1 - Misericordia University



Lab List of Structures

Note lymph nodes as encountered during the dissections. Use skeletons, cadavers, models, and diagrams.

1. Thorax

a. Bony Landmarks and Surface Anatomy

i. Sternum:

manubrium

jugular notch –trachea marker

sternal angle-marks 2nd rib

body

xiphoid process

ii. Ribs: (12 pairs) head, neck, tubercle, body, costal groove, costal cartilages

(7 vertebrosternal (true), 3 vertebrochondral (false), 2 vertebral (floating and false)

-note rib articulation with vertebra (most intervertebral)

iii. Thoracic Vertebra: centrum, pedicle, transverse process, lamina, spinous process, superior and inferior articulating surfaces, spinal canal, rib facets

iv. Other surface features

-clavicle-acromion joint forming point of shoulder

-deltopectoral triangle –contains cephalic vein located between pectoralis major and deltoid

-thoracic apertures (superior and inferior)

b. Female Breast

i. Nipple, areola, mammary gland, suspensory ligaments, lactiferous ducts

ii. retromammary space

iii. nipple in males associated with T4 dermatome

c. Muscles (innervations and actions)

i. Pectoralis Major –adducts arm, note: pectoral nerves if present

ii. Pectoralis Minor –draws scapula forward, note: pectoral nerves if present

iii. Internal intercostals –expiration; depresses ribs

iv. External intercostals –inspiration; elevates ribs

v. Innermost intercostals

vi. Transversus Thoracis

vii. Serratus Anterior –abduction and raising of arm (pushing), long thoracic nerve

viii. Diaphragm -central tendon; aortic, IVC and esophageal hiatus; inspiration; phrenic nerve

ix. Internal thoracic A&V

x. Intercostal nerve, and A&V –supplies intercostals

d. Pleural Cavities

i. Pleural membranes

1. Parietal pleura (diaphragmatic, cervical, costal, and mediastinal portions)

2. Visceral pleura

3. Phrenic nerves (ventral rami of C3-C5)

ii. Lungs

1. Lobes: Superior and Inferior (middle on right lung), position in chest.

2. Fissures: oblique and horizontal

3. Trachea, primary bronchi

4. Root of the Lung: hilum, secondary (lobar) bronchus, pulmonary artery and veins, pulmonary ligament, note any visible pulmonary lymph nodes

iii. Deep root of lung: segmental (tertiary) bronchi lead to bronchopulmonary segments

iv. Left Pleural Cavity: descending aorta, thoracic aorta, intercostal A&V, intercostal nerves, sympathetic trunk and ganglia

v. Right Pleural Cavity: Sympathetic trunk, sympathetic chain ganglia, azygous vein

e. Mediastinum –cavity between the two pleural cavities (anterior, middle, and posterior)

i. Middle mediastinum –contains the heart with its ensheathing pericardium and the roots of the great vessels

ii. Pericardium and Pericardial Sinus (Cavity) –parietal and visceral layers

1. Heart –before removing heart note the following: ascending aorta, superior vena cava, left vagus nerve and the recurrent laryngeal nerve, ligamentum arteriosum, pulmonary trunk, inferior vena cava, pulmonary veins

a. External heart anatomy: right ventricle, right atrium, left ventricle, left atrium, apex, coronary sulcus, interventricular sulcus, auricles

b. Coronary Circulation:

Left Coronary artery: Left anterior descending (LAD) artery and the Circumflex artery, Left marginal a.

Right Coronary artery: Right marginal artery and the Posterior Descending artery

Coronary Veins: Small cardiac vein, Middle cardiac (posterior interventricular) vein, Great cardiac (anterior interventricular) vein, coronary sinus

c. Internal heart anatomy: layers: epicardium (visceral pericardium), myocardium and endocardium

Right atrium: Pectinate muscles, fossa ovalis, right auricle, interatrial septum, and openings of SVC, IVC and coronary sinus.

Right atrioventricular (AV) valve (tricuspid) – 3 cusps, chordae tendinae connecting to papillary muscles in ventricle,

Right ventricle: papillary muscles, moderator band, trabecula carnae, interventicular septum, pulmonary semilunar valve (3 cusps) opening of pulmonary trunk

Left atrium: pectinate muscles, auricle, openings for the pulmonary veins

Left AV valve (bicsupid or mitral) –2 cusps, chordae tendinae

Left ventricle: trabecula carnae, papillary muscles. (Note thicker wall of this ventricle.) opening for aorta, aortic semilunar valves cusps, (In ascending aorta, aortic sinus and openings for right and left coronary arteries)

iii. Posterior and Anterior (to include structures superior to heart) Mediastinum

1. Posterior Mediastinum –azygous vein, hemiazygous vein, intercostal arteries and veins, thoracic duct, vagus nerves passing posterior to root of lungs, esophagus, esophageal hiatus, trachea, tracheal carina, tracheo-bronchial lymph nodes, primary bronchi, thoracic aorta, aortic hiatus, sympathetic trunk

2. Anterior Mediastinum –thymus gland (only in young), phrenic nerves - follow (above the root of the lung) to diaphragm

a. Aortic Arch –Great arteries: brachiocephalic (innominate) trunk, left common carotid artery, and the left subclavian artery, descending aorta

b. Follow the subclavian a. to find the vertebral a. and thyrocervical trunk

c. SVC –right and left brachiocephalic veins

2. Neck

a. Bony Landmarks and Surface Anatomy

i. Larynx (thyroid cartilage, cricoid cartilage), Hyoid (body, lesser and greater cornua), Mandible (body, symphysis, angle and ramus), Clavicle, Scapula

ii. Triangles

1. Posterior Triangle –bounded by sternocleidomastoid (SCM), trapezius, and middle portion of clavicle

-visible within triangle are the accessory nerve (XI), brachial plexus, inferior belly of omohyoid muscle, external jugular vein and a small portion of subclavian A&V

