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ANAT 2020

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UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG

SCHOOL OF ANATOMICAL SCIENCES

HUMAN ANATOMY FOR

MBBCh II, BHSc II & BSc (Biomed Engineering) III

COURSE CODE: ANAT 2020

YEAR 2021

Professor AO Ihunwo

and

Staff members of the School of Anatomical Sciences

School of Anatomical Sciences

Faculty of Health Sciences

University of the Witwatersrand

Copyright 2021

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Table of Contents

Page

A. ORGANISATIONAL COMPONENT

1. Course Brief 1

2. Course outline 2

3. Tests and Examinations 3

4. Satisfactory Performance (SP) Requirements 7

5. Textbooks 7

6. Dress Code 8

7. Laboratory Rules 9

8. Important Contact Details 10

9. Guidelines for Students Enquiries and Complaints 10

10. Anatomy School Website Login_______________________________________________10

11. Annexure 1: Answering Questions in Anatomy 11

12. Annexure 2: Rules and Regulations pertaining to the human bones 13

13. Weekly Timetable 15

B. STUDY COMPONENT: HISTOLOGY 36

UNIT THEME 1: PRIMARY TISSUES 36

SUB-UNIT THEME1.1: EPITHELIAL TISSUE

SUB-UNIT THEME1.2 GLANDULAR EPITHELIUM (GLANDS)

SUB-UNIT THEME1.3: CONNECTIVE TISSUE

SUB-UNIT THEME1.4: BONE AND CARTILAGE

SUB-UNIT THEME1.5: MUSCLE TISSUE

SUB-UNIT THEME1.6: NERVOUS TISSUE

UNIT THEME 2: ORGANS AND ORGAN SYSTEMS 41

SUB-UNIT THEME 2.1: SKIN

SUB-UNIT THEME 2.2: CENTRAL NERVOUS SYSTEM

SUB-UNIT THEME 2.3: CARDIOVASCULAR SYSTEM

SUB-UNIT THEME 2.4: LYMPHATIC SYSTEM

SUB-UNIT THEME 2.5: RESPIRATORY SYSTEM

SUB-UNIT THEME 2.6: GASTROINTESTINAL SYSTEM

SUB-UNIT THEME 2.7: GIT GLANDS

SUB-UNIT THEME 2.8: URINARY SYSTEM

SUB-UNIT THEME 2.9: MALE REPRODUCTIVE SYSTEM

SUB-UNIT THEME 2.9: FEMALE REPRODUCTIVE SYSTEM

SUB-UNIT THEME 2.10: ENDOCRINE SYSTEM

C. STUDY COMPONENT: EMBRYOLOGY 45

UNIT THEME 1: EARLY EMBRYOLOGY 45

SUB-UNIT THEME 1.1: THE FIRST WEEK OF DEVELOPMENT

SUB-UNIT THEME 1.2: THE SECOND WEEK OF DEVELOPMENT

SUB-UNIT THEME 1.3: THE THIRD WEEK OF DEVELOPMENT

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UNIT THEME 2: ORGAN SYSTEMS 47

SUB-UNIT THEME 2.1: DEVELOPMENT OF THE HEART

SUB-UNIT THEME 2.2: DEVELOPMENT OF PHARYNGEAL ARCH ARTERIES & VEINS

SUB-UNIT THEME 2.3: DEVELOPMENT OF FACE AND PALATE

SUB-UNIT THEME 2.4: DEVELOPMENT OF PHARYNGEAL ARCHES, TONGUE &

THYROID

SUB-UNIT THEME 2.5: EMBRYOLOGY OF THE NERVOUS SYSTEM

SUB-UNIT THEME 2.6: EMBRYOLOGY OF THE GIT

SUB-UNIT THEME 2.7: COELOM AND MESENTERIES

SUB-UNIT THEME 2.8: THE DEVELOPMENT OF THE UROGENITAL SYSTEM

D. STUDY COMPONENT: MORPHOLOGICAL ANATOMY 51

BLOCK1:

UNIT THEME 1: UPPER LIMB 51

SUB-UNIT THEME 1.1: THE PECTORAL GIRDLE AND BREAST

SUB-UNIT THEME 1.2: THE AXILLA, BRACHIAL PLEXUS AND ARM

SUB-UNIT THEME 1.3: CUBITAL FOSSA AND FOREARM

SUB-UNIT THEME 1.4: THE HAND

UNIT THEME 2: THORAX 60

SUB-UNIT THEME 2.1: THE THORACIC CAGE, INTERCOSTAL SPACES,

SUB-UNIT THEME 2.2 PLEURA & LUNGS

SUB-UNIT THEME 2.3: THE MEDIASTINUM, PERICARDIUM & HEART

SUB-UNIT THEME 2.4: POSTERIOR MEDIASTINUM

BLOCK 2:

UNIT THEME 3: HEAD & NECK 69

SUB-UNIT THEME 3.1: THE SKULL AND FACE, MASTICATION, FOSSAE AND THE

ORAL CAVITY

SUB-UNIT THEME 3.2: SPECIAL SENSES: THE ORBIT AND EYE, AUDITORY

APPARATUS, NASALCAVITY AND PARANASAL SINUSES &

REVIEW OF LYMPHATICS OF THE HEAD AND NECK

SUB-UNIT THEME 3.3: SUPERFICIAL STRCUTURES AND ANTERIOR TRIANGLES OF

THE NECK

SUB-UNIT THEME 3.4: THE POSTERIOR TRIANGLE OF THE NECK; LARYNX

& PHARYNX

UNIT THEME 4: NEURO ANATOMY 87

SUB-UNIT THEME 4.1: THE SCALP, BASE OF SKULL, CRANIAL FOSSAE, MENINGES

SUB-UNIT THEME 4.2: BLOOD SUPPLY TO THE BRAIN, THE BRAINSTEM &

CRANIAL NERVES

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SUB-UNIT THEME 4.3: DIENCEPHALON AND CORPUS STRIATUM

SUB-UNIT THEME 4.4: THE CEREBRUM

SUB-UNIT THEME 4.5: CEREBELLUM FOURTH VENTRICLE & SPINAL CORD

BLOCK 3:

UNIT THEME 5: ABDOMEN 100

SUB-UNIT THEME 5.1: ANTERIOR ABDOMINAL WALL AND INGUINAL CANAL

SUB-UNIT THEME 5.2: THE PERITONEUM AND ABDOMINAL ORGANS

SUB-UNIT THEME 5.3: ABDOMINAL ORGANS, POSTERIOR ABDOMINAL WALL,

DIAPHRAGM & LUMBAR PLEXUS

UNIT THEME 6: PELVIS & PERINEUM 111

SUB-UNIT THEME 6.1: THE MALE AND FEMALE PELVES – PELVIC GIRDLE

SUB-UNIT THEME 6.2: PELVIC VISCERA (URINARY BLADDER, MALE & FEMALE

INTERNAL GENITALIA)

SUB-UNIT THEME 6.3: THE PERINEUM THE MALE & FEMALE EXTERNAL GENITALIA

BLOCK 4:

UNIT THEME 7: LOWER LIMB 121

SUB-UNIT THEME 7.1: GLUTEAL REGION, POSTERIOR THIGH, POPLITEAL FOSSA,

POSTERIOR LEG

SUB-UNIT THEME 7.2: THIGH: ANTERIOR & MEDIAL COMPARTMENTS; FEMORAL

TRIANGLE, LEG: ANTERIOR & LATERAL COMPARTMENTS,

FOOT DORSUM

SUB-UNIT THEME 7.3: TARSAL TUNNEL, SOLE OF THE FOOT, JOINTS OF THE

LOWER LIMB

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1. COURSE BRIEF

1.1 PURPOSE OF COURSE

The purpose of this course is to provide knowledge of anatomical sciences and develop

multiple skills as a foundation for prospective health care professionals.

1.1.1 MORPHOLOGICAL (GROSS) ANATOMY This is a course in morphological anatomy, and consists of regional dissection of most of

the human body. Those regions not dissected will be studied by using prosected human

specimens. The basic aspects of the central nervous system, head and neck, thorax,

abdomen, pelvis, perineum, back, upper and lower limbs will be covered.

1.1.2 HISTOLOGY This is a course consisting of lectures, practicals and tutorials dealing with the histology

and, where relevant, the ultrastructure of the primary tissues and organ systems.

1.1.3 EMBRYOLOGY This is a course consisting of a series of lectures in which the development of the embryo

and fetus, and the development of all major systems of the body will be covered.

1.2. COMPETENCIES

This is an outline of the competencies a student should be able to fulfil at the end of

ANAT2020. Specific and comprehensive objectives are provided in this section to direct

student learning.

Primary Competencies:

- Appreciate of general body form and structure.

- Acquire critical knowledge of certain specified anatomical structures / regions.

- Recognise the implications of normal anatomical variations.

- Acquire sufficient knowledge to appreciate the anatomical basis of physical

examination.

Secondary Competencies:

- Develop skills to work in a team within a social context and medical environment.

- Integrate anatomical information with clinical data.

- Develop self-directed learning and problem solving skills.

- Acquire dexterity skills.

Tertiary Competencies:

- Recognize the cadaver as a person with psycho-social, ethical and medical concerns.

- Integrate the core concepts of life and death.

1.3 CRITICAL COURSE OUTCOMES

- Identifying and solving problems in which responses display that responsible

decisions using critical and creative thinking have been made.

- Working effectively with others as a member of a team, group, organisation or

community.

- Organising and managing oneself and one’s activities responsibly and effectively.

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2 COURSE OUTLINE

2.1 MORPHOLOGICAL (GROSS) ANATOMY

The aims and objectives of the morphological anatomy component of this course are to

give the second year medical/health science/biomedical engineering student a basic

understanding of the structure and function of the entire human body. The students will be

introduced to the basic and applied anatomical structure and function of body on

macroscopic level. Reference will be made to clinical application in order to highlight the

importance of structures. As a result, the student should be able to apply this knowledge to

corresponding anatomical structures and provide explanations for relevant clinical

scenarios. In general, students are required to identify, name, describe, discuss and

provide well labelled diagrams. In addition, students will be required to explain the

anatomy underlying specific clinical scenarios. These scenarios are included in the

objectives list.

The course comprises of lectures, tutorials (including Problem Solving Exercises), practical

dissection of most areas of the human body and study by means of prosected specimens

of those areas not dissected. Attendance at practical sessions (histology, dissection or

demonstrations) and tutorials (including problem solving exercises) is COMPULSORY and

failure to attend these sessions without a valid medical certificate or an acceptable written

report will result in the refusal of a Satisfactory Performance (SP) clearance.

ALL OF THE MATERIAL DEALT WITH IN PRACTICAL SESSIONS (HISTOLOGY,

DISSECTION OR DEMONSTRATIONS), TUTORIALS AND LECTURES WILL BE

EXAMINED.

The following is a breakdown of the different regions covered during the course of the year

and the approximate time spent on them:

Upper limb 4 weeks

Thorax 3 weeks

Head and neck 4 weeks

Neuroanatomy 4 weeks

Abdomen, pelvis and perineum 7 weeks

Lower limb 4 weeks

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2.2 HISTOLOGY AND EMBRYOLOGY

The aim of the abbreviated Histology course is to provide the student with the opportunity

to familiarise him/herself with the microscopic appearance of most of the tissues of the

body. This is accomplished by first concentrating on the primary tissues i.e. Epithelium,

Connective Tissue, Muscle and Nerve. Following this, all the major organ systems of the

body are studied and closely integrated with the study of morphological anatomy. The

course comprises lectures, practicals and pre- and post-practical tutorials. Videos, CD-

ROMS, and demonstration slides and posters are available for self-study. A Histology

Practical Manual will be provided.

Embryology is taught by means of lectures only, although a number of videos are available

for self-study. Some tutorial sessions may be arranged. The development and implantation

of the early embryo as well as the development of all major systems will be dealt with.

Note that knowledge of Embryology will be tested in BOTH the Morphological

Anatomy and the Histology components of tests and examinations.

3 TESTS AND EXAMINATIONS

3.1 YEAR’S RECORD AND ALLOCATION OF MARKS

In accordance with Rule G.17 (1) students are hereby informed that tests taken by them

during the course of the academic year will count towards the end-of-year mark. The

year’s record based upon these tests will contribute fifty percent (50%) towards the End-

of-Year total.

“The use of electronic devices including but not limited to smart watches, cell

phones and tablets is strictly prohibited during a Test and Exam and these devices

are banned from Test and Exam venues”.

3.2 TESTS

3.2.1

Three End of Region tests and four End of Block tests will be written during the course of the

year and will include questions from all components of the course i.e. Morphological

Anatomy, Histology and Embryology. Note that the knowledge required, and the testing, will

be cumulative throughout the year.

Two different methods of testing (or any combination of them) will be used:

1. A test consisting of Multiple Choice Questions (MCQs)

2. Two practical (spot) tests where a student has to identify different structures and

answer questions within a given time period using the Riddel programme in the

Computer Lab.

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3.2.2

Absence from any of the tests will require a valid medical certificate, certified by Campus

Health, or a formal document with reason(s) for the absence with the Faculty Office of

Student Success (OSS) properly informed. Whichever document that applies should be

communicated to the course coordinators within 5 days of the test.

Please note that NO DEFERRED TESTS WILL BE GIVEN IN LIEU OF MISSED TESTS.

3.2.3. TEST DATES FOR 2021

Description Type of Assessment Weight (marks) Date

End of Region Test 1 Multiple Choice Questions 50 01 Mar

End of Block 1 Test Multiple Choice Questions 100 23 Mar

End of Region Test 2 Multiple Choice Questions 50 10 May

End of Block 2 Test Practical Test (Spot) 100 10 Jun

End of Region Test 3 Multiple Choice Questions 50 02 Aug

End of Block 3 Test Multiple Choice Questions 100 03 Sept

End of Block 4 Test Practical Test (Spot) 100 20 Oct

TOTAL FOR YEAR MARK = 550 MARKS

3.2.4.

Each End of Region test will cover all the work for that region/period and each End of

Block tests from the beginning of the year, i.e. cumulative. The year mark will contribute

50% to the final Examinations mark.

3.3 SUBMINIMUM REQUIREMENTS

PLEASE NOTE: A 40% subminimum for each of the Morphological (Gross) Anatomy

and Histology/Embryology components of the course will be implemented.

The implications of this are as follows:

3.3.1 EXEMPTION FROM EXAMINATIONS

3.3.1.1

Students who have attained a YEAR MARK of 60% or more after writing ALL End of

Region and Block Tests will be exempted from the final examinations PROVIDED THAT

THEY HAVE ATTAINED A MINIMUM OF 40% IN EACH OF THE TWO COMPONENTS.

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3.3.1.2

Should any student fail to achieve 60% in the year mark and /or fail to attain a minimum of

40% in each of the components they will be required to write the full final examination

comprising of the two components (Morphological anatomy and Histology/Embryology).

3.3.1.3

Failure to take a test, even with a valid reason, will result in disqualification from the

“Exemption” rule. The student will have to write the Final Examination

3.3.1.4

Students who have qualified for “Exemption” may still elect to write the final examination.

However, this may result in either an increase or decrease in the final mark

depending on performance in the End of Year examination. If a student elects to

write the final examination despite qualifying for exemption, the final examination

mark will be included as their final mark.

3.4 FINAL EXAMINATIONS

3.4.1

Students who have attained a FINAL COURSE MARK of 50% and above AFTER THE

EXAMINATION will pass the course PROVIDED THAT THEY HAVE ATTAINED A

MINIMUM OF 40% IN EACH OF THE COMPONENTS IN THE FINAL EXAMINATION.

3.4.2 Failure to meet Subminimum at Final Examination

Students with a pass mark of 50% and above but who have not attained the subminimum

of 40% in any of the two components will have to write the full supplementary examination.

3.5 SUPPLEMENTARY EXAMINATIONS

3.5.1

Students who have attained a SUPPLEMENTARY EXAM MARK of 50% will pass the

course. The subminimum requirement will not apply at the supplementary examination.

3.6 GENERAL INFORMATION ON FINAL EXAMINATIONS

3.6.1

The Continuous Assessments (all End of Regions and End of Block Tests) will contribute

50% to the End of Year final mark while the End of Year examinations proper will

contribute the remaining 50%.

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3.6.2. EXAMINATION DATES FOR 2021

3.6.2.1. END OF YEAR FINAL EXAMINATIONS


Written Multiple Choice Questions 100 05-Nov.

Practical (Spot) Morphological Anatomy 60 09-Nov.

Histology & Embryology 40 09-Nov.

TOTAL MARKS FOR END OF YEAR EXAMINATION = 200

Students who have attained a FINAL COURSE MARK of 50% AND ABOVE AFTER

THE EXAMINATION will pass the course PROVIDED THAT THEY HAVE

ATTAINED A MINIMUM OF 40% IN EACH OF THE 2 COMPONENTS IN THE FINAL

EXAMINATION.

3.6.2.2. SUPPLIMENTARY EXAMINATIONS


Written Multiple Choice Questions 100 22-Nov.

Practical (Spot) Morphological Anatomy 60 24-Nov.

Histology & Embryology 40 24-Nov.

TOTAL MARKS FOR THE SUPPLEMENTARY EXAMINATION = 200

Note that in calculating the supplementary examination score, the End of Year

scores will not be included.

THERE IS NO VIVA VOCE (ORAL) EXAMINATIONS

3.6.3.3 RESULTS OF END OF YEAR AND SUPPLEMENTARY EXAMINATIONS

Please note that it is ONLY the Faculty that releases the results of the End of Year and

Supplementary examinations after the Board of Examiners’ Meeting. Students are to

contact the Faculty to confirm if they have been granted supplementary examinations or

not.

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SATISFACTORY PERFORMANCE (SP) REQUIREMENTS

4.1

This School lays down certain minimum requirements in terms of Rule G.9 for satisfactory

participation in course work.

4.2

A student registered for Anatomy in the second year of study leading to the degree

MBBCh, BHSc, or third year in the BSc (Biomedical Engineering) shall attend and actively

participate in ALL of the following:

Morphological (Gross) anatomy practical sessions (dissection and demonstrations).

Histology practical sessions.

Riddel Tutorials in Morphological (Gross) anatomy, histology and embryology.

Any other tutorials, seminars and practicals as may be arranged from time to time.

Surface anatomy practical classes and problem solving exercises.

Writing of all class tests.

4.3

Failure to comply with these regulations WILL disqualify a student from presenting

himself/herself for the final examinations in the course.

4.4

Failure to sit for at least THREE (3) END OF REGION AND THREE (3) END OF BLOCK

TESTS will disqualify a student from presenting himself/herself for the final examinations

in the course.

4 TEXTBOOKS (Prescribed for ANAT 2020)

There are a number of anatomy textbooks that can be used to study anatomy. Due to

learning objectives set for this course, we recommend that you use the textbooks listed

below.

ANATOMY MBBCH II, BHSc II and BSc (Biomed. Eng. III): ANAT2020

Prescribed

Kieser, J & Allan, JC

(Ed. Hutchinson E, Hemingway J & Brits D)

Practical Anatomy Wits University Press

Print ISBN: 978-1-77614-572-0

PDF: 978-177614-573-7

EPUB: 978-1-77614-574-4

Crossman, AR & Neary, D Neuroanatomy; An illustrated colour text. 6th edition

Churchill Livingston (Elsevier)

ISBN 978 0 7020 7462-2

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Kramer, B & Allan, JC Fundamentals of Human Osteology Lexis Nexis, Butterworths

Moore, K, Dalley AF Clinically Oriented Anatomy 8th edition

Williams & Wilkins.

ISBN:13 978 1 4963 5404-4

Ross & Pawlina Histology: A text and atlas Lippincott, Williams & Wilkins

Lee, Agur & Dalley AF

Netter, F

Grant’s Atlas of Anatomy 14th edition (International) OR

Atlas of Human Anatomy (Enhanced International version) 6th edition

Williams & Wilkins

ISBN: 978-1469890685

Elsevier

ISBN: 13-9781455704187

Allan, JC & Kramer B The Fundamentals of Human Embryology - A Student Manual 2nd edition

Wits University Press

Recommended

Burkitt, HG; et al Wheater's Functional Histology Churchill Livingston

Richard Drake The developing human Churchill Livingstone

5 DRESS CODE

Students are advised to consult the Faculty dress code. Copies of this code have been

placed on Notice Boards in the School for student information. These regulations are

strictly enforced in the School at all times.

All students:

Closed shoes and a clean laboratory coat are compulsory. Safety glasses are advisable.

Male students:

Long pants

Shirts, T-shirt or collared shirt - NO VESTS

Female students:

Long pants or suitable dress/skirt

Shirts long enough to reach waistline- no bare midriffs, no strapless or shoestring tops

White coats are to be worn in the Dissection halls and the Ann-Andrew E-

Laboratories during Practical Tests and Examinations (Spot).

Hunterian Museum for Self-Study by Students Opens at 07h45 and closed at 16h45. Not available on dates for Spot Test Covid-19 Protocols to be observed in the museum

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6 LABORATORY RULES

Only signatories of the Anatomy Register are allowed into the dissection halls.

Anyone found taking unauthorized people into the dissection halls will be subjected to

disciplinary action and /or suspension from the course.

NO PHOTOGRAPHY: Anyone who violates this rule will be subjected to disciplinary

action and /or suspension from the Course

Students are required to wear laboratory coats at all times

Identity cards must be visibly displayed at all times

No foods and drinks are allowed

No smoking

No briefcases, suitcases, handbags are allowed. Lockers have been provided by the

Faculty.

Wearing of hats or caps in the labs is forbidden unless it is of a religious nature.

All cadaveric material to be adequately wet with the wetting agent and wrapped at the end of the dissection session.

Ensure that the correct dissection tray is used at all tables. DO NOT MIX CADAVER MATERIALS.

THE ‘C’ CORRIDOR IS COMPLETELY OUT OF BOUNDS FOR ALL STUDENTS.

All students are expected to be seated in the dissection halls by 10h20 and must

have watched the Pre-dissection videos for the week in advance.

No student will be allowed to leave the Dissection Hall before the end of

Dissection except with the permission of a Lecturer

SAFETY GUIDELINES FOR STUDENTS WORKING IN THE DISSECTION HALLS

Embalming solution and Wetting agent contain hazardous chemicals

The embalming solution contains Formaldehyde, Phenol, Methanol, Glycerol and Thymol.

The Wetting agent is 0.355% Phenol. These can cause skin and eye irritations.

Prolonged exposure can also cause headaches and nausea (and may cause fertility

problems). Personal Protective Equipment (PPE) and protective clothing are required

and include:

1. White lab coats and closed shoes.

2. Nitrile gloves recommended, dispose gloves in the Biohazard Bins provided.

3. Safety glasses may be worn if eye irritation occurs

4. Wash your hands after dissection.

Covid-19 Dissection Protocol

Wear a Face mask and the face Shield (provided by the School), Maintain Social

Distancing and Wash your hands after dissection.

Vaccination

All students are advised to get vaccinated against Hepatitis B

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7 IMPORTANT CONTACT DETAILS

Overall Course Coordinator:

Professor AO Ihunwo

School of Anatomical Sciences, 2nd Floor, Room 2B05. Tel: 011 717 2767

Email: [email protected]

Dr Nanette Briers (July to December 2021)

School of Anatomical Sciences, 2nd Floor, Room 2P21. Tel: 011 717 2445


Histology and Embryology Coordinator:

Prof Ejikeme F Mbajiorgu (Overall July to December 2021)

School of Anatomical Sciences, 2nd Floor, Room 2B38 Tel: 011 717 2018


Course Secretary: Ms. Lizzie Marole

School of Anatomical Sciences, 2nd Floor, Room 2B16, Tel: 011 717 2305.


BHSc Admin Course Coordinator: Mrs Rukeya Harris

Bachelor of Health Science Office Tel: 011 717 2920. Email: [email protected]

Head, Morphological Anatomy Division: Professor Amadi O. Ihunwo

Head, Histology & Embryology Division: Professor Ejikeme F. Mbajiorgu 8. GUIDELINES FOR STUDENT ENQUIRIES AND COMPLAINTS

Enquiries and complaints should be directed in the first instance to the Lecturer and then

to the responsible course coordinator, then to the Head of Division and then the Head of

School as appropriate. If not resolved, the matter should be addressed to the Assistant

Dean (Teaching and Learning) in the Faculty, and if unresolved, then the Dean.

The school also has a Staff-Student Liaison Committee which meets once every Block

(four times a year) where all Student Representative(s) for all the Anatomy courses are

members and free to raise issues from the class that have not been resolved as at the

time of the meeting.

9. Anatomy Website Lecture notes, quizzes, tutorials and other learning resources will be posted on the Wits-e / SAKAI page for ANAT2033 as well as the School’s website. The anatomy website address is: http://anatomical-sciences.health.wits.ac.za/ Password: anatomy2021

mailto:[email protected]





http://anatomical-sciences.health.wits.ac.za/

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ANNEXURE 1: ANSWERING QUESTIONS

Use a systematic approach and supplement your answers with correct and relevant

diagrams wherever possible.

1. Bones

a. position in the body (vertebrae - region)

b. classification (long, flat, irregular, short or sesamoid)

c. articulations

d. side where applicable

e. borders, surfaces, bone markings and formations.

f. special features (tubercles, lines, fossae, foramina, etc.)

g. muscle attachments (humerus, clavicle, scapula, hip bone, femur)

h. attachments of ligaments (especially on vertebrae)

i. attachments of joint capsules

2. Skull

a. mandible (as above)

b. cranium

c. identify separate bones as seen from: norma verticalis (superior view), norma dorsalis

(posterior view), norma lateralis (lateral view), and norma frontalis (anterior view)

d. bones of nasal cavity and paranasal sinuses

e. bones of orbit

f. calotte and sutures

g. some individual bones (e.g., ethmoid, sphenoid, temporal, maxilla)

h. three cranial fossae

i. special features

j. foramina and structures passing through them

3. Joints

a. classification (Fibrous, Cartilaginous and Synovial and subtypes)

b. bones and articular surfaces involved

c. capsule

d. synovial membrane

e. bursae

f. intra-articular disc

g. ligaments

h. blood supply and nerve supply

i. movements and the muscles that cause them k) stability

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4. Muscles

a. proximal and distal attachments of skeletal muscles

b. innervation and action

5. Arteries

a. origin

b. course and relations (limited to adjacent structures)

c. branches (primary) - secondary only in special cases

d. surface markings where possible

e. sheaths (e.g., axillary, carotid, femoral)

6. Veins

a. organ(s) drained

b. course and relations (limited to adjacent structures)

c. tributaries (veins very rarely have branches)

d. end drainage (into which main venous channel or organ does it drain?)

e. surface markings where possible

7. Nerves

a. origin

b. type (cranial nerves - motor, sensory, parasympathetic. mixed)

c. course and relations (limited to adjacent structures)

d. branches and distribution (motor and sensory)

e. surface markings where possible

8. Viscera

a. definition (what is it?) and function (what does it do?)

b. position, shape and size

c. components, borders, surfaces, etc.

d. special features (capsules, ducts, etc.)

e. relations (limited to adjacent structures)

f. arterial supply, venous drainage and lymphatic drainage

g. nerve supply

h. embryology if relevant

i. surface markings if relevant

9. Triangles, fossae, spaces and canals

a. position

b. boundaries I borders including roof and floor (if necessary)

c. recesses where applicable

d. contents

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ANNEXURE 2: RULES AND REGULATIONS PERTAINING TO THE HUMAN BONES

Dear Student,

Please take note of the following rules and regulations pertaining to the human bones you have been entrusted with for the academic year: It is your responsibility to provide a padlock for your bone box before the end of BLOCK 1. Failing to do so will result in the bones being removed from your possession by the School of Anatomical Sciences. You are only allowed to use the bones for study within the boundaries of the Faculty of Health Sciences building and also within the lecture theatres on Wits Education campus. Bones may be used within the School of Anatomical Sciences and in other official venues (i.e. allocated on the timetable) used to teach anatomical sciences in the health sciences or education precincts. The bones are not allowed to be used or exposed in any public setting including but not limited to, for example, the cafeteria, the adjoining hospital or York Road when accessing the education precinct. You are responsible for the bones; any bones that are damaged or lost will either result in disciplinary action being taken against you depending on the extent of the damage or loss of bones. In the event that you lose a bone/s, you will be required to provide an affidavit indicating the details related to the loss of the specimens, and also an inventory indicating which bones are missing. You are not allowed to take any bones home with you. Bones should be returned to their bone boxes housed within the School of Anatomical Sciences before you leave each day. In the event that the School is closed before you return the bones it is your responsibility to ensure that you keep them safe in your locker assigned to you by the Faculty of Health Sciences and return them the next morning when the School opens. By law, you are not allowed to have human remains in your personal possession outside of the institutional domain and as such the School of Anatomical Sciences will not be held responsible should you be apprehended with exposed specimens outside of the above mentioned areas or if legal action is taken against you. Bone handling Don’t place any specimen on an unprotected surface; ensure that there is a foam, bubble-pack or other cushion in place before you set it down. Don’t tip out the contents of the box onto the working surface; unpack it carefully. Don’t pour the bones back into the storage box; re-pack it carefully – biggest bones at the bottom with the smallest bones on top.

