24小时动态血压/心电分析系统

ESSENTIAL CLINIC ANATOMY Keith L. Moore Made By Professor Chen’s Courseware 2010.01 Introduction 1.Approaches to studying anatomy What is anatomy? IT is a scientific for studying morphology and structures of the human body. 1) systemic anatomy 2) regional anatomy 3) clinical anatomy 4) surface anatomy 2.Introduce the systemic anatomy according to the functions of the organs and structures, we can arrange the organs and structures into a number of system. 1) Integumentary system---skin 2) Skeletal system—bones and cartilages 3) Articular system---joints 4) Muscular system 5) Nervous system—central nervous system (brain and spinal cord)peripheral nervous system (cranial nerves, spinal nerves) 6)Circulatory system—cardiovascular (heart, artery, vein, and capillary)lymphatic system (lymphatic tissue, lymph nodes, lymph organ and lymph ducts) 7)Digestive system— 8)Respiratory system— 9)Urinary system 10)Reproductive system 11)Endocrine system— ductless glands ( producing hormons ) 12)Sense organs—receive the stimulation, convert it into impulses 3.Anatomical position * the body is standing erectly. * the eyes/face of the human is directed anteriorly. * the upper limbs have by the sides of the body. *the palms face anteriorly. *the lower limbs have together with the feet directed anteriorly. 4.Axes and planes of the body 1). Vertical axis : from superior to the inferior part of the body, It is a vertical line to the surface of the earth. 2) Coronal axis it is a parallel Line, in the left and right direction. 3)Sagittal axis the line, in the anterior and posterior direction 4) Sagittal planes are vertical plane to the surface of earth (along the anterior and posterior direction), and parallel to the median plane. 5) Median plane is a vertical plane.It passes longitudinally through the body (along the anterior and posterior median lines) 6) Horizontal planes are paralle to the surface of earth. 7) Coronal planes are vertical planes passing through the body at right angle to the median plane. 5. Terms of position 1) Superior and inferior: Nearer to head is superior. Nearer to feet is inferior. 2) Anterior and posterior means near to front and near to back respectively. 3) Medial and lateral means near to median plane and farther from median plane respectively. 4) Internal and external: If a structure is in a cavity, we call the structure is internal to the cavity. If a structure is out of a cavity, it is external. 5) Proximal means near to the trunk. Distal is farther from trunk. 6) Superficial is near to the surface of skin. Deep is farther from surface of skin. Skeletal system (P.8) Function 1) protection 2) support for body 3) storage for salts (such as calcium, phosphorus) 4) movement 5) producing blood cells The bones 1. Classification of bones 1) long bones: feature—long, two ends (epiphysis), articular surface, shaft(干/体), marrow cavity/medulla cavity 2) short bones: feature– cuboidal shape, such as carpus and tarsus 3) flat bones: feature—broad, flat and thin, such as sternum. 4) irregular bones: feature—shape is various, such as vertebra. 5) sesamoid bone: feature—in the tendons, such as patella 2.Bone development includes the membranous origin and cartilaginous origin. (you will study at the histology) 3. Structures of the bone *Osseous substance: compact substance and spongy substance ( trabeculae ) *Bone marrow: red marrow and yellow marrow *periosteum: development, growth,repairing , reconstruction Visceral system Joints (P.13) The joint means the connection between the bones. 1. Classification of the joints 1).fibrous joints: united by the fibrous tissue such as ligaments, sutures (between the flat bones) 2).cartilaginous joints 3). Synostosis ( bony joints) means the bones connected by the ossification-tissue. 