DEFINITION: Anatomy is the science of structure and function of the body anatome = ana (up) + tome (cutting) BASIC ANATOMY : is the study of the minimal amount of anatomy consistent with the understanding of the overall structure and function of the body CLINICAL ANATOMY : is the study of the macroscopic structure and function of the body as it relates to the practice of medicine and other health sciencesAPPROACH TO THE STUDY OF GROSS ANATOMY e Regional anatomy ° Systemic anatomyORGANIZATION OF THE HUMAN BODY © Cells are the smallest living unit of body A tissue is a grouping of like cells working together. e An organ isa structure composed of several different tissues performing a particular function. Systems are groups of organs which together perform an overall function.HUMAN ANATOMICAL TERMS Make up a distinct nomenclature to describe: e Areas of the body © To provide orientation when describing parts of human anatomy © To distinguish different movements of the body.° Body erect © Head, eyes, toes directed forward ° Limbs at sides of body ° Palms directed forwardANATOMICAL POSITION e When the body is lying face down in the anatomical position, this is called the prone position. © When the body is lying face up, this is called the supine position."ANATOMICAL PLANES e Median Sagittal/Median plane e Para Median /Sagittal ° Frontal (coronal) © Horizontal (transverse)MEDIAN PLANE ® Vertical plane, passing through the center of body, dividing it into two equal halves right and left— PARAMEDIAN PLANE Sagittal plane © Vertical, parallel to median plane© Vertical, perpendicular to median plane © separates the body into Anterior and Posterior parts¢ Parallel to floor, perpendicular to median & coronal plane ° Separates the body into Superior and Inferior parts~ ANATOMICAL TERMS RELATED TO POSITION a VENTRAL/ANTERIOR(palmar)......... DORSAL/POSTERIOR CEPHALIC/SUPERIOR....... CAUDAL/INFERIOR(planter) UPPER LOWER MIDDLE/MEDIUS/INTERMEDIATE SUPERFICIAL....... DEEP PROXIMAL......DISTAL IPSILATERAL...... CONTRALATERAL EXTERNAL. ‘INTERNAL MEDIAL (ulnar/tibial)......... LATERAL(radial/fibular)° Anterior (ventral) closer to the anterior surface of the body Thoracic cavity © Posterior (dorsal) Vora | Dap closer to the posterior cavty surface of the body ° reference point -- ee frontal or coronal plane Pelvic cavity Body Cavity—Lateral ViewEsophagus Trachea tung spina! Reed sternum seat Heart column Biaptragm Liver Kidey- Galtbiadaer Stomach . Transverse Aseetoa coun Coils of ‘Small intestine RectumSUPERIOR/INFERIOR e Superior (closer to the head) © Inferior (closer to the feet) © reference point -- horizontal plane Axial skeleton (blue) Appendicular ‘skeleton (pink)e Reference point is surface of body- SS — PROXIMAL/DISTAL IPSILATERAL/ CONTRA LATERAL © Proximal closer to root of limbs Distal further away from the root of limbs Reference point -- the origin of a structureEXTERNAL/INTERNAL °refers to a hollow structure (external being soni outside and internal being inside) intercostalMEDIAL/LATERALa Movements of trunk in sagittal plane: © FLEXION (bending anteriorly)......EXTENSION (straightening posteriorly) e PLANTER FLEXION DORSIFLEXION Movements of trunk in coronal plane: ° ADDUCTION (Towards the median plane).....ABDUCTION e LATERAL FLEXION Movements of f body around its long axis: © MEDIAL ROTATION (Anterior surface of part facing medially)...... LATERAL ROTATIONof shoulder joint ‘of knee jointABDUCTION & ADDUCTIONof shoulder jointaa = — TERMS RELATED TO MOVEMENT © PRONATION (medial rotation of forearm).....S5UPINATION ° CIRCUMDUCTION (Flexion/extention/abduction/ adduction) ° INVERSION (Sole faces medially) ....... EVERSION © PROTRACTION (To move forward)..... RETRACTION * PROTRUSION....... RETRACTION « DEPRESSION........ELEVATION‘supination of forearm, ronation of forearmTHANK YOUORGAN SYSTEMS OF HUMAN BODYIntroduction Cell- Basic structural and functional unit of a living organisms. ee Cats amt YS ian Tissues tom organs BES Organs tri organ systems Att, Organ SystemsTypes of Organ Systems ® Digestive system ® Respiratory system © Circulatory system ® Skeletal system ® Muscular system ® Excretory system ® Nervous system © Reproductive systemAnatomy of the Digestive System Organs Digestive system The food passes through a continuous canal which is divided into various compart ments.[Link] cavity We chew the food with the teeth and break down mechanically into small pieces 2. Foodpipe or Oesophagus © The swallowed food passes into the ~~ foodpipe. ® Food is pushed down by movement of wall of the foodpipe.[Link] ai © It receives food from the foodpipe | at one end and opens into small intestine at the other. 4-Small intestine © It receives secretions from the liver and the pancreas. © The largest gland of the body that is liver secretes bile juice which helps in digestion of fats.[Link] Intestine © It absorbs water and some salts berm from the undigested food [Link] remaining waste sto caning passes into the rectum and remain: - there as semi-solid faeces. [Link] s att © The faeced matter is removed on through the Anus from time to ween time.Respiratory System The LungsThe Circulatory System Transportation system by which oxygen and nutrients reach the body's cells, and waste materials are carried away.The Heart © Size of your fist © Thick muscular walls ® Divided into two pumps © Each pump has two chambers © Upper chamber - atrium receives blood coming in from the veins © Lower chamber - ventricle squeezes blood out into the arteriesSuperior vena cava Pulmonary valve Right atrium Tricuspid valve Right ventricule Aorta Pulmonary artery Left atrium Aortic valve Bicuspid valve Left ventricle interventricular septumBlood © Pumped by your heart. © Travels through thousands of miles of blood vessels © Carries nutrients, water, oxygen and waste products to and from your body cells. © Made up of liquids, solids and small amounts of oxygen and carbon dioxide.Blood © Red blood cells carry oxygen from the lungs to all the cells of the body. © Takes carbon dioxide and transports it back to the lungs © About 5,000,000 Red Blood Cells in ONE drop of blood. © White blood cells protect the body from germs © Attack and destroy germs when they enter the bodyBlood Vessels Binoe Bomanely © Hollow tubes that circulate your blood ao of © There are three kinds of nutrients and _ blood vessels: Arteries, other Veins and Capillaries. materials Blood to vein3 Kinds of Circulation: ® Pulmonary circulation © Coronary circulation © Systemic circulationMovement of blood from the heart, to the lungs, and back to the heart againCoronary Circulation Movement of blood through the tissues of the heartSystemic Circulation Supplies nourishment to all of the tissue located throughout the body , except for the heart and lungsThe Skeletal System*The skeleton is a rigid structure of bones which provides an anchor for the muscles ,skin and protects vital organs. wITHOUT N | SKELETON LBB,The human body has 206 bones as a adult ,;when you are born you have 300 bones. Over 230 moveable and semi-moveable joints in your body. Bones are connected to