-Deep muscles are the splenius capitis, levator scapulae, and the scalenes

2. Anterior Triangle –bounded by the SCM, the neck midline and the mandible; further divided into 4 smaller triangles:

a. Muscular triangle –bounded by superior belly of omohyoid, anterior border of SCM, the hyoid and the midline of neck

-contains the thyroid and parathyroid glands, the larynx, as wells as, the infrahyoid muscles (sternohyoid, sternothyroid, thyrohyoid muscles)

i. Thyroid gland -left and right lobes, and isthmus; note thyroid A&V; deep

ii. Parathyroids glands found on posterior surface of thyroid lobes (maybe too small and diffuse to recognize)

iii. Larynx –thyroid cartilage with its laryngeal prominence, cricoid cartilage, epiglottis, true (vocal fold) and false (vestibular fold) vocal cords

b. Submental triangle –bounded by the mandible, hyoid and anterior bellies of the diagastrics

c. Carotid triangle –bounded by the superior belly of omohyoid, posterior belly of digastrics, and medial border of SCM

-contains the carotid sheath which contains the common carotid artery, the vagus nerve and the internal jugular vein; also within the triangle the hypoglossal nerve

-the common carotid divides into internal and external carotids; find the carotid sinus and carotid bodies at its bifurcation

-follow the external carotid to find the superior thyroid a., lingual a., maxiallry a. (this will be followed later into the infratemporal fossa,and facial a. (two branches run posteriorly (the ascending pharyngeal and post. auricular) but may be difficult to detect

d. Submandibular (Digastric) triangle –bounded by the anterior and posterior bellies of the diagastrics, and the mandible

-nearly filled with submandibular gland and submandibular lymph nodes

iii. Root of Neck

1. thoracic duct, external and internal jugular veins, Subclavian A&V

3. Head

a. Skull –find and study these features

i. Frontal –glabella, superior orbital notch, coronal suture, supracillary process

ii. Parietal –sagittal suture, lambda, bregma, parietal emissary foramen, sup. and inf. temporal lines, emissary foramen

iii. Occipital –lambdoidal suture, foramen magnum, external occipital protuberance, occipital condyles, median, sup., and inf. nuchal lines, condyles, jugular fossa, condylar canal, emissary foramen

iv. Temporal –squamosal suture, mastoid process, styloid process, external auditory meatus, zygomatic process, temporal lines, temporal fossa, note: pterion (area of a sphenoid fontanel), mastoid foramen, stylomastoid foramen, petrous portion, mandibular fossa

v. Orbit –maxilla, lacrimal, lacrimal canal, sphenoid, frontal, ethmoid, optic foramen, sup. & inf. orbital fissures

vi. Sphenoid –pterygoid process, greater and lesser wings, pterygoid process (lateral and medial), pterygoid fossa, sphenopalatine foramen, infratemporal fossa

vii. Nasal area –nasal bone, external nares and conchae, perpendicular plate of ethmoid

viii. Maxilla –infraorbital foramen, alveoli, teeth, incisive foramen, palatine process, infraorbital groove

ix. Zygomatic –frontal process

x. Palantine –greater and lesser palantine foramen, transverse and median palatine sutures, pyramid process

xi. Ethmoid –perpendicular plate, crista galli, cribiform plate and foramina, conchae, orbital plates

xii. Mandible –alveoli, teeth(by type), coronoid process, mandibular condyle, mental foramen, mandibular foramen, mandibular notch, ramus, angle, symphysis, mylohyoid line, oblique line

xiii. Vomer –internal nares

xiv. Sinuses (ethmoid, maxillary, frontal and sphenoid) –see x-rays

xv. Orbital plates of bones in orbit

b. Face

i. Muscles, nerves and superficial vessels

1. Masseter –elevates jaw, Trigeminal nerve

2. Buccinator –presses cheek inward, Facial nerve

3. Frontalis (occipitofrontalis)–wrinkles forehead, raises eyebrows, Facial nerve

4. Orbicularis oculi –closes eyelids, blinking, squinting, Facial nerve

5. Orbicularis oris –closes lips, kissing, Facial nerve

6. Zygomaticus –smiling muscle, Facial nerve

7. Temporalis –elevate jaw, Trigeminal nerve

c. Interior of Skull and Brain

i. Cranial Fossa, greater and lesser wing of sphenoid, crista galli, sella turcica (hypophyseal fossa, anterior and posterior clinoid processes, chiasmatic groove, dorsum sella), transverse sinus depression, sigmoid sinus depression, petrous portion of temporal

ii. Openings: foramen magnum, foramen ovale, foramen rotundum, hypoglossal canal, internal auditory meatus, foramen spinosum, jugular foramen, cribiform foramina, optic canal, carotid canal, foramen lacerum

iii. Brain and Meninges

1. Meninges:

a. dura mater (two layers: an outer rough layer that adheres to the skull and an inner smooth lining that rests against the arachnoid (distinguishable only where they separate to allow venous blood flow through venous sinuses); see diagrams in book to understand meningeal blood flow, venous sinuses, arachnoid granulations and the flow of CSF and blood drainage)

-note space between dura and arachnoid (subdural space) is potential space normally devoid of fluid –in trauma (like concussions) may fill with blood, same is true for epidural space which normally only contains the meningeal arteries

-three dural folds help to suspend brain within cranium (tentorium cerebelli, falx cerebri, and falx cerebelli)

b. arachnoid –membrane with fibrous extensions that create the subarachnoid space which is filled with CSF; the subarachnoid space directly connects via three brain foramen to the 4th ventricle of the brain where CSF forms

c. pia mater –thin, transparent covering of brain

2. Brain

a. Gross External features

i. Cerebrum divided in half by longitudinal cerebral fissure into the:

1. cerebral hemispheres –divided into lobes: frontal, parietal, occipital, temporal with two large fissures: Lateral (Sylvius) and Central (Rolando) sulci