4) Synovial joints: the bones are connected by the articular capsule. (1) three main structures * articular surface and articular cartilage *articular capsule *articular cavity is formed by the synovial membrane and articular cartilage. The cavity is lodged with synovial fluid. (2). The synovial joints are reinforced by the accessory structures. ligaments articular disc articular lip 2.The movement of the synovial joints (joints) 1) Flexion and extension 2) Adduction and abduction 3) Rotation (Pronation and supination ) 4) circumduction Muscular system To be belong to locomotor system *Skeletal muscle: to insert into the bony surface,contraction and diastole/expanding consciousness *Cardiac muscle: to occur to the heart, unconsciousness *Smooth muscle: to be found in the blood vessels, hollow organs of the viscera, unconsciousness 1.The shape of the skeletal muscles *long muscle *short muscle *orbicularis *broad muscle 2.The origin and insertion of the muscle the origin not move usually—fixative point the insertion can move this point—movable point 3. Supplementary structures of muscles 1). Fascia (1) superficial fascia It lies on the deep to the skin and is formed by the loose connective tissue. So, usually we call it as subcutaneous tissue. (2) Deep fascia It lies in the deep to superficial fascia and is formed by the strict or tight connective tissue. *muscular sheath *vessel-nerve sheath *intermuscular septum 2). The tendon sheath (1) synovial tendon sheath (2) fibrous tendon sheath 4.The action of muscle agonist 主动肌 antagonist 拮抗肌 synergist 协同肌 Cardiovascular system Belong to the vessel-system, it pushes and guides the blood flowing Including: heart: motive power organ artery: blood vessel, guideing or carrying the blood away from the heart vein: blood vessel, carrying the blood returning to the heart capillaries: They are endothelial tubes and very small (no see by the eye), and form networks. They lie between the small a. and v. They are the place that the materials ( oxygen and nutrient in the blood in the a. and carbon dioxide and substance with metabolism in the cells, in the tissue ) are changed through the capillaries. The greater / systemic circulation left ventricle → aortic orifice → aorta(ascending aorta → aortic arch → descending aorta) → each branch of the arteries → capillaries → lesser vein → inferior vena cava(IVC) / superior vena cava(SVC)/→ right atrium The lesser / pumonary circulation right ventricle → pulmonary orifice → pulmonary trunk → left and right pulmonary arteries →lungs → capillaries (in the wall of the pulmonary alveolus)→ tributaries of the pulmonary veins → pulmonary veins →left atrium Lymphatic system Lymph vessels Lymphatic capillaries Lymphatic tubes Lymphatic trunk Lymphatic duct Fibrous capsule Synovial membrane producing the synovial fluid (lubricating the surface) Lymphatic tissue Lyphatic organ: spleen, thymus, tonsils, lymph nodes What is lymph? It is the liquid from the tissue fluid. When the tissue fluid flows from the tissue into the lymphatic capillaries, then, the tissue fluid is called lymph. Nervous system control the activities of the body, and formed by the nervous tissue. 1.Nervous tissue (neuron and neuroglia) (1) neuron * the basic structure and function units * cell body process *synapses (points of contact between neurons) (2) Neuroglia provides support and nourishment for neurons. 2. Division central nervous system: brain in the cranial cavity spinal cord in the vertebral canal peripheral nervous system *12 pairs of cranial nerves connect to the brain *31 pairs of spinal nerves connect to the spinal cord *visceral nerves connect to the visceral organ, cardiovascular and glands The viscera 1.What is viscera? The viscera includes the many organs and some functional systems. The functions of the organs and systems are to fulfil the metabolism，and the organs and systems directly or indirectly open the external body through the foramen， and includes • digestive system, • respiratory system, • urinary system • reproductive system. 2. Classification 1). Tubular viscera as tube shaped device (1)mucosa (2)submucosa (3)muscular layer SM (4)fibrous layer connective tissue or serosa 2) Parenchymatous organ Features: tissue-mass glands the hilum on the surface of the parenchymatous organs, where the blood vessels, nerves, lymphatic tubes and another tube enter or leave the organ, such as the porta hepatis, hilum of the kidney. The sense organs Sense organs can receive the stimulation from the external or internal environment of the body, and convert it into the nerve impulses. The division of the sense organs exteroceptors 外感受器 proprioceptors 本体感受器 enteroceptors or visceroceptor 内感受器 The endocrine system The feature * the ductless glands * producing the hormones * the hormones into the blood and reaching the particular / target tissue or organ such as hypophysis(垂体), thyroid gland（甲状腺）, suprarenal gland（肾上腺） Vertebral Column (p.190) 1.Vertebrae 1) The number of vertebrae 7 cervical vertebrae 24 vertebrae 12 thoracic vertebrae In the adult 5 lumbar vertebrae 1 sacrum—it is formed by the 5 sacral vertebrae fused with each other. 