each other by ligaments. Organs are protected by the skeleton. The brain is protected by skull The heart, liver and lungs are protected by the rib and sternum.The skull © The skull or cranium is a protective cover of the brain ,and provides a structure for the face or head. © The skull consists of 28 bones or vertebrae. © The skull is made of many bones that are closely fitted together.Arms ‘The arms consists of 3 main bones and 15 other little ones.The Spine * The spine has 33 vertebrae, the spine is not straight the skeleton forms an s- shape. There are 3 main parts of the spine ,they are the cervical, thoracic and the lumbar. «In the centre of the spine is the spinal cord.Distal phalanges *There are 27 bones and 5 fingers in each hand. Seen Roy miei Ruy armory Coy (oyna a Ure doles snl on Renton erie 1p) (a thanks to the saddle joint.What are bones made of? * Bones are made of calcium, mineral salt, cells and living parts your body. * They are also made of stringlike material called the collagen. » Bones have a red and yellow tube called the marrow. * The marrow is a tube that makes red blood cells to replace the destroyed and worn out ones. * The marrow also stores fat and sugar. * An average of 2.6 million red blood cells are made every second by the marrow. * The outer layer is called hard bone, the spongy bone is a honeycomb of bones cells with spaces between them.*The ribs, the spine and the sternum combine to make up the ribcage. The RibcageLegs *The human leg consists of 8 bones, 4 per leg. Femur »The femur bone Patella >The tibia bone ens a >The fibula bone Fibula >The patella boneWhat are the possible diseases? re teeWhat’s the strongest bone? Eemur bone: » Longest and largest bone provide stability and strength Cd »solid bone i DT eh ¥Most sensitive bones © Hips © Shoulders © Spine © Thighs © Sternum © SkullSUITED icoFunctions of the Muscles © Movement © Maintenance of postures and muscles © Heat production © Protect the bones and internal organseg muscles Vv Vv Vv Cardiac Smooth NS) collared muscle muscle muscle |Cardiac Muscle © Found ONLY in the heart. © Contractions of the heart muscles pump blood throughout the body and account for the heartbeat. ® Healthy cardiac muscle NEVER fatigue.Frontal plane coh test Arch of aorta Bachman's bundle Sinoatrial %, Sey sae if Left atrium Anterior intemadal Atrioventricular jo =n (AV) node ~ Atrioventricular (AV) Middl ternodal bundle (bundle of His) Posterior intemodal i Right atrium \ \ a Loft ventricle Right ventricle Right and left bundle | branches Purkinje fibers Anterior view of frontal sectionSmooth Muscle © They fatigue..But very slowly. © Helps in circulation of the blood. © Lining of blood vessels. © Controls digestion. © Controls breathing.Skeletal Muscles © Attached to skeleton by tendons. © Causes movement of bones at the joints. © They also do fatigue. © Can be moved at will-Voluntarily. © Fibers are long and cylindrical.Neck muscles held the head up and move it Shoulder muscles raise and lower the arms. Ties straighten the arm. Biceps bend the arm. Abdominal muscles move the torso and help with breathing. Thigh muscles move the lower leg. Colf muscles pull the heel up and point the toes. Shin muscles help move the fost up and down and side to side.HUMAN EXCRETORY SYSTEM Excretory system© The process by which the unwanted substances and metabolic wastes are eliminated from the body. © Various systems in the body are involved ® Digestive system excretes food residues in the from of feces. © Some bacteria and toxic substances also are excreted through feces.© Lungs remove carbon dioxide and water vapor. © Skin excretes water, salts, and some wastes, It also remove heat from the body. © Liver excretes many substances like bile pigments, heavy metals, drugs, toxins, bacteria etc though bile.© Although various organs are involved in removal of wastes from the body, their excretory capacity is limited. © The renal system or urinary system is the one having maximum capacity of excretory function and so, it plays the major role.Process of urinary system © Kidneys produce the urine. © Ureters transports the urine to urinary bladder. © Urinary bladder stores the urine until it is voided © Urine is voided from bladder through urethra.RINAL SYSTEM OR URINARY SYSTEMRenal System © Renal system includes: © 1) pair of kidneys © 2) urethras © 3) urinary bladder © 4) urethra © Skin, liver, lung, large intestine are also part of excretory system.SKIN © SKIN useful to maintain body temperature. © Excess heat is lost from the body through skin by radiation, conduction. Sweat glands of the skin play active part in heat loss by secreting sweat. © Skin can excrete small quantities of wast material.Composition of the Blood 1) Plasma 2) The Formed Elements (blood cells/cell fragments)Whole Blood - Fraction of body weight 8% ~ Volume Female: 4-5 L Male: 5-6 L - temperature 38° C (100.4° F) - pH 7.35 - 7.45 - Viscosity (relative to water) Whole blood: 4.5-5.5 plasma: 2.0 -QOsmolarity 280-300 mOsm/L - ia _ ™ an a 0.85%Hematocrit RBCs as percent of total blood volume 100% - Female: 37%-48% - male: 45%-52%General Properties of Whole Blood (continued) Hemoglobin Female: 12-16 g/100 ml male: 13-18 g/100 ml Mean RBC count Female: 4.8 million/ul male: 5.4 million/ul Platelet counts 130,000-360,000/,1 Total WBC counts 4,000-11, 000/11Composition of Plasma Water 92% by weight Proteins Total 6-9 g/100 mi Albumin 60% of total plasma protein Globulin 36% of total plasma protein Fibrinogen 4% of total plasma protein Enzymes of diagnostic value trace Glucose (dextrose) 70-110 mg/100 ml Amino acid 33-51 mg/100 mI Lactic acid 6-16 mg/100 mlComposition of Plasma (continued) Total lipid 450-850 mg/100 ml Cholesterol 120-220 mg/100 mi Fatty acids 190-420 mg/100 mi High-density lipoprotein (HDL) 30-80 mg/100 mi Low-density lipoprotein (LDL) 62-185 mg/100 mi Neutral Fats (triglycerides) 40-150 mg/100 mi Phospholipids 6-12 mg/100 mlComposition of Plasma (continued) Iron Vitamins (A, B, C, D, E, K) amount Electrolytes Sodium Potassium Magnesium Calcium Chloride Bicarbonate Phosphate Sulfate 50-150 ug/100 mi Trace 135-145 mEq/L 3.5-5.0 mEQiL 1.3-2.1 mEq/L 9.2-10.4 mEq/L 90-106 mEq/L 23.1-26.7 mEq/L 1.4-2.7 mEq/L 0.6-1.2 mEqiLComposition of Plasma (continued) Nitrogenous Wastes Ammonia 0.02-0.09 mg/400 mi Urea 8-25 mg/100 mi Creatine 0.2-0.8 mg/100 mi Creatinine 0.6-1.5 mg/100 ml Uric acid 4.5-8.0 mg/100 mi Bilirubin 0-1.0 mg/100 mI Respiratory gases (02, CO2, and N2)plasma — serum 1d clotting proteins (fibrin)The Formed Elements 7 (Blood Cells)Formed elements include: Erythrocytes (red blood cells, RBCs) Platelets (cellular fragments) Leukocytes (white blood cells, WBCs) _ Granulocytes Neutrophils Eosinophils Basophils Agranulocytes Lymphocytes MonocytesFormed Elements of Blood Le -@’ . oe AD ee oe oe * g ae @ ee Erythrocyte ve a : - Young (band) nearer — _ f neutrophil Large __ | ~ i Monocyte lymphocyte ean £9 o @e- Neuronn eo e 2Erythrocytes (red blood cells)Erythrocytes (Red Blood Cells, RBCs) 1 imiccomelors| E>... Appearance: - biconcave disc shape, which is suited for gas exchange. The shape is flexible so that RBCs can pass though the smallest blood vessels, i.e., capillaries.Erythrocytes are smaller than Leukocytes. Monocyte we - o ge i= : lymphocyte oe P Neutrophil cou gy a4 Of (band) neutrophi lymphocyte sti Large: Monocyte ly om e4 Neutrophil emo £9‘Sectional view 7.5 crometers 2.0 crometers Structure: -Primary cell content is the protein that binds oxygen and carbon dioxide. - no nucleus nor mitochondriaHemoglobin consists of : globin and heme pigmentGlobin - Consists of two « and two B subunits - Each subunit binds to a heme groupHeme Groups Each heme group bears an atom of iron, which binds reversibly with one molecule of oxygen Heme Group Structure Hemoglobin Structure CH, CH=CH, ce Vp ia HC—C. c=cH I Sy ¢ cae ST =c—cH, l N-Fe?