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Don’t force bones into the storage box; pack them in with care. Don’t stick your fingers into the orbits of the skull when handling the crania, use both hands and if need be the foramen magnum. Don’t try to store the skull with the mandible articulated; always protect the teeth. Don’t try to fix any damage yourself; report it immediately to the Curator in charge. Don’t mark the bones in any way. Don’t damage the bones by using sharp instruments to point out or probe features (even measuring instruments carelessly used can cause significant damage). Don’t attempt to alter or re-write any number on the specimen, even if it appears smudged or illegible; report it to the Curator. Don’t handle the bones with dirty hands. Don’t attempt to take samples from any of the bones for any purpose, unless you have been specifically authorised to do so by the Head of School or the Head’s appointed nominee. I ___________________________________hereby agree to abide by the rules and regulations pertaining to use of bones as delineated by the School of Anatomical Sciences. I am aware that should I fail to abide by these rules and regulations, the School of Anatomical Sciences may institute disciplinary proceedings against me. I am further aware that should my failure to abide by these rules and regulations result in legal action against me, the School of Anatomical Sciences will not take responsibility. Student Signature Student Number Date Witness Name Witness Signature Date

Curator: Head of School: Dr. Brendon Billings Room 2L02 Email: [email protected] Phone: 011 717-2057


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ANAT 2020 Summary of Weekly Activities 2021 Please note that all our courses are mainly contact based, and conducted on a person to person basis. However, due to the unprecedented global pandemic, some content may be delivered online instead of in person. The modes of delivery may change in response to national and university recommendations, and students are to remain informed by regularly checking their announcement platforms (SAKAI/ Canvas and Anatomy Website: anatomical-sciences.health.wits.ac.za). Similarly, dates for activities may also change in accordance with Covid-19 recommendations or laws, and this will be announced timeously on the teaching platforms. The activities that take place every week are: Lectures (Online), Morphological Anatomy Tutorials on Riddel (Online), Histology Practical (Mostly Online) and Dissections (On campus and Face to Face). Please note that the Dissection Groups, Days, Times and Venues will be Available after Registrations with the school. All students can be placed on one of the Dissection Days except for the BHSc (Exercise Science Track) and BSc (Biomedical Engineering III) students who will dissect on Thursdays.

Week 1: 01 – 05 Feb

Block 1 (7 weeks)

Day Activity Topic Lecturer

Registration Registration (ONLINE) Profs Ihunwo, Mbajiorgu & All Staff

LECTURE Anatomical Terminology and Orientation of human body (Synchronous on MS Teams)

Prof Ihunwo

LECTURE Anatomy Introduction & Rules Profs Ihunwo & Mbajiorgu

LECTURE Anterior Pectoral Region & Breast Prof Ihunwo

Ceremony DEDICATION CEREMONY (VIRTUAL) HoS and Staff

Ceremony Allocation of tables & Signing of Anatomy Register Prof Ihunwo & Staff

LECTURE Shoulder Region, Shoulder Joint and Back Dr Olateju

LECTURE Embryology: Early Embryology I Mr. Tshabalala

LECTURE Embryology: Early Embryology II Mr. Tshabalala

Dissection Anterior Pectoral Region & Breast & Bone distribution All Staff

Due to the surge in the covid-19 and to keep to the regulations of 30% students on

campus and also maximum of 50 people in a gathering, the dissection will only start

in the Week of 08-12 February 2021.

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Week 2: 08 – 12 Feb


LECTURE Histology: Epithelium Prof Mbajiorgu

Histology Histology: Intro to Olivia and Epithelium Prof Mbajiorgu

Tutorial Introduction to Riddel & Osteology: Clavicle, Scapula & Humerus

Drs Pillay/Calvey

LECTURE Axilla & Brachial Plexus Prof Ihunwo

Dissection Post. Pec, The Axilla, Brachial Plexus, Ant. & Post. Arm

LECTURE Arm, Cubital Fossa & Elbow Joint Dr Olateju

Week 3: 15-19 Feb


LECTURE Histology: Glands Mrs Johnson

Histology Histology: Glands Mrs Johnson

Tutorial ) Ulna, Radius and Bones of the Hand Drs Pillay/Calvey

LECTURE Forearm, Carpal Tunnel & Wrist Joint Dr Olateju

LECTURE Histology: Connective Tissue I Dr Xulu

Dissection Ant. & Post. compartments of forearm & cubital fossa

Week 4: 22 – 26 Feb


LECTURE Histology: Connective Tissue II Dr Augustine

Histology Histology: Connective Tissue I & II Dr Augustine

Tutorial Problem Solving Exercise (PSE) Upper Limb Drs Pillay/Calvey

LECTURE The Hand including Joints in Hand Dr Olateju

Dissection Wrist, Hand & Joints of the Upper Limb

LECTURE Histology: Cartilage Dr Ngwenya

Week 5: 01 – 05 Mar


TEST END OF REGION TEST (UPPER LIMB) All Staff

Histology Histology: Cartilage Mrs Johnson

Tutorial Sternum, Ribs & Thoracic vertebrae Drs Pillay/Calvey

LECTURE Thoracic cage & intercostal spaces Mediastinum Dr Olateju

LECTURE Pleura and Lungs Dr Olateju

Dissection Thoracic cage, Lungs & Bronchial tree

LECTURE Histology: Bone Dr Augustine

Week 6: 08 - 12 Mar


LECTURE Histology: Osteogenesis Dr Augustine

Histology Histology: Bone and Osteogenesis Dr Augustine

Tutorial Diaphragm / Answering SEQs in Upper Limb & Thorax Drs Pillay/Calvey

LECTURE Pericardium & Heart Dr Pillay

LECTURE Innervation & Blood Supply to the Heart Dr Pillay

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LECTURE Histology: Muscle Prof Mbajiorgu

LECTURE Embryology: Early Embryology III Mr. Tshabalala

LECTURE Radiological Anatomy of the Thorax Dr Pillay

` Dissection Mediastinum, Pericardium & Heart

Week 7: 15 – 19 Mar


LECTURE Embryology: CVS I Mr. Tshabalala

Histology Histology: Muscle Dr Dlamini

Tutorial PSE Thorax (Radiological Anatomy of Thorax) Drs Pillay/Calvey

LECTURE Embryology: CVS II Mr. Tshabalala

Dissection Posterior mediastinum & Posterior Thoracic Wall

LECTURE Embryology: CVS III Mr. Tshabalala

Wed ETHICS ALIVE

END OF BLOCK 1 TESTS

Week 8: 22 – 26 Mar


Mon PUBLIC HOLIDAY FOR HUMAN RIGHTS

Tue TEST (MCQs)

ANATOMY / HEALTH SYSTEM SCIENCES All Staff

Thu MEDICAL THOUGHT & PRACTICE

Week 9: 29 Mar – 02

Apr


Mon TEST PHYSIOLOGY / PUBLIC HEALTH All Staff

Thu TEST MOLECULAR MEDICINE/EXERCISE SCIENCE/PHY2006A

Fri PUBLIC HOLIDAY – GOOD FRIDAY

Week 10: 05 – 09 Apr

Mon PUBLIC HOLIDAY – FAMILY DAY

MIDTERM BREAK

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Week 11: 12 – 16 Apr

Block 2 (8 Weeks)


LECTURE Histology: Nervous Tissue Dr Ngwenya

Histology Histology: Nervous tissue and test review Dr Ngwenya

Tutorial Bones of the Head and Neck. Face & Scalp Drs Pillay/Calvey

LECTURE Bones of the Head and Neck. Face & Scalp Dr Hutchinson

LECTURE Temporomandibular Joint and Muscle of Mastication Dr Hutchinson

LECTURE Temporal, Infratemporal & Pterygopalatine fossae Dr Hutchinson

Dissection Face, mm of Mastication, Fossae, Oral and Tongue (Specimens)

LECTURE Oral cavity and tongue Dr Hutchinson

Week 12: 19 – 23 Apr


LECTURE Histology: Skin Mrs Johnson

Histology Histology Skin Mrs Johnson

Tutorial Special Senses, Nasal cavity & Paranasal Sinuses Drs Pillay/Calvey

LECTURE Eyeball and Accessory structures Dr Hutchinson

Dissection Special Senses: Orbit, Eye, Auditory apparatus, Sinuses

LECTURE Ear (Auditory Apparatus) Dr Hutchinson

Week 13: 26 – 30 Apr


LECTURE Cervical Fascia & Anterior Triangle of Neck Dr Hutchinson

Histology Histology: Lymphatic system Mrs Johnson

Tutorial Cervical Vertebrae & Joints, ECA, IJV, Cervical Plexus Drs Pillay/Calvey

LECTURE Embryology: Face and Palate Mr. Tshabalala

LECTURE Histology: Lymphatic System Mrs Johnson

Tue PUBLIC HOLIDAY – FREEDOM DAY LECTURE Embryology: Pharyngeal Derivatives I Mr. Tshabalala

Dissection Ant. Triangles of the neck, Thyroid gland & laryngeal nn

Week 14: 03 – 07 May


LECTURE Posterior Triangle of the neck Dr Hutchinson

Histology Histology: Revision

Tutorial Salivary glands, thyroid and parathyroid glands overview of H&N Lymphatics

Drs Pillay/Calvey

LECTURE Pharynx and Cervical esophagus Dr Hutchinson

LECTURE Larynx and Cervical Trachea Dr Hutchinson

LECTURE Embryology: Pharyngeal derivatives II Mr. Tshabalala

Dissection Post. triangle, CN, CCA, Larynx & Pharynx LECTURE Embryology: Pharyngeal derivatives III Mr. Tshabalala

Wed Afternoon (ETHICS ALIVE)

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Week 15: 10 – 14 May

Day Activity Topic

Mon TEST ANATOMY EOR TEST 2: HEAD AND NECK All Staff

Histology Histology: Cardiovascular system (CVS) Mrs Johnson

Tutorial Skull Interior & Dural Venous sinuses Drs Pillay/Calvey

LECTURE Introduction to CNS and Meninges Prof Ihunwo

LECTURE Histology: Cardiovascular system (CVS) Dr Xulu

Dissection Scalp, cranial fossae and general morphology brain

LECTURE Ventricles & CSF circulation Prof Ihunwo

Week 16: 17 – 21 May


LECTURE Arterial Supply and Venous Drainage of Brain Prof Ihunwo

Histology Histology: Respiratory system Mrs Johnson

Tutorial Lateral, third & 4th ventricles Drs Pillay/Calvey

LECTURE Histology: Respiratory system I Prof Steyn

LECTURE Brainstem, Cranial Nerves and Lesions Dr Maseko

LECTURE Diencephalon Dr Maseko

LECTURE Corpus striatum Dr Maseko

Dissection Blood supply, brainstem and cranial nerves

LECTURE Histology: Respiratory System II Prof Steyn

Wed Afternoon MSC SPORTS DAY

Week 17: 24 – 28 May


LECTURE Histology: Central Nervous System (CNS) Dr Ngwenya

Histology Histology: Central Nervous System (CNS) Dr Ngwenya

Tutorial Autonomic nervous system and Exercise on Spot (Riddel) Drs Pillay/Calvey

LECTURE Cerebrum & Functional Areas of the Brain Dr Maseko

LECTURE Spinal cord and tracts Dr Maseko

LECTURE Cerebellum Dr Maseko

Dissection The cerebrum including cross-sections

LECTURE Optic & Auditory pathways Dr Maseko

Week 18: 31 May – 04 Jun


Mon LECTURE Embryology: CNS I Mr. Tshabalala

Histology Revision & Mock spot Prof Mbajiorgu

Tutorial PSE: Neuroanatomy

Tue LECTURE Embryology: CNS II Mr. Tshabalala

Dissection The cerebrum including coronal sections

Wed LECTURE Cross-sectional anatomy of brain and spinal cord Prof Ihunwo

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Week 19: 07 - 11 June


Mon TEST PHYSIOLOGY TEST 2/ PUBLIC HEALTH

Thurs TEST ANATOMY TEST 2 (SPOT TEST) / PUBLIC HEALTH All Staff

Fri

Week 20: 14 – 18 Jun


Mon TEST MOLECULAR MEDICINE/ EXERCISE SCIENCE

Tue PHY2006A

Week 21: 21 – 25 Jun

WINTER RESEARCH BREAK TILL 13 JULY


Week 22: 28 Jun – 02 Jul



Week 23: 05 – 09 Jul


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Week 24: 12 – 16 Jul

Block 3


Histology EoB Test 2 Review Mrs Johnson

Tutorial Lumbar vertebrae, sacrum & Coccyx Drs Pillay/Calvey

LECTURE Anterior Abdominal wall Dr Small

LECTURE Inguinal Canal and Hernias Dr Small

LECTURE Embryology: GIT I Mr. Tshabalala

Dissection Anterior Abdominal wall & Inguinal Canal

LECTURE Embryology: GIT II Mr. Tshabalala

LECTURE Peritoneal sacs & Abdominal viscera arrangements Dr Small

LECTURE Embryology: GIT III Mr. Tshabalala

Week 25: 19 – 23 Jul


Histology Embryology Revision Self-study

Tutorial Abdominal Aorta and Its branches Drs Pillay/Calvey

LECTURE Histology: GIT I Prof Steyn

LECTURE Histology: GIT II Prof Steyn

LECTURE Abdominal Oesophagus, Stomach & Duodenum New Lecturer

Dissection Peritoneum & Abdominal Organs

LECTURE Liver and Gall bladder New Lecturer

LECTURE Pancreas and Spleen

LECTURE Small & Large Intestines New Lecturer

Week 26: 26 – 30 Jul


Histology Histology: GIT I Mrs Johnson

Tutorial Portal vein & portal-systemic anastomoses Drs Pillay/Calvey

LECTURE Histology: GIT glands I Prof Steyn

LECTURE Histology: GIT glands II Prof Steyn

LECTURE Posterior Abdominal Wall and Lumbar plexus Dr Small

Dissection Abdominal Organs: Post. Abd. Wall & Lumbar Plexus

LECTURE Blood Supply to GIT Dr Small

LECTURE Kidneys, Ureters and Suprarenal gland Dr Small

LECTURE Self-study

LECTURE Embryology: Coelom & Mesentery I Mr. Tshabalala

Week 27: 02 – 06 Aug


Mon TEST END OF REGION TEST 3: ABDOMEN All Staff

Histology Histology: GIT II Glands Mrs Johnson

Tutorial Hip Bone, Sacrum & Coccyx Drs Pillay/Calvey

LECTURE Male & Female Bony Pelvis New Lecturer

LECTURE Embryology: Coelom & Mesentery II Mr. Tshabalala

Dissection Male & Female Pelvis – Pelvic Girdle

LECTURE Histology: Urinary System I Prof Steyn

LECTURE Urinary Bladder & Male internal genitalia New Lecturer

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LECTURE Histology: Urinary System II Prof Steyn

LECTURE Female Internal Genitalia New Lecturer

Week 28: 09 – 13 Aug


Mon PUBLIC HOLIDAY - WOMEN’S DAY

Histology Histology: Urinary System Dr Dlamini

Tutorial Articulated Male and Female Bony Pelves Drs Pillay/Calvey

Dissection Perineum, Male & Female External Genitalia

LECTURE Pelvic Diaphragm New Lecturer

LECTURE Male & Female External genitalia New Lecturer

LECTURE Perineum & Perineal Pouches New Lecturer

LECTURE Rectum & Anal Canal New Lecturer

Week 29: 16 – 20 Aug


Histology Histology: Revision Dr Xulu

Tutorial PSE: Pelvis Drs Pillay/Calvey

LECTURE Vessels & Nerves of the Pelvis and Perineum New Lecturer

LECTURE Autonomic Innervation of Abdominopelvic Organs New Lecturer

LECTURE Embryology: Urogenital System I Mr. Tshabalala

Dissection The Perineum

LECTURE Embryology: Urogenital System II Mr. Tshabalala

LECTURE Embryology: Urogenital System III Mr. Tshabalala

Week 30: 23 – 27 Aug


Mon Histology Embryology Revision Mr. Tshabalala

Tutorial PSE: Perineum Drs Pillay/Calvey

LECTURE Histology: Male Reproductive System I Dr Ngwenya

LECTURE Histology: Male Reproductive System II Dr Ngwenya

Tue LECTURE Radiological Anatomy: Abdominal & pelvic organs Dr C Hartman/ G.Rubin

Dissection REVISION

Wed LECTURE Interactive Session on Answering Questions Dr Small

LECTURE REVISION of pelvis and perineum – Self-study

Fri LECTURE REVISION of pelvis and perineum – Self-study


Week 31: 30 Aug-03 Sep


Mon

Tue TEST MOLECULAR MEDICINE TEST3 / PHY 2006A

Wed

Thu

Fri TEST ANATOMY TEST 3 WRITTEN / PUBLIC HEALTH

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Week 32: 06 – 10 Sept

Day Activity Topic Lecturer Mon Tue Wed Thu

Fri TEST PHYSIOLOGY TEST 3 / HEALTH SYSTEM SCI

Week 33: 13 – 17 Sept


Mon MID TERM BREAK Tue Wed Thu

Fri

Week 34: 20 – 24 Sept

Block 4


Histology Histology: Male Reproductive System Dr Ngwenya

Tutorial Femur, Patella, Tibia and Fibula Drs Pillay/Calvey

LECTURE Overview of lower limb & Gluteal Region Dr Briers

LECTURE Posterior thigh and leg & Popliteal fossa Dr Briers

LECTURE Histology: Female reproductive system I Mrs Johnson

Dissection Gluteal Region, posterior thigh and leg, popliteal fossa

LECTURE Anterior & Medial compartments of thigh & Femoral triangle

Dr Briers

LECTURE Histology: Female reproductive system II Mrs Johnson

Thu PUBLIC HOLIDAY: HERITAGE DAY LECTURE Hip & Knee Joints Dr Briers

Week 35: 27 Sep – 01 Oct


Histology Histology: Female Reproductive System Mrs Johnson

Tutorial Bones of the Foot Drs Pillay/Calvey

LECTURE Histology: Endocrine system I Dr Xulu

LECTURE Histology: Endocrine system II Dr Xulu

LECTURE Anterior & Lateral aspect of Leg, Dorsum of foot Dr Briers

Dissection Anterior & Medial thigh, anterior & lateral leg Drs Pillay/Calvey

LECTURE Tarsal tunnel, Ankle Joint, Joints of the foot Dr Briers

LECTURE Sole of the foot I Dr Briers

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Week 36: 04 – 08 Oct


Histology Histology: Endocrine System Dr Xulu

Tutorial PSE: Lower Limb Drs Pillay/Calvey

LECTURE Arches of the Foot Dr Briers

LECTURE Applied Anatomy of Nerves of Lower Limb Dr Briers

LECTURE Radiological Anatomy of Lower Limb Dr Briers

Dissection Tarsal tunnel, Dorsum & Sole of foot, Joints of lower limb

LECTURE Self Study

LECTURE Revision

Week 37: 11 – 15 Oct


Histology Histology revision: Mock Spot Mrs Johnson

Anatomy Self-Study/ Mock Spot Dr Briers &All Stall

Anatomy Self-Study

LECTURE Final Lecture (COMPULSORY & INTERACTIVE) Dr Briers

Anatomy Self-Study/ Mock Spot

Wed Ceremony DEDICATION CEREMONY HoS All Staff

Anatomy Self-Study

Anatomy Self-Study/ Mock Spot

LECTURE Self-Study


Week 38: 18 – 22 Oct


Mon TEST PHYSIOLOGY / HEALTH SYSTEMS SCIENCE

Tue

Wed TEST ANATOMY (SPOT) / PUBLIC HEALTH All Staff

Thu

Fri TEST MOL MED/ EXERCISE SCIENCE/PHY2006A

Week 39: 25-28 Oct

Day Activity Topic Lecturer STUDY BREAK

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FINAL EXAMS FRIDAY 29 OCT – THURSDAY 11

NOVEMBER

Fri FINAL EXAM

MOLECULAR MEDICINE/ EXERCISE SCIENCE/PHY2006A

Week 40: 01 - 05 Nov


Mon FINAL EXAM

PHYSIOLOGY / HEALTH SYSTEMS SCIENCE

Tue

Fri FINAL EXAM

ANATOMY (WRITTEN)/ PUBLIC HEALTH All Staff

Week 41: 08 – 12 Nov


Tue FINAL EXAM

ANATOMY SPOT All Staff

Week 42: 15 – 19 Nov


Mon UPLOAD RESULTS TO FACULTY: 12:00

Thu BOARD OF EXAMINER MEETING

Week 43: 22 – 26 Nov SUPPLEMENTARY EXAMINATIONS


Mon SUPP EXAM

ANATOMY (SUPP) WRITTEN All Staff

Tue

Wed SUPP EXAM

ANATOMY SPOT All Staff

Thu

Fri SUPP EXAM

Week 4: 29 Nov – 03 Dec


Mon MOLECULAR MEDICINE/ EXERCISE SCIENCE

Thu SUPP EXAM

PHYSIOLOGY / HEALTH SYSTEMS SCIENCE

Week 45: 06 – 10 Dec


Thu UPLOAD RESULTS TO FACULTY

Week 46: 13 – 17 Dec


Week 47: 20 – 24 Dec

Tue BOARD OF EXAMINERS MEETING

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ANAT 2020 Lecturers and Dissection Schedule Coordinators 2021

Block Topics Coordinating Staff for Lectures Coordinating Staff for Dissections

Block

1 Upper limb Prof AO Ihunwo and Dr O Olateju

Drs, Olateju, Small, Hutchinson, Briers,

Davimes, New Lecturer

Thorax Drs. O Olateju & D Pillay

Block

2

Head and

Neck Dr. Erin Hutchinson

Neuro Dr. B Maseko and Prof AO Ihunwo

Block

3 Abdomen

Drs D Pillay, B. Maseko & New

Lecturer

Drs Small, Hutchinson, Small, Briers,

Davimes & New Lecturer

Pelvis and

perineum Dr C. Small & New Lecturer

Block

4 Lower limb Dr N Briers

Online

Riddel

Tutorial

Drs D. Pillay and T. Calvey

Responsibilities: The Lecturers in charge of the Block and Dissections will also be responsible for;

a. Attending to students’ enquiries regarding Dissection for that block b. Implementing the Dissection Hall Rules as in the Yellow Book c. Overseeing the Teaching Assistants (TAs) assigned to the Groups d. Signing off the TA hours and the Form that Mrs Cheryl Bove usually provides to the TAs e. Oversee the Prosections in PVT and Vesalian Laboratories

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B. STUDY COMPONENT: HISTOLOGY

ANAT 2020 HISTOLOGY OBJECTIVES

Histology objectives

In this section of the course, the students will be introduced to the basic histological structure

and function of the primary tissues and organ systems at light microscopic level.

Reference will only be made to ultrastructure where deemed relevant and necessary.

The student should be able to apply this knowledge to corresponding anatomical structures

and embryological development. Histology should also be related to the function of the human

body in both normal and pathological conditions.

General Objectives

This is an outline of the objectives a student should be able to fulfil at the end of the

course. Specific and more comprehensive objectives may be obtained from the Histology

Practical Manual.

Students are required to make a diagrammatic representation at different levels of

magnification of all tissues and organs studied (see Histology Practical Manual).

In addition to the Histology Manual, students are required to use the Road maps that

contain the labelled photomicrographs of all primary tissues and organ systems to

complement their study of the specific topic.

After combining the information obtained from the lectures (1), histology practical manual

(2) and road maps (3) the student are required to study the Olyvia slides (4) in order to

identify the specific structure including the related details previously studied using 1, 2

and 3.

Study Resources: Histology Practical Manual Olyvia slides, Road maps, Textbook

UNIT THEME 1: PRIMARY TISSUES

Specific examples of each primary tissue type in sections of many different organs will be

studied.

Capability statement:

After systematic and committed studying of four primary tissues, the student should be

able to fully apply the obtained knowledge in order to understand the histological structure

and function of different organs and organ systems.

Sub-unit themes:

Sub-unit theme 1.1: Epithelial tissue

Sub-unit theme 1.2: Glandular epithelium (glands)

Sub-unit theme 1.3: Connective tissue

Sub-unit theme 1.4: Muscle tissue

Sub-unit theme 1.5: Nervous tissue

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Embedded knowledge (applicable to all primary tissues):

Students must know and understand the following before studying the sub-unit themes:

Cell structure

Definition of tissues

Explain what is understood by the concept of tissue

SUB-UNIT THEME 1.1: EPITHELIAL TISSUE

After studying the histological structure of different types of epithelia as a part of different

organs or organ systems, the student will be able to identify, classify, describe the

structure, give the function and provide location of the following types of epithelia:

Simple squamous, cuboidal and columnar epithelia with various surface modifications

(cilia or microvilli)

Stratified squamous (non-keratinised and keratinised) epithelium

Pseudostratified columnar epithelium with surface modifications (cilia)

Transitional epithelium

Epithelial tissue – Specific outcomes

1. Identify and classify the two types of epithelia found in choroid plexus

2. Provide the function and specific location of the two epithelia found in the choroid

plexus

3. Identify and classify the epithelium found in jejunum, trachea, oesophagus, thick skin

and urinary bladder

4. Provide the function and specific location of the epithelia found in jejunum

5. Identify and classify the two types of epithelia found in trachea, oesophagus, thick skin

and urinary bladder

6. Identify possible junctional complexes present in different epithelia.

7. Provide the diverse functions of epithelia and their specific locations.

SUB-UNIT THEME 1.2: GLANDS

After studying the histological structure of certain types of glands, the student will be able

to identify, classify, describe the structure, function and provide location of the following

types of glands:

Simple tubular with goblet cells (e.g. the colon)

Simple coiled tubular (e.g. eccrine sweat glands)

Simple branched alveolar (e.g. sebaceous glands)

Compound tubulo-alveolar (e.g. the submandibular gland)

Apart from the classification according to the morphology, glands can be classified

according to their mode of secretion (holocrine, merocrine or apocrine) and nature of

secretion (mucous, serous, mixed - mucous-serous, oily/waxy and sudoriferous/sweat

secretion).