-note other gyri and sulci

ii. Cerebellum –sulci and folia, right and left cerebellar hemispheres and the vermis

iii. Thalamus –hypothalmus, optic chiasma, infundibulum, pituitary gland

iv. Midbrain –superior and inferior colliculi, pineal gland, mammillary body

v. Pons

vi. Medulla oblongata

b. Sagittal Features of Brain

i. Distinguish features from above list

ii. Corpus callosum, intermediate mass, fornix, septum pellucidum, choroid plexus, arbor vitae, the 4 ventricles, and the cerebral aqueduct

c. Blood Supply

i. Circle of Willis, internal carotid artery vertebral arteries, posterior communicating, anterior communicating, basilar artery and posterior, middle and anterior cerebral arteries; see x-rays too

ii. Study Blood Supply from book

d. Cranial Nerves 12 know by name and number –from model and book diagrams

d. Orbit of eye and Eye

i. Review bones of eye socket

ii. Socket Anatomy and associated structures

1. Eyelids (palpebrae) –conjunctiva, eyelashes, medial and lateral angles (canthi), caruncle

2. Muscles

a. Orbicularis oculi -squinting, Facial nerve

b. Levator palpebrae superioris –raises upper eyelid, Occulomotor nerve

c. Superior rectus, inferior rectus, medial rectus, inferior oblique -move eyeball, Occulomotor nerve

d. Superior oblique –move eyeball, Trochlear nerve (note: trochlea)

e. Lateral rectus -move eyeball, Abducens nerve

3. Lacrimal Apparatus –lacrimal gland, lacrimal ducts, lacrimal punctum, nasolacrimal duct

4. Nerves in Socket:

V1 (ophthalmic n.) ( frontal n. ( lacrimal n., supraorbital n., and supratrochlear n.

Optic n. (CN II)

Occulomotor n. (CN III) –ciliary ganglion

Trochlear n. (CN IV)

Abducens (CN VI)

5. Eye

a. Sclera - cornea

b. Iris - ciliary body, choroid, lens, suspensory ligaments, anterior and posterior chambers of anterior segment, posterior segment with vitreous humor (body), pupil

c. Retina- optic nerve

d. Agueous and Vitreous humor

e. Temporal Region and Ear

i. Landmarks: Temporal bone: mastoid process, styloid process, squamosal portion, external acoustic meatus, zygomatic arch, mandibular foss and ramus, stylomastoid foramen

ii. See muscles dissected previously

iii. Parotid gland and duct, facial nerve plexus in parotid

iv. Ear

1. Outer ear: pinna, auditory canal, tympanum

2. Middle ear: ear ossicles (malleus, incus and stapes), tensor tympanii and stapedial muscles, Eustachian (auditory or pharyngotympanic) tube, round and oval window, chorda tympanii (branch of facial n. sensory to taste buds on tongue and parasym. Innervations to sublingual and submandibular glands), Vestibulocochlear nerve –model or diagrams only

3. Inner Ear: cochlea, semicircular canals, vestibule

f. Infratemporal fossa -on one side saw through zygomatic arch

i. Trace maxillary artery branches: middle meningeal a., infraorbital a., and sphenopalatine a.

ii. Identify the lateral and medial pterygoid mm.

g. Oral Cavity and Pharynx

i. Lips and red margin, gingiva, vestibule, labial frenulum

ii. Maxilla –hard palate, teeth (incisor, canine, bicuspids, tricuspids)

iii. Mandible

iv. Tongue –Papilla (fungiform, filiform, vallate), lingual frenulum, lingual tonsil, apex, root

v. Palatoglossal arch, soft palate, uvula, palantine tonsils

vi. Pharynx, (oropharynx, nasopharynx, laryngeal-pharynx)

vii. Nasal cavity: conchae, Eustachian tube, adenoids

4. Abdomen

a. Bony Landmarks and Surface Anatomy

i. Xiphoid process

ii. Costal margin

iii. Pubic symphysis (marks L1 dermatome) and tubercle, and the anterior iliac spine the inguinal ligament connects the pubic tubercle and anterior iliac spine

iv. Abdominal regions (9) and quadrants (4)

v. Umbilicus (marks level of T10 dermatome)

b. Muscles (innervation, blood supply, AOI)

i. External and Internal Oblique –compresses and supports viscera

ii. Rectus abdominis and linea alba –flexes trunk

iii. Transversus abdominis (aponeurosis of IO and TA join to form conjoint tendon in inguinal region) -compresses and supports viscera

iv. Epigastric A&V

c. Peritoneal Cavity

i. Mesenteries

1. Peritoneum

2. Falciform ligament and ligamentum teres

3. Lesser omentum (hepatogastric and hepatodoudenal ligaments)

4. Omental bursa and epiploic (omental) foramen

5. Greater Omentum

a. gastrosplenic ligament

b. gastrophrenic ligament

c. gastrocolic ligament

6. Mesentery Proper

ii. Stomach

1. Fundus, body, antrum, and pylorus; open to find rugae

2. Greater and lesser curvatures

iii. Small Intestine –plicae circularis

1. Doudenum –major duodenal papilla (ampulla of Vater) and the sphinter of Oddi –these small structures from diagrams only)

2. Jejenum

3. Ileum

iv. Pancreas

1. Head, neck, body, tail

2. Pancreatic duct (diagram / model)

v. Liver

1. Right and left lobes (quadrate and caudate lobes)

2. Hepatic ducts

3. Common hepatic duct

vi. Gall Bladder – open to find rugae and stones if present

1. Cystic duct

2. Common bile duct, Hepatic artery proper, Hepatic portal vein all found in hepatodoudenal ligament

vii. Spleen

1. Hilum, red pulp, white pulp

viii. Large Intestine (Colon) –plica semilunaris, haustra, taenia coli, epiploic appendages

1. Cecum and vermiform appendix

a. mesoappendix

2. Ascending Colon

a. Right colic (hepatic) flexure

3. Transverse Colon

a. Transverse mesocolon

4. Descending Colon

a. Left colic (splenic) flexure and phrenicocolic ligament

5. Sigmoid Colon

a. sigmoid mesocolon

6. Teniae coli, haustra, and epiploic appendages

ix. Kidneys

1. Hilum, perirenal fat

a. capsule, cortex, medulla, renal columns, renal pyramids, major and minor calyx, renal pelvis, renal sinus, stones if present

2. Ureters

3. Renal A & V

x. Adrenal glands

xi. Abdominal Vessels

1. Abdominal aorta and Inferior Vena Cava (IVC)

2. Celiac artery

a. common hepatic trunk

b. left gastric a.

c. splenic a.

