11th ribs.

• Surfaces: it has a diaphragmatic smooth surface and a medial

visceral surface which is related to the stomach, left kidney, pancreas,

and left colic flexure.The hilum is present in the visceral surface.

• Size: it is not palpable, unless if it is enlarged at least three times.

• Functions:

1- In the fetus, the spleen has a role in the formation of the blood cells.

2- In the adult: the spleen stores and concentrates blood cells. So, in

case of hemorrhage it pours the concentrated blood into circulation.

3- It destroys the old expired red cells.

4- It filters the blood from organisms or any harmful substances.

N.B.:

The lymph nodes filtrate the lymph but the spleen filtrate the blood.

71


Q1. Explain factors affecting lymph drainage.

Q2. Determine sites devoid of lymph vessels.

72

Endocrine System

It is formed by glands which secretes hormones directly to the blood.

(1) The Pituitary gland (the hypophysis)

• A small gland, in the size of a pea, which lies in the pituitary fossa (the

sella turcica) in the middle part of the base of the skull, below the brain.

• It consists of:

A) Anterior lobe: Is epithelial in origin and called the adenohypophysis;

- Function: It secretes the important hormones which stimulate the

growth and function of other endocrine glands and hence called "the

master gland".

B) Posterior lobe: Nervous in origin and is called the neurohypophysis;

it is controlled by nerve fibers from the hypothalamus.

(2) The Thyroid Gland:

• Situated in the lower part of the front of the neck clasping the larynx and

upper part of trachea.

• It is formed of 2 lobes connected together by isthmus.

• It enlarges slightly in adolescence, menstruation and in pregnancy.

• Function: It secretes thyroxin which influence the metabolism of the cells

of the body; its hyperfunction will increase the basal metabolic rate of the

body.

(3) The Parathyroid glands:

• Two pairs of small glands embedded in the posterior part of the thyroid

gland.

ILOs:


• Determine the site of each endocrine gland.

• Describe the function of the different endocrine gland..

73

• Function: They are very important because they secrete the hormone

responsible for the calcium and phosphorus metabolism.

(4) The Suprarenal (adrenal) glands:

• Two glands, each one situated over the upper pole of the corresponding

kidney.

• Each is formed of an outer part (the cortex) and an inner part (the

medulla).

• Function: The cortex secretes cortisone and other essential hormones,

The medulla secretes adrenaline and noradrenaline.

(5) Pancreas:

• A mixed endocrine and exocrine gland which lies transversely on the

posterior abdominal wall extending from the duodenum till the spleen.

• Function: Its endocrine part is called islets of Langerhans and it secretes

insulin and glucagon hormones that regulate the blood glucose level

(6) Gonads:

They include the two testes in male and 2 ovaries in female.

a. Testis:

• Oval firm organ lies inside the scrotum within a strong capsule.

• It is divided into 200-300 compartments; each contains 1-2 convoluted

tubules called seminiferous tubules.

• Function:

1. Secretion of the male sex hormone: Testosterone hormone.

2. Formation of the sperms by the process of spermatogenesis.

b. Ovary:

• It is an oval or almond-shaped organ.

• Attached to the lateral margin of uterus by round ligament of ovary

• Function:

1. Secretion of the female sex hormones: Estrogen and progesterone.

2. Production of ova (female germ cells) by the process of oogenesis.

74

(7) Thymus gland:

• It is formed by two lobes and present in the thorax just behind the sternum.

• The size of the thymus continues to increase in size until the age of puberty,

and then it decreases in size with advance of age.

• Function: It secretes thymocine hormone.

Formative Assessment Q. Determine the site and function of the pituitary gland.

75

Nervous System

The nervous system is formed of highly specialized nerve cells called neurons,

which can receive stimuli, deal with them, and then transmit impulses to the

effectors which may be muscles or glands.

Parts of the neurons: it composed of Cell body or soma and processes of

nerve cell called axon and dendrites.

The nervous system is divided into:

1- Central nervous system (C.N.S).

2- Peripheral nervous system (P.N.S.): composed of:

a. Somatic nervous system

b. Autonomic nervous system

1- Central Nervous System:

It is subdivided into brain and spinal cord which lie inside the skull and vertebral

canal, respectively. They are covered by three membranes called Pia matter,

Arachnoid matter, and Dura Matter.

A- The brain is subdivided into:

Two cerebral hemispheres, diencephalons, brain stem (Mid-brain, Pons, and

Medulla) and cerebellum.

B- The spinal cord is formed by H-shaped gray matter contains

central canal inside and white matter outside.

ILOs:


• Classify parts of the nervous system.

• Determine the parts of the brain.

• Compare the spinal and cranial nerves.

• Discuss the two parts of the autonomic nervous system.

76

2- Peripheral Nervous System:

A- Somatic nervous system

There are 12 pairs of cranial nerves attached to the brain and 31 pairs of spinal

nerves attached to the spinal cord.

- The Cranial nerves: They are 12 craneal nerves:

1. Nerves attached to the cerebrum:

I- Olfactory nerve : for smell

II- Optic nerve: for vision

2. Nerves attached to the midbrain:

III- Oculomotornerve: motor to eye muscles

Grey matter white matter

77

IV- Trochlear nerve: Motor to one muscle of the eye.