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Glands – Specific outcomes

1. Identify and classify the two types of glands found in jejunum

2. Provide the mode of secretion for the glands found in jejunum

3. Identify and classify the gland found in colon, uterus and thin skin

4. Provide the mode of secretion for the glands found in colon, uterus and thin skin

5. Classify the submandibular gland

6. Provide the mode and nature of secretion of submandibular gland

SUB-UNIT THEME 1.3: CONNECTIVE TISSUE

NB: Connective tissue includes:

Connective tissue proper

Connective tissue with a fluid matrix

Connective tissue with a solid matrix

Osteogenesis

After studying the histological structure of different types of connective tissue, the student

will be able to identify, classify, describe the structure, give the function and provide

location of the following types of connective tissues (including cells, fibres and ground

substance as the main structural components):

Connective tissues with a semi-solid matrix

o Loose (areolar) connective tissue

o Dense regular connective tissue

o Dense irregular connective tissue

o Elastic and reticular tissue

Connective tissue with a fluid matrix:

o Blood

Connective tissue with a solid matrix - Cartilage:

o Hyaline

o Fibrocartilage

o Elastic cartilage

Chondrogenesis – Cartilage formation

o Appositional growth

o Interstitial growth

Connective tissue with a solid matrix - Bone:

o Compact bone

o Cancellous bone

Osteogenesis – Bone formation

o Intramembranous ossification

o Endochondral ossification

Connective tissue – Specific outcomes

Identify the three main constituents of all connective tissues (including blood, cartilage

and bone)

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Connective tissue proper

1. Classify connective tissue proper

2. Explain the histology of loose connective tissue

3. Provide the location and function of loose connective tissue

4. Explain the histology of dense irregular connective tissue

5. Provide the location and function of dense irregular connective tissue

6. Explain the histology of dense regular connective tissue

7. Provide the location and function of dense regular connective tissue

8. Explain the histology of elastic tissue

9. Provide the location and function of elastic tissue

10. Explain the histology of reticular tissue

11. Provide the location and function of reticular tissue

Connective tissue with a fluid matrix

1. Classify connective tissue with a fluid matrix (blood)

2. Classify leukocytes

3. Explain the histology and function of erythrocytes, neutrophils, eosinophils, basophils,

lymphocytes, monocytes and thrombocytes

Connective tissue with a solid matrix

1. Identify the three main types of cartilage

2. Explain the histology of hyaline cartilage including perichondrium

3. Provide the location and function of hyaline cartilage

4. Explain the histology of fibrocartilage

5. Provide the location and function of fibrocartilage

6. Explain the histology of elastic cartilage

7. Provide the location and function of fibrocartilage

8. Discuss the main cartilage cell types including their specific location and function

9. Provide detailed explanations of two types of cartilage development

10. Identify the two main types of bone

11. Explain the histology of cancellous (spongy) bone

12. Provide the location and function of cancellous bone

13. Explain the histology of compact bone

14. Provide the location and function of compact bone

Osteogenesis

1. Identify the two types of bone development

2. Discuss the main bone cell types including their specific location and function

3. Provide detailed explanations of intramembranous ossification

4. Provide detailed explanations of endochondral ossification

SUB-UNIT THEME 1.4: MUSCLE TISSUE

After studying the histological structure of muscle, the student will be able to identify,

classify, and describe the structure, function and provide location of the following types of

muscle:

Skeletal (striated) muscle

Cardiac (striated) muscle and Purkinje fibres

Smooth (visceral) muscle

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Muscle tissue - Specific outcomes

1. Identify the three main types of muscle tissue (your identification should be based on

the fibre size, shape and presence/absence of branching, number, shape and position

of nuclei and presence or absence of cross-striations)

2. Provide the histological and ultrastructural organisation of the skeletal muscle

3. Provide the location and function of the skeletal muscle

4. Provide the histological and ultrastructural organisation of the cardiac muscle

5. Provide the location and function of the cardiac muscle

6. Discuss histology of the Purkinje fibres

7. Provide the specific location and function of the Purkinje fibres

8. Provide the histological organisation of the smooth muscle

9. Provide the location and function of the smooth muscle

SUB-UNIT THEME 1.5: NERVOUS TISSUE

After studying the histological structure of nervous tissue, the student will be able to

identify, classify and describe the structure, function and provide location of the following

components of nervous tissue:

Neurons in:

o the CNS (anterior horn cells)

o the PNS (spinal/dorsal root ganglion cells)

Nerve fibres of:

o the PNS (spinal nerves)

o the ANS (autonomic nerves)

o Supporting cells related to these neurons and fibres including Schwann cells and

satellite cells in the PNS and the different types of neuroglia in the CNS

o Neuromuscular junctions

Nervous tissue – Specific outcomes

1. Classify the neurons according to their structure (morphology)

2. Classify the neurons according to their function

3. Discuss the histology of a motor neuron

4. Provide the specific location of the motor neuron

5. Discuss the histology of a sensory neuron

6. Provide the specific location of a sensory neuron

7. Discuss the histology of a peripheral nerve including the three connective tissue sheets

(coverings)

8. Discuss the main parts of a motor neuron

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UNIT THEME 2: ORGANS AND ORGAN SYSTEMS

Specific organs and organ systems will be studied:

Capability statement: After systematic and committed studying of all organs and organ

systems in healthy conditions, the student should be able to apply the obtained knowledge

to the tissues and organs in the pathological settings.

Sub-unit themes: (all organs and organ systems from skin and up to and including the

endocrine system).

Sub-unit theme 2.1: Skin

Sub-unit theme 2.2: Central nervous system (CNS)

Sub-unit theme 2.3: Cardiovascular system (CVS)

Sub-unit theme 2.4: Lymphatic system

Sub-unit theme 2.5: Respiratory system

Sub-unit theme 2.6: Gastrointestinal system (GIT)

Sub-unit theme 2.7: GIT glands

Sub-unit theme 2.8: Urinary system

Sub-unit theme 2.9: Male reproductive system

Sub-unit theme 2.9: Female reproductive system

Sub-unit theme 2.10: Endocrine system

Embedded knowledge (applicable to all organs and organ systems)

Students must know and understand the following before studying the sub-unit themes:

Detailed histology of primary tissue including identification, classification, structure,

location and function

Without the prior detailed knowledge of the primary tissues, understanding of the

organ systems will not be possible!

SUB-UNIT THEME 2.1: SKIN

After studying the histological structure of skin, the student will be able to, identify and

describe the structure and function of the following:

Thin skin (e.g. skin of scalp)

o Epidermis, dermis and hypodermis

o Sebaceous glands → see primary tissues – glands above

o Eccrine sweat glands → see primary tissues – glands above

o Blood vessels and nerves

Thick skin (e.g. skin of palm/fingertip)

o Epidermis, dermis and hypodermis

o Eccrine sweat glands → see primary tissues – glands above

o Blood vessels and nerves

o Encapsulated nerve endings (e.g. Meissner’s and Pacinian corpuscles)

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Skin – Specific outcomes

1. Discuss the histology of the epidermis of thin skin (four distinct layers and the relevant

cell types as well as their importance)

2. Discuss the histology of the dermis of thin skin (two distinct layers, the type of

connective tissue being the main constituent of these layers and associated

appendages

3. Discuss the histology of the epidermis of thick skin (five distinct layers and the relevant

cell types as well as their importance)

4. Discuss the histology of the dermis of thick skin (two distinct layers, the type of

connective tissue being the main constituent of these layers and associated

appendages)

5. Compare and contrast between the epidermis and dermis of thin and thick skin

6. Revise on the basic tissue knowledge involving epithelium and glands associated

with the dermis of thin and thick skin

7. Identify, classify and provide the exact location, structure and function of Meissner’s

and Pacinian corpuscles

SUB-UNIT THEME 2.2: CENTRAL NERVOUS SYSTEM (CNS)

After studying the histological structure of the central nervous system, the student will be

able to identify and describe the structure and function of:

The meninges

Cerebrum

o The white and grey matter and corresponding cells and fibres types

o The layers of the cerebral cortex

o Neuronal types

Cerebellum

o The arbor vitae and folia

o The layers of the cerebellar cortex

o Neuronal types

The choroid plexus

SUB-UNIT THEME 2.3: CARDIOVASCULAR SYSTEM (CVS)

After studying the histological structure of the cardiovascular system, the student will be

able to:

Identify, classify, describe the structure and function of the components of:

o Elastic arteries

o Medium sized arteries and veins

o Arterioles, venules and capillaries

Describe the structure and function of cardiac muscle (including Purkinje fibres → see

primary tissues – muscle above)

SUB-UNIT THEME 2.4: LYMPHATIC SYSTEM

After studying the histological structure of the lymphatic system, the student will be able

to identify, classify, and describe the fibrous framework and cellular components as well

as the function of:

Diffuse and nodular lymphatic tissue

The lymph node (including the filtration of lymph)

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The spleen (including the blood supply)

The thymus

SUB-UNIT THEME 2.5: RESPIRATORY SYSTEM

After studying the histological structure of the respiratory system, the student will be able

to identify and describe the structure and function of:

The conducting passages:

o Nasal cavities and air sinuses

o Trachea

o Intrapulmonary bronchus

o Bronchioles

o Terminal bronchioles

The respiratory units of the lung:

o Respiratory bronchiole

o Alveolar duct

o Alveolar sac

o Alveoli with interalveolar septum (including the blood-air barrier)

SUB-UNIT THEME 2.6: GASTROINTESTINAL SYSTEM (GIT)

Students will study the general four layered histological pattern (mucosa, submucosa,

muscularis externa and serosa/adventitia) of the gastrointestinal tract and will examine

how this pattern changes in the following regions of the digestive tract in accordance to

the function that has to be performed in that particular region.

Oesophagus

Stomach

Small intestine

Large intestine

SUB-UNIT THEME 2.7: GIT GLANDS

After studying the histological structure of selected glands, the student will be able to

identify and describe the structure and function of:

The liver

The pancreas (exocrine component only as the endocrine pancreas will be studied

with the endocrine system)

The salivary glands (→ see primary tissues – submandibular gland above)

The gall bladder

SUB-UNIT THEME 2.8: URINARY SYSTEM

After studying the histological structure of the urinary system, the student will be able to:

Identify and describe the structure and function of:

o The kidney:

The cortex (including the renal corpuscle and associated tubules)

The medulla

o The urinary bladder (epithelium only → see primary tissues – epithelium above)

Describe the blood supply of the kidney

Describe the filtration apparatus and juxtaglomerular apparatus of the kidney

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SUB-UNIT THEME 2.9: MALE REPRODUCTIVE SYSTEM

After studying the histological structure of selected regions of the male reproductive

system, the student will be able to:

Identify and describe the structure and function of the components of the testis

The testes

The seminiferous tubules

Describe spermatogenesis

The epididymis

The tubuli recti

The rete testis

The efferent ductules

The vas deferens

The prostate gland

The penis

The penile urethra

SUB-UNIT THEME 2.9: FEMALE REPRODUCTIVE SYSTEM

After studying the histological structure of selected regions of the female reproductive

system, the student will be able to:

Identify and describe the structure and function of:

o The ovary

o The different stages of the follicular development

o Corpus luteum

o The uterus (preovulatory endometrium)

o The uterus (postovulatory endometrium)

o Non-lactating and lactating mammary gland

Identify and describe the structure and function of the placenta

SUB-UNIT THEME 2.10: ENDOCRINE SYSTEM

After studying the histological structure of selected endocrine glands, the student will be

able to identify and describe the structure and function of:

The hypophysis (pituitary gland)

o Pars tuberalis

o Pars distalis

o Pars intermedia and

o Pars nervosa

The thyroid gland

The suprarenal gland

The endocrine pancreas

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C. STUDY COMPONENT: EMBRYOLOGY

ANAT 2020 EMBRYOLOGY OBJECTIVES

EMBRYOLOGY OBJECTIVES

In this section of the course, the students will be introduced to the development of human

embryo at different stages including gametogenesis, fertilization, implantation, the embryonic

period, the foetal period and development of the pharyngeal arches and their derivatives. The

student should be able to apply this knowledge to corresponding anatomical structures and

embryological development. Also, students will develop the ability to correlate between the

embryological structure and its clinical significance as this course trains the student to

understand any related clinical problems.

Study Resources: The fundamentals of Human Embryology (Allan and Kramer)

UNIT THEME 1: EARLY EMBRYOLOGY

The processes of fertilization, implantation, placentation and gastrulation will be covered.

Capability statement:

Students will be able to describe the factors which are involved in the fusion of the male and

female gametes. In addition students will be able to explain the formation of the placenta and

the notochord which is a critical structure during embryogenesis.

Embedded Knowledge

Students must have the following information/knowledge prior to lectures:

Cell structure

Mitosis and Meiosis

Sperm structure

SUB-UNIT THEMES:

Sub-unit theme 1.1: The first week of development (Fertilization and implantation)

Sub-unit theme 1.2: The second week of development (Placentation)

Sub-unit theme 1.3: The third week of development (Gastrulation and Neurulation)

SUB-UNIT THEME 1.1: THE FIRST WEEK OF DEVELOPMENT

Students will be able to explain the process of fertilization, consequences of fertilization,

cleavage, passageway along uterine tube, implantation and sites of implantation.

Specific outcomes

Students should:

1. Accurately describe the process of fertilization

2. Explain the stages of cell division and the link to formation of zygote

3. Describe the process of implantation

4. Explain the "critical period" in development

5. Define the embryonic stage

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6. Explain the path of an egg from the ovary to implantation.

7. Name the stages of implantation and the structures formed.

SUB-UNIT THEME 1.2: THE SECOND WEEK OF DEVELOPMENT

Students will be able to describe the formation of a bi-laminar embryo and the placenta,

including the extra-embryonic membranes.

Specific outcomes

Students should be able to describe the following:

1. Formation of hypoblast and epiblast layers

2. Formation of syncytiotrphoblast and cytotrophoblast layers

3. Formation of the amniotic cavity and the yolk sac

4. The establishment of the lacunar stage of development

5. Formation of chorionic villi

6. The formation of the extraembryonic mesoderm

7. Early coelom formation

8. Ectopic implantation sites

SUB-UNIT THEME 1.3: THE THIRD WEEK OF DEVELOPMENT

Students will be able to describe the process of gastrulation and the formation of a tri-

laminar embryo, primitive streak formation, folding of “flat” embryo into tubular structure and

neural tube formation.

Specific outcomes

Students should be able to:

1. Name the three germ layers ectoderm, mesoderm and endoderm and list the adult

tissues derived from each of these three layers

2. Describe the formation of the mesenchymal cells from the epiblast layer

3. Describe the differentiation of mesoderm into the paraxial, intermediate and lateral

plate mesoderm

4. Describe the differentiation of somites from paraxial mesoderm

5. Describe neural tube formation and how the neural tube differentiates into specific

components of the nervous system

6. Describe the migration of neural crest cells from the neural tube

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UNIT THEME 2: ORGAN SYSTEMS

Capability statement: Students will be able to describe the fundamental aspects of

embryonic development which are involved in the normal formation of organ systems. In

addition students will be able to explain the factors which may lead to the abnormal

development of certain organs, leading to birth defects.

SUB-UNIT THEMES:

Sub-unit theme 2.1: Development of the heart

Sub-unit theme 2.2: Development of pharyngeal arch arteries and veins

Sub-unit theme 2.3: Development of face and palate

Sub-unit theme 2.4: Development of pharyngeal arches, tongue and thyroid

Sub-unit theme 2.5: Embryology of the Nervous system

Sub-unit theme 2.6: Embryology of the GIT

Sub-unit theme 2.7: Coelom and Mesenteries

Sub-unit theme 2.8: The development of the urogenital system

Embedded Knowledge

Students must have the following information/knowledge prior to lectures:

The process of implantation

Neural tube formation

Folding of the embryo into a tubular structure

Histology of the male and female reproductive systems

The formation of the three germ layers

SUB-UNIT THEME 2.1: THE EMBRYONIC DEVELOPMENT OF THE HEART

After studying the development of the heart students should be able to explain how a single

tubular heart is converted into four chambers to sub-serve the adult circulation.

Students should also be able to explain the development of particular structures e.g. Septum

primum, septum secundum and foramen ovale, which assist in conversion from a fetal to a

neonatal circulation.

Specific outcomes

1. To explain the formation of a single heart tube from cardiogenic mesoderm

2. To explain the formation of the truncus arteriosus, bulbus cordis, ventricle, atrium and the

sinus venosus

3. To explain blood circulation through a primordial heart

4. To describe the sepation of the AV canal

5. Describe the formation of the intermediate bar

6. Describe the sepation of atrium and ventricle

7. Describe the fate of the bulbus cordis and the sinus venosus

8. Describe the formation of the left atrium

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SUB-UNIT THEME 2.2: DEVELOPMENT OF PHARYNGEAL ARCH ARTERIES AND

VEINS

To illustrate the important changes which occur when the fetus foregoes an aquatic

environment and changes to the terrestrial environment of the neonate/adult.

Specific outcomes

Students should be able to explain the following:

1. The steps involved in normal development from the angiogenesis stage to the

completion of the 4-chambered fetal heart.

2. The flow of blood entering and exiting the developing fetal heart and blood flow within the

fetal heart (fetal circulation)- closure or patency of foramen oval (at birth) and changes in

percentage oxygen saturation of the blood at each stage of the fetal circulation.

3. The effects of the following cardiac anomalies to normal cardiac function

4. Atrial Septal Defects of both the primum and secundum type

5. Premature closure of the foramen ovale

6. Persistent atrio-ventricular canal

7. Ventricular Septal Defects of both the membranous and muscular type

8. Ectopia cordis

9. Tricuspid atresia

10. Tetralogy of Fallot

11. Transposition of the great vessels

12. Persistent truncus arteriosus

SUB-UNIT THEME 2.3: DEVELOPMENT OF FACE AND PALATE

To ensure an understanding of the abnormalities which occur in these regions and their

underlying causes.

Specific outcomes

1. Name the prominences that contribute to face formation

2. Frontal prominence, 2 maxillary prominences, 2 mandibular prominences

3. Recognize the contribution of each prominence to the formation of various face parts:

Frontal prominence: Forehead, nasal bridge, lateral nose

Maxillary prominences: Lateral upper lip, Cheeks (above mouth line)

Mandibular prominences: Cheeks (below mouth line), lower lip, chin

4. Understand the formation and position of nasolacrimal duct from the nasolacrimal groove

5. Understand the formation of oblique facial cleft

6. Able to describe the formation of the intermaxillary segment.

7. Recognize the embryological origin of the median cleft lip and be conversant with the

most common associated syndromes.

SUB-UNIT THEME 2.4: PHARYNGEAL ARCHES, TONGUE AND THYROID

To ensure an understanding of the gross anatomy of the head and neck, particularly

innervation.

To enhance the understanding of the major glands/structures of the neck and thorax and

resulting

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To ensure an understanding of the diverse innervation of the tongue; and abnormalities.

To ensure an understanding of the development and position of the thyroid gland and

abnormalities.

Specific Outcomes

1. Understand and describe pharyngeal arches, pharyngeal pouches, pharyngeal grooves,

pharyngeal membranes

2. Understand and list the derivatives of each pharyngeal arch basic structural component

(artery, nerve, muscle, cartilage skeleton).

3. List the derivatives of the first pharyngeal groove and describe the pattern of obliteration

of pharyngeal grooves.

4. List the derivatives of the different pharyngeal pouches.

5. Describe the terms Pharyngeal/Branchial Arch, Pouch & Grooves/Cleft.

6. Understand the abnormalities of the pharyngeal arch apparatus

SUB-UNIT THEME 2.5: DEVELOPMENT OF THE NERVOUS SYSTEM

Formation of neural tube, neural crest, spinal cord and brain, cells layers, alar and basal plates

nuclei, folding of the brain, enormous development of cerebral cortex

Specific outcomes

1. Comprehend neural development and the formation of spinal cord and brain from neural

tube

2. Know the layers of developing spinal cord and its contents

3. Describe the neurogenesis of the neural tube

4. Outline the mantle and marginal zones

5. Differentiate between the grey and white matter from the neural tube.

6. Understand the role of migration of neurons during neural development.

7. Understand the respective adult derivatives of the brain vesicles and their walls.

8. Know the origin of neural crest cells their input in the development some tissues.

9. Appreciate and know the embryological basis of some congenital anomalies of the

nervous system e.g. hydrocephalus, spina bifida, anencephaly and encephalocele

SUB-UNIT THEME 2.6: EMBRYOLOGY OF THE GIT

Students should be able to describe the formation of the following:

Tube, derivatives of the stomodeum, including the development of the hypophysis

cerebri; foregut development

Midgut development and rotation, formation of greater omentum; common abnormalities

Development of hindgut; development of liver including invasion of vessels; common

abnormalities

Development and “rotation” of the pancreas; formation of lesser sac; common

abnormalities

Specific Outcomes

1. Understanding how the germ layer contributes to the primitive gut formation

2. Explain the significance of folding of the embryo during GIT development

3. Describe the three main embryonic divisions of the primitive gut

4. List and describe the derivatives of the foregut, midgut, hindgut and their blood supply

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5. Know the development of other GIT organs (liver, pancreas, spleen)

6. Understanding of the rotation of the stomach and the midgut loop during GIT

development

7. Explain the process of umbilical herniation and the embryonic development of

mesenteries

8. Understand the abnormalities of GIT development

Sub-unit theme 2.7: Coelom and Mesenteries

Students should be able to describe the development of the extra- and intra-embryonic

coelomic cavities; separation of intra-embryonic coelom into four; formation of “folds”;

formation of mesenteries; fixed and free mesenteries; development of diaphragm,

abnormalities

Specific outcomes

1. To understand what a coelomic cavity is and how it comes to protect the major organs of

the body.

2. To ensure an understanding of what a mesentery is and where they are located;

3. To understand the innervation and position of the diaphragm.

SUB-UNIT THEME 2.8: THE DEVELOPMENT OF THE UROGENITAL SYSTEM

Students will be able to explain the early development of the kidney and gonads (migration

of primordial germ cells); ureters and urethra; abnormalities.

In addition students should be able to describe internal genital development and the different

gonads.

Specific outcomes

1. Describe the embryonic development of kidneys, ureters, and urinary bladder.

2. Understand the development of the pronephros, mesonephros, and metanephros

3. Describe the collecting and excretory systems of the kidney

4. Describe the ascent and rotation of the kidneys

5. Understand the congenital anomalies of the kidneys and urinary bladder.

6. Describe the development of testes, ovaries, and their descent.

7. Describe the development of the mesonephric and paramesonephric ducts and genital

ducts.

8. Describe the development of the vagina, uterus and the uterine tubes.

9. List the adult derivatives and vestigial remnants of embryonic urogenital structures.

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D. STUDY COMPONENT: MORPHOLOGICAL ANATOMY

UNIT THEME 1: UPPER LIMB

Capability statement

By completion of this section the student must be able to understand the basic and applied

anatomical structure and function of the upper limb. The student should be able to apply

this knowledge and provide the anatomical basis underlying specific clinical scenarios

pertaining to diseases and injuries to the upper limb.

Embedded knowledge

Students must know and understand the following before studying the sub-unit theme:

Anatomical terminology

Anatomical orientation

SUB-UNIT THEME 1.1: THE PECTORAL GIRDLE AND BREAST

(Practical Anatomy)

WEEK 1: SPECIFIC OUTCOMES

By the end of this week, the student should be able to:

Identify and describe the bones of the pectoral girdle (scapula, clavicle and humerus)

Identify the joints of the pectoral girdle (sternoclavicular, acromioclavicular)

Distinguish between the terms upper limb, arm, forearm and hand

Explain the concept of superficial fascia and list its contents

Describe the anatomy of the female breast, including the surface anatomy, arterial

supply, venous drainage and innervation

Describe position and drainage area of the axillary lymph nodes

Explain the lymphatic drainage of the breast and upper limb and in the spread of tumors

Describe the attachments of the muscles of the anterior aspect of the pectoral girdle,

their actions and nerve supply

Identify the boundaries of the axillary space

Describe the attachments, actions and nerve supply of the muscles around the scapula

Describe the formation of the arterial anastomosis around the scapula

Describe the boundaries and contents of the quadrangular and triangular spaces

Explain how the actions of the muscles would be affected should the nerves be damaged

Identify anatomical features and major relations on diagnostic images, e.g. CT, MRI,

radiographs

WEEK 1: DISSECTION SPECIFIC OUTCOMES

THE PECTORAL GIRDLE

1. Identify the bones of the pectoral girdle on the articulated skeleton: clavicle, scapula, and

humerus.

2. Identify the following joints on an articulated skeleton and a radiograph:

acromioclavicular joint, sternoclavicular joint

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THE BREAST:

1. Examine the female and male breasts, noting the difference in size and extent.

2. Identify the areola and nipple, taking note of the variation in the position of the nipple in

different female cadavers.

3. Examine the cut section of the female breast and identify the duct system.

THE ANTERIOR ASPECT OF THE PECTORAL REGION

1. Identify the 5 major muscles in this region: Pectoralis major, pectoralis minor,

Subclavius, serratus anterior, deltoid.

2. Study the attachments, nerve supply and actions of these muscles.

3. Identify the axillary space and the muscles that form its boundaries.

THE POSTERIOR ASPECT OF THE PECTORAL GIRDLE

1. Identify the 3 most superficial muscles in this region: Trapezius, deltoid, latissimus dorsii

2. Identify the deep muscles, which are in two convenient groups:

Medial group: levator scapulae, rhomboid major, rhomboid minor,

Lateral group: supraspinatus, infraspinatus, teres major, teres minor, subscapularis

3. Identify the arteries in this region and describe the important connections (anastomosis)

that they form around the scapula.

4. Identify the boundaries and contents of the quadrangular and triangular spaces.

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SUB-UNIT THEME 1.2: THE AXILLA, BRACHIAL PLEXUS AND ARM

(Practical Anatomy)



Describe the contents of the axillary space

Identify the clavipectoral fascia and the structures passing through it

Draw and describe the arrangement of the axillary lymph nodes

Identify and draw the terminal branches of the brachial plexus and follow them out of the

axilla

Describe the consequences of injury to the brachial plexus and its terminal branches

Identify the muscles of the anterior and posterior compartments of the arm

Describe the actions and nerve supply of the muscles of the anterior and posterior

compartments of the arm

Describe the muscle groups of the anterior and posterior compartments of the arm, their

actions and nerve supply


THE AXILLARY SPACE

1. Review the boundaries of the axilla.

2. What appears to be the most abundant content of the axilla?

3. Identify the following:

Axillary artery and its branches

Axillary vein

Axillary lymph nodes

4. Identify the lateral thoracic artery and long thoracic nerve.

THE BRACHIAL PLEXUS

1. Identify the cords and branches of the brachial plexus. The letter 'M' will be helpful in

this process.

2. Draw the scheme of the brachial plexus on the drawing board or in your book and label

it fully.

3. Think (in general terms) about the likely effect of cutting through (transecting) one of the

branches of the brachial plexus.

THE ANTERIOR COMPARTMENTS OF THE ARM

General:

1. What are the subdivisions of the upper limb?

2. Review the major features of the humerus e.g. head, necks, tuberosities, sulci (grooves),

fossae, capitulum, trochlea, and nutrient foramen.

3. Examine the biceps brachii muscle on your partner and note during which movements of

the upper limb does it become more prominent?

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Muscles of the anterior compartment of the arm

1. Identify and name the 3 muscles in this compartment.

2. What is their nerve supply?

3. Examine the attachments of these muscles. Which joints do these muscles cross?

Examine the orientation of the muscle fibres and try to work out the possible actions of

these muscles.

Neurovascular structures of the arm

Identify the neurovascular structures on the medial aspect of the arm. You should find at

least 5 structures (6 if the vein is present). Trace each of them inferiorly.

POSTERIOR ASPECTS OF ARM

Muscle of the posterior aspect of the arm

This is the triceps muscle.

1. Why is it called “triceps”?

2. The long head contributes to the formation of the boundaries of the quadrangular and

triangular spaces, which you have seen before.

3. Review the boundaries and contents of these spaces now.

Neurovascular structures in the posterior aspect of the arm

These are the radial nerve and profunda brachii artery.