3. Superior Mesenteric artery

a. Intestinal A&V

b. Ileocolic a.

c. Middle and right colic a.

4. Inferior Mesenteric artery

a. Left colic a.

b. Sigmoidal a.

5. Gonadal A&V

6. Lumbar A&V

7. Common Iliac A&V

8. Internal and External Iliac A&V

9. Hepatic Portal Vein

a. Superior Mesenteric vein

b. Splenic vein

c. Inferior Mesenteric vein

d. Pancreaticodoudenal veins

e. Intestinal veins

f. Colic veins

5. Pelvis and Perineum

a. Bony Landmarks and Surface Anatomy and other important features.

i. Greater and lesser (true) pelvis, pelvic brim

ii. Formed by the os coxae, sacrum and coccyx

iii. Os coxae: pubis (pubic symphysis), ilium (iliac crest), and ischium (ischial tuberosity, ischial spine)

iv. Sacrum –sacral promontory, sacral canal, sacral foramina

v. Acetabulum, obturator foramen, pubic arch, lesser and greater sciatic arch (which form foramen when bounded by ligaments

vi. Understand differences in male vs. female bony pelvis

vii. Urogenital triangle borders: both ischial tuberosities and the pubic symphysis

viii. Anal triangle borders: ischial tuberosities and the coccyx

b. Vessels and Nerves

i. Common iliac A&V

ii. External Iliac A&V

iii. Internal iliac A&V

iv. Umbilical and Vesicular A&V

c. Viscera

i. Sigmoid colon, Rectum

ii. Ureters

iii. Urinary bladder

1. Trigone

2. Urethra (in male has three sections: prostatic, membranous, and penile)

iv. Female

1. External Genitalia

a. Mons pubis

b. Vulva

i. Labia majora

ii. Labia minora (vestibule is space between minora)

iii. Clitoris

iv. Prepuce of clitoris

v. Urethral and Vaginal openings

vi. Perineal body

c. Anus

d. Muscles –diagrams only

i. Ischiocavernosus

ii. Bulbospongiosus

iii. External anal sphincter

2. Ovary

a. Ovarian ligament

b. Suspensory ligament

c. Mesovarium (part of broad ligament)

d. Ovarian A&V

3. Fallopian tubes (oviducts or uterine tubes

a. Ampulla, infundibulum, fimbria, isthmus

b. Mesosalpinx (part of broad ligament)

4. Uterus

a. Fundus, body

b. Cervix with its Internal and External Os

c. Layers: perimetrium, myometrium, endometrium

d. Broad ligament (mesometrium segment)

e. Round ligament

f. Rectouterine pouch

g. Vesicouterine pouch

5. Vagina

a. Fornices (2 lateral, anterior and posterior)

b. Rugae, hymen

v. Male

1. External Genitalia

a. Penis

i. Glans penis, prepuce (foreskin) (frenulum if present), raphe

ii. Corpora cavernosa (base is crus)

iii. Corpus spongiosum

1. Bulb of penis (bulb and crus makes up root of penis)

iv. Penis septum

v. Penile urethra

b. Scrotum

i. Raphe and Dartos tunic and muscle

2. Testis

a. Tunica vaginalis (parietal and visceral layers)

b. Gubernaculum

3. Epididymis

a. Head, body, tail

4. Spermatic cord

a. Pampiniform plexus and Testicular artery

b. Ductus (Vas) deferens

c. Inguinal canal

5. Ductus Deferens

6. Seminal Vesicles

7. Prostate gland

a. Ejaculatory duct

8. Bulbourethral glands

6. Back and Spinal Cord

a. Bony Landmarks and Surface Anatomy

i. Review vertebrae anatomy

ii. Review Scapula

b. Muscles (note: thoraco-lumbar fascia and nuchal ligament)

i. Trapezius

ii. Latissimus dorsi

iii. Levator scapulae

iv. Rhomboid major

v. Rhomboid minor

vi. Splenius capitis

vii. Erector spinae

c. Misc.

i. Triangle of Ausculation

ii. Lumbar triangle

iii. Transverse Cervical a.

iv. Spinal Accessory n. (CN XI)

7. Lower Limb

a. Bony Landmarks and Surface Anatomy

i. Sacrum: sacral promontory, sacral hiatus, median sacral spine, sacral foramina, ala, pelvic face, coccyx

ii. Os coax: acetabulum, obturator foramen, pelvic cavity, pelvic inlet and outlet, pelvic brim, pubic symphysis, greater and lesser sciatic notch, arcuate line