*—N Heme—<—"| Peace ee caeme et ee Ch nome” “cate ~*~ COOH \ / oe ih et COOH carry four molecules of oxygenCarbon monoxide competes with oxygen for heme binding with a much higher affinity. Problem: deoxygenate hemoglobin Treatment: hyperbaric oxygen chamberOxyhemoglobin - bound with oxygen - red Deoxyhemoglobin - free of oxygen - dark red. Carbaminohemoglobin 20% of carbon dioxide in the blood binds to the globin part of hemoglobin, which is called carbamino- canalFunctions of Erythrocytes 1) Primary Function Transport oxygen from the lung to tissue cells and carbon dioxide from tissue cells to the lung 2) Buffer blood pHProduction of Erythrocytes Hematopoiesis refers to whole blood cell production. Erythropoiesis refers specifically to red blood cell production. All blood cells, including red and white, are produced in red bone marrow. On average, one ounce, or 100 billion blood cells, are made each day.Hematopoiesis -The red bone marrow is a network of reticular connective tissue that borders on wide blood capillaries called blood sinusoids. As hemocytoblasts mature, they migrate through the thin walls of the sinusoids to enter the blood. Spongy bone: (diploe) Trabeculae- Inner compact boneStem cell Committed colis Precursor cells Ee tee .. ‘SS ee Reticulocyte: All of blood cells ¢ @— =z including red and 7. Mogokaryocyie white arise from ee the same type of ae g stem cell, the hematopoietic stem cell or hemocytoblastFormed Stem Committed Precursor elements of cell cells cells Sreslatn @ @€*. -9 | Erythroblast Normoblast Reticulocyte Erythrocyte Erythropoiesis Erythrocytes are produced throughout whole life to replace dead cells.Feedback Regulation of Erythropoiesis Hypoxemia (inadeq tinker O, transport) - regulated by renal oxygen content, fi = Sensed by liver Q, transport and kidneys - Erythropoietin, a glycoprotein hormone, is es produced by renal cells ee in response to a Increased decreased renal blood RBC count 2 content. Reena Secretion of ‘rie | - Erythropoietin erythropoietin stimulates erythrocyte production in the red ee of bone marrow. bone marrow.A drop in renal blood oxygen level can result from: 1) reduced numbers of red blood cells due to hemorrhage or excess RBC destruction. 2) reduced availability of oxygen to the blood, as might occur at high altitudes or during pneumonia. 3) increased demands for oxygen (common in those who are engaged in aerobic exercise).Ways to increase Red Blood Cell Count in Sports Legal raise RBC count by training athletes at high altitude Illegal use erythropoietin, androgen, or their analogsDietary Requirements for Erythropoiesis Iron vitamin B12 folic acid More important to women due to the loss of blood during menstruationLife Cycle [feptropoiesis Nutrient redbone absorption ee Small intestine Erythrocytes circulate Erythrocyte Sri gait 2 The average : for 120 days life span of y — sa pired erythrocytes is 120 days. break up in liver and spleen Cell fragments Hemoglobin Phagocytized degraded Heme Globi in Peccrecestereerrtiererrsrcrra ctf Biliverdin fron Hydrolyzed to free ‘ tocar amino acids Bilirubin Storage-Reuse Loss by Bile menstruation, injury, etc. 4 FecesErythrocyte Disorders Anemia is a condition in which the blood has an abnormally low oxygen-carrying capacity.Common causes of anemia include: 1) an insufficient number of red blood cells 2) decreased hemoglobin content 3) abnormal hemoglobin Two such examples are Thalassemias and Sickle-cell anemia, which are caused by genetic defects.Erythrocyte Disorders - 2 Polycythemia is an abnormal excess of erythrocytes that increases the viscosity of the blood, causing it to sludge or flow sluggishly. Common causes of polycythemia include: 1) Bone marrow cancer 2) Aresponse to reduced availability of oxygen as at high altitudesHuman Blood GroupsHuman Blood Groups - were learned from tragedies (death) caused by mismatch during transfusion in ancient time. - ABO blood types were identified in 1900 by Karl Landstein (1930 Nobel laureate). - Other blood types were identified later.Blood type is determined by \ Agglutinogens * are specific glycoproteins on red blood cell membranes. * All RBCs in an individual carry the same specific type of agglutinogens.ABO Blood Groups Type A: RBCs carry agglutinogen A. Type B: RBCs carry agglutinogen B. Type O: RBCs carry no A nor B agglutinogens. Type AB: RBCs carry both A and B agglutinogens.Type A blood - RBCs carry type A agglutinogens. - Plasma contain preformed antibodies, Agglutinin B, against B agglutinogens.- are preformed antibodies in plasma - bind to agglutinogens that are not carried by host RBCs - cause agglutination --- aggregation and lysis of incompatible RBCs.with Type B RBCs MixTransfusion Reaction _ Blood from e type A donor j Type B recipient ype B (anti-A) recipient Donor RBCs agglutinated by recipient plasma Agglutinated RBCs block small vesselsType B blood -RBCs carry type B agglutinogens. - Plasma contain agglutinin against A agglutinogens.Type O blood - RBCs carry neither type A nor type B agglutinogens. - Plasma contain agglutinin against both A and 8B agglutinogens. - The person can accept only type O blood transfusion.Type AB blood Agglutinogen(s) ? Agglutinin(s) ?Type AB blood Agglutinogen(s): AandB Agglutinin(s)? NoAnorBSummary of ABO Blood Groups Blood Type Agglutinogen Agglutinin (on RBC) (in Plasma) A A B B B A Oo A&B AB A&BHeart * The heart is a hollow, cone-shaped, muscular pump. The heart beats about 2.5 billion times in an average lifetime. The left side of the heart pumps blood through an estimated 120,000 km of blood vessels, which is equivalent to traveling around the earth's equator about 3 times. The right side of the heart pumps blood through the lungs, enabling blood to pick up oxygen and unload carbon dioxide. Heart pumps more than about 14,000 liters of blood in a day, or 5 million liters in a yearDimensions of Heart * The heart is a small Organ, it is about 12 cm (5 in.) long, 9 cm (3.5 in.) wide at its broadest point, and 6 cm (2.5 in.) thick, with an average mass of 250 g in adult females and 300 g in adult males. * The heart rests on the diaphragm, near the midline of the thoracic cavity.