1. What are their origins?

2. Follow the course of the nerve through the arm to the forearm.

3. Note the relationship of the neurovascular structures to each other.

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SUB-UNIT THEME 1.3: CUBITAL FOSSA AND FOREARM

(Practical Anatomy)



Describe the boundaries and contents of the cubital fossa

Describe the features of the radius and ulna

Identify the bones of the hand

Identify the muscles of the anterior and posterior compartments of the forearm,

Describe the actions and nerve supply of the muscles of the anterior and posterior

compartments of the forearm.


THE CUBITAL FOSSA

Identify the boundaries of the cubital fossa. These should normally include the roof and floor.

Look for as many of the contents as can be seen, especially the:

1. Biceps tendon

2. Brachial artery and vein (Does the artery divide into radial and ulnar arteries in this

fossa?)

3. Median nerve

4. Radial nerve

Applied anatomy:

What veins lie in the roof of this fossa that may be used for withdrawing blood or

administering substances intravenously?

Attempt to feel your arterial pulse on the medial aspect of the base of the fossa just

medial to the tendon of the biceps brachii muscle. This is easier if you extend the elbow

joint.

THE ANTERIOR ASPECT OF THE FOREARM

Surface anatomy:

1. Palpate (feel with your hand) the head of the radius just distal to the lateral epicondyle of

the humerus as you rotate the forearm.

2. Identify the olecranon process and follow the ulna distally to its styloid process.

Osteology:

1. Examine the radius and ulna of an articulated skeleton or from your bone box. Identify

their major features.

2. Identify the interosseous borders and identify the interosseous membrane in a forearm

specimen. What is the function of this membrane?

3. Identify the bones of the wrist and hand.

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THE ANTERIOR ASPECT OF THE FOREARM

Muscles of the forearm (3 groups)

Identify these muscles and know their actions and innervation.

1. Superficial rotator muscles:

Pronator teres

Brachioradialis

Give the nerve supply of these muscles.

2. Flexor muscles of the forearm:

These may be divided into 3 functional groups:

1. Flexors of the wrist

· flexor carpi radialis; [radial deviation of wrist]

· palmaris longus

· flexor carpi ulnaris; [ulnar deviation of the wrist]

2. Flexors of the fingers

· flexor digitorum superficialis

· flexor digitorum profundus

3. Flexor of the thumb

· flexor pollicis longus

What is the nerve supply of these muscles?

3. Deep rotator muscles of the forearm:

· pronator quadratus (Confirm the quadrangular shape)

· supinator

What is the innervation of these muscles?

Pronate and supinate the forearm bones of an articulated skeleton. At what joints do

these movements take place?

THE POSTERIOR ASPECT OF THE FOREARM

Muscles of the posterior aspect of the forearm (3 functional groups)

Identify these muscles and know their actions and innervation.

1. Extensors of the wrist:

· extensor carpi radialis longus

· extensor carpi radialis brevis

· extensor carpi ulnaris

2. Extensors of the fingers:

· extensor digitorum

· extensor indicis

· extensor digiti minimi

3. Extensors of the thumb:

· extensor pollicis longus

· extensor pollicis brevis

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4. Abductor of the thumb:

· abductor pollicis longus (an additional small abductor will be seen later in the hand)

You can also identify these muscles in two layers.

1. Superficial muscles:

· extensor carpi radialis longus and brevis

· extensor digitorum

· extensor carpi ulnaris

· extensor digiti minimi

2. Deep muscles:

· abductor pollicis longus

· extensor pollicis longus and brevis

· extensor indicis

· Supinator

· anconeus.

Which nerve supplies these muscles?

Most of these muscles originate from a common extensor origin. Where is this common

extensor origin?

Neurovascular components of the forearm

1. Identify the median, ulnar and radial nerves and trace them to the wrist

2. Identify the radial and ulnar arteries just distal to the elbow joint and trace them to the

wrist.

3. There is an arterial anastomosis around the elbow joint. You must know about its

formation. What is the benefit of having such arterial anastomosis? Where did you come

across an anastomosis in your previous dissection?

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SUB-UNIT THEME 1.4: THE HAND AND JOINTS OF THE UPPER LIMB

(Practical Anatomy)



Relate the gross anatomy of the palmar skin to its function,

Name the structures that pass through the carpal tunnel and, in very general terms, the

effect of damage to them,

Describe the actions and innervation of the muscle groups of the hand,

Explain the basic significance of the palmar spaces

Describe the shoulder joint as a typical example of synovial joints that are designed

more for a wide range of movements,

Describe the movements that take place at the proximal radioulnar joint.

Know the movements taking place at other joints of the upper limb


radiographs


THE HAND

The bones of the wrist and hand

Review the names of the bones of the wrist and hand again. If you look at an articulated

hand, you will see that the carpal bones form a concavity that is directed anteriorly. The

deep fascia of the wrist (flexor retinaculum) converts this into a tunnel.

1. What is the name of the tunnel?

2. Which structures pass deep to the flexor retinaculum?

3. Which structures pass superficial to it?

4. What is the consequence of increased pressure (e.g. from accumulated pus) in this

tunnel?

The palmar skin

1. How does the skin of your palm differ from that of the dorsal surface of the hand?

2. What is the advantage of the skin creases?

Functional groups of muscles of the hand

The muscles are grouped into flexors, extensors, abductors, adductors, and opposition

muscles.

1. What are the names of the muscles that perform these actions in the fingers?

2. What is the innervation of these muscles?

Neurovascular components of the hand

1. Identify the superficial and deep palmar arterial arches?

2. How are they formed?

3. Follow the ulnar and median nerves distal to the wrist.

4. What is the innervation of the skin of the hand (palmar and dorsal surfaces)? Learn to

draw this.

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JOINTS OF THE UPPER LIMB

Compare, in table format, the different joint using the scheme below.

Types of joints

1. Compare, in table format, the structure and mobility of a fibrous, cartilaginous and

synovial joint. Also provide an example of each.

2. When studying joints, the scheme below should be followed:

Name

Classification or Type (e.g. plane, synovial hinge, pivot, condyloid, ball and socket)

Articulating surfaces

Capsule attachment

Synovial membrane

Ligaments (intra and extracapsular)

Nerve supply

Blood supply

Movements and the muscles that produce them

Relations

The shoulder joint

Examine the shoulder joint. Ask the demonstrator for assistance in opening up a shoulder

joint in the cadaver for you.

1. Using the scheme shown above, learn to describe the joint.

2. Which of the above muscles constitute the group of muscles called the 'rotator cuff' and

why are they given this name?

3. Would you say that this is a very stable joint?

4. Classify the features that account for its strength and weakness.

Elbow Joint

Use the scheme above to study the elbow joint.

The superior radio-ulnar joint

1. What ligament keeps the head of the radius in place?

2. What movement of the forearm takes place at this joint?

3. Name the muscles that produce these movements.

Wrist (Radiocarpal), Intercarpal, Carpometacarpal, Metacarpophalangeal &

interphalangeal Joints

Identify these joints on a mounted skeleton and on radiographs.

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UNIT THEME 2: THORAX



anatomical structure and function of structures within the thorax. The student should be

able to apply this knowledge and provide the anatomical basis underlying specific clinical

scenarios pertaining to diseases and injuries to the thorax.

Embedded knowledge


Anatomical terminology & orientation

Anatomy of the pectoral region, brachial plexus and breast

SUB-UNIT THEME 2.1: THE THORACIC CAGE, INTERCOSTAL SPACES, PLEURA AND

LUNGS



Describe the bony structure of the thoracic wall,

Describe the arrangement of the intercostal muscles, nerves and blood vessels,

Describe the arterial supply and venous drainage of the anterior walls of the thorax,

Describe the arrangement of the layers of the pleural membrane and the formation of

the pleural cavity and the associated recesses,

Describe the basic structure and major subdivisions of the lungs and respiratory

passages,

Describe lines of pleural reflection and surface markings of lung fissures.


radiographs


THE RELATIONSHIP OF THE THORAX TO THE NECK AND ABDOMEN

The thorax (chest) is located between the root of the neck and the abdomen. It houses the

cardiovascular and respiratory organs and their associated blood vessels and nerves. All

neurovascular and tubular structures that descend or ascend between the neck and the

thoracic cavity have to pass through the superior thoracic inlet.

The posterior part of the thoracic cage (the vertebrae) transmits the weight of the body to the

lumbar vertebrae.

1. Define the boundaries of the cervicothoracic inlet on the articulated skeleton.

2. With the help of a dissected specimen of the root of the neck, identify the main

structures that pass through the cervicothoracic inlet.

The thoracic cavity is bounded inferiorly by the diaphragm (thoraco-abdominal diaphragm).

This has openings in and around it for the passage of nerves and blood vessels between the

thoracic and abdominal cavities, and for the passage of the oesophagus from the thoracic to

the abdominal cavity.

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THE THORACIC CAGE

This is the bony structure that forms the framework of the thoracic wall.

1. Identify the components of the thoracic cage.

2. Explain do ribs articulate with the thoracic vertebrae.

3. What is the single most important feature for differentiating the thoracic vertebrae from

the other vertebrae?

4. Note also the slanting position of the ribs. How does this feature contribute to the

mechanisms that alternately increase and decrease the diameters of the thoracic cavity

during inspiration and expiration?

One of the ways of classifying the 12 pairs of ribs is according to their attachment anteriorly

and posteriorly. Examine the ribs on the articulated skeleton again.

1. How many ribs are attached directly to the sternum?

2. How many ribs are attached to cartilages anteriorly?

3. How many ribs are unattached anteriorly?

4. What names are given to these groups of ribs?

THE INTERCOSTAL SPACES

You have already reflected the skin from the anterior and lateral aspects of the thoracic wall

during your dissection of the pectoral region.

1. Press your fingers against the thoracic wall and identify 2 or 3 ribs.

2. What is the name of the soft area between the two ribs?

3. Dissect carefully through one intercostal space directly inferior to the axilla and identify

the 3 layers of muscle. Name these muscles form superficial to deep.

4. Name and draw a well labelled diagram to demonstrate the blood vessels and the nerve

in the space that you dissected.

5. Between which muscle layers do these nerves and blood vessels lie?

6. How are these structures arranged in the intercostal space?

NOTE:

Although there are 12 pairs of ribs, there are only 11 intercostal nerves, arteries and

veins. The 12th set of nerve and vessels are called subcostal nerve and vessels.

The arteries come from two sources: anteriorly from the internal thoracic artery and

one of its terminal branches (musculophrenic artery), and posteriorly from the

thoracic descending aorta.

The veins drain in two directions: anteriorly to the internal thoracic veins and

posteriorly to the azygos system of veins and the brachiocephalic veins.

You will have the opportunity to identify the azygos veins later when the posterior

thoracic wall will be dissected. The knowledge of the arrangement of these nerve and

blood vessels is important if one is to avoid damage to them when an incision (cut) is

being made in the intercostal space. The nerves and blood vessels supply the

intercostal muscles and the overlying skin, including the breast.

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THE PLEURAL SACS

1. What is the two-layered membrane called that encloses the lung?

2. Name the outer layer of the pleura. What is its position in relation to the thoracic wall?

3. Name the inner layer of the pleura. What is its position in relation to the lungs?

4. What is the potential space between the two pleural layers called?

5. Examine the inside of the anterior thoracic wall.

6. Peel off a part of the parietal pleural membrane from the innermost intercostal muscle so

as to have a feel of this membrane.

7. What are the different parts of the pleural layers?

8. Note that the pleural cavities are larger than the lungs. The extra pleural spaces in the

inferior parts of the thoracic cavity and around the anterior margins of the left and right

lungs are the pleural recesses. They allow for the expansion of the lungs during

inspiration.

9. What is the function of the pleural membrane?

10. What is the nerve supply of the parietal and visceral pleural layers?

NOTE:

The left and right pleura do not communicate and are separated by a movable septum called

the mediastinum (to study at a later stage) but are connected by a tubular fold of pleura that

surrounds the roots of the lungs. The anterior thoracic wall would have been cut for you. Pull

the cut segment of the thoracic cage inferiorly towards the abdomen. The parietal pleural

membrane would most probably have been pulled onto the deep surface of the anterior

thoracic wall.

THE LUNGS Practical Anatomy

Examine the lungs in situ (i.e. in their natural positions). They appear to fill up the entire

thoracic cavity. The two lungs are however, separated by the mediastinum.

1. What are the main structures in the mediastinum? (No details at this stage).

2. Remove the lungs and compare the two lungs and determine their major differences

(especially the size, shape, and weight, number of fissures and lobes and cardiac

impressions).

3. Are the impressions likely to be present in the living state?

4. Make an incision into one of the lungs (Groups X1, X2 and Z1 to cut the left lung and

Groups Y1, Y2 and Z2 the right lung) and examine the cut surface (preferably with the

aid of a hand lens).

NOTE:

Microscopic study of the lungs and bronchi will later help you to understand the structural

arrangement that enables the lungs to perform their gaseous exchange function.

THE BRONCHIAL TREE

Identify a bronchus at the root of the same lung that you are dissecting. Follow it for some

distance into the substance of the lung to confirm that it divides repeatedly into smaller

bronchi. The right lung receives three lobar bronchi while the left lung receives two.

Review the names of the bronchopulmonary segments in each lung.

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NEUROVASCULAR COMPONENTS

Two sets of arteries enter the lung tissue: Pulmonary arteries & Bronchial arteries

1. Identify these blood vessels.

2. What are the differences between these two arteries in terms of the type of blood that

they convey?

Two sets of veins leave the lung tissue: Pulmonary veins & Bronchial veins

1. Identify the pulmonary vein (the bronchial vein may be difficult to identify).

2. What are the differences between these two veins in terms of the type of blood that they

convey?

3. What is the nerve supply of the visceral pleura and the lungs?

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SUB-UNIT THEME 2.2: THE MEDIASTINUM, PERICARDIUM AND HEART



Define and describe the divisions of the mediastinum,

Identify and describe the arrangements of the main contents of the superior

mediastinum,

Identify the structures that have similar arrangements on both left and right aspects of

the mediastinum,

Identify the structures that differ in their arrangements on both left and right

mediastinum,

Describe the arrangement of the pericardial layers,

Define the position and orientation of the heart in the thoracic cavity,

Draw and demonstrate the surface markings of the heart on the surface of the human

body,

Identify and describe the major differences in the features of the internal surfaces of the

walls of the chambers of the heart,

Describe the path and direction of blood flow through the heart,

Describe the blood and nerve supply of the heart.

Describe the surface markings of the heart valve and their areas of auscultation

Explain the anatomy underlying referred pain from the heart (angina pectoris)


radiographs


THE MEDIASTINUM

This movable septum (partition) consists of all the anatomical structures that lie between the

two pleural cavities.

Divisions

It is divided into Superior and Inferior mediastina.

Superior mediastinum

Above the level of the horizontal line that joins the sternal angle to the lower border of the

body of the 4th thoracic vertebra. Identify these bony points on the articulated skeleton

Inferior Mediastinum

Below the level of the horizontal line that joins the sternal angle to the lower border of the

body of the 4th thoracic vertebra. The inferior mediastinum is subdivided into 3 parts:

Anterior mediastinum – narrow cleft between the pericardium and the sternum

Middle mediastinum – constituted by the pericardium, the heart and the roots of the

great vessels that emerge from or enter it.

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Posterior mediastinum – the interval between the vertebrae (posteriorly) and the

pericardium and diaphragm (anteriorly)

Examine the thoracic cavity and be sure that you can demonstrate the boundaries of these

subdivisions of the mediastinum.

CONTENTS

Superior mediastinum:

Identify, from anterior to posterior, the following main contents:

Remnant of Thymus

Brachiocephalic veins and superior vena cava

Pulmonary trunk and pulmonary arteries

Arch of the aorta and its branches

Trachea, with the vagus nerves in the grooves between it and

Oesophagus. Phrenic nerves, cardiac plexus, Left recurrent laryngeal nerve

Thoracic duct & lymphatics

NOTE:

It is always helpful to learn them from anterior to posterior: thymus. Veins, arteries, airway,

GIT, nerves, lymphatics

Anterior mediastinum:

Thymus gland or its remnants

Middle mediastinum:

Heart

Roots of the great vessels.

Which blood vessels are referred to as “the great vessels”?

Posterior mediastinum:

There is asymmetry in the contents that are seen on the left and right aspects of this

mediastinum.

Right side: Some structures are more prominent on the right surface of the mediastinum.

Examine this side of the mediastinum and list the structures that you can see more

prominently.

Left side:

Examine the left surface of the mediastinum and list the structures that you can see more

prominently.

Other structures have equal presence in both sides of the mediastinum. Identify the

sympathetic chain and take note of its location on the bodies of the vertebrae. It contributes

to the autonomic plexuses that supply the viscera of the thoracic cavity and send splanchnic

nerves through the diaphragm to the abdominal cavity.

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THE PERICARDIUM

1. Examine the pericardium and determine its extent. Note that it is attached inferiorly to the

central tendon of the diaphragm and that a number of large blood vessels emerge from it

superiorly.

2. Identify these blood vessels, noting their relations to one another.

3. Make a circular incision into the pericardium in the coronal plane and remove the anterior

segment. This will expose the glistering serous pericardium, which is in two layers: the

visceral serous layer clothes the heart while the parietal serous layer lines the inside of

the fibrous pericardium. The space between the visceral and parietal layers of serous

pericardium is the pericardial cavity. (Compare this arrangement with that of the visceral

and parietal pleural layers and pleural cavity).

THE HEART

Surfaces and borders of the heart:

1. Observe the position and orientation of the heart in situ.

2. Identify the surfaces and borders of the heart.

Surface markings of the heart:

Place the cut anterior thoracic wall back in place and mark the outline of the heart on it. You

should learn to draw the surface markings of the heart on the living anterior chest wall.

Compare the surface marking of the four heart valves with the area of their

auscultation.

Coronary vessels:

Identify the right and left coronary arteries and their major branches

1. Anterior interventricular artery

2. Posterior interventricular artery

3. Circumflex artery

4. Marginal artery

The interior of the heart: (Incisions shown in Practical Anatomy)

Examine the interior of the heart and identify the following structures:

1. Mitral, tricuspid, pulmonary and aortic valves

2. Interatrial and interventricular septa

3. Pectinate muscles of the atria

4. Trabeculae carneae and papillary muscles of the ventricles

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SUB-UNIT THEME 2.3: POSTERIOR MEDIASTINUM



Describe the position, division, immediate relations, blood supply and innervation of the

thoracic part of the trachea,

Describe the position, immediate relations, blood supply and innervation of the thoracic

part of the oesophagus,

Describe the origin, course and termination of the thoracic duct,

Define the thoracic vertebral level at which the inferior vena cava, the oesophagus and

the descending aorta penetrate the diaphragm.


radiographs


THE TRACHEA

This is the main tube that conveys air to the lungs. It is continuous with the larynx above at

the level of the 6th cervical vertebra. (The cervical part of the trachea will be seen later). It

terminates inferiorly by dividing into the principal bronchi at the level of the sternomanubrial

joint (disc between thoracic vertebrae 4 and 5).

1. Identify these landmarks on the articulated skeleton.

2. Examine the trachea and ascertain that:

It consists of C-shaped plates of hyaline cartilage, which open posteriorly

The posterior surface, which lies on the oesophagus, is made up of smooth muscle

(trachealis muscle)

It divides into the 2 principal bronchi, which, unlike the trachea, consist of irregularly

arranged C-shaped cartilages.

3. Apart from the smooth muscle fibres, what other structures hold the hyaline cartilages

together?

4. Identify the anterior, left lateral, right lateral and posterior relations of the trachea.

5. What is the arterial supply, venous drainage and nerve supply of the trachea?

6. What is responsible for the “cough reflex”?

Quiz

What is surface marking of trachea bifurcation?

Name other events occurring at the surface marking mentioned above.

THE OESOPHAGUS

This is a fibromuscular tube, which is flattened anteroposteriorly. It consists of 3 parts:

cervical, thoracic and abdominal.

The cervical part is continuous with the pharynx at the level of the 6th cervical vertebra. The

thoracic part lies in the superior and posterior mediastina and becomes continuous with the

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abdominal part by passing through the diaphragm at the level of the 10th thoracic vertebra.

1. Examine the thoracic part of the oesophagus and identify its main relations.

2. Identify the oesophagus as it passes through the diaphragm. What is the position of this

“oesophageal hiatus” in relation to the midline of the vertebral column?

3. Identify the nerves that accompany the oesophagus through the diaphragm.

4. What is the arterial supply, venous drainage and nerve supply of the oesophagus?

THE THORACIC DUCT

This is the main lymphatic duct that receives lymph from the abdomen, pelvis, lower limbs,

left mediastinal nodes, left side of the head, neck and face.

1. Identify the thoracic duct posterior to the right border of the lower part of the oesophagus

and follow its course cranially as far as possible. You should be able to see its terminal

part in the neck at a later stage.

2. Where does it originate?

3. Which lymphatic duct receives lymph from the right side of the head, face, neck and

face?

THE DIAPHRAGM

This fibromuscular septum separates the thoracic from the abdominal cavity. It has 3 main

sites of origin: costal, xiphisternal and vertebral.

1. Identify the costal and xiphisternal origins. The lumbar vertebral origin will be seen later

when the posterior abdominal wall is dissected.

2. At which vertebral levels do the inferior vena cava, oesophagus and descending aorta

pass through the diaphragm?

3. What is the arterial supply, venous drainage and nerve supply of the diaphragm?

4. In which direction (superiorly or inferiorly) does the diaphragm move when it contracts

during inspiration?

NOTE:

Please see later section of this guide for more on the diaphragm.

THE POSTERIOR THORACIC WALL

1. Identify the descending aorta and revise its posterior intercostal branches.

2. Identify and revise the azygos system of veins.

3. Identify and revise the sympathetic trunk. Pay attention to the cardiopulmonary

splanchnic nerves.

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UNIT THEME 3: HEAD AND NECK



anatomical structure and function of structures within the head and neck. The student

should be able to apply this knowledge and provide the anatomical basis underlying

specific clinical scenarios pertaining to diseases and injuries to the head and neck.

Embedded knowledge



Anatomy of the pectoral region, brachial plexus, thoracic cage, brachial plexus and

great blood vessels

SUB-UNIT THEME 3.1: THE SKULL AND FACE, MASTICATION, FOSSAE AND THE

ORAL CAVITY



Identify and name all the bones of the skull and their major landmarks

Identify the landmarks and muscle markings (origins/insertions) on the mandible

Identify and name all the foramina of the skull and the nerves associated with each

Describe the layers of the scalp and its blood supply, innervation and lymphatic drainage

Describe the innervation to the skin of the face

Identify the muscles of facial expression, describe their actions and innervation

Identify the muscles of mastication, describe their origins, insertions, actions and

innervation

Fully classify and describe the temporomandibular joint

Describe the movements possible at the temporomandibular joint and the muscle that

elicit these actions

Describe the trigeminal nerve, it origin and distribution in the face

Describe the borders and contents of the Temporal fossa

Describe the borders and contents of the Infratemporal fossa

Identify the origin of the maxillary artery and identify the major branches from its three (3)

named parts

Describe the mandibular nerve, its origin and its distribution in the face

Draw and describe the borders and contents of the Pterygopalatine fossa

Describe the maxillary nerve, it origin and distribution in the face

Define the boundaries and subdivisions of the oral cavity (mouth)

Describe the basic tissues that form the walls, floor and roof of the oral cavity

Describe the innervation of the mucous lining of the oral cavity

Describe the anatomy of the lip and the tongue, including their blood supply, lymphatic

drainage and innervation

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DISSECTION OF THE FACE

The structures on the face and temporal fossa to be dissected are:

1. The four groups of muscles of facial expression

2. The facial artery and vein

3. The parotid gland and duct

4. The temporalis, masseter and buccinator muscles. The buccinator muscle is pierced by

the parotid duct and it is a muscle of facial expression

NOTE:

Due to their insertion directly into the skin, these muscles are extremely superficial and should

be dissected with great care.

MUSCLES OF MASTICATION

NOTE: The origins and insertions of the muscles of mastication are examinable

There are 4 muscles of mastication: - temporalis, masseter, medial pterygoid and lateral

pterygoid muscles.

In order to see these muscles, two things have to be done: the skin of the side of the face and

head will have to be reflected, and the muscles deep to the ramus of the mandible will have

to be studied on specimens that will be set out during the session.

1. Identify the four muscles of mastication, noting the orientation of their fibres.

2. With this information, you can reason out their actions on the mandible at the

temporomandibular joint.

3. Define the innervation of these muscles.

4. Describe their origins and insertion points. Identify these landmarks on the skull and

mandible

THE TEMPORAL, INFRATEMPORAL FOSSAE AND PTERYGOPALATINE FOSSAE

Identify and/ or study the following structures, using the specimens provided where

necessary:

Pterygopalatine fossa on a dry skull, noting its borders.

Trace the course and distribution of the maxillary nerve: from entering foramen

rotundum, via the pterygopalatine fossa until it supplies branches to the greater palatine

foramen

Pterygopalatine ganglion that attaches to the maxillary nerve, a cell station where

parasympathetic fibres from the greater petrosal nerve synapse before redistribution to

the lacrimal, nasal and palatine glands

Revise the course and distribution of the facial nerve

Muscles of mastication

Mandibular nerve that innervates them, and

Maxillary artery that supplies them

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The mandibular nerve

The mandibular nerve is a division of the trigeminal nerve (CN V), which is the nerve of the

first pharyngeal arch. The mandibular nerve is a mixed nerve. The sensory components, along

with the other two divisions of the trigeminal nerve that are completely sensory, supply the

skin of the face. The motor component of the mandibular nerve innervates the muscles of

mastication.

1. Look for the mandibular nerve deep to the lateral pterygoid muscle and zygomatic arch.

2. Identify a few of its muscular branches.

3. Identify the lingual and inferior alveolar branches.

4. What is the distribution of the lingual nerve and inferior alveolar nerve?

The maxillary artery

1. What is the origin of the maxillary artery?

2. Identify the artery and observe its relationship to the lateral pterygoid muscle, which is

used to divide this artery into 3 parts (for descriptive purposes).

3. Learn the names of the branches coming from the three parts of the maxillary artery (No

details of the distribution of these branches required at this stage).

4. Through its branches, the artery supplies the principal muscles of mastication, the

buccinator muscle, skin and mucosa of the cheek, the mandible, maxilla, roots of the

teeth and gingivae.

THE ORAL CAVITY (MOUTH)

The mouth is the beginning of the digestive tract. It acts as the initial receptacle for food and

the initiator of the digestive process.

1. Confirm in the mid-sagittal section of the head that the oral cavity opens anteriorly

between the lips and posteriorly into the pharynx. (Refer to Figure in Practical Anatomy)

2. The oral cavity is divided into the vestibule and the oral cavity proper. Identify these two

parts of the oral cavity.

3. Identify each of the teeth in both the maxillary and mandibular arcades

4. Which divisions of the trigeminal nerve supply the mucous lining of the oral cavity, teeth

and gingiva (gums)?

5. Look into the back of the mouth of your partner while he/she says "ah ah!" (This

depresses the tongue).

6. The uvula, palatine tonsils and the two folds between which the tonsils are located

(palatoglossal and palatopharyngeal) are usually visible when the tongue is depressed in

this way. Can you identify them?

7. Into which lymph node does the palatine tonsil drain?

8. Why is this lymph node important?

The walls of the oral cavity

The walls of the oral cavity are made up of the lips and cheeks.

1. What are the layers of the walls of the oral cavity?

2. Examine (by palpation) the walls of your oral cavity and note the difference in the texture

of the inner and outer surfaces

3. What are the small lumps that you can feel through the mucous lining of the wall of the

oral cavity?

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4. What does the palate, which forms the roof of the oral cavity, consist of?

5. Describe the structure and innervation of the palate

LIPS

These are the muscular folds surrounding the oral cavity, which are covered externally by

skin and internally by mucous membrane.