1. Ilium: ala (wing), iliac crest, iliac spines (by anatomical position), iliac fossa

2. Ischium: ischial tuberosity, ramus, ischial spine

3. Pubis: ramus, pubic tubercle, pubic arch

iii. Femur: head, neck, greater and lesser trochanter, intertrochanteric crest, intertrochanteric line, gluteal tuberosity, linea aspera, medial and lateral condyles, medial and lateral epicondyles, intercondylar fossa

iv. Patella

v. Tibia: medial and lateral condyles, intercondylar eminence, tibial tuberosity, medial malleolus, fibular notch, Gerdy’s tubercle

vi. Fibula: head, neck, lateral malleolus

vii. Foot: Tarsals (calcaneus, talus, cuboid, cuneiforms (3), navicular), meatarsals, phalanges

viii. Femoral Triangle –borders are the sartorius, adductor longus and inguinal ligament; contains femoral A&V and nerve

b. Hip

i. Muscles and Nerves

1. Gluteus maximus

ii. Joint

1. Iliofemoral ligament

2. Ischiofemoral ligament

3. Pubofemoral ligament

4. Ligamentum teres

iii. Vessels, Nerves, Lymph

1. Sciatic nerve

2. Femoral nerve

3. External Iliac A&V

4. Femoral A&V

5. Inguinal lymph nodes

c. Femoral (thigh)

i. Muscles

1. Sartorius

2. Gracilis

3. Quadriceps femoris

a. Vastus lateralis

b. Vastus medialis

c. Rectus femoris

d. Vastus internus (intermedius)

4. Tensor fascia latae (tendon becomes iliotibial tract)

5. Adductor longus

6. Adductor magnus (note: Adductor hiatus)

7. Hamstring muscles:

a. Biceps femoris

b. Semitendinosus

c. Semimembranosus

ii. Vessels and Nerves

1. Femoral A&V

2. Popliteal A&V (note: popliteal fossa)

3. Great Saphenous V.

4. Femoral nerve

5. Saphenous nerve

d. Knee

i. Quadriceps tendon

ii. Patella

iii. Patellar ligament

iv. Lateral (fibular) collateral ligament

v. Medial (tibial) collateral ligament

vi. Anterior cruciate ligament (ACL)

vii. Posterior cruciate ligament (PCL)

viii. Medial and lateral menisci

e. Crural (lower foreleg)

i. Muscles (note: extensor retinaculum)

1. Gastrocnemius

2. Soleus

3. Flexor digitorum longus

4. Flexor hallicus longus

5. Tibialis anterior

6. Extensor digitorum longus

7. Fibularis (Peroneus) longus

ii. Vessels and Nerves

1. Anterior and Posterior Tibial A&V

2. Fibular A&V

3. Tibial nerve

4. Common peroneal (fibular) nerve

f. Pedal (Foot)

8. Upper Limb and Girdle

a. Bony Landmarks and Surface Anatomy

i. Scapula –acromion, spine, coracoid, glenoid cavity, subscapularis fossa, supraspinatus fossa, infraspinatus fossa

ii. Humerus –head, neck, surgical neck, greater and lesser tubercle, trochlea, capitulum, olecranon fossa

iii. Radius –radial tuberosity, head, styloid process

iv. Ulna –olecranon process, coronoid process, trochlear notch, styloid process

v. Hand –carpals (Scaphoid (navicular), Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate), metacarpals, phalanx

vi. Brachium, antebrachium, cubital fossa, olecranon

b. Shoulder

i. Muscles

1. Deltoid

2. Supraspinatus

3. Infraspinatus

4. Subscapularis

5. Teres minor

6. Teres major

ii. Joint

1. Rotator cuff –know parts of

2. Biceps brachii tendons

iii. Vessels, Nerves and Lymph

1. Axillary A&V

2. Subscapular A.

3. Basilic V. –diagram or model

4. Cephalic V. –diagram or model

5. Musculocutaneous nerve

6. Radial nerve

7. Median nerve

8. Ulnar nerve

9. Axillary lymph nodes

c. Brachium

i. Muscles

1. Biceps brachii (short and long heads)

2. Brachialis

3. Triceps Brachii (long, lateral and medial heads)

ii. Vessels

1. Brachial A&V

2. Median cubital vein -diagram

d. Antebrachium

i. Muscles

1. Flexors

a. Flexor carpi radialis

b. Palmaris longus

c. Flexor carpi ulnaris

d. Pronator teres

e. Flexor retinaculum

2. Extensors

a. Brachioradialis

b. Extensor carpi radialis longus

c. Extensor carpi radialis brevis

d. Extensor digitorum

e. Extensor carpi ulnaris

f. Extensor retinaculum

e. Hand

i. Thenar and lumbricals muscles, carpal tunnel

Lab 1. Back Dissection

Review the following bony structures: (prior to lab)

Mastoid Process

Occipital bone: External Occipital Protuberance

Scapula: scapular spine, acromion, coracoid, margins, angles, notch, fossae

Cervical Vertebrae:

Centrum, spinous process, transverse process, transverse foramen, spinal foramen, lamina, pedicle

Thoracic vertebrae: spinous process, transverse process, spinal foramen, lamina, pedicle, rib facets

Lumbar vertebrae: spinous process, transverse process, spinal foramen, lamina, pedicle

Sacrum: sacral spine, promontory, sacral foramina, sacral hiatus, sacral ridges

1. Place cadaver prone (face down)

2. Locate the following structures through the skin: External occipital protuberance (ECP), spinous processes, acromion, medial margin of scapula, scapular spine, iliac crests, sacrum, mastoid, midaxillary line, and midline

3. Make the following incisions: (Note: incisions should cut through the skin and superficial fascia only, leaving the deep fascia and muscle untouched)

• Cut from the ECP to the sacrum along the midline.

• Cut horizontally along occipital to the mastoid

• Cut horizontally between the two acromions

• Cut horizontally along bottom of rib cage near T6, T7, or L1

• Cut along iliac crest from midline

All incisions should proceed laterally to the midaxillary plane.

DO NOT REMOVE THE SKIN. Leave attached at the midaxillary line.

4. Reflect each skin section back starting at the lower midline corner and reflecting it laterally and superiorly. Use a hemostat to grasp the skin, (later a button hole can be cut to assist in gripping the skin). Look for neurovascular bundles that course between the deep fascia and the superficial fascia. These will need to be cut as you retract the skin. The bundles pass segmentally through fovea close to the midline in the thoracic region and more laterally in the lumbar region.