1 coccyx—it is formed and fused by the 4 coccygeal vertebrae. In a child the normal number of the vertebrae is 33. 2). General features of the vertebrae (typical vertebrae) vertebrae body: to occupy the anterior part of vertebrae superior articular process inferior articular process transverse process vertebrae arch spinous process vertebral pedicle (root) sup. vertebral notch inf. vertebral notch Vertebral foramen: it is surrounded by the body and arch. Vertebral canal: the all of vertebral foramens formthe canal. Intervertebral foramen: it is formed by the Sup.and Inf.vertebral notches of the tow vertebrae. 3). Introduce the vertebrae in each region (1) Cervical vertebrae have transverse foramen. (2). Thoracic vertebrae have the costal facet. (3).Lumbar vertebrae have no transverse foramen and costal facet. (4) Sacrum * Promontory * Ant. Sacral foramen * Transverse line * Median sacral crest * Auricular surface of sacrum * Sacral canal * Sacral hiatus * Sacral horn (mark/symbol of anesthesia/poisoning for sacral canal) (5)Coccyx 2. Intervertebrae main joints 1) Intervertebrae discs lie between the adjacent vertebral bodies. each disc includes tow parts * nucleus pulposus (remainder of the notochord in the embryo) *anulus fibrosus 2) Ant. Longitudinal lig. extends from base of skull to the sacrum.to prevent hyperextension of the vertebral column 3) Pos. Longitudinal lig. extends inside vertebral canal from atlas to sacrum. To prevent hyperflexion 4) Ligamenta flava(yellow lig.): to prevent hyperflexion 5) Interspinous lig 6) Intertransverse lig. 7) The joints of articular processes are synovial joints 3. Vertebral column 1) Curvatures of vertebral column four curvatures: *cervical curvature--convex anteriorly, concerning with head erect, secondary curvsature *thoracic curvature--concave posteriorly, primary curvature *lumbar curvature--convex anteriorly, concerning with standing and walking secondary curvsature *sacrococygeal curvature--concave posteriorly, primary curvature 2) functions of vertebral column (1) movements: flexion; extension; lateral flexion; rotation;circumduction (2) Protection: such as spinal cord; organs in the thorax cavity and abdomen Lower limb Bones of the lower limb(P.217) 1.Hip bones fused with ilium(Sup.position) pubis(anterointerior position) ischium Main structures Iliac crest; Anterior sup.iliac spine Greater and lesser sciatic notch Ischial tuberosity Ischial spine Obturator foramen Acetabulum ; acetabular fossa; acetabular notch; lunate surface Symphyseal surface Pubic tubercle Auricular surface Arcuate line 2. Femur head of femur fovea of head neck of femur greater trochanter lesser trochanter intertrochanteric line intertrochanteric crest linea aspera nutrient foramen madial and lateral condyle adductor tubercle 3. Patella 4.Tibia at the leg medial and lateral condyles intercondylar eminence tibil tuberosity (patellar lig.ends to it) medial malleolus fibular notch soleal line 5. Fibula at the leg head lateral malleolus 6.Bones of foot 1)Tarsal bone * talus * calcaneus * navicular * cuboid *cuneiforms 2) Metatarsal bones 3) phalanges superficial structures of the lower limb (main Bl. vessels and nerves) 1.Great saphenous vein beginning at the dorsal venous arch→ Ant. to medial malleolus→ medial surface of leg→ Post. to the medial condyle of femur→ medial surface of thigh→ perforating (pierceing) cribriform fascia of saphenous opening→ draining into femoral v. receiving 5 tributaries,before piercing the opening: Superficial epigastric v. Superficial circumflex iliac v. External pudendal v. Superficial medial femoral v. Superficial lateral femoral v. 2.Small saphenous vein beginning in dorsal veinous arch→ at the lateral margin of foot→ passing through Post. to lateral malleolus→ ascending along the midline of the back of leg→ piercing deep fascia of popliteal fossa → ending in the popliteal v. 3.Cutaneous nerves Saphenous n. Sural cutaneous n. Sup.gluteal cutaneous n. 4. Superficial inguinal lymph nodes are arranged in two groups —upper group and lower group. Joints of lower limb (P.145-149,266-280) 1. sacro-iliac joint: It is formed by the union of the auricular surfaces of the sacrum and ilium Lig. iliolumbar lig. anterior sacroiliac lig. posterior sacroiliac lig. Characteristic: *little movement *cushioning and