1. What is the musculature of the lips made of?

2. Describe the blood supply, innervation and the lymphatic drainage of the lips.

3. What is the clinical significance of the lymphatic drainage of the lips?

Floor of the oral cavity:

1. What are the main structures that constitute the floor of the oral cavity?

2. Examine the floor of the living mouth and identify, by name, the longitudinal and oblique

ridges that are visible through the mucous layer.

TONGUE

The muscles of the tongue are classified into intrinsic and extrinsic groups.

1. How are the fibres of the intrinsic muscle arranged?

2. Identify the extrinsic muscles of the tongue.

3. What is the main blood supply of the tongue?

4. What is the lymphatic drainage of the tongue?

5. Why is this drainage clinically important?

6. What is the nerve supply of the muscles of the tongue?

7. What is the innervation (common sensation and taste) of the mucous membrane of the

tongue?

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SUB-UNIT THEME 3.2: SPECIAL SENSES: THE ORBIT AND EYE, AUDITORY

APPARATUS, NASALCAVITY AND PARANASAL SINUSES

WEEK12: SPECIFIC OUTCOMES

Describe the major features of the bony walls of the orbit

Describe the features of the eyelids and major landmarks of the eyes of a living subject

Describe the arrangement, innervation and actions of the extra-ocular muscles

Describe the distribution of the optic nerve, ophthalmic nerve and ophthalmic artery in the

orbit

Draw a fully labelled diagram of the horizontal section of the eyeball

Describe the actions and innervation of the constrictor and dilator pupillae muscles

Describe the parts and innervation of the external ear

Describe the basic organization of the external, middle and inner ear and their contents

Draw and describe the middle ear using a fully labelled diagram (figure in Prac Anat)

Draw and describe the features of the tympanic membrane (figure in Prac Anat)

Relate the structure of the middle ear to common pathologies and the spread of infection

Draw and describe the conduction of sound through the ear by relating it to the

anatomical features of the external, middle and inner ear

Describe the bony and membranous labyrinths of the inner ear and relate their structure

to their function of both balance and hearing

Identify and describe the main features of the bony skeleton of the nose

Describe the basic anatomy of the external nose

Describe the walls and septum of the nasal cavities

Describe the blood and nerve supply to the walls of the nasal cavities

Identify the bones of the skull that contain air spaces (sinuses)

Identify the function of the paranasal sinuses and where they open in the lateral wall of

the nasal cavity

Relate the structure of the paranasal sinuses to common pathologies and the spread of

infection


THE ORBIT

The walls of the orbit

Examine the walls of the orbit on a dry skull and identify the bones that make up:

1. the superior wall (roof)

2. the lateral wall

3. the inferior wall (floor)

4. the medial wall

Note that the ethmoidal air sinuses are inside the bone mass that lies between the medial

walls of the two orbits.

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Identify the following bony features of the orbit the:

1. optic canal

2. superior orbital fissure

3. inferior orbital fissure

4. nasolacrimal groove

5. nasolacrimal canal

THE EYE

1. Examine the eyes of your partner and identify the following:

the eyebrows: folds of skin on the forehead, covered with short stout hairs

the eyelids (palpabrae): upper and lower sheets of skin, lined by mucous membrane,

which cover the eyes

the canthi (singular = canthus): the medial and lateral angles of the eye where the

upper and lower eyelids meet

the palpebral fissure: the space or gap between the upper and lower eyelids

the eyelashes: the curved hairs, which emerge from the eyelids

the lacrimal caruncle: a small triangular patch of skin containing sweat glands, in the

medial palpebral angle

the plica semilunaris: a semilunar fold of conjunctiva immediately lateral to the lacrimal

caruncle

the lacrimal papilla: small elevation on each eyelid, just medial to the plica semilunaris

Examine the eyes of your partner and identify the following:

the eyebrows: folds of skin on the forehead, covered with short stout hairs

the eyelids (palpabrae): upper and lower sheets of skin, lined by mucous membrane,

which cover the eyes

the canthi (singular = canthus): the medial and lateral angles of the eye where the

upper and lower eyelids meet

the palpebral fissure: the space or gap between the upper and lower eyelids

the eyelashes: the curved hairs, which emerge from the eyelids

the lacrimal caruncle: a small triangular patch of skin containing sweat glands, in the

medial palpebral angle

the plica semilunaris: a semilunar fold of conjunctiva immediately lateral to the lacrimal

caruncle

Also, note the lacrimal canaliculi, that drain lacrimal fluid into the lacrimal sac on the

specimens provided

In order to appreciate the functions of the extra-ocular muscles,

1. Make a list of the extra-ocular muscles and indicate the movements that they produce

and the nerves that supply them, and

2. With the aid of “Practical Anatomy” and atlas, identify the extra-ocular muscles.

The nerves of the orbit

The cranial nerves II, III, IV, V and VI and autonomic nerves are the nerves of the orbit.

Cranial nerves III, IV and VI innervate the extra-ocular muscles. The cranial nerves II and V

supply sensory innervation to the coats of the eyeball. The autonomic nerves innervate the

constrictor and dilator muscles of the iris.

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1. What are the names of the cranial nerves mentioned above?

2. Identify the optic nerve.

3. From which layer of the eyeball does the optic nerve originate?

4. Identify the ophthalmic nerve in the orbit.

5. Which main nerve gives rise to the ophthalmic nerve?

6. Through which bony passage does the ophthalmic nerve enter the orbit?

7. Identify the branches of the ophthalmic nerve (nasociliary, lacrimal and frontal).

8. Where, in general terms, are these branches of the ophthalmic nerve distributed?

The blood vessels of the orbit

The ophthalmic artery, the artery of the eye and orbit, enters the orbit with the optic nerve

through the optic canal. It winds round the lateral surface of the optic nerve and then passes

medially in the orbit. It gives rise to several branches by which it supplies the contents of the

orbit.

1. Identify the ophthalmic artery.

2. Which main artery gives rise to the ophthalmic artery?

There are 2 ophthalmic veins (superior and inferior). You may not be able to see these veins

in the specimens provided, but it is important to remember that these veins provide important

communication channels between the cavernous sinus (in the cranial cavity) and the veins of

the face and scalp (scalp = soft tissue covering the skull).

The lacrimal apparatus

The lacrimal apparatus is located in the upper lateral corner of the orbit, within the fossa for

the lacrimal gland of the frontal bone. The gland is responsible for the secretion of lacrimal

fluid via a number of excretory ducts. This fluid is then conveyed over the eye ball by the

eyelids, before accumulating in the lower medial corner of the eye where it either spill onto

the cheeks as tears or is drained into the nasolacrimal sac. Identify the following parts of the

lacrimal apparatus on the specimens provided while tracing the production and flow of

lacrimal fluid:

The lacrimal gland.

The excretory glands of the lacrimal gland

The lacrimal canaliculi

The lacrimal puncta

The lacrimal papillae

The lacrimal lake

The lacrimal sac

The nasolacrimal sac

Where does the nasolacrimal duct drain?

THE EAR

Refer to “Practical anatomy” (Page 311) and identify the parts of the pinna of your partner.

Using a model of the ear note, the following aspects listed below.

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The External ear

1. The tympanic membrane (eardrum) is at the medial end of the external acoustic meatus.

2. The external acoustic meatus is not straight. Therefore, in order to be able to see the

tympanic membrane with an otoscope, the pinna should be pulled up.

The Middle ear (tympanic cavity)

1. This cavity lies between the external ear and the inner ear. Remember that this is the

cavity of the ear that is connected to the nasopharynx by the Eustachian tube. Infection

in the nasopharynx may therefore spread via this tube to the middle ear, resulting in otitis

media (infection of the middle ear cavity). Because of the continuity of the middle ear

cavity with the mastoid antrum, mastoiditis may complicate otitis media.

2. Learn to draw this cavity (Figure in Pract Anat).

3. It contains the three auditory ossicles.

4. Learn the names and arrangement of these ossicles. The joints between them are

synovial joints. Inflammation of the joints (arthritis) will result in impairment of the

affected ear.

5. The stapedius and tensor tympani muscles which protect the tympanic membrane and

cochlea against the effects of excessive vibration of the auditory ossicles in response to

very loud noises. Learn the function and innervation.

The inner ear

1. The bony labyrinth, which is a complex series of passages, lined with endosteum.

2. The membranous labyrinth, a replica of the bony labyrinth, which lies inside the bony

labyrinth.

3. The cochlea which contains the cochlear duct in which the organ of Corti (sense organ of

hearing) resides.

4. The vestibule, which has the 3 semicircular canals projecting from it and housing the

otolith organ (sense organ of balance, which responds to gravity).

5. The facial nerve and vestibulocochlear nerve pass through the internal acoustic meatus

into the inner ear. Otitis media that spreads beyond the confines of the middle ear may

affect the facial nerve and result in facial nerve palsy.

THE NOSE

The nose, which draws air into the respiratory passages, and contains the olfactory

apparatus and the openings of the paranasal air sinuses, may be divided into the:

1. External nose, which is a protuberance on the face and which varies greatly in size and

shape from one individual to the other, and

2. Nasal cavities, which are separated from one another by the nasal septum.

OSTEOLOGY

Examine the following bony landmarks on a dried skull:

the anterior nasal aperture (piriform aperture) that leads into the nasal cavities

the nasal bones, which form the upper boundaries of the anterior nasal aperture

the nasion, a depression that is located at the frontonasal suture

the maxilla, which forms the lateral border of the anterior nasal aperture

the nasal spine where the two maxillary bones meet in the midline

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the perpendicular plate of ethmoid and vomer, which form the bony septum of the

nasal cavities

the choanae, by which the nasal cavities open into the nasopharynx

the superior, middle and inferior nasal conchae, which are bony shelves in the lateral

walls of the nasal cavities

Boundaries of the nasal cavities

Define the following boundaries of the nasal cavity: Floor, roof, lateral wall and medial wall

(the septum).

Blood and nerve supply to the nose

1. Which main arteries supply the walls of the nasal cavities?

2. The veins generally follow the arteries. Which other veins do they communicate with?

(See “Practical Anatomy” ).

3. What is the significance of these communications in spread of infections?

4. Which main nerves carry general and special sensation from the walls of the nasal

cavities?

PARANASAL SINUSES

The paranasal sinuses may be regarded as diverticula of the nasal cavities because they

open into the lateral walls of these cavities. Learn to draw the structures as illustrated in

“Practical anatomy” to illustrate the openings of these sinuses in one of the lateral walls of

the nose.

1. Which bones of the skull have air spaces in them?

2. Do all of these air sinuses qualify, by definition, to be called “paranasal” sinuses? If not,

which one is exempt?

3. What are the functions of the paranasal sinuses?

4. How may infections in the nasal cavities affect these sinuses?

5. Compare, in table format, the location and drainage of the following paranasal sinuses:

Frontal sinus

Maxillary sinus

Ethmoidal sinuses (anterior, middle and posterior groups)

Sphenoidal sinus

LYMPHATICS OF THE HEAD AND NECK (Refer to Clinically Oriented Anatomy for

details)

Describe the lymphatic drainage of the following structures:

1. The face and scalp

2. The lips

3. The tongue

4. The salivary glands

5. The tonsils

6. The neck and structures associated with it

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SUB-UNIT THEME 3.3: SUPERFICIAL STRCUTURES AND

ANTERIOR TRIANGLES OF THE NECK



Describe the surface anatomy of the neck and identify important surface landmarks

(such as the tip of the chin, the suprasternal notch, the clavicle, the mastoid process of

the temporal bone and the occipital bone) on the articulated skeleton and on a living

subject,

Demonstrate the sternocleidomastoid muscle, the hyoid bone, the thyroid cartilage and

the trachea on a living subject,

Draw and describe the arrangement of the layers of the deep fascia of the neck,

Describe the subdivisions of the triangles of the neck,

Draw and describe the boundaries and contents of the subdivisions of the triangles of

the neck,

Describe the arrangement of the lymph nodes of the neck in the superficial and deep

layers,

Describe the structure, relations, blood supply, lymphatic drainage and innervation of

the thyroid gland,

Describe the origin and distribution of the laryngeal nerves.

Describe the origin and distribution of laryngeal nerves.


SURFACE ANATOMY

The main landmarks of the neck include the tip of the chin, the suprasternal (jugular) notch,

the clavicle, the mastoid process, the occipital bone and the anterior border of the trapezius

muscle.

1. Identify these points on the articulated skeleton and on yourselves.

2. Put your middle finger on the superior border of the manubrium of the sternum

(suprasternal notch). Push your finger in gently in a posterior direction and feel the

movement of the trachea as you swallow. Tracheostomy (an emergency incision in the

trachea to relieve severe upper airway obstruction) can be performed in this position.

3. Flex your neck and, at the same time, turn your face to one side against resistance and

observe the sternocleidomastoid muscle, which stands out on the opposite side of the

neck. You will soon see how this muscle divides the neck into two main triangular areas.

4. Attempt to identify the laryngeal prominence (Adam’s apple) on your partner. This is the

usually sharp upper anterior border of the thyroid cartilage. It is usually more visible in

males than females.

5. Feel for the hyoid bone in the angle between the anterior aspect of the neck and the jaw.

With your fingers on it, swallow saliva and feel the movement of this bone under your

fingers.

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SUPERFICIAL STRUCTURES OF THE NECK

Superficial structures

Identify and study the positions and important immediate relations of the following structures:

Fascia: investing layer of deep fascia

Muscles: trapezius, sternocleidomastoid, inferior belly of omohyoid and infrahyoid

muscles

Blood vessels: external jugular veins

Nerves: branches of the cervical plexus and spinal accessory

Gland: submandibular gland

Lymph nodes: superficial cervical lymph nodes

Cervical fasciae

Apart from the superficial fascia (tela subcutanea; hypodermis) that is immediately deep to

the skin, there is a deep fascia that consists of 3 layers. The most superficial of these is the

investing layer. It invests the neck like a stocking but splits to enclose the trapezius and

sternocleidomastoid muscles and the inferior belly of omohyoid. Immediately above the

manubrium of the sternum, the investing fascia splits into two to create the suprasternal

space. This space contains the lower ends of the 2 anterior jugular veins, the venous arch

that connects them, a few lymph nodes and the sternal ends of the 2 sternocleidomastoid

muscles.

Look for these structures.

What are the names of the other two layers of the deep fascia of the neck?

Which structures do they enclose?

What is the clinical and structural significance of these 3 layers of the deep cervical

fascia?

Learn to draw the structures as depicted in Figures in “Practical Anatomy”.

Muscles

1. Identify the trapezius, sternocleidomastoid and infrahyoid muscles. The latter lie anterior

to the trachea and cartilages of the larynx.

2. What are the actions and innervation of these muscles?

Blood vessels

1. Identify the anterior and external jugular veins as they descend vertically across the

superficial surfaces of the sternocleidomastoid muscles.

2. How are these veins formed?

3. Where do these veins terminate?

4. Which tributaries do they receive before their termination?

NERVES

Cervical plexus

A. Cutaneous branches: Dissect carefully through the investing layer of deep fascia and

identify the nerves that emerge from the deep surface of the sternocleidomastoid muscle

at about the midpoint of its posterior border. These are the supraclavicular, transverse

cervical, great auricular and lesser occipital nerves. They are the cutaneous branches of

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the cervical plexus derived from the anterior primary rami of C2-C4 segments of the

spinal cord.

Ansa cervicalis: These are motor branches of the cervical plexus. They are derived

from the anterior primary rami of C1-C3 segments of the spinal cord, and innervate the

infrahyoid strap muscles as well as the geniohyoid and thyrohyoid muscles. You will see

these muscles later and you do not have to look for the nerves.

B. Spinal Accessory nerves

1. Look for these nerves as they descend postero-inferiorly on the surface of the levator

scapulae and disappear deep to the anterior border of the trapezius muscle on both

sides.

2. Which muscles do these nerves innervate?

3. Supposing the accessory nerve on one side is cut, what will the individual not be able to

do?

GLANDS

Submandibular gland

Carefully reflect the investing layer of deep cervical fascia from the lower border of the

mandible and identify the submandibular gland immediately deep to this border. Study its

anatomy.

Cervical Lymph nodes

These are disposed in 2 groups:

Superficial group

These are located around the upper part of the external jugular vein.

Deep

These are located deep to the sternocleidomastoid muscle (see Clinically Oriented

Anatomy). The jugulo-omohyoid and jugulo-digastric nodes are of particular clinical

importance.

1. From which structures do they receive lymph?

2. In which clinical conditions may they be implicated?

TRIANGLES OF THE NECK

For ease of description, the neck is divided into 2 main triangular areas, namely the anterior

and posterior triangles. The anterior triangle is further divided into carotid, submandibular,

submental and muscular triangles.

NOTE:

Your prescribed textbook, Clinically Oriented Anatomy by KL Moore, AF Dalley and AMR

Agur, has a slightly different naming convention for triangles of the neck (namely Posterior-

posterior to the anterior border of Trapezius, Lateral- anterior to the anterior border of

Trapezius; and Anterior triangle –as described here). For reference, the Lateral Triangle in

Clin Anat will henceforth be referred to as the Posterior Triangle, both in text and lectures.

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THE ANTERIOR TRIANGLE OF THE NECK

Carotid triangle

1. Define the boundaries of the carotid triangle.

2. Identify the contents of this triangle and take note of their relationships to one another.

3. Identify the two terminal branches of the common carotid artery i.e. internal and external

carotid arteries. At this stage, learn to draw Figure in Pract Anat.

4. What are the branches of the external carotid artery?

5. What are the branches of the vagus/accessory nerves in the neck?

Submandibular triangle

1. Define the boundaries of this triangle.

2. Identify the contents of this triangle.

3. Remove as much of the submandibular gland as is necessary for you to see the

relationship between it and the facial artery and vein.

Submental triangle

1. Define the boundaries of this triangle.

2. Know that the submandibular and submental triangles combine to form the floor of the

mouth. They contain the important submental lymph nodes, which drain the lower lips

ipsilaterally and contralaterally. This implies that cancer on one side of the lower lip

will spread to lymph nodes in the opposite triangle as well as to those on the same

side.

THE THYROID GLAND:

This is an endocrine (ductless) gland that clasps the front and sides of the cervical tubes

(larynx and trachea; pharynx and oesophagus) like a shield at the level of the bodies of the

5th, 6th and 7th cervical vertebrae.

Morphology and relations

1. Identify the thyroid gland and define its morphological parts.

2. Verify the immediate relations of the thyroid gland.

3. On which tracheal rings does the isthmus lie?

4. Does the thyroid gland in the cadaver have a third (pyramidal) lobe?

5. If so, what is its embryonic origin?

Blood vessels

1. Identify the thyroid arteries and veins.

2. How many arteries and veins supply this gland?

3. What are the origins of the thyroid arteries?

4. Where do the thyroid veins drain?

Innervation

The thyroid gland receives its innervation from postganglionic nerves that are derived from

the superior, middle and inferior cervical sympathetic ganglia.

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They are vasomotor nerves, which travel to the gland along the branches of the vagus nerve

and the arteries that supply the gland. What does the term “vasomotor” mean?

Lymphatic drainage

Vessels lie in interlobular fascia near arteries and communicate with capsular network of

lymph vessels. They drain into:

Prelaryngeal lymph nodes (LN) that drain to superior cervical lymph nodes

Pretracheal LN and Paratracheal LN that drain into inferior deep cervical LNs

Laterally, vessels along superior thyroid vein drain via the following nodes:

Inferior deep cervical LNBrachiocephalic LN Thoracic duct

Applied anatomy

What will be the effect of an enlarged thyroid gland (goitre) on the trachea and oesophagus?

THE LARYNGEAL NERVES:

Remove the thyroid gland and look for the recurrent, external and internal laryngeal nerves.

Recurrent laryngeal nerves

1. Look for the left and right recurrent laryngeal nerves in the grooves between the trachea

and the oesophagus.

2. At what level does each of these nerves originate from the corresponding vagus nerve?

3. Which structures do they wind around as they leave the vagus nerves?

Note:

The terminal part of the recurrent laryngeal nerve is also known as the inferior laryngeal

nerve.

Superior laryngeal nerves

1. These are branches (one on each side) of the vagus nerve. Each divides into the

external and internal laryngeal nerves.

2. Identify the superior laryngeal nerve lateral to the hyoid bone.

3. Attempt to locate the external and internal laryngeal nerves. The external laryngeal

nerve crosses the superior thyroid vessels deep to the apex of the lobe of the thyroid

gland and supplies the cricothyroid muscle. The internal laryngeal nerve pierces the

thyrohyoid membrane to supply the laryngeal mucous membrane above the vocal fold.

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SUB-UNIT THEME 3.4: THE POSTERIOR TRIANGLE OF THE NECK; LARYNX,

PHARYNX AND REVIEW OF LYMPHATICS OF THE HEAD AND NECK

WEEK14: SPECIFIC OUTCOMES


Draw and describe the boundaries and contents of the posterior triangle

Identify and describe the three parts into which the subclavian artery is divided

Name the branches of the subclavian artery and the structures that they supply

Identify and observe the continuity of supraclavicular and infraclavicular parts of the

brachial plexus with one another

Identify and name the Scalene muscles and note their relations to the Subclavian artery

and Phrenic nerve

Describe the arrangement and the distribution of the last 4 cranial nerves (namely the

glossopharyngeal, vagus, accessory and hypoglossal) in the neck

Identify the foramina of the skull through which these four (4) cranial nerves pass into the

neck

Describe the course and immediate relations of the common carotid artery

Describe the course, immediate relations, direct and terminal branches of the external

carotid artery (*revise this objective in conjunction with week 13 SPECIFIC OUTCOMES

Describe the course of the internal carotid artery and its exit from the neck

Describe the origin and course of the vertebral artery and its exit from the neck

Describe and identify the structures in the root of the neck

List the important structures at the C6 vertebral level

Identify and name the prevertebral muscles and their relations to the vertebral artery

Draw a well labelled diagram of the structures in the suboccipital triangle

Describe the basic structure, divisions and immediate relations of the pharynx

Describe the blood supply and innervation of the pharynx

Describe the organization of the cartilages, membranes and muscles of the larynx

Define the boundaries of the laryngeal inlet

Describe the blood supply and innervation of the muscles and mucous membrane of the

larynx,

Describe how the rima glottidis is controlled to vary the volume of air that enters the

respiratory passages

Explain how the change in tension of the vocal ligament is produced to vary the pitch of

the sound that is produced in the larynx

Review the lymphatic drainage of various structures of the head and neck and relate this

to the spread of pathologies


radiographs

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THE POSTERIOR TRIANGLE OF THE NECK

1. Define the boundaries, roof and floor of this triangle.

2. The triangle is sometimes subdivided into the upper, larger occipital triangle and the

lower, smaller subclavian triangle.

3. What are the contents of the posterior triangle?

4. Follow some of the contents (blood vessels and nerves) to axilla to verify the continuity

of their cervical and axillary parts with one another.

SUBCLAVIAN ARTERY

1. What is the origin of the subclavian artery?

2. Define the three parts into which the subclavian artery is usually divided when describing

it.

3. What are the branches of the subclavian artery? Learn them in conjunction with Figure

8.23 in “Practical Anatomy”.

4. You may have to detach the sternal and clavicular attachments of the

sternocleidomastoid muscle for you to obtain adequate access to these arteries.

5. Which structures are supplied by each of these branches?

CERVICAL PLEXUS

Please refer to section “superficial structures of the neck” for content. Practice drawing the

plexus.

THE LAST FOUR CRANIAL NERVES:

These are the:

Glossopharyngeal nerve (CN IX)

Vagus nerve (CN X)

Accessory nerve (CN XI)

Hypoglossal nerve (CN XII)

These nerves are closely related to the internal jugular vein, the internal carotid artery and to

one another, at the base of the skull. The first three leave the cranial cavity through the

jugular foramen, while the hypoglossal leaves through the hypoglossal canal.

They all lie between the internal jugular vein and the internal carotid artery.

1. Identify the jugular foramen and hypoglossal canal on the dry skull.

2. Identify the four nerves and follow them inferiorly.

As they descend in the neck, they do so in different directions.

1. Verify the major relations and landmarks along their course that can assist you to identify

them.

2. What structures do these nerves innervate?

3. Learn to draw the structures as illustrated in Figure in “Practical Anatomy”.

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THE COMMON CAROTID ARTERIES:

1. Identify the right and left common carotid arteries.

2. How do the two arteries differ from each other with regard to their origin?

3. Follow one artery cranially until it divides into its 2 terminal branches. At what vertebral

level does this division take place?

4. What are the names of these terminal branches?

5. Look for the dilated area at the beginning of the internal carotid artery.

6. What is the name and physiological importance of this dilated portion?

7. Note the relative positions of the external and internal carotid arteries.

THE EXTERNAL CAROTID ARTERY

1. Define the course of the external carotid artery, its main branches and the structures

supplied by them.

2. Identify the two terminal branches of the external carotid artery.

3. Complete this part of the exercise in conjunction with Figure in Pract Anat.

THE INTERNAL CAROTID ARTERY

The internal carotid artery leaves the neck and passes into the cranial cavity to supply the

brain, by passing through the carotid canal and the upper part of the foramen lacerum in the

petrous part of the temporal bone of the skull.

1. With the aid of your atlas, identify these bony parts on the dry skull.

2. Does the internal carotid artery supply any structure in the neck?

THE VERTEBRAL ARTERIES

You must have seen the left and right vertebral arteries as they originated from the first part

of the corresponding subclavian arteries in the posterior triangles of the neck.

1. Identify one of these arteries again and follow it cranially to the transverse foramen of the

sixth cervical vertebra.

2. Define the three parts of the vertebral artery in the neck. (The last part is in the cranial

cavity where the two arteries unite to form the basilar artery. The third part was

discussed with you in the tutorial/teaching that you had in Week 8 on the suboccipital

triangle).

3. Revise the course of the vertebral artery through and its exit from, the suboccipital

triangle now (follow the course description from Clinical Anatomy textbook).

4. What structure does this artery supply in neck?

PHARYNX (Practical Anatomy:

The pharynx is the muscular cranial end of the digestive tract that lies mainly between the

oral cavity and the oesophagus.

1. Define its three parts on a specimen of the head that has been cut into two along the

mid-sagittal plane.

2. Define the walls of the three parts of the pharynx.

3. Identify the following features in the lateral wall of the nasopharynx - pharyngeal opening

of the auditory tube and the salpingopharyngeal fold, in the depth of which is the

salpingopharyngeus muscle (one of the longitudinal muscles).

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4. What is the importance of the pharyngeal opening of the auditory tube?

5. What is the name of the protuberance in the nasopharynx, formed by the cartilaginous

part of the auditory tube adjacent to its opening?

6. At what vertebral level does the pharynx become continuous with the oesophagus?

7. Identify the muscles of the pharynx, which may be grouped into two: muscles with

circular fibres and muscles with longitudinal fibres.

8. What is the nerve supply of these muscles?

9. There are 4 gaps in the muscular wall of the pharynx. Define each and identify each of

the structures that traverse them.

10. What is the nerve supply of the mucous lining of the pharynx?

THE LARYNX

The membranes convert the larynx into a closed tube that opens into the laryngopharynx

superiorly via the laryngeal inlet and is continuous inferiorly with the trachea at the level of

the 6th cervical vertebra.

The muscles produce appropriate movements at the joints to widen or narrow the rima

glottidis and tighten or slacken the vocal ligament.

1. Identify the 3 parts of the laryngeal cavity.

2. Identify and name the unpaired laryngeal cartilages

3. Identify and name the extrinsic membranes that connect the unpaired cartilages to each

other and to the hyoid bone.

4. Identify and name in the intrinsic ligaments of the larynx that form the true and false

vocal cords.

5. Identify and know the names of the paired cartilages.

6. What are the main morphological features of the thyroid, cricoid and arytenoid cartilages

and the epiglottis?

7. Identify the cricothyroid joint.

8. Identify and know the names of the paired cartilages.

The muscles of the larynx may be classified into intrinsic and extrinsic groups.