* The heart lies in the mediastinum an anatomical region that extends from the sternum to the vertebral column, from the first rib to the diaphragm, and between the lungs Hoart ‘Apex of heart Diaphragm (c) Anterior viewRelations of Heart Superiorly —- the aorta, superior vena cava, P artery and pulmonary vein. Inferiorly — the diaphragm Anteriorly - the ribs and_ intercostal muscles. Posteriorly - the esophagus, trachea, left and right bronchus, descending aorta, inferior vena cava and thoracic vertebrae Laterally — the lungsANTERIOR pr me ‘ \ Heart 7 - fu Q Ne Muscle PERICARDIAL i a \ CAVITY ; ] (he Bs ot ing Right lung Esophagus Aorta Sixth thoracic RIGHT PLEURAL vertebra LEFT PLEURAL CAVITY \) POSTERIOR* The pointed apex is formed by the tip of the left ventricle and rests on the diaphragm. It is directed anteriorly, inferiorly, and to the left. * The base of the heart is its posterior surface. It is formed by the atria of the heart.Surfaces * The sternocostal or anterior surface is deep to the sternum and ribs. * The diaphragmatic or inferior surface is the part of the heart between the apex and right border. * The pulmonary or left surface is occupies the cardiac notch of the left lung.Superior vena cava Arch of aorta SUPERIOR BORDER : as ‘ulmonary RIGHT BORDER 4 shine Right hung ; Heart Ploura (cut io Sey LEFT BORDER reveal lung inside) } Pericardium (cut) APEX OF HEAAT Diaphragm INFERIOR SURFACE (b) Anterior view of heart in thoracic cavityBoarders The right border is formed by right atrium and it faces the right lung and extends from the inferior surface to the base. The inferior border is formed by right ventricle and partly left ventricle. The left border also called the pulmonary border, is formed by left ventricle and the left auricle and it faces the left lung and extends from the base to the apex. The superior border is formed by both atria.Midsternal line 2nd ribSulci of Heart It is a groove on the outer surface of the heart marking the division between the atria and the ventricles. 1. Atrioventricular sulcus 2. Anterior interventricular sulcus 3. Posterior interventricular sulcus* Atrioventricular sulcus: Separates atria from ventricles, it contains right coronary artery, left coronary artery, circumflex artery, coronary sinus. + Anterior interventricular sulcus : lies between left ventricle and right ventricle on the anterior surface, marks location of interventricular septum contains left anterior descending artery, great cardiac vein. * Posterior interventricular sulcus:lies between left ventricle and right ventricle on posterior surface, contains posterior interventricular artery and middle cardiac veinPericardial Sinuses * The lines of reflection between visceral and parietal pericardium form two pericardial sinuses a. The transverse pericardial sinus lies anterior to the superior vena cava and posterior to the ascending aorta and pulmonary trunk. b. The oblique pericardial sinus lies posterior to the heart in the pericardial sac.The transverse pericardial sinus The oblique pericardial sinusAnterior Surface of heart § } 2p i; artery ier Aortic aren Loh common carotid Brachiocephalic trunk Superior vena cava Ligamentum arteriosum Right pulmonary artery Lett pulmonary artery Ascending aorta. — Loh pulmonary voine Puimonary trunk — " ” Right pulmonary veins. Right atrium: Riight coronary artary (in coronary sulcus) Anterior cardiac vain ————4 . + — Ler ventricle 2 vein iy — Antorior interventricular J artery (in antorior intorventricular suicus) Right ventricte Right marginal artery Small cardiac vein Inforior vana cava aAURICLE + Anterior surface of each atrium is a wrinkled pouch like structure called an auricle. Each auricle slightly increases the capacity of an atrium so that it can hold a greater volume of blood.Posterior Surface of Heart ‘Superior vona cava Right pulmonary artery Loft pulmonary artory Loft pulmonary voins Auricle of fof atriuim (Leste atrium) ——______ Great cardiac vein ———— Fight coronary artery Posterior vain of left vontricie fin coronary sulcus) Lett ventricte Posterior interventricular artery (in posterior intorventricular sulcus) —— Middle cardiac vein Right ventricle.Coverings of the Heart Pericardium * The heart is enclosed in a double-walled sac called the pericardium * It consists of two main parts: 1. The fibrous pericardium 2. The serous pericardium + The fibrous pericardium is composed of tough, inelastic, dense irregular connective tissue. The functions of fibrous pericardium is to 1, Prevent overstretching of the heart 2. Protection of heart 3. Anchors the heart in the mediastinumRelationship of serous pericardium to heart Parietal layer of serous Heart pericardium Pericardial Serous pericardium cavity Visceral layer of serous pericardium* The serous pericardium is a thinner membrane that forms a double layer around the heart —The outer parietal layer: it is fused to the fibrous pericardium, —The inner visceral layer is also called the epicardium helps the layers of the heart wall to adheres tightly to the surface of the heart.The pericardial layers and layers of the heart wall.* A slippery fluid is present in between the parietal and visceral layers helps to give lubrication and reduces friction while the heart beats is the pericardial fluid. + The space between the two layers are called the pericardial cavity.Layers of the Heart Wall myocardium epicardium The wall of the heart grooadiym peticardium consists of three layers i — The epicardium (external layer) adipose tissue = Tikernvocardliny visceral layer of (gatas layer) serous pericardium — The endocardium ; (inner layer) parietal layer of serous pericardium fibrous pericardium pericardial cavityEpicardium * It is a thin transparent outer layer of the heart wall is composed of mesothelium (membrane composed of simple squamous cells) * The epicardium contains blood vessels, lymphatics, and vessels that supply the myocardium. sricardiam pericardium [— adipose tissue | visceral layer of serous pericardium parietal layer of serous pericardium fibrous pericardium pericardial cavityMyocardium * The myocardium is responsible for the pumping action of the heart and is composed of cardiac muscle tissue. The muscle fibers are wrapped and bundled with connective tissue sheaths composed of endomysium and perimysium. * The cardiac muscle fibers are organized in bundles that swirl diagonally around the heart and generate the strong pumping actions of the heartCircular and spiral arrangement of cardiac muscle \ Superior “ vena cava inatria == Superficial bundle in muscle ventricle e bundles in ~ ventriclesEndocardium * The endocardium is a glistening white sheet of endothelium (squamous _ epithelium) resting on a thin connective tissue layer. * It lines the heart chambers and covers the fibrous skeleton of the valves. * The endocardium is continuous with the endothelial linings of the blood vessels leaving and entering the heart.Chambers of the Heart * The heart has four chambers. The two superior receiving chambers are the atria and the two inferior pumping chambers are the ventriclesSuperior vena cava Right pulmonary artery Mitral (bicuspid) vaive Right pulmonary veins Fossa ovalis Pectinate muscles Tricuspid valve Right ventricle \Chordae tendineae Papillary muscle =— interventricular septum T— Epicardium = — Myocardium ‘Trabeculae carneae - * ‘ Endocardium,Right Atrium The right atrium forms the right border of the heart and receives blood from three veins: the superior vena cava, inferior vena cava, and coronary sinus. The right atrium is about 2-3 mm (0.08-0.12 in.) in thickness. The posterior wall is smooth but the anterior wall is rough due to the presence of muscular ridges called pectinate muscles The right atrium and left atrium is separated by interatrial septum. A prominent feature of this septum is an oval depression called the fossa ovalis. Blood passes from the right atrium into the right ventricle through a valve that is called the tricuspid valve, it consists of three leaflets or cusps.