Human Anatomy — Tutorial Question

Answers
End of Semester Exam Revision Notes
Compiled answers to the 20 tutorial questions

1. Organs of the Thorax and Their Blood Supply

The thoracic cavity contains three main compartments: the two pleural cavities (each containing a lung),
and the mediastinum, which is subdivided into superior, anterior, middle and posterior parts.
Major organs
• Lungs and trachea/bronchi — gas exchange and conduction of air
• Heart and pericardium — pump, situated in the middle mediastinum
• Oesophagus — passes through the posterior mediastinum
• Thymus — lymphoid organ of the superior/anterior mediastinum (largest in childhood)
• Great vessels — aorta and its arch branches, superior vena cava, pulmonary trunk and veins,
azygos system
Blood supply
• Heart: right and left coronary arteries arising from the aortic sinuses; the left divides into anterior
interventricular (LAD) and circumflex branches
• Lungs: bronchial arteries (usually 1 right, 2 left) arising directly from the descending thoracic aorta
supply the bronchial tree and connective tissue; the pulmonary arteries carry deoxygenated blood
for gas exchange, not nutrition of lung tissue
• Oesophagus: upper third by inferior thyroid artery, middle third by oesophageal branches directly
from the thoracic aorta, lower third by branches of the left gastric artery
• Thymus: branches of the internal thoracic and inferior thyroid arteries
• Pericardium and diaphragm: pericardiacophrenic and musculophrenic arteries (branches of the
internal thoracic artery)
• Chest wall: posterior intercostal arteries (from the aorta) and anterior intercostal arteries (from
the internal thoracic artery)
2. Organs of the Abdomen and Their Innervation
Abdominal viscera are innervated by the autonomic nervous system (sympathetic and parasympathetic),
which travels with the major arteries to reach the gut and solid organs, plus visceral afferent (pain)
fibres that usually follow the sympathetic pathway back to the spinal cord.
General pattern
• Sympathetic supply: preganglionic fibres from T5–L2 travel as the greater, lesser and least
splanchnic nerves to synapse in the coeliac, superior mesenteric, aortico-renal and inferior
mesenteric ganglia; postganglionic fibres follow the corresponding arteries. Sympathetic activity
generally inhibits motility/secretion and causes vasoconstriction and sphincter contraction
• Parasympathetic supply: the vagus nerve (CN X) supplies the gut from the oesophagus to the
splenic flexure of the colon (foregut and midgut derivatives); the pelvic splanchnic nerves (S2–S4)
supply the hindgut from the splenic flexure to the anal canal. Parasympathetic activity stimulates
motility and secretion, and relaxes sphincters
Organ-specific innervation
• Stomach and duodenum (proximal): vagus (anterior and posterior trunks) and coeliac plexus
sympathetics
• Liver and gallbladder: hepatic plexus (vagal and sympathetic fibres from the coeliac plexus); pain
from gallbladder distension refers to the right shoulder via phrenic nerve overlap
• Pancreas: coeliac and superior mesenteric plexuses; pain classically radiates to the back
• Small intestine and proximal large bowel: superior mesenteric plexus (sympathetic) and vagus
(parasympathetic)
• Distal large bowel (descending colon, sigmoid, rectum): inferior mesenteric plexus (sympathetic)
and pelvic splanchnic nerves (parasympathetic)
• Kidneys and ureters: renal plexus, sympathetics from T10–L1; ureteric colic pain refers along the
T11–L2 dermatomes to groin/scrotum-labia
3. Histological Organization of the Structures of the G.I.T
From the oesophagus to the anal canal, the gut wall follows a common four-layer plan, with regional
modifications suited to each organ's function.
General layers (lumen to outside)
• Mucosa: epithelium, lamina propria (loose connective tissue with glands/lymphoid tissue) and
muscularis mucosae (thin smooth muscle)
• Submucosa: dense connective tissue with blood vessels, lymphatics and the submucosal
(Meissner's) nerve plexus; may contain glands (e.g. Brunner's glands in the duodenum)
• Muscularis externa: usually an inner circular and outer longitudinal smooth muscle layer, with the
myenteric (Auerbach's) plexus between them
• Serosa (intraperitoneal parts) or adventitia (retroperitoneal/thoracic parts, e.g. oesophagus)
Regional features
• Oesophagus: non-keratinised stratified squamous epithelium; mucous glands in submucosa; upper
third skeletal, middle mixed, lower third smooth muscle
• Stomach: simple columnar surface mucous cells; gastric pits leading to glands with parietal (acid),
chief (pepsinogen) and mucous neck cells; three layers of muscularis externa (added oblique layer)
• Small intestine: villi and crypts of Lieberkühn increase surface area; enterocytes with brush border,
goblet cells, Paneth cells at crypt base; duodenum has Brunner's glands, ileum has Peyer's patches
• Large intestine: no villi; straight crypts rich in goblet cells; taeniae coli (three bands of outer
longitudinal muscle)
• Anal canal: transition from simple columnar (above pectinate line) to stratified squamous
epithelium (below), reflecting its embryological hindgut/proctodeum origin