5. Identify and clean (remove fascia and separate muscles with blunt dissection) the following superficial structures:

-Nuchal ligament

-Thoracolumbar fascia

-Trapezius –orignates on occipital bone, nuchal ligament, and C7-T12 and inserts on lateral clavicle, acromion and scapular spine. It elevates, retracts, depresses and rotates scapula.

-Lattissimus dorsi –originates from T7-sacrum via the thoracolumbar fascia, iliac crest, inferior three ribs and inserts on the intertubercular groove of humerus. Extends, adducts and medially rotates humerus, or raises body toward the arms in climbing.

-Triangle of Auscultation –bounded by medial border of scapula, trapezius and lattissimus mm., area where it is easiest to hear breath sounds.

-Lumbar Triangle –bounded by lattissimus, ext. oblique mm. and iliac crest, area where pus may drain from abdominal wall.

6. ON ONE SIDE ONLY. Starting at the inferior site of attachment of the trapezius, detach and reflect the trapezius from its origin. Being careful not to cut the deeper muscles, also free the trapezius from the scapular spine and reflect the muscle laterally. Note: the spinal accessory n. (CN XI) and the transverse cervical a. on the underside of the trapezius m.

7. ON ONE SIDE ONLY. Detach the lattissmus dorsi m. from its origins in an inferior direction. Cut the muscle horizontally parallel to the iliac crest.

8. Identify and clean: Rhomboid major and minor, Splenius capitis, Levator scapulae, and Erector Spinae, Infrspinatus, Teres major and minor, Suprsspinatus mm.

9. Put holes in the skin flaps near medial border and thread string through holes to tie skin flaps in place. HYDRATE the dissection thoroughly and tie skin flaps back in place. Close cadaver tanks.

10. Clean work area, clean dissection tools and put in correct containers, Clean any spills on floor and drain and empty tank bucket. Clean of front of apron with damp paper towels and hang up apron.

11. Wash Hands.

Lab 1 List of structures in this lab.

Mastoid Process

Occipital bone: External Occipital Protuberance

Scapula: scapular spine, acromion, coracoid, margins, angles, notch, fossae

Cervical Vertebrae:

Centrum, spinous process, transverse process, transverse foramen, spinal foramen, lamina, pedicle

Thoracic vertebrae: spinous process, transverse process, spinal foramen, lamina, pedicle, rib facets

Lumbar vertebrae: spinous process, transverse process, spinal foramen, lamina, pedicle

Sacrum: sacral spine, promontory, sacral foramina, sacral hiatus, sacral ridges

Muscles:

Trapezius, Lattissimus dorsi, Rhomboid major, Rhomboid minor, Splenius capitis, Levator scapulae, Errector spinae, Supraspinatus, Infraspinatus, Teres major and minor

Other Structures:

Triangle of Auscultation, Lumbar triangle, Spinal accessory n., transverse cervical a., nuchal ligament, thoracolumbar fascia

Lab 2. Anterior Chest

Review the following structures prior to lab:

Sternum: Jugular notch, manubrium, sternum body, sternal angle, xiphoid process.

Ribs: Head, neck, tubercle, body, costal groove, costal cartilage, angle, demi-facets, number and types

Scapula: acromion, coracoid process, fossae, glenoid cavity

Clavicle: sternal end and acromial end

1. Place cadaver supine (face up).

2. Wipe down skin surface with paper toweling.

3. If you have a female cadaver, make a sagittal incision through the nipple and continue through the entire breast. Identify the nipple, areola, lactiferous ducts, and suspensory ligaments. Note the retro mammary space where you just separated the breast from the body.

4. Make a midline incision from the jugular notch to the xiphoid process.

5. Make a horizontal incision paralleling the clavicle.

6. Make an incision around the base of each arm from the axilla to the distal portion of the deltoid m.

7. Grip the lower section of skin at the midline and retract the skin laterally and superiorly. Look for neurovascular bundles.

8. Clean and identify the following structures separating them from surrounding CT.

-Pectoralis major m. –has clavicular and sternal heads, adducts arm

-Deltoid m.

-Deltopectoral triangle –contains cephalic v.

9. Free Pect. Major from underlying structures with your fingers, detach the muscle from its origins (the sternum and clavicle) and reflect laterally. Watch for the pectoral nerves near the arm.

10. Reflect the Pect. Minor m. laterally by cutting it from its origins.

11. Identify the External and Internal intercostal mm. (best seen in the upper intercostals spaces.

12. Reflect laterally the heads of the Serratus anterior.

13. Identify the origins of the Rectus abdominus m. on the chest. Detach them from their point of origin and reflect to the abdomen.

14. Cut a window through the 1st intercostal space just lateral to the sternum; identify and transect the internal thoracic vessels.

15. Using a marker pencil, mark the following structures: a spot on the manubrium just superior to the sternal angle and at the same level as the internal thoracic vessel transect, the 1st intercostals space inferior to the 1st rib, the midaxillary line until the 8thth intercostal space, along the superior border of the 8th intercostal space, and the sternoxiphoid joint. Using the bone saw or bone forceps, cut the sternum and ribs being sure not to go too deep. (One must avoid cutting through the parietal pleura.)

16. Use a scalpel to cut through the intercostal muscles between the bone incisions.

17. Lift the rib cage, using your fingers to separate the endothoracic fascia located between the internal intercostals and the parietal pleura. (note: it may be impossible to lift the rib cage without tearing the parietal pleura, especially if adhesions are present.)

18. Examine the internal surface of the removed anterior chest wall. Identify and isolate the internal thoracic vessels on both sides of the sternum.

19. Identify the rectus thoracis mm.

20. On the cut ends of the rib cage, identify the External, Internal and Innermost intercostal mm. Also identify the Intercostal a. v. and n. running along the costal groove.