* The cusps of the tricuspid valve are connected to tendon like cords, the chordae tendineae which in turn are connected to cone-shaped trabeculae carneae called papillary muscles. Wey ‘Cusp of tricuspid valve Cherdae tendineae Papillary muscleRight Ventricle The right ventricle is about 4-5 mm (0.16-0.2 in.) in average thickness and forms most of the anterior surface of the heart. The right ventricle contains a series of ridges formed by bundles of cardiac muscle fibers called trabeculae carneae, it helps the heart for conduction. The right ventricle is separated from the left ventricle by the interventricular septum. Blood passes from the right ventricle through the pulmonary valve into a large artery called the pulmonary trunk, which divides into right and left pulmonary arteriesLeft Atrium The left atrium is about the same thickness as the right atrium and forms most of the base of the heart. It receives blood from the lungs through four pulmonary veins. It has a smooth anterior and posterior wall, because pectinate muscles are confined to the auricle of the left atrium. Blood passes from the left atrium into the left ventricle through the bicuspid (mitral) valve It is also called the left atrioventricular valve.Left ventricle The left ventricle is the thickest chamber of the heart, averaging 10-15 mm (0.4-0.6 in.) and forms the apex of the heart. Like the right ventricle, the left ventricle contains trabeculae carneae and has chordae tendineae that anchor the cusps of the bicuspid valve to papillary muscles. Blood passes from the left ventricle through the aortic valve (aortic semilunar valve) into the ascending aorta from here blood flows into the coronary arteries, which branch from the ascending aorta and carry blood to the heart wall. The remainder of the blood passes into the arch of the aorta and descending aorta (thoracic aorta and abdominal aorta). Branches of the arch of the aorta and descending aorta carry blood throughout the body.Comparison of right and left atrium 1 Receives venous blood from body. 1 Receives oxygenated blood from Lung. 2 Pushes blood to Rt ventricle through 2 Pushes blood to Lt ventricle through tricuspid valve. bicuspid valve. 3 Forms Rt boarder, parts of 3 Forms major part of the heart base sternocoastal and small part of base of the heart Comparison of right and left ventricle 1 Thin 1 Thicker 2. Pushes blood only to the lung 2 Pushes blood to entire body except lung Contains three papillary muscles Contains two papillary muscles 4 | Cavity is crescentic Contains deoxygenated blood Cavity is circular Contains oxygenated blood a jin) = |e 6 Forms sternocoastal surface Forms diaphragmatic surfaceValves of Heart Arn, memoThe Tricuspid Valve * The tricuspid valve consists of three cusps anterior, septal and inferior (posterior). These cusps are formed by a fold of the endocardium and some connective tissue. The bases of the cusps attach to the fibrous ring of the heart skeleton and their free edges attach to the chordae tendineae connecting them to the papillary muscles.The Mitral Valve * The mitral valve consists of two cusps anterior and posterior: its structure is similar to the tricuspid valve. The anterior cusp is larger and intervenes between the atrioventricular and the aortic orifices. The chordae tendineae attach the cusps to papillary muscles as in the tricuspid valve.(a) Bios ee openThe Pulmonary Valve It consists of three semilunar cusps formed by folds of the endocardium and some connective tissue. The lower margins of the cusps and their sides are attached to the arterial wall. The pulmonary valve has three cusps: the anterior cusp (AC), the left cusp (LC), and the right cusp (RC). There are no chordae tendineae or papillary muscles attached to these valves.Pulmonary Valve Anterior Left Right PosteriorThe Aortic Valve * The valves are arranged as one anterior (right) and two posterior (left and posterior). * The aortic valve has three cusps: the left coronary cusp (LCC), the right coronary cusp (RCC), and the non-coronary cusp (NCC). * The right coronary artery originates from the anterior aortic sinus and the left coronary artery from the left posterior sinus.Aortic Valve Pulmonary Valve Left coronary cusp (CC) ‘The right coronary cusp (RCC) The anterior cusp (AC) The left cusp (tc) ‘The non-coranary cusp The right cusp (RC) (cc) _Blood supply to the heart Arterial Supply * The first two branches of the aorta, called the right and left coronary arteries, supply blood to the tissues of the heart. * The left coronary artery runs toward the left side of the heart and then divides into two major branches: — The anterior interventricular artery follows the anterior interventricular sulcus and supplies blood to the interventricular septum and anterior walls of both ventricles. — The circumflex artery supplies the left atrium and the posterior walls of the left ventricle.* The right coronary artery courses to the right side of the heart, it has two branches: — The right marginal artery supply blood to the lateral right side of myocardium. -The posterior interventricular artery supplies blood to the posterior ventricular walls and merges (anastomoses) with the anterior interventricular artery.Aorta Superior Pulmonary vena cava y | trunk Left atrium Anastomosis (junction of vessels) Left coronary Right artery atrium Circumflex artery Right coronary artery Left Right ventricle ventricle Right Anterior marginal = interventricular artery Posterior rtery interventricular arteryCoronary Veins The venous blood is collected by the cardiac veins. These veins join to form an enlarged vessel called the coronary sinus, which empties the blood into the right atrium. The principal tributaries carrying blood into the coronary sinus are the following: 1. Great cardiac vein in the anterior interventricular sulcus, which drains the areas of the heart supplied by the left coronary artery (left and right ventricles and left atrium) 2, Middle cardiac vein in the posterior interventricular sulcus, which drains the areas supplied by the posterior interventricular branch of the right coronary artery (left and right ventricles) 3. Small cardiac vein in the coronary sulcus, which drains the right atrium and right ventricle 4. Anterior cardiac veins, which drain the right ventricle and open directly into the right atriumRight atrium ‘SMALL