1. Identify the muscles of the larynx on appropriate specimens/models available.

2. Which nerves supply these muscles?

3. Classify the muscles of the larynx, on the basis of their actions, into those that widen

(abductors) or narrow (adductors) the rima glottidis and those that tighten or slacken the

vocal ligament or act as a sphincter.

4. What is the effect of tightening or slackening the vocal ligament?

5. What is the blood supply of the larynx?

The interior of the larynx has a number of important features, which you should be able to

identify in mid-sagittal specimens/models, which will be made available to you during this

session. These include the following:

Vocal fold, in the depth of which is the vocal ligament (vocal cord)

Rima glottidis, which is the horizontal gap between the left and right vocal folds

Vestibular fold, in the depth of which is the vestibular ligament

Ventricle and saccule of the larynx

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UNIT THEME 4: NEUROANATOMY



anatomical structure and function of the central nervous system. The student should be


scenarios pertaining to diseases and injuries to the central nervous system.

Embedded knowledge



Anatomy of the head and neck, including osteology

SUB-UNIT THEME 4.1: THE SCALP, BASE OF SKULL, CRANIAL FOSSAE, MENINGES


By the end of this week, the student should be able to answer the following questions:

List the layers of the scalp, give the arterial supply and nerve supply of the scalp and

discuss the characteristic features of the layers of the scalp that are of importance in the

management of wounds and lacerations of the scalp.

Name the bones that constitute the base of the skull.

List the foramina of the base of the skull in each cranial fossa and name the blood

vessels and nerves that are transmitted by each of them.

Describe the boundaries and main features of the cranial fossae.

Name the parts of the brain that are directly related to the floor of each of the cranial

fossae.

Describe the layers of the meninges and their relationship to the brain and skull bone.

Name and describe the spaces that are associated with the layers of the meninges and

indicate which ones are real spaces and which ones are potential spaces.

Describe the locations of the dural venous sinuses and the circulation of blood through

them.

List the inflow and outflow channels of the cavernous sinuses.

Describe the location of the cavernous sinuses and name the structures that pass

through their medial and lateral walls.

Describe the clinical effects of severe pressure (e.g. a cavernous sinus thrombosis) on

the structures passing through the walls of the cavernous sinus (signs: what does the

doctor observe; symptoms: what does the patient experience).

Which veins of the face and neck communicate with the cavernous sinuses and what

is the implication of these communications?

Draw a coronal section through the body of the sphenoid bone to show the structures in

the walls of the cavernous sinuses and the relation of the cavernous sinuses to the

hypophysis cerebri as in ‘Practical Anatomy’

Describe the general and superficial morphology of the brain.

List the subarachnoid cisterns and give their locations.

List the contents of the cisterna ambiens.

What is the clinical significance of the cerebello-medullary cistern?

Describe the formation, circulation and absorption of cerebrospinal fluid.

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radiographs


REMOVAL OF THE CALOTTE

Make the scalp incisions as shown on page 330 and elevate the quadrants. Use a piece of

chalk to mark out the outline of the calotte to be removed. This line should pass

immediately above the external ear (auricle) and 3 – 5 cm above the external occipital

protuberance. This will provide a wide enough space for the removal of the brain. When this

has been done, the technical staff will cut through the exposed bone for you. Remove the

calotte.

REMOVAL OF THE BRAIN

This will be shown to and done for you by a demonstrator.

THE SCALP

This is the soft tissue covering the skull. It is more than just the skin covering the skull. It is

made up of five layers.

1. Identify these 5 layers of the scalp on your cadaver. Dissect through the anterior, middle

and posterior parts of the scalp that you removed with the calotte and identify the

frontalis and occipitalis muscles, as well as the aponeurosis between them.

2. What are the characteristic features of the layers of the scalp, which are of importance in

the management of wounds and lacerations of the scalp?

NOTE:

You must discuss other features of the scalp according to the first objective.

STRUCTURE OF THE CENTRAL NERVOUS SYSTEM, BASE OF THE SKULL AND

FORAMINA OF THE SKULL

This section gives you an overview and most of its contents will be dealt with in tutorials.

1. With the help of a dry skull, revise the foramina in the base of the skull and the

structures that pass through them. Do this from the internal and external aspects of the

base of the skull.

2. Which bones of the skull contribute to the formation of its base?

3. Can the base of the skull fracture, say in a road traffic accident? What are the likely

complications?

4. The cranial fossae refer to the three hollows on the internal aspect of the base of the

skull in which the brain rests.

5. Examine the cranial fossae on the dry skull and define their boundaries.

6. Identify the parts of the brain that are present in each fossa.

7. Identify the foramina that are present in each cranial fossa.

8. Examine the cranial fossae in the skull from which you have just removed the brain.

Note that the floor of the fossae is lined by dura mater.

9. Identify the features of the floor of the cranial fossae.

10. Identify the nerve stumps (by name and Roman numeral) that you can see passing into

the foramina in the floor of the cranial fossae. You will always be required to give both

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the name and Roman numeral of a cranial nerve. If the two do not correspond, you will

not be given credit for your answer

NOTE: Previous Exam Question

Tabulate the foramina and other apertures of the middle cranial fossa and the structures

traversing them. [10 Marks]

EXAMINATION OF THE EXPOSED DURA MATER

Plastinated specimens will be available, as you will not be able to demonstrate everything

on the cadaver.

1. Name the three layers of meninges.

2. Identify the major folds of the dura mater: falx cerebri, falx cerebelli, tentorium cerebelli

and their attachments, and the tentorial notch.

3. Identify the dural venous sinuses: superior sagittal sinus, inferior sagittal sinus,

confluence of sinuses, straight sinus, transverse sinus, sigmoid sinus, superior and

inferior petrosal sinuses, sphenoparietal sinus and marginal sinus.

4. Into which sinus does the superior sagittal sinus usually drain?

5. Into which sinus does the straight sinus usually drain?

STUDY OF STRUCTURES OF THE INTRACRANIAL BASE

1. Dissect the trigeminal ganglion and find the ophthalmic, maxillary and mandibular

nerves emanating from the ganglion (we often use the singular e.g. trigeminal

ganglion, but most structures are bilateral).

2. What is the trigeminal ganglion?

3. Dissect the cavernous sinus and find the internal carotid artery and abducent nerve.

4. Identify the diaphragma sellae and cut it open to scoop out the hypophysis cerebri. Note

the different embryonic origins of its anterior and posterior lobes.

STUDY OF THE CAVERNOUS SINUSES

1. Note the relations of the cavernous sinuses as indicated by figure in Pract Anat

2. What are the inflow and outflow channels of the cavernous sinuses?

SUMMARY OF THE INTRACRANIAL VENOUS SINUSES

Revise the dural venous sinuses and the direction of the flow of blood in them.

THE BRAIN

Note the instruments that should be at hand when dissecting the brain. Sharp scalpel means

a fixed blade scalpel that is sharpened, not a scalpel with a detachable blade. Only the

demonstrators will use the brain knife.

ORIENTATION OF THE CENTRAL NERVOUS SYSTEM, CISTERNS, CSF AND SPACES

BETWEEN THE MEMBRANES

1. Define the following potential or real spaces, associated with the meninges:

Epidural (extradural) space

Subdural space

Subarachnoid space

2. What are arachnoid villi and arachnoid granulations, and where are they found?

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3. Describe the circulation of CSF.

4. Where is the CSF finally absorbed?

5. What is the effect of obstruction of the normal flow of CSF?

6. Remove the arachnoid mater carefully. Take care not to remove the cranial nerves in the

process.

7. Define hydrocephalus and list three likely causes.

GENERAL AND SUPERFICIAL MORPHOLOGY OF THE BRAIN

For the purposes of this general study, the brain should be kept intact (undivided). Examine

the brain that you removed from your cadaver and demonstrate the following:

1. The cerebrum and cerebral hemispheres

2. The brainstem: midbrain, pons, medulla oblongata

3. The cerebellum

Also demonstrate on the cerebrum:

1. the corpus callosum

2. the lobes of the cerebrum

3. gyri and sulci

central sulcus

lateral sulcus

precentral gyrus

postcentral gyrus

NOTE

Detail of the external features of the lateral surface of the brain will be done in later

dissections. The inferior and medial surfaces will also be studied later.

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SUB-UNIT THEME 4.2: BLOOD SUPPLY TO THE BRAIN, THE BRAINSTEM AND

CRANIAL NERVES



Draw the arterial blood supply to the brain (figure in Pract Anat).

Draw the cerebral arterial circle (of Willis).

Draw diagrams of the lateral and medial surfaces of the cerebrum to indicate the

distribution of the cerebral arteries (figure in Pract Anat ).

Describe the venous drainage of the brain (internal and external).

Name the parts of the brain that constitute the brainstem.

Describe the external features of the brainstem.

Describe/draw a diagram of the interpeduncular fossa to illustrate its boundaries and

contents (figure in Pract Anat).

List the nerve fibres contained in the crus cerebri.

Draw a diagram of a cross section of the midbrain at the level of the superior colliculus.

Note differences with level of inferior colliculus.


radiographs


THE ARTERIES OF THE BRAIN

The brain is supplied by the:

1. Vertebral arteries

2. Internal carotid arteries

Revise the origin and course of the vertebral arteries and internal carotid arteries in the neck.

1. Identify these arteries and their branches.

2. Identify the cerebral arterial circle (of Willis).

When you have studied the arteries, remove them using fine scissors. Try to keep all of them

connected so that your masterpiece looks like figure in Pract Anat

THE VEINS OF THE BRAIN

The brain is drained by superficial and deep groups of veins.

1. Which are the superficial veins that drain the brain?

2. How is the great cerebral vein formed?

3. Where does this vein terminate?

The essential questions that you should be able to answer about each of the cranial nerves

are:

1. What is the name and Roman numeral of this nerve? (Note: when referring to a cranial

nerve, both the name and Roman numeral must be given. e.g. optic nerve – CN II) Add

cranial nerve names to Figure in Practical Anatomy)

2. What functions do the fibres contained in this nerve serve? (E.g. general sensory,

special sensory, motor, autonomic)

3. Which brainstem nuclei are associated with each functional component of the nerve and

where are these nuclei located?

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4. Where does the nerve leave the surface of the brain?

5. Through which foramen in the skull does the nerve leave or enter the cranial cavity?

6. The course, if you have come across it elsewhere, e.g. nerves passing through the walls

of the cavernous sinus.

7. Main branches, if you have come across them elsewhere (e.g. terminal branches of the

facial nerve on the face)

8. List of the structures innervated (i.e. distribution)

9. Main functions – see Neuroanatomy textbook by Crossman & Neary.

THE BRAINSTEM

The brainstem is the narrow, almost cylindrical part of the brain that connects the spinal

cord to the cerebrum and cerebellum. It consists of three parts, which appear to be

demarcated from each other in their anterior aspects. However, the three parts are

structurally continuous with each other, with no internal demarcation. Internally are found

tracts, cranial nerve nuclei, other nuclei, the reticular formation etc. Look at cross sections of

the different parts of the brainstem to appreciate the complexity of the internal organisation.

1. What are the three parts of the brainstem?

2. Which structures connect the three parts of the brainstem to the cerebellum?

The midbrain

1. Examine the anterior, posterior and lateral aspects of the external surface of the

midbrain and identify their main features.

2. Identify the boundaries and contents of the interpeduncular fossa.

3. Which structures of the interpeduncular fossa (boundaries and contents) are constituents

of the midbrain and which belong to the hypothalamus? Which belong to neither?

4. List the nerve fibres contained in the crus cerebri.

5. With which functions are the superior and inferior colliculi associated?

6. Which cranial nerves have their nuclei in the midbrain?

The pons

1. Examine and identify the main features of the external surface of the pons.

2. Which part of the brain prevents you from seeing the posterior surface of the pons?

3. Which cranial nerves have their nuclei in the pons?

The medulla oblongata

1. Examine the medulla oblongata and identify the main features of its anterior, lateral and

posterior surfaces.

2. Which cranial nerves have their nuclei in the medulla oblongata?

3. What structures are found deep to the pyramids, olives, gracile and cuneate tubercles?

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THE CRANIAL NERVES AND STRUCTURES AT THE POSTERIOR ASPECT OF THE

MIDBRAIN AND THALAMUS

Identify all the cranial nerves and note where CN III to CN XII emerges from the brainstem.

Be specific when you give the point of attachment/emergence, e.g. for CN XII, the

hypoglossal nerve, the answer “medulla oblongata” is not good enough; it should be “from

the posterior surface of the medulla oblongata lateral to the pyramid/between the pyramid

and the olive”.

The superior and inferior colliculi

These are four elevations on the posterior aspect of the midbrain. Collectively they are called

the corpora quadrigemina.

The geniculate bodies

These are four elevations found at the back of the thalami, two on each thalamus. They are

the lateral and medial geniculate bodies. The lateral geniculate body is structurally

associated with the superior colliculus of the midbrain and the optic tract and therefore

functionally with the visual pathway.

Follow the optic tract around the crus cerebri to the lateral geniculate body.

1. Gently separate the cerebellum from the cerebrum to visualise the superior and inferior

colliculi. The membranes should be removed to get a clear picture. The pineal body is

imbedded in the membranes; try to preserve it.

2. Identify the brachium of the superior colliculus.

3. The medial geniculate body is similarly associated with the inferior colliculus and the

auditory pathway.

4. Identify the medial geniculate body inferomedial to the lateral geniculate body.

5. Identify the brachium of the inferior colliculus.

6. Where is the transverse cerebral fissure of the brain and which dural fold occupies most

of it when the brain is still in the cranial cavity?

SECTION OF THE MIDBRAIN AT THE LEVEL OF THE SUPERIOR COLLICULI

1. Cut through the midbrain at the level of both the superior and inferior colliculi.

2. Learn to draw a well labelled diagram of sections at these two levels.

3. Which cranial nerve nuclei are found in the periaqueductal grey matter at the levels of

the superior and inferior colliculi respectively?

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SUB-UNIT THEME 4.3: THE CEREBRUM



Describe the locations of the functional areas of the cerebral cortex.

Describe the main features of the cerebrum that are visible on the medial aspect of the

cerebral hemisphere.

List the structures related to the floor of the central part of the lateral ventricle from lateral

to medial (figures in Pract Anat).

Draw and label a diagram of a horizontal section through a cerebral hemisphere to

illustrate the deep nuclei and the associated white matter (figure in Pract Anat).

Describe the boundaries/roof/floor/lateral walls of the third ventricle (or any

combination of the parts).

Describe the anatomy of the frontal horn/central part/occipital horn/temporal horn of the

lateral ventricle (or any combination of the four parts).

What are the components of the diencephalon? Relate function to these components.


radiographs


THE EXTERIOR OF THE CEREBRUM

The lateral surface

Revise the lobes of the cerebrum (the insula can also be regarded as a lobe). Use an atlas

to identify the following:

1. Central sulcus

2. Lateral sulcus: anterior (horizontal) ramus, ascending ramus, posterior ramus

3. Precentral and postcentral sulci

4. Superior and inferior frontal sulci; superior, middle and inferior frontal gyri

5. Opercular, triangular and orbital portions of the inferior frontal gyrus (these parts are not

easy to identify accurately, but knowledge of them is required when studying functional

areas)

6. Superior and inferior temporal sulci; superior middle and inferior temporal gyri

7. On the superior surface of the superior temporal gyrus: transverse temporal gyri

8. Intraparietal sulcus; superior and inferior parietal lobules; supramarginal and angular gyri

(those portions of the inferior parietal lobule that surround the upturned ends of the

lateral sulcus and superior temporal sulcus are called the supramarginal and the

angular gyrus, respectively) – these gyri and lobules of the parietal lobe are not easy to

identify accurately, but knowledge of them is required. Use the lateral and superior

temporal sulci as guide.

On the LEFT hemisphere, cut away the frontal, parietal and temporal opercula to expose the

insula. Identify:

1. Circular sulcus and central sulcus of the insula

2. Limen insulae, long and short gyri of the insula

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The inferior surface

Identify the following:

1. Sulcus rectus (also known as the olfactory sulcus because the olfactory bulb and tract

occupy the sulcus) and gyrus rectus

2. Orbital gyri (they are irregular)

3. Collateral sulcus, parahippocampal gyrus and uncus, lingual gyrus

4. Occipitotemporal sulcus, medial and lateral occipitotemporal gyri (the lateral one is

continuous with the inferior temporal gyrus)

5. Olfactory bulb and tract, medial and lateral olfactory striae, anterior perforated substance

Functional areas

Identify and describe the location and function of the following functional areas:

1. Somatomotor area: precentral gyrus

2. Somatosensory area: postcentral gyrus

3. Auditory area: the two most anterior transverse temporal gyri (Heschl’s convolutions;

corresponds to areas 41 and 42 of Brodmann)

4. Olfactory area: uncus

5. Wenicke’s area (= auditory association cortex): posterior to the transverse gyri of Heschl,

extending onto the lateral surface of the superior temporal gyrus

6. Receptive (sensory) language area: auditory association cortex (Wenicke’s area) and

supramarginal and angular gyri of the LEFT hemisphere

7. Expressive speech area (Broca’s area or motor speech area): opercular and triangular

portions of the inferior frontal gyrus of the LEFT hemisphere

8. Taste (gustatory) area: adjacent to the general sensory area for the tongue at the inferior

end of the postcentral gyrus

9. Visual area: surrounds the calcarine sulcus on the medial surface of the occipital lobe

(corresponds to area 17 of Brodmann)

NOTE:

It is interesting to note that both the taste and olfactory areas extend onto the insula, which

suggests that the insula may be a site of integration of these two functionally related special

senses

THE INTERIOR OF THE CEREBRUM

The interior of the cerebrum is best studied by means of a series of horizontal, sagittal and

coronal sections. The demonstrators will make horizontal sections from one cerebral

hemisphere and coronal sections from the other.

The lateral ventricles

These are the largest ventricles in the brain.

1. Define the walls of the lateral ventricle and note the lobes of the cerebrum into which the ventricle extends.

2. What role does this ventricle play in CSF production?

3. Identify the prominent head of the caudate nucleus in the frontal horn.

4. Identify the interventricular foramen and the structures related to the floor of the central

part.

5. Identify the bulb of the occipital horn (a bulge formed by the forceps major) and inferior to

it another bulge, the calcar avis, formed by the calcarine sulcus.

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The deep nuclei of the cerebrum

With the use of these sections, you are expected to study the deep nuclei of the cerebrum.

These include, in each hemisphere the following:

Caudate nucleus

Lentiform nucleus

Thalamus

Claustrum

Internal capsule

External capsule

Extreme capsule 1. Use a flow chart to show the components of the basal ganglia.

2. List the afferents and efferent connections of the striatum.

3. Draw a well labelled 3- D diagram of the corpus striatum.

4. What are the functions of the corpus striatum?

5. Describe the four basal ganglia circuits.

6. List any three disorders of the basal ganglia.

The interior of the temporal lobe

Explore the depths of the temporal lobe of the cerebrum and identify the following:

Crus of the fornix

Fimbria

Hippocampus and pes hippocampus

Dentate gyrus

Collateral eminence (formed by the collateral sulcus)

Collateral trigone (the triangular area where the occipital and temporal horns diverge from

the central part)

Gyrus fasciolarus.

THE MEDIAL SURFACE OF THE CEREBRAL CORTEX

Before this surface of the brain can be studied, the corpus callosum needs to be identified

and divided longitudinally. A demonstrator will cut the brain in half for you.

Examine the medial surface of the cerebral cortex.

1. Identify the following major gyri and sulci:

Medial frontal gyrus

Cingulate sulcus

Cingulate gyrus

Callosal sulcus

Paracentral lobule

Parieto-occipital sulcus

Calcarine sulcus

Cuneus

Precuneus.

2. Identify the corpus callosum and its named parts.

3. Identify the following structures:

Septum pellucidum

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Lamina terminalis

Anterior commissure

Optic chiasma

Mammillary body

Column and body of the fornix

Habenular commissure and trigone

Pineal gland

Posterior commissure 4. To which functional system does the cingulate gyrus belong?

5. The diencephalon lying on the medial aspect of the cerebral hemisphere consists of the

thalamus, hypothalamus and third ventricle.

6. What are the components of the diencephalon?

7. Identify the hypothalamus, hypothalamic sulcus, thalamus, stria medullaris thalami,

interthalamic adhesion and third ventricle and study their relationship to each other.

8. What are the boundaries of the third ventricle?

9. How does the third ventricle communicate with the fourth ventricle?

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SUB-UNIT THEME 4.4: CORONAL SECTIONS OF THE CEREBRUM; CEREBELLUM

AND THE FOURTH VENTRICLE, SPINAL CORD



Describe the external anatomy of the cerebellum.

Describe the internal structure of the cerebellum.

Describe the location and arrangements of the nuclei of the cerebellum.

Describe the type of nerve fibres that are associated with the nuclei of the cerebellum.

Distinguish between the motor function of the cerebellum and that of the basal nuclei.

Draw and label a diagram of the floor of the 4th ventricle (figure in ‘Practical Anatomy ‘).

Describe the boundaries of the fourth ventricle


radiographs


CORONAL SECTIONS OF THE CEREBRUM

When MRI investigations are done on the brain, coronal, horizontal and sagittal views are

obtained. The student should learn how to interpret them.

Identify the structures in a coronal section

Through the head of the caudate nucleus and anterior commissure (figure in Pract Anat )

Through the mammillary body showing body of the caudate nucleus curving over the

thalamus (figure in Pract Anat)

You may be provided with additional sections. Study these sections.

THE CEREBELLUM

The position of the cerebellum

1. In which cranial fossa is the cerebellum located?

2. Examine it in relation to the fourth ventricle.

3. What is the contribution of the cerebellum to the boundaries of the fourth ventricle?

4. Revise the embryonic development of the cerebellum.

Ask a demonstrator to detach the cerebellum from the brainstem. Do not cut the cerebellum

in half before you have studied the external morphology. Only some of the specimens will be

sectioned, therefore ask a demonstrator if your specimen should be sectioned or kept intact.

The external morphology of the cerebellum

Examine the external anatomy of the cerebellum and identify the following:

1. the cerebellar hemispheres

2. the superior and inferior vermis

3. the vallecula

4. the superior, middle and inferior cerebellar peduncles

5. the floccules,

6. the tonsils

7. the primary and horizontal fissures

8. the lobes of the cerebellum

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The internal morphology of the cerebellum

If the cerebellum at your table is to be kept intact, join another table for the sectioning.

Divide the cerebellum into two halves.

1. Identify the arbor vitae.

2. What does this term mean?

3. Identify the fastigium.

4. Identify the superior medullary velum with the lingula of the vermis lying on it. Identify the

nodule of the vermis (part of the flocculonodular lobe). You do not need to know the

other named parts of the vermis.

Remove as many slices of the cerebellum as are necessary to expose its nuclei.

1. Identify the dentate nucleus (fastigial, globose and emboliform nuclei are not

visible to the naked eye).

2. How are they arranged in relation to each other?

3. What is the function of these nuclei in terms of the types of fibres (afferent or efferent)

that are associated with them?

General

1. What are the functions of the cerebellum?

2. What fibre groups (tracts) enter or leave the cerebellum to enable it to perform these

functions?

3. How does its motor function differ from that of the basal nuclei? (i.e. is its motor function

associated with voluntary or involuntary movements?)

4. Revise the blood supply of the cerebellum.

THE FOURTH VENTRICLE

1. Define the boundaries of the fourth ventricle.

2. Identify the features of the floor (Rhomboid fossa) of the fourth ventricle.

3. Which ventricle does the fourth ventricle communicate with and how does it do this?

4. How does CSF leave the fourth ventricle?

SPINAL CORD

1. At what vertebral level does the spinal cord terminate in the adult and in the neonate?

2. What are the cauda equina, the conus medullaris and the filum terminale?

3. Where would you insert the needle to do a lumbar puncture and how would you locate

the correct level to insert the needle?

4. In which regions are there enlargements of the spinal cord and why do they occur?

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UNIT THEME 5: ABDOMEN



anatomical structure and function structures within the abdomen. The student should be


scenarios pertaining to diseases and injuries to the abdomen.

Embedded knowledge



Anatomy of the thorax

SUB-UNIT THEME 5.1: ANTERIOR ABDOMINAL WALL AND INGUINAL CANAL


Describe the general arrangement of the dermatomes of the anterior abdominal wall

Describe the general arrangement and attachments of the muscles and aponeuroses

of the anterior abdominal wall

Define the boundaries (wall) and describe the contents of the rectus sheath

Identify the folds on the deep surface of the anterior abdominal wall and state what

they represent

Define the walls and describe the contents of the inguinal canal

Describe and explain the principle of the formation of inguinal hernias

Differentiate between the different types of inguinal hernia

differentiate between an inguinal hernia and a femoral hernia


DERMATOMES

1. Revise the definition of the word “dermatome”. The skin of the anterior abdominal wall

receives its nerve supply mainly from the intercostal nerves, which are derived from the

anterior primary rami of T7 – T11 and from the subcostal nerve (T12). These nerves

descend obliquely and anteriorly beyond the costal margin to supply the skin of the

anterior abdominal wall. Two dermatomes form important reference points for marking

out the remaining ones.

2. The skin of the epigastrium (area below the xiphoid process of the sternum) is

innervated by T7.

3. The umbilicus and the skin that extends obliquely superiorly and laterally from it, is

innervated by T10.

4. What is the usefulness of the knowledge of dermatomes in clinical practice?

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THE ANTERIOR ABDOMINAL WALL

1. Follow the dissection instruction in the Practical Anatomy textbook.

2. Identify a few of the cutaneous nerves. Remember that the cutaneous nerve that

supplies the skin around the umbilicus is derived from T10 segment of the spinal cord.

3. Note that the deep fascia of the anterior abdominal wall is thinner than the one that

covers limb muscles. What is the advantage of having minimal deep fascia in the

abdominal wall?

Muscles of the anterior abdominal wall:

The knowledge of the attachments of the muscles of the anterior abdominal wall is essential

to the understanding of the inguinal canal, linea alba and the rectus sheath, all of which are

of great clinical importance. Therefore, the detailed attachments of these muscles must be

learned.

The 3 pairs of flat muscles are the:

External oblique muscle

Internal oblique muscle

Transversus abdominis muscle

Note that the three muscles correspond to, and are in the same plane as, the 3 intercostal

muscles of the thoracic wall.

1. Identify these abdominal muscles.

2. Note the orientation of their muscle fibres.

3. What are the attachments and nerve supplies of these muscles?

The two long muscles:

These are the rectus abdominis muscles. They lay vertically, one on either side of the

midline of the anterior abdominal wall.

1. Note that the lateral border of the muscle is gently curved laterally and is called the

semilunar line (linea semilunaris).

2. Identify where this line crosses the 9th costochondral junction. This is an important

landmark as it overlies the fundus of the gallbladder on the right side. The horizontal line

that joins these points on both sides is the transpyloric plane. You will see the

importance of this plane later.

3. The rectus abdominis muscle is enclosed in an aponeurotic sheath that must be cut

open before the muscle can be seen.

4. Study the attachments of the rectus abdominis muscles.

5. What are the blood supply and innervation of these muscles?

6. What are the functions of these muscles?

The rectus sheath:

The aponeuroses of the three flat muscles enclose the intermediate parts of the rectus

abdominis muscle to form the rectus sheath (see Figure in Practical Anatomy). The

proximal and distal parts of these muscles lie on costal cartilages and transversalis fascia

respectively.

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Therefore, the rectus sheath is incomplete in these parts.

1. Identify the 3 flat muscles and their aponeuroses.

2. Follow each aponeurosis to the midline of the anterior abdominal wall where they form

the linea alba and ascertain its contribution to the formation of the rectus sheath at 3

levels: above the costal margin, above the umbilicus and above the pubic symphysis.

3. Is the linea alba very vascular?

4. How does the degree of vascularity of the linea alba influence the choice for making

abdominal incisions and subsequent wound healing in this part of the abdominal wall?