3. Nerves attached to the pons:

V- Trigeminal: Sensory to the face and motor to the muscles of mastication.

VI- Abducent: Motor to one muscle of the eye.

VII- Facial: Motor to the muscles of the face, taste sensation and

parasympathetic to salivary glands.

VIII- Auditory (Stato-acoustic): For hearing and equilibrium.

4. Nerves attached to the medulla oblongata:

IX- Glossopharyngeal: Sensory to the pharynx and tongue, motor to one

muscle of the pharynx and parasymphathetic to the parotid gland.

X- Vagus: Motor to the muscles of the pharynx and larynx and

parasympathetic to the structures in the thorax and abdomen

XI- Accessory: Motor to muscles of the neck.

XII- Hypoglossal: Motor to the muscles of the tongue.

- Spinal Nerves:

- The spinal cord gives attachment to 31 pairs of the spinal nerves which are

distributed as follows:

• 8 cervical nerves; in the cervical region.

• 12 thoracic nerves: in the thoracic region,

• 5 lumbar nerves: in the lumbar region.

• 5 sacral nerves: in the sacral region.

• 1 coccygeal nerve: in the coccygeal region.

- Each spinal nerve arises from the side of the spinal cord by 2 roots:

(1) Dorsal root:

- Its fibers are sensory or afferent conveying sensations from the skin, joints,

bones and muscles to the posterior horn cells of the grey matter of spinal cord.

- It has a ganglion attached to it. This ganglion consists of sensory nerve cells,

and is called dorsal root ganglion.

(2) Ventral root:

- Its fibers are motor or efferent.

78

- Its fibers arise from the anterior horn cells (A.H.Cs) situated in the anterior

horn of the spinal cord.

❖ The two roots unite to form nerve trunk, containing mixed fibres.

❖ The nerve trunk divides into two rami; both contain mixed fibres:

a- Anterior (ventral) primary ramus.

b- b -Posterior (dorsal) primary ramus.

B- The Autonomic nervous system:

It is concerned with the involuntary activities. It is divided into:

I. Sympathetic nervous system.

II. Parasympathetic nervous system.

Roots of the spinal nerve

79

I. Sympathetic Nervous System

Origin: Thoraco-lumbar outflow:

• It arises from the thoracic and upper 2 lumbar segments of the spinal cord.

• The Fibers (preganglionic fibers) passes in the anterior rami of the

corresponding spinal nerves of the thoracic and upper two lumbar nerves

to relay in sympathetic ganglion situated in two sympathetic chains one in

each side of the vertebral column, the fibers may not relay in the chain

and relay in collateral ganglion.

• The relayed fibers (postganglionic) join the anterior rami of all spinal

nerves to reach the effector organs.

80

II. Parasympathetic Nervous System

Origin: Cranio-sacral outflow:

It presents in the followings:

a- Cranial nerves: Oculomotor, facial, glossopharyngeal and vagus.

b- Sacral nerves: From the second, third and fourth sacral segments.

• The cranial outflow (preganglionic fibers) relays in parasympathetic

ganglia of the head and neck.

• The sacral outflow relays in ganglia in the wall of the innervated viscous

or near its wall.

Function of both sympathetic and parasympathetic nervous systems

Their function is complementary to each other:

• Sympathetic system prepares the body for activity, increases its capacity

and arranges it for performing severe muscular effort as in emotional

states, fight and fear.

• Parasympathetic stimulation is anabolic and energy preserving. It arranges

the body for sleep and digestion.

81

References

1. Anderson, J.E. (1983): Grant's Atlas of Anatomy, 8th ed. Williams & Wilkins, london, Sydney, Baltimore, Los Angeles.

2. Clemente, C. D. (1997): A regional Atlas of Human Body, 4th ed. Williams & Wilkins, london, Sydney, Baltimore, Philadelphia, Tokyo.

3. Drake, R. (2009): Gray's Anatomy for students, 2nd ed. Churchill livingstone, UK, Philadelphia.

4. Martini, F.h.; Timmons, M.S. and Tallittsch, R.B. (2012): Human Anatomy-Atlases, 7th ed. Benjamin Cummings, London Dubai, Madrid, Paris Toronto, Sydney, HongKong, Tokyo.

5. Moore, K.L.; Agur, A.M.R and Dalley, A.F. (2006): Essential Clinical Anatomy, 4th ed. Lippincott Williams & Wilkins, london, Philadelphia, Baltimore, New York.

6. Netter, F.H. (2019): Atlas of Human Anatomy, 7th ed. W.B. Saunders Co. USA.

7. Olson, T.R. (1996): Student Atlas of Anatomy, International edition. Williams & Wilkins, london, Philadelphia, Baltimore,Bangkok.

8. Williams, P.L.; Bannister, L.H.; Berry, M.M. Collins, P.; Dyson, M.; Dussek, J.E.; and Ferguson, M.W.J. (1995): Gray's Anatomy, 38th ed., ELBS with Churchill livingstone, Edinburgh, London, Melbourne, New York.

introduction to human anatomy ame 102 i. basics of …

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