CARDIAC ANTERIOR CARDIAC MIDDLE CARDIAC Right ventricle Interior vena cava CORONARY SINUS: GREAT GARDIAC Left ventricleNerve supply to the heart The cardiac nerves are branched autonomic nerve fibers and are found at the level of the tracheal bifurcation. Their function is to innervate the electrical conducting system of the heart, the atrial and ventricular myocardium and the coronary vasculature. The medulla is the primary site in the brain for regulating sympathetic and parasympathetic outflow to the heart and blood vessels. The hypothalamus and higher centers modify the activity of the medullary centers and are particularly important in regulating cardiovascular responses to emotion and stress (eg, exercise, thermal stress).The Sympathetic Nerve actions . The sympathetic fibers stem from the intermediolateral cell column of the thoracic cords T1 to T4 before merging into the sympathetic trunk. The preganglionic fibers synapse in the sympathetic ganglia of the cervical and thoracic regions, which in turn pass on postganglionic fibers to the cardiac plexus. Sympathetic innervation directly opposes the parasympathetic system by increasing the heart rate, cardiac contractions and constricting the coronary resistance vessels.Carcdioinhibitory — = eee = ‘center Cardioacceleratory Medulle oblongata Vague (X} PARASYMPATHETIC Parasympathetic pregangiionie fieer ‘Synapses in sardiac plexus rasympathetic Sicipenencourdea postganglionic (corvical ganglia and Da fibers stipertor thoracic ganglia (T, —Tald CardiacParasympathetic Nerve Actions The parasympathetic fibers are contributed by the vagus nerve (CN X) and are classed as preganglionic fibers. Their role during innervation is to decrease the heart rate, to decrease the force of cardiac contractions and to dilate the coronary resistance vessels. + Most of the vagal effects are limited to the area around the sinoatrial node.Cardiac muscle fibers Cardiac muscle fibers are shorter in length and less circular in transverse section. The branching cardiac muscle fibers produce a “stair-step” appearance. A cardiac muscle fiber is 50-100\im long and has a diameter of about 144m and one centrally located nucleus. The cardiac muscle together by irregular transverse thickenings of the sarcolemma called intercalated discs. The discs contain desmosomes, which hold the fibers together, gap junctions, which allow muscle action potentials to conduct from one muscle fiber to other. This gap junctions allow the entire myocardium of the atria or the ventricles to contract as a single, coordinated unit.* Cardiac muscle fibers have the same arrangement of actin and myosin, and the same bands, zones, and Z discs, as skeletal muscle fibers.(b) Arrangement of components in a cardiac muscle fiberApplied Anatomy X-ray (Radiography) - Chest * Chest x-ray uses a very small dose of ionizing radiation to produce pictures of the inside of the chest. It is used to evaluate the lungs, heart and chest wall and may be used to help diagnose shortness of breath, persistent cough, fever, chest pain or injury. It also may be used to help diagnose and monitor treatment for a variety of lung conditions such as pneumonia, emphysema and cancer.Coronary angiography * Coronary angiography is a procedure that uses a special dye (contrast material) and x- rays to see blood flows through the arteries in heart. The dye helps to highlight blockages in blood flow.Lymphatic system* The lymphatic system is a network of lymphatic vessels and lymph nodes in different areas of body that maintains homeostasis as well as immunity of our body. + Lymphatic system returns fluids that have leaked from the blood vascular system back to the blood to maintain the blood volume. * The lymphatic system consists of: f OLymph 8 _ OLymphatic vessels ~~ Lymph nodes L d orgsLYMPH * Lymph is a clear watery fluid that circulates through the lymphatic vessels. * Once the interstitial fluid drains into the — lymphatic vessels, it is called lympl / lymph is identical in composition x _ interstitial fluid. 4Formation of lymph As blood circulates through the body, most components of blood plasma such as nutrients, gases, and hormones filter through blood capillary walls to form interstitial fluid” and reabsorbed back by venous capillaries. The excess filtered fluid (about 3 liters p Ne drains into lymphatic ves becomes lymph. ie. the interstitial ee vessalbi is calledLYMPH VESSELS * Lymph vessels are thin walled, valved structures that carry lymph. * Lymphatic vessels begin as lymphatic capillaries, which join up to form lymphatic vessels. Larger lymphatic vessels unite to form lymphatic a trunk. i Lymphatic trunk opens into two large lym p luct - right lymphatic duct and thora atic)duct.* In small intestine, specialized lymphatic capillaries called lacteals absorb dietary lipids into lymphatic vessels and ultimately into the blood. The presence of these ‘lipids: causes the lymph draining from e ia* Tissues that lack lymphatic capillaries include avascular tissues (such as cartilage, the epidermis, and the cornea of the eye), y, the central nervous system, bones, teeth, { portions of the spleen, and red boStructure Lymph capillaries * Lymph capillaries are made up of single layered endothelial cells. * The edge of one endothelial cell overlap with other endothelial cell and forms flap like minivalves that ensure lymph flow only in one way , ie. towards the thorax. * Lymphatic capillaries are attached to the surrounding tissue by anchoring filaments, which collagen filaments andLymphatic vessels * Structure similar as veins. * Thin walls and more valves. * 3 tunica layers - intima, media and adventitia. OTunica intima, the inner layer is made up of single flattened simple squamous epithelium composed of epithelium called endothelium, and the cells are called endothelial cells. OThe middle tunica media is of smooth muscles and elastic tissue that are arranged in a circular fashion around the endothelium. yo OThe outermost adventitia consists of fibrous tissu * Afferent ae vessels - the vessel SS h no Ip. rent lymphatic vessel - the \ yh ode. -Lymphatic trunk * Lymphatic vessels exit lymph nodes and unite to form lymphatic trunks. * The major trunks are — Lumbar trunks (right and left lumbar trunks) — Intestinal trunk — Bronchomediastinal trunks (right and left) — Subclavian trunks (right and left) = Jugular trunks (right and left) * The lumbar trunks drain lymph from the lower limbs, the wall and viscera of the pelvis, the kidneys, the adrema! glands, and the abdominal wall. _ + The intestinal trunk drains lymph from the stoma be _ intestines, pancreas, spleen, and part of the li : Se eis ath trunks drain | _ thoracic wall, lung, and heart. 