5. What are the contents of the rectus sheath?

6. Learn to draw and label the structures as depicted in Figure in Pract Anat.

DEEP SURFACE OF THE ANTERIOR ABDOMINAL WALL

Make incisions through the whole thickness of the anterior abdominal wall along vertical

lines that begin just below the costal margins and extend inferiorly to the iliac crest in the

mid-axillary lines. Extend the inferior end of the incisions forward to the level of the anterior

superior iliac spine. Join the top ends of the vertical incisions. This sets the anterior

abdominal wall free, which can now be turned inferiorly.

1. Identify the median, medial and lateral umbilical folds on the posterior surface of the

anterior abdominal wall.

2. What structures lie within these folds?

3. Identify the falciform ligament.

4. Why does it persist?

5. To which organ does the falciform ligament attach superiorly?

DIVISIONS OF THE ANTERIOR ABDOMINAL WALL

The anterior abdominal wall is often divided into 9 areas by imaginary lines (Addison’s

planes). The positions of the organs of the abdomen are then described with reference to

these planes and the areas between them.

1. Name the imaginary lines (planes) that are used for this purpose.

2. What are the names of the 9 areas between these lines?

3. List the organs/structures that are found within each region.

THE INGUINAL CANAL

1. On the skeleton, identify the pubic tubercle, pubic crest and the anterior superior iliac

spine.

2. Identify these bony parts on one side of the cadaver.

3. As you dissect the inguinal canal, identify

the spermatic cord in the male

the round ligament of the uterus in the female

the superficial or external inguinal ring

the deep or internal inguinal ring

conjoint tendon

transversalis fascia

inferior epigastric artery

the ilio-inguinal nerve

You should also study the inguinal canal under the following headings:

Definition and position, including size (length)

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Walls: Anterior, Posterior, Floor, Roof

Rings

Contents

Hernia formation

Differentiation between direct and indirect hernias

Congenital/acquired inguinal hernias

Differentiation between inguinal and femoral hernias.

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SUB-UNIT THEME 5.2: THE PERITONEUM AND ABDOMINAL ORGANS



Describe the general organization of the peritoneal layers and sacs

Describe the general arrangement of the abdominal viscera

Describe the anatomy of the liver and gall bladder

Describe the biliary apparatus

Describe the anatomy of the stomach

Demonstrate the coeliac trunk and its branches

Know the anatomy and relations of the duodenum

Describe the anatomy and relations of the pancreas

Describe the morphological features and blood supply of the spleen


radiographs


THE PERITONEUM

The peritoneum is the smooth membrane that covers completely some of the abdominal

viscera and lines the abdominal cavity. It may be likened to the pleural and pericardial

membranes of the thoracic cavity.

Read carefully through relevant page in “Practical anatomy” (taking note of, and learning to

draw the diagrams) for an understanding of:

1. How peritoneum surrounds or covers abdominal viscera,

2. The term peritoneal cavity,

3. The term abdominal cavity,

4. The term mesentery,

5. The retroperitoneal position of certain abdominal organs.

GENERAL ARRANGEMENT OF ABDOMINAL ORGANS

1. Examine the contents of the abdominal cavity with minimal displacement of these

contents so as to see them in situ (their normal, undisturbed position).

2. Examine particularly the following structures, noting in which part of the abdominal

cavity they are located with reference to the nine areas into which the abdominal cavity

is usually divided in clinical practice:

the greater omentum

the liver

the gall bladder

the small intestine and the mesentery

the large intestine

the hepatic and splenic flexures

the kidney

the lesser omentum

the pancreas (this is not readily visible at this stage)

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THE PERITONEAL SACS

1. What is the difference between the greater and lesser peritoneal sacs?

2. Identify the following:

supracolic and infracolic compartments of the greater peritoneal sac

the left and right subphrenic recesses between the abdominal surface of the diaphragm

and the corresponding lobes of the liver.

the subhepatic (hepatorenal) space between the inferior surface of the right lobe of the

liver and the right kidney

the left and right paracolic quarters or grooves lateral to the ascending and descending

colons

3. Identify and define the boundaries of the omental (epiploic) foramen, which leads into

the lesser sac (omental bursa).

4. What is the relationship of the lesser omentum to the omental foramen?

5. What is the relationship of the lesser sac to the stomach?

THE LIVER AND GALL BLADDER

Take note of, and be able to demonstrate the following features of the liver and gall bladder:

the position of the liver in the abdominal cavity

the shape of the liver

the surfaces of the liver

the borders of the liver

the lobes of the liver

the peritoneal relations of the liver (not in detail)

the grooves for the inferior vena cava, gall bladder, ligamentum teres and

ligamentum venosum

the vena porta hepatis

Blood supply and innervation of the liver

The liver has dual blood supply.

1. Identify the three blood vessels that supply the liver?

2. What is the source of the blood in each of these vessels?

3. Where are these blood vessels found in relation to the lesser omentum?

4. Do somatic or autonomic nerves innervate the liver and gall bladder?

THE STOMACH

1. Examine the stomach of your cadaver in situ and determine in which of the 9 areas of

the abdominal cavity it is located.

2. What is the shape of the stomach in this cadaver?

3. What other possible shapes may it have?

4. Identify the junction of the stomach and the abdominal part of the oesophagus.

5. Follow the oesophagus cranially and confirm that it passes through the diaphragm.

6. Identify the five named parts of the stomach.

7. Draw and label the 5 parts as well as the borders, and notches.

8. Study the peritoneal relations of the stomach.

9. Define the term “mesentery.

10. Which two folds of mesentery are attached to the stomach?

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11. What is the arterial blood supply of the stomach?

12. Locate these arteries and trace them to the coeliac trunk, a branch of the aorta.

13. The lymphatic drainage of the stomach is of importance because of its involvement in the

spread of cancer of the stomach. Figure 5.37 of “Practical anatomy” provides you with a

summary of the lymph nodes. Learn to draw this diagram.

14. What is the nerve supply of the stomach?

15. Examine the mucosal surface of the stomach.

16. What is the name of the folds or ridges of mucosa?

THE DUODENUM

1. Identify and examine the duodenum, and determine its shape.

2. Identify the pyloric antrum of the stomach and feel the thickness of its wall between two

fingers. Move these fingers distally until you are well into the duodenum. How would you

know when your fingers have passed from the stomach to the duodenum?

3. What are the different parts of the duodenum and which parts are retroperitoneal?

4. What are the major relations of the duodenum? (See Figure in Pract Anat)

5. Identify the structures that you referred to in Figure 5.38.

6. Make a full thickness longitudinal incision into the second part of the duodenum, turn the

duodenal wall inside out and look for the duodenal papillae.

THE PANCREAS

This is an abdominal organ that has both exocrine and endocrine functions.

1. What do these two terms mean?

2. Peel off the peritoneum from the posterior abdominal wall, starting from the concavity of

the duodenum and ending at the hilus of the spleen.

3. Identify the pancreas and its 5 named parts.

4. How would you describe the position of the pancreas in relation to the peritoneum?

5. Define the relations of the pancreas.

6. Identify again the splenic artery and vein and note their relation to the pancreas.

7. What effect will the carcinoma of the neck of the pancreas have on the biliary system?

THE SPLEEN

Although the spleen is usually described with the gastrointestinal tract, it is functionally not

related to intestine. The reason is that the spleen develops in close relation to the stomach.

1. Identify and name the function of the spleen.

2. In what part of the abdominal cavity is the spleen located?

3. To which part of the stomach is the spleen closely related?

4. Take out the spleen and study its morphological features.

5. Identify the blood vessels that supply the spleen and note their relationship to the

pancreas and spleen.

6. Can the human being survive after the surgical removal of the spleen (splenectomy)?

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SUB-UNIT THEME 5.3: ABDOMINAL ORGANS, POSTERIOR ABDOMINAL WALL,

DIAPHRAGM & LUMBAR PLEXUS



Differentiate between the jejunum and the ileum

Describe the arterial blood supply and venous drainage of the small intestine

Know the nerve supply of the small intestine

Differentiate between the different parts of the large intestine

Describe the peritoneal relations of the different parts of the large intestine

Differentiate the large intestine from the small intestine

Draw the surface marking of the base of the appendix on a living subject and define the

different positions in which the apex of the appendix may lie

Describe the blood supply and nerve supply of the large intestine

Describe the anatomy of the kidneys

Identify and distinguish the suprarenal glands from the kidneys

Describe the branches of the abdominal aorta and be able to relate them to the

derivatives of the three parts of the embryonic gut tube

Describe the sites of the porto-systemic venous anastomosis

Describe the muscles, arteries and nerves of the posterior abdominal wall

Define the attachments and openings of the thoraco-abdominal diaphragm

Describe the formation and branches of the lumbar plexus

Explain the anatomy underlying referred pain from the kidney and appendix


radiographs


THE SMALL INTESTINE

The duodenum (See previous sub-unit)

The jejunum and ileum

These are the parts of the small intestine that are immediately distal to the duodenum.

1. Note that the jejunum and ileum occupy the central part of the abdominal cavity.

2. Identify the duodeno-jejunal junction and determine where it lies in relation to the

midline of the abdominal cavity.

3. At this point, the duodenum is supported by a suspensory ligament (of Treitz). Identify

this ligament.

4. Lift the jejunum and ileum up and identify the mesentery that attaches them to the

posterior abdominal wall.

5. Feel for the blood vessels that are present in the mesentery. Mesenteries form the routes

through which blood vessels, lymph vessels and nerves reach or leave the viscera to

which they are connected. The arteries terminate on the intestinal wall by dividing into

straight branches called vasa recta.

6. Identify the terminal part of the ileum and take note of where it is attached to first part

of the large intestine.

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7. What are the differences between the jejunum and the ileum?

8. What are the arterial blood supply, venous drainage and nerve supply of the small

intestine?

THE LARGE INTESTINE

The large intestine occupies peripheral parts of the abdominal cavity and continues into the

pelvis.

1. Examine and identify the different parts of the large intestine. These include the caecum,

appendix, ascending colon, transverse colon, descending colon, sigmoid colon

and rectum

2. Note the peritoneal relations of these parts of the large intestine and identify the parts

that have mesentery.

3. What term will you use to describe the other parts that have no mesentery?

4. The fibres of the outer longitudinal muscle layer of the large intestine are not distributed

uniformly around the circumference of the wall of the gut tube. Rather, they are grouped

into 3 longitudinal bands called taenia coli.

5. Identify the taenia coli of the ascending colon and follow them inferiorly.

6. Where do the 3 taenia coli converge?

7. Are taenia coli present in the wall of the small intestine?

8. What are the differences between the small and large intestine?

9. Identify the appendix and its base. The position of its base is relatively constant but its

apex may lie in different parts of the abdominopelvic cavity.

10. What is the surface marking of the base of the appendix? The surgical incision for the

removal of the appendix (appendectomy) is usually placed at this point.

11. In what positions may the apex of the appendix lie?

12. What are the arterial blood supply and venous drainage of the large intestine?

13. Which main arteries supply the derivatives of the embryonic foregut, midgut and

hindgut?

14. In which parts of the body are porto-systemic anastomoses present?

15. What is the nerve supply of the large intestine?

THE KIDNEYS AND SUPRARENAL GLANDS

The kidneys, which develop in the pelvis, normally ascend to and lie in the upper part of the

paravertebral gutter of the abdominal cavity.

1. Identify the two kidneys and note the difference in the horizontal levels of their upper

poles. Which kidney lies at a lower level and what is the probable reason for this?

2. The kidney is coated by two capsules – an outer, fatty false capsule and an inner firmly

adherent true capsule. Confirm the presence of these two capsules by peeling away the

entire false capsule and peeling away the true capsule over a small area of the kidney.

3. Identify the suprarenal gland, which is related to the superior pole of the kidney.

4. Examine the kidney in situ and identify the structures that form its immediate relations.

(Figures 5.51 & 5.52 of Practical Anatomy are very useful. You should learn to draw

them)

5. What is the position of the kidney in relation to the peritoneum?

6. Identify the arteries and veins of the kidney, taking note of where the arteries arise from

and to where the veins drain.

7. Is there more than one artery on each side?

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8. What is the developmental reason for the possible presence of additional renal

arteries?

9. Divide one kidney longitudinally into anterior and posterior halves and examine its

internal structure. Draw and label what you see.

10. Identify the ureter and follow it distally across the pelvic brim, taking note of the blood

vessels that it crosses and how they are related.

11. What is the position, shape, relations and blood supply of the suprarenal glands

THE POSTERIOR ABDOMINAL WALL

The posterior abdominal wall consists of the lumbar vertebrae, the lower ribs, the posterior

part of the diaphragm and the psoas major, psoas minor (if present) and quadratus

lumborum muscles. Lying on the posterior abdominal wall are the abdominal aorta and its

branches, the inferior vena cava and its tributaries, the sympathetic trunk and nerves,

which are terminal branches of the lumbar plexus.

1. Identify these structures and note their relationship to one another. Practical Anatomy

contains relevant and simple line drawings to illustrate these structures (Figures 5.55 –

5.57).

2. At what vertebral level does the aorta bifurcate?

3. Note the relationship between the inferior vena cava and the right renal artery.

Supposing a distended inferior vena cava compresses the right renal artery, what will be

the pathophysiological effect on the right kidney?

THE DIAPHRAGM

The diaphragm, which you have seen before, is the muscular partition between the

abdominal and thoracic cavities.

1. Examine its posterior attachments to the lumbar vertebrae and 12th rib.

2. Identify the median, medial and lateral arcuate ligaments.

3. What structures pass posterior to these ligaments?

This is an opportunity for you to review the other openings in the diaphragm through which

structures pass between the thoracic and abdominal cavities. On the whole, the openings

may be classified into major and minor ones as follows:

Major openings:

aortic opening

oesophageal opening

inferior vena caval opening

Question

What are the vertebral levels of these openings and the structures that pass through each

opening?

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Minor openings:

behind medial arcuate ligament

behind lateral arcuate ligament

between attachments of diaphragm to the xiphoid process and the 7th costal cartilage

between costal slips of origin of the diaphragm

There are some structures which pass from the thoracic cavity to the abdominal cavity, but

which do not make use of specific openings in the diaphragm. These are the left phrenic

nerve, which pierces the diaphragm to supply its abdominal surface, and the splanchnic

nerves, which pierce the substance of the crura of the diaphragm. (See pages 143-144 of

Practical Anatomy).

LUMBAR PLEXUS

1. Which spinal nerves are involved in the formation of the plexus

2. In which muscle is the plexus formed

3. List the 7 branches of the plexus

REVISE THE ABDOMINOPELVIC SPLANCHNIC NERVES

T5—T9 constitute the Greater splanchnic nerves

T10-T11, the Lesser splanchnic nerves

T12, the Least splanchnic nerve

Question

What are diaphragmatic hernias?

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UNIT THEME 6: PELVIS & PERINEUM



anatomical structure and function of the pelvis. The student should be able to apply this

knowledge and provide the anatomical basis underlying specific clinical scenarios

pertaining to diseases and injuries to the pelvis.

Embedded knowledge



Anatomy of the abdomen

SUB-UNIT THEME 6.1: THE MALE AND FEMALE PELVIS – PELVIC GIRDLE &

PERITONEUM



Describe the components of the pelvic girdle, their main bony features and surface

markings

Differentiate between male and female pelvic bones,

Distinguish between the true pelvis and the false pelvis

Describe the bony components of the pelvic wall

Differentiate between male and female pelvic bones and pelvic cavities

Appreciate the continuity of the pelvic cavity with the abdominal cavity

Describe the reflections of the pelvic peritoneum


radiographs


THE PELVIC GIRDLE:

1. Which bones constitute the pelvic girdle?

2. Identify the following landmarks on the pelvis:

Anterior superior and inferior iliac spines

Iliopubic crest and pubic tubercle

Obturator foramen (and bony groove that is concerted to a canal)

Ischial tuberosity and spine

Posterior superior and inferior iliac spines

Iliac crest and tuberosity

THE PELVIS:

The pelvis consists of a musculoskeletal wall (pelvic wall), which encloses a cavity (pelvic

cavity). The bony structure of the pelvic wall is bound together and to the vertebral column

by strong ligaments. This is necessary as the pelvis transmits the weight of the body to the

bones of the lower limb. The cavity of the pelvis contains the urinary bladder and rectum as

well as the internal organs of reproduction (internal genitalia) in males and females.

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The major differences between male and female pelvis result mainly from the fact that the

female pelvis is designed for childbearing. Compare the male and female pelves in table

format.

Question

What are the major differences between the male and female pelvis?

SUBDIVISIONS OF THE PELVIC CAVITY

As a part of the lower limb, you studied the parts of the pelvic bones and in week 21, you

studied the sacrum and coccyx. The two pelvic bones, the sacrum and coccyx are

articulated to form the bony pelvis.

1. Examine the articulated bony pelvis and identify its major parts.

2. Identify the pelvic brim (pelvic inlet), which demarcates the true pelvic cavity from the

false pelvic cavity.

3. How do these two parts of the pelvic cavity differ from one another?

4. Why are they called true and false parts of the pelvic cavity?

5. What are the main differences between the male and female pelvic cavities?

CONTINUITY OF PELVIC AND ABDOMINAL CAVITIES

Examine the pelvis of the cadaver and:

1. Define the true and false parts of the pelvic cavity.

2. Confirm that there is no muscular partition between the abdominal and pelvic cavities.

Recollect that the coils of small intestine (which are abdominal structures) extended to the

iliac fossae, which are parts of the pelvic cavity. The iliac fossa is therefore common to both

the abdomen and the pelvis. Some pelvic organs sometimes extend to the abdominal cavity,

for example a pregnant uterus. This is possible because of the continuity of the two cavities.

For this reason, the two cavities are sometimes called the abdominopelvic cavity.

PELVIC FASCIA AND PELVIC PERITONEUM

The viscera in the pelvis are surrounded by loose, fatty connective tissue called the pelvic

fascia. For descriptive purposes, this fascia may be divided into the visceral pelvic fascia,

which immediately surrounds the viscera, and the parietal pelvic fascia, which lines the

pelvic wall. The viscera and the surrounding fascia are then covered above (and to some

extent on the sides) by the pelvic part of the peritoneum, which is simply called the pelvic

peritoneum.

Study the reflections (outline) of the pelvic peritoneum from the posterior surface of the

anterior abdominal wall to the rectum and note the pouch between the urinary bladder and

the rectum (in the male) and between the urinary bladder and the uterus (in the female).

1. Describe the peritoneal reflections, endopelvic fasciae and ligaments of the pelvis

1. What are the names of these pouches?

2. Note the presence of an additional, but deeper pouch between the uterus and the rectum

in the female.

3. What is the name of this pouch?

4. Which abdominal structures are normally present in these pouches?

5. Since the pouches between the uterus and the rectum and between the urinary bladder

and the rectum are the most dependant (lowermost) parts of the peritoneal cavity, fluid

(blood, serous fluid or infected fluid) may collect in them.

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6. Peel away the peritoneum from the pelvic viscera. Dissect around these viscera in order

to convince yourself that they are surrounded by fascia

7. Why is this fascia of the loose type?

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SUB-UNIT THEME 6.2: PELVIC VISCERA

(URINARY BLADDER, MALE & FEMALE INTERNAL GENITALIA)

WEEK 28 (cont.): SPECIFIC OUTCOMES


Describe the basic anatomy, including the relations, of the urinary bladder in males and

females

Describe the basic anatomy and relations of the male internal genitalia

Describe the basic anatomy and relations of the female internal genitalia

Describe the peritoneal relations, shape, blood supply and immediate relations of the

rectum in males and females

Identify the internal iliac artery and its major branches

Describe the muscular components of the pelvic wall

Identify muscle groups of the pelvic diaphragm and the perineal body.


radiographs

WEEK 28 (cont.): DISSECTION SPECIFIC OUTCOMES

PELVIC VISCERA THAT ARE COMMON TO BOTH SEXES

The urinary bladder and rectum are common to the male and female pelvis.

The Urinary Bladder

This organ may not be readily identifiable in the cadaver because it is usually empty and

pressed down posterior to the body of the pubic bone and the pubic symphysis.

1. Identify the urinary bladder in this location and dissect it clear of the pubic bone.

2. Describe the anatomy of the bladder

3. What are the immediate relations of the urinary bladder?

4. Note that there is a small space between the bladder and the pubic bone. What is the

name of this space?

5. You should study the morphological features of the urinary bladder.

6. Compare, in table format, the structure of the male & female urethra

7. What remnant of an embryonic structure extends from the fundus of the urinary bladder

to the umbilicus?

8. Is a fracture of the pubic bone likely to affect the urinary bladder? If yes, in what

physiological state?

The Rectum

1. Identify the rectum.

2. What is the shape of the rectum in the coronal and median planes?

3. What are the peritoneal relations of the rectum?

4. What are the other immediate relations of the rectum?

5. What are the arterial blood supply and venous drainage of the rectum?

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THE MALE INTERNAL GENITALIA

The internal genitalia of the male are the seminal vesicles, the prostate gland, the ductus

(vas) deferens and the urethra. If the cadaver is a female, team up with the students on a

nearby table with a male cadaver for this segment of the dissection.

1. Identify these structures in the male cadaver.

2. Study the prostatic urethra.

3. The prostate gland enlarges (hypertrophies) frequently in old age. This hypertrophy may

be a benign one (not life threatening) or it may be due to a carcinoma.

4. What is the possible effect of prostatic hypertrophy on the prostatic urethra?

5. Identify the ductus deferens and the ureter at the pelvic brim. Follow the ureter to the

urinary bladder and the ductus deferens to the seminal vesicle. Note the very important

relationship between the ductus deferens and the ureter (See Figure 5.61).

6. Explain the structure & organisation of seminal vesicles, ejaculatory ducts and ductus

deferens.

7. Describe the anatomy of the prostate and bulbo urethral glands.

THE FEMALE INTERNAL GENITALIA

The female internal genitalia are the uterus, the uterine tubes, the ovaries, the vagina and

the urethra. The uterus, uterine tubes, ovaries and vagina are covered to varying extents by

pelvic peritoneum. The uterine tube, in particular, is draped by a double layer of peritoneum,

which is called the broad ligament.

1. Identify these structures in the female cadaver. If the cadaver is a male, you need to

team up with members of a table with a female cadaver.

2. Which of the female internal genitalia may expand into the abdominal cavity and under

what conditions?

3. List the structures of the female internal genitalia

4. Describe the function of the ovaries and the boundaries of the ovarian fossa

5. List the parts of the uterine tubes

6. Describe the uterus, its positions and the relationship between the uterus and other

pelvic structures

7. Describe the functions and relations of the vagina

THE PELVIC WALL

The demonstrator will select a few cadavers in which the pelvic organs will be removed in

order that the pelvic wall may be accessible. The pelvic organs in the other cadavers will be

left intact for future revision exercises. When you have removed these organs, examine the

pelvic wall. It consists of bony, muscular and neurovascular components.

Bony components

1. Study the articulated bony pelvis again to determine the parts that contribute to the wall

of the pelvis.

2. Identify these bony parts as far as possible in the cadaver.

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Muscular components

1. Identify the piriformis and obturator internus muscles.

2. Can you still remember the nerve that passed into the gluteal region, inferior to the

piriformis muscle? What is its name?

Neuromuscular component

This consists of the internal iliac artery and its branches, the accompanying veins,

lymphatics, sympathetic trunk and branches of the sacral plexus.

Identify the following:

Internal iliac artery, which is the main artery of the pelvis

Lumbosacral trunk

Sciatic nerve, the nerve of the back of the thigh and the leg and foot and

Sympathetic trunk

THE PELVIC DIAPHRAGM

This is the muscle of the pelvic floor. It is perforated by the outlets of the gastrointestinal tract

(anal canal), the urinary tract (urethra) and the reproductive tract (vagina). It also forms the

roof of the soft tissue area that surrounds these outlets (the perineum).

1. What are the different muscle components of the pelvic diaphragm?

2. Identify these different components.

3. Are these muscles of skeletal or smooth type?

4. What type of nerves supplies them?

5. What are the other functions of the pelvic diaphragm?

6. Identify the perineal body (central tendon of perineum).

7. What is the function of this body?

8. From what does this body develop?

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SUB-UNIT THEME 6.3: THE PERINEUM THE MALE AND FEMALE EXTERNAL

GENITALIA



Describe the developmental process that resulted in the formation of the spermatic cord

Describe the layers of the spermatic cord

Describe the coverings and the basic structure of the testis

Describe the origin, course and termination of the ductus deferens

Describe the anatomy of the penis

Describe the component parts of the female external genitalia

Describe the boundaries of the perineum and how it is subdivided into urogenital and

anal triangles

Demonstrate the position and boundaries of the male and female deep perineal pouches

Demonstrate the position and boundaries of the male and female superficial perineal

pouches

Describe the contents of the perineal pouches in both sexes

Describe the position, boundaries and contents of the ischio-anal fossa

Describe the anatomy of the anal canal

Describe the position and arrangement of the internal and external anal sphincters


radiographs


THE SPERMATIC CORD

The testis developed in the posterior abdominal wall at about the level of the first lumbar

vertebra. From this position, it descended through the lower part of the anterior abdominal

wall into the scrotum in the perineum. In its course, it took a fold of the peritoneum and of

every other layer of the anterior abdominal wall around itself and the ductus deferens.

Therefore, the ductus deferens and accompanying neurovascular structures, together with

the tissue layers that surround them form the spermatic cord.

1. Identify the spermatic cord as it descends across the surface of the pubic bone.

2. Follow the spermatic cord proximally and determine the n opening through which it exits

the anterior abdominal wall.

3. Dissect through the spermatic cord and identify the ductus deferens. What makes it

different from the other structures in the spermatic cord?

4. What are the other contents of the spermatic cord?

5. Tabulate the layers of the spermatic cord against the layers of the anterior abdominal

wall from which they are derived.

THE TESTIS

Since the testis descended through the anterior abdominal wall, it necessarily has the same

tissue coverings as the ductus deferens, with the addition of a smooth muscle layer called

the dartos muscle. These coverings constitute the wall of the scrotum. The testis lies in

the scrotal sac.

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1. What is the function of the dartos muscle?

2. Make an incision through the scrotal wall to release the testis.

3. If the outer coat of peritoneum (parietal tunica) has been cut and reflected with the

scrotal wall (this is usually the case in the cadaver), you will see a shining surface to the

testis. This is due to the presence of a visceral tunica on the surface of the testis

4. What is the name given to the two coats (tunica) and the cavity between them?

5. What is the name of the embryonic proximal continuation of this sac that is normally

obliterated as the testis descends?

6. Identify the epididymis and its different parts.

7. Follow the ductus deferens proximally to determine its course through the spermatic

cord, inguinal canal and pelvic cavity.

8. Cut the testis into two and examine its internal structure.

9. Identify the mediastinum testis, the tunica albuginea and the region between these

two where the seminiferous tubules are concentrated.

THE PENIS

Compress the penis between your fingers and notice the firmness of its texture. This is due

to the presence of 3 bundles of erectile tissue called the corpora cavernosa (two) and

corpus spongiosum.

1. Examine the dorsal surface of the penis and identify the dorsal vein of penis.

2. Divide the penis transversely into two and identify the structures seen on the cut surface.

3. Reflect the coverings of the distal stump of the penis and follow the corpora cavernosa

to the glans penis, taking note of their continuation with the glans.

4. Put a probe into the external urethral orifice and confirm the presence of the probe in the

corpus spongiosum.

5. Follow the corpora cavernosa of the proximal stump as far into the perineum as possible

and ascertain their attachment to the ischiopubic rami of the pelvic bones.

6. What are the names of the muscles that you find associated with the erectile tissues?

THE FEMALE EXTERNAL GENITALIA

Examine the anterior part of the perineum where the female external genitalia are located.

1. Identify the mons pubis, the area of skin on the anterior surface of the pubic bone,

which usually bears a lot of hairs.