Lab 2. List of structures seen in this lab.

Sternum: Jugular notch, manubrium, sternum body, sternal angle, xiphoid process.

Ribs: Head, neck, tubercle, body, costal groove, costal cartilage, angle, demi-facets, number and types

Scapula: acromion, coracoid process, fossae, glenoid cavity

Clavicle: sternal end and acromial end

Muscles: Pectoralis major and minor, Serratus anterior, External intercostals, Internal intercostals, Innermost intercostals, Rectus Thoracis

Pectoral n., Intercostal spaces, a., v, and n., Internal thoracic vessels, nipple, areola, lactiferous ducts, suspensory ligaments, and the retro-mammary space

Lab 3. Pleural Cavity

1. Identify the parietal and visceral pleura, and pleural cavities. Free margins of lungs from wall if adhered. Identify the mediastinum containing the pericardial cavity.

2. Identify the pleura recesses along inferior border of each lung. (costomediastinal and costodiaphragmatic recesses). Cut through the parietal pleura if not already torn to expose each lung.

3. Identify and isolate the right and left phrenic nn. (The left phrenic courses from the left subclavian a. and v., across the aortic arch and over the root of the lung adhered to the pericardium on its way to the diaphragm; the right is located lateral to the IVC proceeding over the root of the lung on to the diaphragm). Do Not Cut either phrenic n.

4. Remove each lung. First, expose the root of each lung by using your hand to pull the each lung laterally. Then use a scalpel to cut the root of the lung being careful not to cut the heart or your hand. (Lung adhesions may have to be cut to free the lung either with your hand or a scissors.)

5. Identify the following structures on each lung:

Hilum, Apex, Pulmonary ligament (a double membrane of the parietal pleura hanging inferiorly from the hilum), Primary Bronchi, Pulmonary a., Pulmonary v., Bronchopulmonary lymph nodes, Cardiac impression, Aortic impression on Left side and Esophageal Impression on right side, Superior and Inferior lobes, horizontal fissure, (Middle lobe on Right lung and Oblique fissure), on left lung the Cardiac notch and Lingula.

6. Mediastinum. The superior mediastinum contains the Thymus gland (which is usually visible only in children) and the Great Vessels of the Heart: Identify SVC, Aorta, and Pulmonary trunk. Identify the Ligamentum arteriosum found at the bifurcation of the Pulmonary trunk into right and left Pulmonary aa. And attached to the underside of the aortic arch. Identify the Left Vagus n. which runs immediately lateral to the Ligamentum arteriosum. The left vagus runs over the aortic arch and continues posteriorly to the root of the lung, find the left recurrent laryngeal n. which branches from the vagus next to the lig. arteriosum, loops around the aortic arch and heads upwards to the larynx. The right vagus running along the right brachiocephalic v.

7. Cut open the pericardial sac by incising it from the superior to the apex and folding it back and cutting horizontally near the great vessels. Identify the visceral pericardium (epicardium) and the fibrous and serous sides of the parietal pericardium (pericardial sac).

8. Identify the Transverse Pericardial Sinus by pushing your right index finger beneath the pulmonary trunk and ascending aorta. Likewise demonstrate the Oblique pericardial sinus, by placing your fingers under the heart and push anteriorly under the aorta into a space between the Pulmonary vv. and the IVC.

Lab 3. List of structures seen.

Pleural cavities with parietal and visceral pleura.

Mediastinum

Pericardial cavity with parietal (pericardial sac, pericardium) and visceral pericardium (epicardium).

Pleural Recesses: costomediastinal and costodiaphragmatic recesses.

Phrenic n., Vagus n., Recurrent Laryngeal n.

Root of the Lung

Lung: Hilum, Apex, Pulmonary ligament (a double membrane of the parietal pleura hanging inferiorly from the hilum), Primary Bronchi, Pulmonary a., Pulmonary v., Bronchopulmonary lymph nodes, Cardiac impression, Aortic impression on Left side and Esophageal Impression on right side, Superior and Inferior lobes, horizontal fissure, (Middle lobe on Right lung and Oblique fissure), on left lung the Cardiac notch and Lingula

SVC and IVC, Ascending aorta, Aortic arch, Descending aorta, Brachiocephalic v., Subclavian a. and v., Ligamentum arteriosum, Pulmonary trunk, Transverse Pericardial Sinus, Oblique Pericardial Sinus

Lab 4. Heart and Middle Mediastinum

Review the structures of the heart and great vessels supplying the heart.

Understand the arrangement of the mediastinal cavities.

1. With a scalpel, transect the great vessels of the heart.

a. Pulmonary Trunk and Ascending aorta –cut at the level of the transverse pericardial sinus

b. SVC –cut about 2cm above its junction with the RA

c. IVC –cut it as inferiorly as possible

d. Pulmonary vv. –lift the heart by the apex to stretch these vessels and transect each one (try to leave a short length attached to the heart.)

2. Use blunt dissection to remove the CT from the pericardial sac. Observe the cavities present in the superior aspect of the pericardial sac (the transverse pericardial and oblique sinuses.)

3. Inspect the surface of the heart and identify the following:

a. Anterior and posterior surfaces

b. SVC, IVC, Ascending Aorta, Pulmonary trunk, Pulmonary vv.

c. Coronary sulcus, Ant. & Post. Interventricular sulci (grooves)

d. Apex, epicardium

e. Auricles

4. Identify and isolate the following Coronary aa. & vv.:

a. Right coronary a. –arises from Asc. Aorta just superior to right cusp of the aortic valve.

i. R. Acute Mariginal a. –supplies lateral right ventricle

ii. Post. Interventricular a. (right posterior descending a.) –descends in the posterior interventricular sulcus

b. Left Coronary a. –arises from Asc. Aorta just sup. to left aortic cusp, and divides at the left atrium into:

i. Ant. Interventricular a. (left anterior descending a. (LAD)) –glides down ant. interventricular sulcus

ii. Circumflex a. –runs through coronary sulcus and gives off left marginal aa.

c. Cardiac vv.

i. Coronary sinus –large venous sinus that collects blood from all the cardiac veins except the anterior vv. (these flow directly into the RA) and drain into RA

ii. Middle cardiac v. –flows along post. Interventricular a.

iii. Small cardiac v. –flows along the right margin of the r. ventricle

iv. Great cardiac v. –large vein which ascends with LAD

NOTE: Often two of the above veins parallel the corresponding aa.