3 bclavian trunks drain the ujLymphatic duct * Thoracic duct * Right lymphatic duct Thoracic duct / Left lymphatic duct * Main duct for the return of lymph to blood. * 38-45 cm length. * Begins at cisterna chyli (anterior to 2"! lumbar vertebrae). * Cisterna chyli is an enlarged lymph sac which receives lymph from right and left lumbar trunks and intestinal trunk. Receives lymph from cisterna chyli, left j jugu le ubclavian, and left bronchomediastinRight lymphatic duct * About 1.2 cm length. * Receives lymph from the right jugular, right subclavian, and right ail ¥ tei. iLYMPH NODES Regional A lymph node is a small, bean-!ymeh nodes: shaped organ that serves as a filtering and processing center for cericar immune system. nodes « It filter lymph before it is returned to the blood. Axillary * Located along lymph vessels. podem ° About 600 lymph nodes in body. © Usually occur in groups. Inguinal ph nodes are major sites of B, Tnoaes ater inmune cellsLymph Node Structure Bean or kidney-shaped. 1-25 mm length. Covered by capsule. Capsule is composed of connective tissue. Trabeculae, the capsular extensions divide the node into compartments which provide a route for blood vessels into the interior of a node. internal to the capsule is a sup} ing network of reticular* Subcapsular sinus is the space between capsule and cortex. * The lymph node is divided into — superficial cortex — deep medulla * Cortex is the portion beneath subcapsular sinus. * Cortex consists — outer cortex = inner cortex * Outer cortex contain — Lymphatic nodules — Germinal center + Lymphatic nodules (follicles)are egg- .._ shaped aggregates of B cells in outer — Secondary lymphatic nodules —Primary lymphatic nodule consist of B cells. Secondary lymphatic nodules form in response to an antigen. After B cells in a primary lymphatic nodule recognize an antigen, the primary lymphatic nodule develops into a secondary lymphatic nodule. The center of a secondary lymphatic nodule contains a region of light- staining cells called a germinal center. Germinal center are B cells, follicular dendritic cells and ophages.The inner cortex consists mainly of T cells and dendritic cells that enter lymph node from other tissues. Medulla is the inner part of lymph node. Medulla includes, — Medullary cords — Medullary sinuses The medullary cords are thin inward extensions from the cortical lymphoid tissue and include plasma cells, macrophages, and B cells. Medullary sinuses are spaces separating medullary cords.* Several afferent lymphatic vessels penetrate the convex surface of the node directs the lymph inside the node. * One or two efferent lymphatic vessels convey lymph outside the node. * Efferent lymphatic vessels emerge from one side of the lymph node at a slight depression called a hilum or hilus. * Blood vessels also enter and leave the node at the hilum.Flow of lymph inside a node Lymph enters into node through Afferent lymphatic vessel Subcapsular sinus Trabecular sinus Medullary sinus Efferent lymphatic leavesthenode. =FLOW/TRANSPORT /CIRCULATION OF LYMPH Lymphatic capillaries have greater permeability than blood capillaries. Greater pressure in interstitial fluid opens lymph valves and fluid enters into lymphatic capillaries. * Lymph passes from lymphatic capillaries into s lymphatic vessels and then through lymph nodes. * Later drains into lymphatic trunk. i * Lymph passes from lymphatic trunks into two main aN ducts, the thoracic duct and the right lym <, id then drains into venous blooTissue space FPoroblas! in losses comodve toa Higher pressure ‘Silla outside minvave Endothelial — call Filaments ‘anchored 10 connscive (b) tissueThe sequence of lymph flow is Blood capillaries (blood) Interstitial spaces (interstitial fluid) Lymphatic capillaries (lymph) Lymphatic (afferent) vessels (lymph)‘Thoracic i (lymph) Lymphatic vessel (lymph) Lymphatic trunks (lymph) Lumbar trunks intestinal trunk, Left jugular Left subclavian Left bronchomediastinal, Right jugular Right subclavian Right bronchomediastinalLymphatic duct Subclavian vein ‘SYSTEMIC CIRCULATION PULMONARY CIRCULATIONThe flow of lymph is regulated by; * The milking action of active skeletal muscles. Pressure changes in the thorax during breathing. Pulsations of nearby arteries promaiy lymph flow. + Rhythmic contraction of smooth ae cl me walls lymphatic vessels. in lymphatic vesselsae 4 Overiapping endothelial celts. Interstitial fluid (IF) entering capillaryLymph node groups (Distribution of lymph nodes) + Lymph nodes throughout the body are arranged in clusters. They are classified according to their location. The major cluster of lymph nodes are; — Cervical nodes — Axillary nodes — Thoracic nodes — Mediastinal nodes — Supratrochlear nodes — Abdominal nodes lesentric nodesCervical lymph nodes Located in the head and neck region. Found deep in the neck, behind the ears and bottom of the jaw. Draw lymph from the scalp, face, nasal cavity and pharynx. Drains into right and left jugular trunks. i Cervical lymph node group include f — Deep cervical lymph nodes [ — Regional cervical lymph nodes Deep cervical lymph nodes — Jugulodigastric node = Jugulo-omohyoid node ‘Lymph _ — Supra clavicular node < cervical Bee nodesDeep cervical lymph nodes Situated along the entire length of internal jugular vein. The entire lymph from head and neck drains ultimately into deep cervical lymph nodes either directly or through regional cervical lymph nodes. Drains into right and left jugular trunks. It includes, — Jugulodigastric node — Jugulo-omohyoid node = — Supra clavicular node _bsetrma Sigs esta* Jugulodigastric node: © situated where the posterior belly of the digastric muscle crosses the internal jugular vein, between the angle of mandible and anterior border of sternocleidomastoid. o Drains from tonsils and tongue. + Jugulo-omohyoid node: — Situated above the intermediate tendon of the omohyoid, under cover of the posterior border of sternocleidomastoid. — Drains from tongue. + Supra clavicular node: ated superior to clavicle. m upper chest.Regional cervical lymph nodes * Arranged in two circles - superficial and deep. — Superficial regional cervical lymph nodes — Deep regional cervical lymph nodes * Superficial regional cervical lymph nodes — It forms the outer circle and extend from chin to occiput. = Itincludes; Submental Submandibular Buccal and mandibular (facial) Preauricular (parotid) Postauricular (mastoid) Occipital Anterior cervical : cal Cee oN1, Submental nodes — Lie below the chin. = Drains from; + Tip of tongue * Floor of anterior part of mouth * Incisors + Central part of lower lip * Skin over chin — Drains into submandibular nodes and few into Jugulo-omohyoid node 2. Submandibular nodes — Lie beneath the deep cervical facia on the surface of submandibular salivary P, glands. — Drains from; v + Center of forehead 2G * Frontal, maxillary and ethmoidal sinuses i + Inner canthus of eye , Upper lip Anterior part of cheek with underlying gum and teeth3. Buccal and mandibular (facial) — Buccal node lies on the buccinator muscle. — Mandibular node lie on the lower border of the mandible at the anterior border of masseter. = They drain part of the cheek and lower eyelid. = Drains into Jugulodigastric node, 4. Preauricular (parotid) — Lies on or within parotid gland, partly in superficial fascia and partly in deep fascia. Middle ear — Drains from; * Temple ‘ * Side of scalp i a + Lateral surface of auricle + External acoustic meatus Parotid gland Upper part of cheek ‘arts of