2. Identify also the labia majora, labia minora and the clitoris.

3. Does the clitoris contain the same three erectile tissues as are in the penis?

4. Does the urethra pass through clitoris?

The space between the labia minora is generally referred to as the vagina. But, in fact, it

leads to the vaginal vestibule. The vestibule contains the vaginal introitus (or vaginal

opening), and the external urethral orifice.

1. Identify the vaginal introitus and the external urethral orifice.

2. Put a finger (respectfully) in the vaginal introitus and assess the capacity and limits of

the vaginal cavity.

3. Put a probe into the urethra and feel for it in the urinary bladder (if the urinary bladder is

still present).

4. Dissect through the skin of the labia minora and identify the bulbs of the vestibule and

the greater vestibular glands. What are the male equivalents of these structures?

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THE PERINEUM

This is the lowermost part of the trunk, which lies between the upper medial surfaces of the

thighs and surrounds the openings of the three tubular systems, namely the anal canal

(gastrointestinal tract), the urethra (urinary tract) and the vagina (genital tract). It is diamond-

shaped, with the angles at the pubic symphysis, coccyx and ischial tuberosities.

1. Define the boundaries of the perineum.

2. Which imaginary line is used to divide the perineum into two triangular areas?

3. What are the names of these triangles?

4. Where is the surface marking of the perineal body?

THE DEEP PERINEAL SPACE (POUCH)

This is the potential space, which lies inferior to the medial free borders of the levator ani

muscle. A fascial layer, which is attached to the perineal body posteriorly and the ischio-

pubic rami anterolaterally enclose the space. It leaves a small gap between its anterior

margin and the pubic symphysis for the passage of the deep dorsal vein of the penis or

clitoris. Inside the space is a triangular sheet of muscle called the deep transverse perineal

muscle. The central fibres of the muscle surround the urethra forming the external urethral

sphincter in the male. Similar muscle fibres surround the vagina in the female forming the

sphincter vaginae. Together with its covering fascia, the muscle is called the urogenital

diaphragm.

1. Which blood vessels and nerves are present in this space?

2. What is the name of the gland that is present in this space in the male?

3. What are the named parts of the fascia covering the muscle?

4. Which of the male internal genitalia rests on the superior surface of the superior fascia

of the urogenital diaphragm?

THE SUPERFICIAL PERINEAL SPACE (POUCH)

This is the fascial space inferior to the urogenital diaphragm, which encloses the external

genitalia in both sexes.

The space is bounded externally by the membranous layer of superficial fascia called Colles’

fascia, which is an extension of the fascia from the anterior abdominal wall to the perineum.

Hence, the superficial perineal space is continuous with the space under the membranous

layer of superficial fascia in the anterior abdominal wall.

1. Define the outline of the perineal fascia (Colles’ fascia).

2. What is the territorial spread of urine following a rupture of the urethra in the superficial

perineal spaces of the male and female?

THE ISCHIO-ANAL FOSSA

The ischio-anal fossa is a wedge-shaped fat-filled space between the anal canal and the

ischium of the pelvic bone. The space is to allow for the expansion of the anal canal when

necessary.

1. What are the boundaries of the ischio-anal fossa?

2. What are the other contents of the ischio-anal fossa?

3. Considering the large amount of fat that is present in the fossa, what do you think is the

disadvantage of an infection of the ischio-anal fossa?

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THE ANAL CANAL

The anal canal begins at the ano-rectal junction and slopes postero-inferiorly to its opening.

The anal canal developed from two sources. This fact explains the dual source of the blood

supply, nerve supply and lymphatic drainage of the anal canal.

1. What are the two sources from which the anal canal developed?

2. Identify the beginning of the anal canal.

3. What are the characteristic features of the mucosa of the anal canal?

4. What are the relations of the anal canal?

5. What are the arterial blood supply and venous drainage of the anal canal?

6. It is a useful exercise at this stage to review the locations of the porto-systemic

anastomoses and the effects of portal hypertension at these sites.

7. What is the nerve supply of the anal canal?

8. What is the lymphatic drainage of the anal canal?

9. Which muscles form the sphincter of the anal canal and how are they arranged?

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UNIT THEME 7: LOWER LIMB



anatomical structure and function of the lower limb. The student should be able to apply

this knowledge and provide the anatomical basis underlying specific clinical scenarios

pertaining to diseases and injuries to the lower limb.

Embedded knowledge



Anatomy of the pelvis

SUB-UNIT THEME 7.1: GLUTEAL REGION, POSTERIOR THIGH, POPLITEAL FOSSA,

POSTERIOR LEG,



Describe the muscles, nerves and blood vessels of the gluteal region,

Describe the arrangement, actions and innervation of the muscles of the posterior

compartment of the thigh

Describe the boundaries (including floor and roof) and contents of the popliteal fossa,

Describe the relationship of the common fibular nerve to the fibula,

Describe the basic osteological features of the tibia and fibula and side both bones,

Identify the muscles of the posterior compartment of the leg, and describe their actions

and nerve supply

Explain the clinical implication of nerve injuries


radiographs


OSTEOLOGY

1. Identify the following bony landmarks on the:

Femur: Fovea capitis femoris, the head and neck, the greater and lesser* trochanters,

the inter-trochanteric crest and line, the quadrate tubercle*, the linea aspera, the

adductor tubercle*, the condyles, and epicondyles

Tibia: Medial and lateral condyle, tibial tuberosity*, intercondylar eminence*, articular facet

for fibula, lateral and medial malleolus, anteromedial subcutaneous surface, soleus line*

Fibula: Head of fibula, neck of fibula, shaft of fibula, lateral malleolus

Foot: Calcaneus, talus, navicular, cuboid, cuneiform boned (medial*, intermediate, lateral),

metatarsals (1st metatarsal*), phalanges

2. Note which muscles and ligaments attach to bony landmarks marked with *.

3. Explain the difference between the angle of inclination and the angle torsion at the

proximal part of the femur.

4. Explain, with special reference to the blood supply to the femur head, how a femur neck

fracture would cause avascular necrosis.

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5. Explain anatomically, why would the foot be rotated laterally and the limb in question be

shorter than the “normal” limb after femur neck fracture.

THE GLUTEAL REGION

Superficial muscles: These are the gluteus maximus and tensor fasciae latae.

1. What are their distal attachments?

2. What are their actions and innervation?

Deep structures: These consist of muscles, nerves and blood vessels:

Muscles:

gluteus medius

gluteus minimus

piriformis

superior gemellus

obturator internus

inferior gemellus

quadratus femoris

These muscles can be classified into either functional or positional groups.

1. What are these groups and the corresponding actions?

2. What is the innervation of these muscles?

3. Explain how injury to the inferior gluteal nerve and superior gluteal nerve will affect the

functioning of these muscles.

4. Explain the anatomical basis of a positive Trendelenburg’s sign.

Neurovascular structures:

The piriformis is a major landmark in the identification of the nerves and blood vessels in this

region. Identify this muscle again.

The neurovascular structures enter the gluteal region in relation to the upper and lower

borders of the muscle.

1. Identify the sciatic nerve.

2. What are the root values of this nerve?

3. Examine the general disposition of the nerves and blood vessels in the gluteal region.

4. In which quadrant of the buttock is it safe to give an intramuscular injection? Motivate

your answer by referring to:

a) the surface anatomy of the sciatic nerve

b) location of other important structures.

5. Explain how injury to the sciatic nerve will affect the patient.

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THE POSTERIOR COMPARTMENT OF THE THIGH

Muscles

There are 3 muscles in this compartment:

biceps femoris

semimembranosus

semitendinosus

1. Identify these muscles and name their innervation.

2. What are their actions?

3. What actions would be difficult if a patient has weakness of the hamstring muscles?

Sciatic nerve

1. Name, identify and schematically illustrate the anatomical landmarks would you use to

make sure you did not damage the sciatic nerve when performing intramuscular

injections into the gluteal region.

2. Where did it divide into its two terminal branches and what are these branches?

3. Is this point of division constant in all human beings?

4. Note the course of the lateral branch (common fibular (peroneal) nerve). It has an

important bony relation at the neck of the fibula.

5. What may happen to this nerve in the event of a fracture of the neck of the fibula?

Differentiate between the motor and cutaneous effects in case injury to the nerve.

THE POPLITEAL FOSSA:

The popliteal fossa is the diamond-shaped depression on the posterior surface of the knee

joint.

1. Identify the boundaries of this fossa.

2. The roof consists of the skin and fascia (popliteal fascia) of the posterior aspect of the

knee. The floor consists of the popliteal surface of the femur, the popliteus muscle and

the capsule of the knee joint.

3. Identify the popliteal artery and vein, and note the change in their positions relative to

each other as they pass through the fossa.

4. Attempt to palpate the popliteal pulse on yourself. Flex your knee as you do this.

5. Did you palpate the artery easily? If not, why not?

6. Note at what level the artery divides into its terminal branches.

7. What are the names of these terminal branches?

8. Describe the trifurcation of the popliteal artery as well as the supply area of each.

9. Identify and describe the origin, course and termination of the lesser (small) saphenous

vein

10. Identify the sciatic nerve and follow its terminal branches out of the popliteal fossa.

11. What are the names and distribution of these branches?

THE POSTERIOR ASPECT OF THE LEG:

Remember that this compartment is bounded posteriorly by skin and anteriorly by the

posterior intermuscular septum, fibula, interosseous membrane and tibia.

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The muscles in this compartment are the principal plantar flexors of the foot. They are

arranged in two layers:

Superficial Muscles:

gastrocnemius

soleus

plantaris (which is not always present)

Explain how the triceps surae is formed.

Deep Muscles:

tibialis posterior

flexor digitorum longus

flexor hallucis longus

popliteus

1. Identify these muscles and note the relationship of their tendons to the ankle joint.

2. What is their innervation?

3. In addition to plantar flexion of the foot, tibialis posterior inverts the foot (i.e. turns the

sole of the foot inward). This movement and its opposite movement (eversion) are

important in walking on uneven roads.

4. What are the names of the artery and nerve in the posterior compartment of the leg?

5. Describe the landmarks and nerve in direct relation to the posterior tibial pulse.

Radiological anatomy:

1. On a normal radiograph of the hip joint and thigh: Ischial tuberosity, ischial spine,

obturator foramen, head of femur, neck of femur, greater and lesser trochanters, medial

and lateral condyles of the femur, shaft of the femur, fovea capitis femoris and adductor

tubercle.

2. On arteriogram: External iliac artery, femoral artery, deep femoral artery.

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SUB-UNIT THEME 7.2: THIGH: ANTERIOR & MEDIAL COMPARTMENTS; FEMORAL

TRIANGLE, LEG: ANTERIOR & LATERAL COMPARTMENTS, FOOT DORSUM



Describe the muscles of the following regions, their actions and innervation: Thigh:

anterior and medial compartments; and leg: anterior and lateral compartments

Distinguish between extrinsic and intrinsic muscles of the foot and give examples of each

Explain the clinical implication of nerve injuries


radiographs


THE ANTERIOR ASPECT OF THE THIGH:

The great saphenous vein:

1. Identify this vein as it joins the femoral vein in the upper part of the thigh.

2. Follow its course distally to the dorsal surface of the foot.

3. Identify the small saphenous vein posterior to the lateral malleolus, and note how this

vein is connected to the great saphenous vein on the dorsal surface of the foot.

4. Where does the small saphenous vein terminate?

5. What will be the effect of blockage of the saphenous veins proximally, close to their

termination?

6. Identify, schematically illustrate and describe the course of great saphenous vein in the

lower limb with special reference to its relations at the dorsum of the foot, the ankle and

the knee;

7. Describe and identify the relationship of the great saphenous vein to the medial

malleolus and knee joint;

8. Explain the anatomical basis of varicose veins and venous “cut down” in volume

depleted patients;

The anterior compartment of the thigh:

The main contents of this compartment are muscles, the femoral artery, femoral vein,

femoral nerve and lymph nodes.

Muscles of the anterior compartment:

Identify and study the actions and innervation of Iliacus, psoas major, sartorius, and

quadriceps femoris

The deep fascia of the lower limb is very strong and fits the limb like an elastic stoking. It limits

outward expansion of contracting muscles thereby increasing the efficiency of venous return

to the heart.

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Fascia lata

1. Identify and schematically illustrate the fascia lata, lateral and medial intermuscular septa

and iliotibial tract.

2. Explain how the iliotibial tract is formed and its relationship to the lateral epicondyle of the

femur.

3. Explain the role of the tensor fascia lata and m. gluteus maximus on the iliotibial tract.

4. Identify the great saphenous vein as it enters through a hiatus in the fascia lata near the

femoral vein in the femoral triangle. This is the saphenous opening.

Iliotibial tract:

1. Identify and describe the iliotibial tract.

2. Explain the relationship of the tensor fascia lata to the iliotibial tract.

3. Describe the attachment of the iliotibial tract.

4. Identify the anterolateral ligament of the knee joint

NOTE:

The iliotibial tract is formed by a laterally thickened potion of the fascia lata. It also forms the

conjoint tendon of tensor fascia lata and gluteus maximus. It extends from the iliac tubercle

on the os coxa to the anterolateral tibial tubercle where the anterolateral ligament of the

knee also attaches to.

Muscles:

1. Identify the muscles. Quadriceps femoris is composed of the following: rectus femoris,

vastus medialis, vastus lateralis, vastus intermedius

2. What are the actions of these muscles at the hip joint?

3. What is the action of quadriceps femoris at the knee joint?

4. What is the nerve supply of the muscles in this compartment and how would the patient

present should this nerve be impinged or injured?

5. What is the major artery that supplies the muscles in this compartment?

The femoral triangle:

This is the triangular intermuscular space in the anterior aspect of the upper part of the thigh.

1. Identify the boundaries (including floor and roof) of this space.

2. Identify the contents of the space, taking note of their arrangement and relationship to

one another.

3. List the relation of the structures within the femoral triangle from lateral to medial and

vice versa;

4. Name, identify and schematically illustrate the contents of the femoral sheath;

5. Tabulate the differences between a direct hernia, inguinal hernia and femoral hernia in

terms of: Position, structures involved and prevalence.

6. Describe and schematically illustrate the position of the adductor canal.

7. Identify, name and schematically illustrate the borders and contents of the adductor

canal.

8. Differentiate, in table format, between a femoral hernia, direct inguinal hernia and indirect

inguinal hernia in terms of location and relations.

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NOTE:

The femoral canal opens superiorly into the abdominal cavity and may be the route by which

an abdominal structure could descend, under pressure, into the upper part of the thigh. Such

an abnormal protrusion is called a hernia. In this case, it is a femoral hernia.

Nerve of the anterior compartment:

This is the femoral nerve.

1. Identify this nerve just inferior to the inguinal ligament and follow it distally until it breaks

up into its terminal branches.

2. What is the name of the nerve plexus from which this nerve arises?

3. Revise the names of the muscles that this nerve supplies.

Arteries of the anterior compartment:

1. Identify the femoral artery, profunda femoris artery (deep artery of the thigh), medial and

lateral circumflex femoral arteries and perforators.

2. Follow the femoral artery and vein through the apex of the femoral triangle to the

popliteal fossa where you have already seen them. The narrow intermuscular passage,

through which the femoral artery and vein pass from the femoral triangle to the popliteal

fossa, is the adductor (subsartorial) canal.

3. Identify, name, schematically illustrate and describe the course and name the origin of

the femoral artery, deep artery of the thigh, medial and lateral circumflex femoral

arteries, and the obturator artery;

4. Identify, name, schematically illustrate and name the origin of the arteries that form the

cruciate anastomosis on the level of the lesser trochanter;

5. Describe and schematically illustrate the relation of the femoral artery to the hip joint; and

6. Explain, identify and schematically illustrate the surface anatomy relevant to palpating

the femoral pulse.

Veins of the anterior compartment

1. Identify the femoral and great saphenous veins.

2. Illustrate by means of labelled diagrams, the deep and superficial venous drainage of the

lower limb. Also add important landmarks.

3. Why might stripping the lesser saphenous vein for varicose veins leave the patient with a

tingling in her little toe?

4. Why will a patient complain of pain and paraesthesia in the medial side of the lower leg

following stripping of the greater saphenous vein for varicosities?

5. Describe the so-called "venous pump" of the leg.

6. Illustrate by means of labelled diagrams the difference between direct and indirect

venous perforators.

7. A patient admitted to the emergency department requires an instant intravenous line. His

veins are collapsed so the attending physician performs a "cut-down" on the greater

saphenous vein. Where would he find it? Provide an anatomical reason for your answer.

8. Illustrate, by means of a well labelled diagram, the location of the venous perforators of

the lower limb and their connections.

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Lymphatic drainage

1. Explain the lymphatic drainage of the lower limb.

2. Explain how infection can spread from the foot to the groin area via the lymphatic

system.

THE ANTERIOR COMPARTMENT OF THE LEG AND THE DORSUM OF THE FOOT

NOTE:

This compartment lies between the lateral surface of the tibia and the anterior intermuscular

septum. The deep fascia of the lower limb extends from the thigh to the leg where it is known

as the crural fascia. It is continues with the periosteum of the tibia. Around the ankle joint,

the crural fascia forms fibrous bands.

1. Identify the superior and inferior extensor retinacula, superior and inferior peroneal

retinacula and flexor retinaculum

2. Which important artery and nerve passes underneath the extensor retinacula to supply

the dorsum of the foot?

Muscles:

These are the extensors (dorsiflexors) of the foot. They are:

Tibialis anterior

Extensor digitorum longus

Fibularis (peroneus) tertius

Extensor hallucis longus

1. Identify these muscles.

2. Which of these muscles supports the medial longitudinal arch of the foot?

3. Which nerve supply these muscles?

4. Why would damage to the nerve supplying these muscles result in the patient presenting

with a “drop foot”?

Nerves:

1. Identify again the common fibular (peroneal) nerve as it winds around the neck of the

fibula.

2. Trace this nerve through the lateral compartment to the anterior compartment of the leg.

3. What will be the effect of a severe injury to this nerve in a fracture of the neck of the

fibula?

Arteries:

1. Identify again the popliteal artery and its terminal branches (anterior and posterior tibial)

in the popliteal fossa as well as the fibular (peroneal artery).

2. Follow the anterior tibial artery into the anterior compartment of the leg. This artery

crosses the anterior aspect of the ankle joint where it becomes the dorsalis pedis artery.

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3. Identify the dorsalis pedis artery and know where the pulse can be palpated by referring

to its direct relations.

4. Palpate the dorsalis pedis artery on yourself.

5. What landmarks are used to find the following pulses: anterior tibial, posterior tibial and

dorsalis pedis pulses?

6. Name the nerve in direct relation to the anterior tibial artery, posterior tibial artery and

dorsalis pedis artery.


1. Identify the following on a normal radiograph of the hip joint, knee joint, ankle joint and

foot:

Shadows of quadriceps, gastrocnemius, hamstrings

Femur: Fovea capitis femoris, the head and neck, the greater and lesser trochanters, the adductor tubercle, the condyles, and epicondyles

Tibia: Medial and lateral condyle, tibial tuberosity, intercondylar eminence, lateral and medial malleolus, anteromedial subcutaneous surface, soleus line

Fibula: Head of fibula, neck of fibula, shaft of fibula, lateral malleolus

Foot: Calcaneus, talus, navicular, cuboid, cuneiform boned (medial, intermediate, lateral), metatarsals, phalanges

Tibio-fibular syndesmoses

Mortise of the ankle joint 2. On arteriogram: External iliac artery, femoral artery, deep femoral artery.

3. Identify the trifurcation of the popliteal artery and the anterior tibial artery, posterior tibial

artery and fibular artery on an arteriogram.

THE MEDIAL COMPARTMENT OF THE THIGH

In this compartment are four muscles that adduct the thigh at the hip joint, one that flexes

and laterally rotates the thigh and one that laterally rotates the thigh and steadies the head

of the femur in the socket.

Muscles

Four of them are arranged in three layers.

interior layer – pectineus and adductor longus (same plane)

intermediate layer – adductor brevis

posterior layer – adductor magnus

Medially is gracilis. This extends from the pelvic bone to the tibia.

Deep to the adductor group of muscles is obturator externus. This also extends from the

pelvic bone to the femur.

Nerves:

1. What is the main nerve of this compartment?

2. How would the patient be affected should this nerve be injured?

3. Which other nerves may supply the pectineus and the adductor magnus muscles?

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Blood vessels:

The blood vessels in this compartment are the profunda femoris artery and vein. The

profunda femoris artery has 4 main branches called arterial perforators. These are not to be

confused with “venous perforators”.

1. Distinguish between the term “arterial perforator” and “venous perforator”.

2. What are the anatomical differences between the two types of perforators?

3. Which main artery gives rise to the profunda femoris artery?

4. Names the braches of the profunda femoris artery that participate in the cruciate

anastomosis.

THE LATERAL COMPARTMENT OF THE LEG:

This is also called the fibular (peroneal) compartment. It is bounded by the anterior and

posterior intermuscular septa, fibula and skin. The two muscles in this compartment are the

evertors of the foot. These are fibularis (peroneus) longus and fibularis (peroneus) brevis.

1. Identify these muscles.

2. Note the relationship of the tendons of these muscles to the ankle joint.

3. What is the nerve supply of these muscles?

4. Explain how will injury to the common fibular nerve, deep fibular (peroneal) nerve and

the superficial fibular (peroneal) nerve affect a patient

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SUB-UNIT THEME 7.3:

TARSAL TUNNEL, SOLE OF THE FOOT, JOINTS OF THE LOWER LIMB



Describe the origin, course and termination of the small and great saphenous veins,

Identify and name the muscles in the anterior compartment of the thigh, and describe

their innervation and actions,

Describe the boundaries (including floor and roof) and contents of the femoral triangle,

Explain the principle of hernia formation,

describe the muscles of the anterior compartment of the leg, their nerve supply and

actions,

Describe the distribution of the blood vessels of the leg,

Describe the muscles of the dorsum of the foot, their actions and innervation,

Describe the structure of the hip joint and compare this with the structure of the shoulder

joint,

Describe the cruciate ligaments and menisci in the knee joint.

Describe the basic arrangement of the ligaments of the ankle joint.


radiographs


TARSAL TUNNEL

1. Describe the boundaries and contents of the tarsal tunnel.

2. Describe the termination of the structures within the tarsal tunnel.

3. What is the function of the flexor retinaculum?

4. Identify and name the positions of the other retinacula around the ankle joint.

THE SOLE (PLANTAR ASPECT) OF THE FOOT:

Skin:

1. How does the skin of the sole of the foot differ from that of the dorsal surface?

2. Compare the skin of the foot with that of the hand.

3. What prevents the skin from slipping?

Muscles:

1. Compare this arrangement with that of the hand.

2. Explain the difference between intrinsic and extrinsic muscles of the foot.

3. List and identify the extrinsic and intrinsic muscles in the different muscle layers of the

foot.

4. The big toe has an adductor hallucis muscle (compare this with adductor pollicis).

5. Lumbricals, plantar and dorsal interosseous muscles are also present in the foot.

Compare similar muscles in the hand (although the movements these muscles produce

in the fingers are much greater than in the toes).

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Tibial nerve and posterior tibial artery:

1. Identify the tibial nerve and posterior tibial artery posterior to the medial malleolus of the

tibia.

2. identify the surface anatomy of the posterior tibial artery behind the medial malleolus and

palpate the pulse on yourself

3. Identify the two branches into which each of these structures divides.

These are the medial and lateral plantar nerves and arteries. The medial and lateral plantar

nerves are equivalent to the median and ulnar nerves respectively. Their distribution to the

muscles and skin in the sole of the foot has some similarities to that of the median and ulnar

nerves in the hand.

The bones of the foot:

1. Identify and examine the bones of the foot.

2. Notice that the articulated bones form longitudinal and transverse arches. These arches

allow the weight of the body to spread to the ground in all directions. They are also

useful in the “springing” of the foot during walking and running. At a later stage, you will

see which nerve damage can result in the collapse of these arches.

3. Using this knowledge, draw a diagram of:

normal footprint made on the floor

a footprint in which the “arch factors” have been damaged.

4. Identify the plantar calcaneonavicular ligament (spring ligament), long plantar ligament

and short plantar ligament and discuss their role in maintaining the foot arches.

5. Explain how extrinsic and intrinsic mm of the foot contribute to maintaining the arches of

the foot.

6. How does the shape of the bones contribute to the stability of the arches?

7. Name and explain the role of dynamic and passive stabilizers of the arches of the foot.

JOINTS OF THE LOWER LIMB

The hip joint:

1. Examine a dissected hip joint.

2. Using the scheme given in week 4, learn to describe the joint

3. Comparison between lower limb and upper limb joints.

4. Classify the joint and name the bones involved.

5. Identify and name the major ligaments.

6. Identify the labrum of the acetabulum and the capsule of the hip joint.

7. Name and demonstrate the movements of the joint and the muscles responsible for

them.

8. Identify the femoral artery anterior to the hip joint.

9. Describe and schematically illustrate the relation of the femoral artery to the hip joint.

10. Explain and schematically illustrate, with special reference to ligaments, bony

components and blood supply, the anatomy underlying the following hip joint injuries:

Femur neck fracture, dislocation of the hip.

11. Compare the structure of this joint with that of the shoulder joint and tabulate the

similarities and differences between them.

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The knee joint:

With the assistance of a demonstrator, open up a knee joint.

1. Examine the cruciate ligaments and menisci.

2. What are the functions of these ligaments?

3. What are the functions of the menisci?

4. Identify and name the anterolateral (ALL), tibial and fibular collateral, and cruciate

ligaments of the knee, patellar ligament, and state the most important relations of each.

5. Describe the attachments and functions of the cruciate ligaments.

6. Identify popliteus and explain its action.

7. Define the term “bursa” and list & identify the bursae around the knee joint.

8. Name and demonstrate the movements of the knee joint; also list the muscles

responsible for each movement.

9. Know the capsule and synovial membrane of the joint.

10. Explain the anatomy underlying the anterior and posterior drawer’s tests.

11. Explain and schematically illustrate, with special reference to ligaments and menisci, the

anatomy underlying knee joint injuries in the following cases:

Anterior cruciate ligament tear

Posterior cruciate ligament tear

Medial meniscus tear.

12. Explain the anatomy underlying the testing of the cruciate ligaments with the anterior and

posterior drawer tests

The ankle joint:

Examine the articular surfaces of the tibia, fibula and talus that are involved in the formation

of the ankle joint.

1. What type of joint is this joint?

2. Which movements are possible at this joint?

3. Do inversion and eversion take place at the ankle joint?

4. The ankle is often involved in injuries (e.g. sprains) that excessively stretch or tear the

ligaments of the joint. These ligaments are grouped into medial and lateral ligaments.

Name the medial (and its 4 different parts) and lateral ligaments of the ankle joint.

5. View the arrangement of these ligaments.

6. Explain and schematically illustrate, with special reference to ligaments and bony

components, the anatomy underlying inversion and eversion ankle injuries.

Tibiofibular joints:

1. Distinguish and tabulate the differences between the superior and inferior tibiofibular

joints with respect to position, bony elements, type of joint and ligaments stabilizing the

joint.

2. Explain the relationship of the common fibular (peroneal) nerve and tendon of popliteus

to the superior tibiofibular joint.

3. Explain how the inferior tibiofibular joint contributes to the formation of the ankle mortise.

ANAT 2020

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Joints of the foot:

1. Identify and classify the subtalar, transverse tarsal, interatrial, tarsometatarsal,

intermetatarsal, metatarsophalangeal and interphalangeal joints.

2. Identify the plantar calcaneonavicular ligament (spring ligament), long plantar ligament

and short plantar ligament and discuss their role in maintaining the foot arches.

3. Revise the names of the remaining joints of the foot


Point out anatomical features and major relations using radiographs as set out in previous

sub-units.

nb20Dec2017

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