5. RA: Starting at the junction of the SVC make a square flap incision. Cut from the SVC to the ant. sup. border of the auricle, then along the inferior border of the auricle to the ant. inf. border, then upwards to the posterior upper edge of the atrium. Use forceps to remove preserved blood and rinse with water.

a. Find the following: Fossa ovalis (remnant of foramen ovale in fetus), Coronary sinus opening, Tricuspid valve, auricle, pectinate mm., interatrial septum, sites for SA and AV nodes

6. RV: Push a blunt instrument through the pulmonary trunk and lodge it into the right ventricle. Make an incision like an upside down “U” in the outer ventricular wall starting near the r. marginal artery and parallel to the coronary sulcus, turning at the pulmonary trunk and paralleling the inventricular sulcus ending near the apex. Open the flap inferiorly and clean the ventricle out.

a. Identify the following: Trabeculae carnae, papillary mm., chordate tendinae, tricuspid valve (cusps), conus arteriosus, pulmonary valve, moderator band, endocardium, myocardium, epicardium. Note: thinness of outer ventricular wall

7. LA: Make an inverted “U” shape flap in the LA between the pulmonary vv. Clean out the chamber.

a. Identify the bicuspid valve, auricle, pectinate mm., pulmonary vv. openings

8. LV: Make an incision from the superior margin parallel to the coronary sulcus and then paralleling the LAD curving laterally near the apex. Fold back the flap and clean out the ventricle.

a. Identify the following: Bicuspid (Mitral) valve, papillary mm., chordae tendinae, trabeculae carnae, interventricular septum, aortic valve. Note: thickness of outer ventricular wall.

Lab 4. List of structures:

Mediastinum –cavity between the two pleural cavities (anterior, middle, and posterior)

ii. Middle mediastinum –contains the heart with its ensheathing pericardium and the roots of the great vessels

iii. Pericardium and Pericardial Sinus (Cavity) –parietal and visceral layers

1. Heart –before removing heart note the following: ascending aorta, superior vena cava, left vagus nerve and the recurrent laryngeal nerve, ligamentum arteriosum, pulmonary trunk, inferior vena cava, pulmonary veins

a. External heart anatomy: right ventricle, right atrium, left ventricle, left atrium, apex, coronary sulcus, interventricular sulcus, auricles

b. Coronary Circulation:

Left Coronary artery: Left anterior descending (LAD) artery and the Circumflex artery, Left marginal a.

Right Coronary artery: Right marginal artery and the Posterior Descending artery

Coronary Veins: Small cardiac vein, Middle cardiac (posterior interventricular) vein, Great cardiac (anterior interventricular) vein, coronary sinus

c. Internal heart anatomy: layers: epicardium (visceral pericardium), myocardium and endocardium

Right atrium: Pectinate muscles, fossa ovalis, right auricle, interatrial septum, and openings of SVC, IVC and coronary sinus.

Right atrioventricular (AV) valve (tricuspid) – 3 cusps, chordae tendinae connecting to papillary muscles in ventricle,

Right ventricle: papillary muscles, moderator band, trabecula carnae, interventicular septum, pulmonary semilunar valve (3 cusps) opening of pulmonary trunk

Left atrium: pectinate muscles, auricle, openings for the pulmonary veins

Left AV valve (bicsupid or mitral) –2 cusps, chordae tendinae

Left ventricle: trabecula carnae, papillary muscles. (Note thicker wall of this ventricle.) opening for aorta, aortic semilunar valves cusps, (In ascending aorta, aortic sinus and openings for right and left coronary arteries

Lab 5. Mediastina

Mediastina: Superior, anterior, middle, and posterior

Vessels: Aortic arch: Brachiocephalic a., Left common carotid a., and Left subclavian a.

Descending aorta: Intercostal aa., (esophageal and bronchial aa. will not be dissected)

SVC: Azygous v., Hemiazygous v., Intercostal vv., Brachiocephalic v.

Thoracic Sympathetic trunk, Vagus nn., intercostals nn., trachea, tracheal carina, primary bronchi, esophagus, thoracic duct, centrums of T5-12

1. With the heart and lungs removed, remove the posterior aspect of the pericardium (leave the pericardium attached to the diaphragm.

2. Identify the following in the Posterior Mediastinum: Esophagus with its attached esophageal nerve plexus), Descending aorta (thoracic aorta), R & L Vagus nn, Left recurrent laryngeal n., Trachea, tracheal rings, carina, Primary bronchi

3. Identify and isolate first tributaries of SVC

a. Azygous v. –arches over right primary bronchi to drain most of thoracic wall

b. Hemiazygous v. –found posterior to aorta, drains most of left thoracic wall into azygous v. (highly variable)

4. Identify the Thoracic Duct, the largest lymphatic vessel of the body, found posterior to esophagus and to the right of the aorta.

5. Peel the endothoracic fascia and parietal pleura form the posterior rib cage. Just lateral to the azgous find the Thoracic sympathetic nerve trunks. Find the same structure on the left side.

6. Isolate and identify the following vessels in the Superior Mediastinum:

a. Brachiocephalic vv. merging to form SVC

b. Aortic Arch

i. Brachiocephalic Trunk –bifurcates to form r. common carotid and r. subclavian aa.

ii. Left common carotid a.

iii. Left subclavian a.

Lab 6. Neck

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download