eyelid5. Postauricular (mastoid) = Lie on mastoid process. - Drain from; * Part of scalp just above and below auricle + Upper half of auricle + Posterior wall of external acoustic meatus. — Drain into jugulo-omohyoid node. 6. Occipital — Located at the back of head, apex of the posterior triangle superficial to trapezius. — Drains occipital region of head. - Drains into supraclavicular nodes. i 7. Anterior cervical ef — Lie along anterior jugular vein. — Drain from skin of anterior part of neck. Drain into jugulo-omohyoid node and jugulodigastric no erficial cervical moe all jugular vein.Deep regional cervical lymph nodes * It forms the inner circle which surrounds larynx, trachea and pharynx. * Ttincludes; 1. Prelaryngeal and Pretracheal 2. Paratracheal 3. Retropharyngeal 1. Prelaryngeal and Pretracheal v — Prelaryngeal nodes lies on cricothyroid membrane. — Pretracheal nodes lies in front of the trachea bel he th thyroid gland. They drain from larynx, trachea and isthmus of thyroi2. Paratracheal = Lies on sides of trachea and esophagus. — Drains lymph from esophagus, trachea and larynx, — Drains into deep cervical nodes. 3. Retropharyngeal — Lie in front of the prevertebral fascia and behind the buccopharyngeal fascia covering the posterior wall of pharynx. — Drains from, y, * Pharynx f + Auditory tube - a * Soft palate ! Posterior part of hard palate Nose into jugulodigastric node.Axillary lymph nodes * Present in the armpit area. * Two types- superficial and deep lymph nodes. odes * Drain lymph from arm, walls of} tymph. thorax and breast. vem * Divided into 5 groups. — Pectoral (anterior) group — Scapular (posterior) group — Lateral group — Central group — Apical or infraclavicular group from pectoral, scapular and late! into central group, later into apit ubclavian trunIp: Pectoral Scapular Lateral Central Apical or infra clayicular Lower border of pectoralis minor Posterior fold of axilla Medial to the axillary vein. Upper axilla Along axillary vessel below clavicle. D age + From upper half of anterior wall of the trunk. * From major part of the breast. + From posterior wall of the upper half of the trunk. * From axillary tail of the breast + From upper limb. + From above groups. + From central group. * From upper part of breast. + From thumb. SeThoracic lymph nodes * Located in thoracic region. * Two types - parietal lymph nodes and visceral lymph nodes. Parietal lymph nodes + Situated in the thoracic wall. * Ttincludes; — Parasternal nodes — Intercostal nodes Diaphragmatic (phrenic) nodes eral lymph nodes Located in relation to internal organs of chest. includes; 1 bronchial nodesParasternal nodes: Intercostal nodes Placed behind the sternum, anterior ends of the intercostal spaces by the side of the internal mammary artery. Derive lymph from, — Mammary gland - Anterior abdominal wall above umbilicus. — Upper surface of the liver . — Anterior thoracic wall. At the right side it drains into right subclavian trunk or right lymphatic duct. At the left side it drains into thoracic duct. Located at posterior part of intercostal spaces. Drains from posterior and lateral part of chest wall and parietal pleura. Drains into, — Right side of upper intercostal nodes into right lymphatic duct. ~ =+Left side of upper intercostal nodes into thoracic duct. — Lower intercostal nodes into Cisterna chyli.Diaphragmatic (phrenic) odes Lie on the upper surface of the diaphragm. It consist of three sets — Anterior — Middle — Posterior Receive lymph from — Diaphragm — Pericardium — Pleura _— Upper surface of liverTracheobronchial nodes * Nodes around trachea and bronchi. * Itincludes, — Pulmonary lymph nodes we — Bronchopulmonary lymph nodes — Trachobronchial lymph nodes * Pulmonary lymph nodes locate in receive lymph from lung and into bronchopulmonary lymph nodes. + Bronchopulmonary (hilar) lymph nodes locate in the hill Sao: lung and receive lymph from lung and empty rachobronchial lymph nodes. - theta hobrochial lymph nodes locate near t ea, They divided 1 into 2 supeniae a ty iMediastinal nodes + Present in the central part of the chest, between the lungs. + Italso considered as part of thoracic * Two major groups — Anterior mediastinal — Posterior mediastinal + Mediastinal lymph nodes are responsible for helping bone marrow and thymus produce mature lymphocytes. Anterior mediastinal lymph nodes + Located anterior to the heart and posterior to the sternum. 7." Receive lymph from,Posterior mediastinal lymph nodes + Located posterior to the heart and anterior to the spinal column. * Lie around oesophagus and thorac * Itdrains from oesophagus and tiss around thoracic aorta.Supratrochlear nodes * These nodes are locate near elbow and medial epicondyle of humerus. * Also known as Cubital lymph nodes. * They drain from, — Fingers — Ulnar side of the arm — Superficial areas of the forearm * Drains into axillary lymphAbdominal nodes Right and left para aortic nodes External illiac nodes Common illiac nodes Internal illiac nodes Epigastric nodes Lumbar glandsMesentric nodes * Distributed in the lower abdomen, they lie close to the small intestine. * They drain cecum, jejunum, ileum, colon and upper part of rectum. Inguinal nodes _ * Located in the groin area. % * They may be superficial or deep. They receive lymph from the g _buttock, anus, abdominal 'Femoral nodes Located in the upper thigh portion along the femoral veins. They drain from some of the genital parts, buttock, thigh and the medial side of the leg. Popliteal nodes Present in the knee area called popliteal fossa. There are two sets of popliteal lymph nodes some are present beneath the popliteal fascia and are found between the popliteal artery and posterior surface of the knee joint. ; drain from the knee, thigh, cal .LYMPHOID ORGANS * Spleen * Thymus * Tonsils * Peyer’s patchesSpleen * Spleen is the largest lymph organ. * Location: In the left hypochondrium of abdominal cavity, directly below the diaphragm, above the left kidney & descending colon, & behind the fundus of the stomach. * Structure: Oval in shape. Purplish in colour. Soft and highly vascular. About 12 cm long. It weighs about 200 g. The anterior surface is ered with peritoneum. cture is similar to lymph ° ° ° oO © ‘Stomach Blcod svpplyCapsille _Trabecula o Trabeculae are inward capsular extensions that divide spleen into Vascular sinusoid compatments. o The spleen parenchyma consists of two different kinds of tissue called Artery Wie pulp white pulp and red pulp. — White pulp involved in immune functions. It consist of lymphocytes —,,,, Red pulp, and macrophages, It is arranged arround central arteries (branches of splenic artery). — Red pulp consists of blood filled venous sinuses called splenic sinusoids and splenic (Billroth’s) cords. Splenic cords are regions of reticular connective tissue, that e, separate splenic sinusoids. Splenic cords consist of RBC, macrophages, Splenic artery ‘Splenic vein —— White pulp Fed pulp: Vereus sinus Splenic cord Central artery lymphocytes, plasma cells, and ; y granulocytes. It destroy da d Hi \ mndblood borne pathogens. (0/1 a | ee at ee Capsule