transmitting the power 2. Symphysis pubis Each pubic bone is covered by a layer of hyaline cartilage and connected together by a dense layer of fibrous cartilage (interpubic disc) 3. Obturator membrane 4. Sacrotuberous lig. Sacrospinous lig. How do we identify the male and female pelvis? Female male *Higher degree shorter and wider higher *Pubic arch 90 degree 70-75 degree *Superior pelvic aperture wider and larger heart-shaped *Ischial tuberosity turned laterally didn't turn *Distance between the both ischial tuberosity longer shorter *bony surface smoother coarser • What is terminal line? promontory of the sacum, anterior border of the sacral ala, arcuate line, pecten pubis, pubic crest and upper border of the symphysis pubis • What is superior pelvic aperture? • What is greater pelvis and lesser pelvis? • What is inferior pelvic aperture? apex of the coccyx, ischial tuberosities, sacrotuberous lig, pubic arches, lower border symphysis pubis 5.Hip joint 1) Articular surface the synovial joint is formed by the head of femur and acetabulum of hip bone. the head is larger; the acetabulum is deepper. 2) Articular capsule * to be strong fibrous capsule * to attach proximally to acetabulum & transverse acetabular lig. distally to neck of femur anteriorly to intertrochanteric line posteriorly to the medial 2/3 parts of neck 3) Accessory structures *acetabular labrum can increase the depth of acetabulum. to increase stability *lig. of head of femur *transverse acetabular lig. *Iliofemoral lig. orbicular zone 4) Movement of hip joint flexion & extension adduction & abduction rotation & circumduction 6.knee joint 1) Articular surface the joint is formed by the * medial and lateral condyle of femur. *medial and lateral condyle of tibia *patella 2) Articular capsule feature: (1) To be the strong fibrous capsule (2) To attach to condyle of femur superiorly, to attach to condyle of tibia inferiorly (3) Ant. wall of capsule is not complete (lack or deficiency), where is filled by the patella. 3) Accessory structures (1) main lig. patellar lig.(ant.) is a continuation of the tendon of quadriceps femoris. it extends from the inf. border of patella to the tuberosity of tibia. ant.cruciate lig. (in the capsule) pos. cruciate lig. tibial collateral lig. fibular collateral lig. transverse lig. oblique popliteal lig. (2) Menisci include medial meniscus and lateral meniscus Shape—the medial meniscus is “c” shaped the lateral meniscus is “o” shaped Function *deepen the articular surface of tibia *absorb shock *cushion/buffer strength or force or power * increase the adaptability of the articular surface (3) The structure of synovial membrane alar folds suprapatellar bursa Prevent the friction 4) Movement of the knee joint Main movements are flexion and extension. Some rotation occurs when the knee joint is flexion. 7. tibiofibular joints (1)Proximal tibiofibular joint---synovial joint (2)Distal tibiofibular joint---fibrous joint (3)Interosseous membrane 8. Ankle joint It is formed by the inf. ends of the tibia and fibula, and talus Many lig. are around the ankle joint. such as deltoid lig(medial) and collateral lig.(lateral) Movement: dorsiflexion / plantarflexion 9 .foot joints intertarsal intermetatarsal interphalanges between tarsal and metatarsal between metatarsal and phalanges Arches of foot: the bones (tarsal and metatarsal) are arranged in longitudinal and transverse arches of the foot. function of the arches (1)to absorb the shock (2)To protect the a.,v.,n (3)to give the foot elasticity (4)to support the weight Anterior and medial thigh(P.228-239) Anteromedial thigh region (P.228,232) 1.muscles 1).quadriceps femoris (femoral N supplying) rectus femoris vastus medialis vastus lateralis vastus intermedius function: flexion hip & extension knee 2).sartorius (femoral N supplying) function: flexion hip and knee; lateror rotation and abduction thigh 3).iliopsoas (L2-4N) Insert on: lesser trochanter function: flexion and lateraly rotation thigh 4).Medial group muscles pectineus m. gracilis adductor longus adductor brevis adductor magnus Main functon: adductor thigh 2. Femoral triangle (P.232) 1) It is bounded superiorly by inguinal lig. medially by adductor longus laterally by sartorius 2).Main contents of femoral triangle from lateral to medial femoral n., a.,v. and femoral canal (1) femoral n. Beginning in lumbar plexus between the psoas major and iliacus deep to inguin