4. Organs of the Pelvic Cavity and Their Blood Supply
The pelvic cavity contains the terminal parts of the urinary and gastrointestinal tracts and the internal
reproductive organs.
Organs
• Urinary bladder and pelvic ureters
• Rectum and anal canal
• Female: uterus, uterine tubes, ovaries, vagina
• Male: prostate, seminal vesicles, vas deferens
Blood supply
Most pelvic viscera are supplied by branches of the internal iliac artery, which divides into anterior and
posterior divisions.
• Bladder: superior and inferior vesical arteries (from the anterior division; superior vesical is often a
continuation of the umbilical artery)
• Rectum: superior rectal artery (from the inferior mesenteric artery), middle rectal artery (from
internal iliac) and inferior rectal artery (from internal pudendal artery) — the basis for portal-
systemic anastomosis in the rectum
• Uterus: uterine artery (branch of internal iliac), anastomosing with the ovarian artery
• Ovaries: ovarian arteries, which arise directly from the abdominal aorta (reflecting their
embryological origin near the kidneys)
• Vagina: vaginal artery (branch of internal iliac or uterine artery)
• Prostate and seminal vesicles: inferior vesical artery
• Venous drainage largely mirrors the arteries, draining into internal iliac veins, with the rectal
venous plexus draining both into the portal system (superior rectal vein) and systemic system
(middle/inferior rectal veins)
5. Muscles of the Lower Limb and Their Blood Supply
Thigh
• Anterior compartment (quadriceps femoris, sartorius) — femoral nerve; supplied by femoral artery
and its branches (profunda femoris)
• Medial/adductor compartment (adductor longus, brevis, magnus, gracilis, pectineus) — obturator
nerve; supplied by obturator artery and profunda femoris
• Posterior compartment/hamstrings (biceps femoris, semitendinosus, semimembranosus) — sciatic
nerve (tibial division); supplied by perforating branches of profunda femoris
Leg
• Anterior compartment (tibialis anterior, extensor digitorum longus, extensor hallucis longus,
peroneus tertius) — deep peroneal nerve; supplied by anterior tibial artery
• Lateral compartment (peroneus longus and brevis) — superficial peroneal nerve; supplied by
peroneal (fibular) artery
• Posterior compartment (gastrocnemius, soleus, plantaris — superficial; popliteus, flexor digitorum
longus, flexor hallucis longus, tibialis posterior — deep) — tibial nerve; supplied by posterior tibial
artery
Foot
Intrinsic foot muscles are supplied mainly by the medial and lateral plantar arteries (branches of the
posterior tibial artery) plantarly, and the dorsalis pedis artery (continuation of anterior tibial artery)
dorsally.
Key arterial trunk
The femoral artery becomes the popliteal artery at the adductor hiatus, which then divides into the
anterior tibial artery and the tibioperoneal trunk (giving posterior tibial and peroneal arteries).
6. Superficial and Deep Drainage of the Upper Limb
Superficial venous drainage
Superficial veins lie in the subcutaneous tissue and are not accompanied by arteries.
• Cephalic vein: arises from the dorsal venous network of the hand, ascends along the lateral (radial)
side of the forearm and arm, and drains into the axillary vein in the deltopectoral groove
• Basilic vein: arises medially from the dorsal venous network, ascends the medial forearm and arm,
pierces the deep fascia in the mid-arm, and joins the venae comitantes of the brachial artery to
form the axillary vein
• Median cubital vein: connects the cephalic and basilic veins obliquely across the cubital fossa; the
classic site for venepuncture
Deep venous drainage
Deep veins accompany the corresponding arteries, usually as paired venae comitantes, and drain
proximally.
• Radial and ulnar veins unite to form paired brachial veins alongside the brachial artery
• Brachial veins join the basilic vein to form the axillary vein at the lower border of teres major
• The axillary vein continues as the subclavian vein at the outer border of the first rib, which then
joins the internal jugular vein to form the brachiocephalic vein
Lymphatic drainage runs a broadly similar course: superficial lymphatics accompany the superficial veins
to the cubital and axillary nodes, while deep lymphatics accompany the deep vessels directly to the
axillary nodes.
7. Origin of Cranial Nerves in the Brainstem
Ten of the twelve cranial nerves attach to the brainstem (CN I attaches to the forebrain/olfactory bulb
and CN II is a forebrain tract, not a true peripheral nerve).
Midbrain
• CN III (Oculomotor): emerges from the interpeduncular fossa, medial aspect of the cerebral
peduncles
• CN IV (Trochlear): the only cranial nerve to emerge from the dorsal (posterior) surface of the
brainstem, just below the inferior colliculus, then wraps around the midbrain
Pons
• CN V (Trigeminal): emerges from the lateral surface of the pons (largest cranial nerve root)
• CN VI (Abducens): emerges at the pontomedullary junction, medially
• CN VII (Facial): emerges at the pontomedullary junction, lateral to CN VI, in the cerebellopontine
angle
• CN VIII (Vestibulocochlear): emerges just lateral to CN VII at the cerebellopontine angle
Medulla
• CN IX (Glossopharyngeal): emerges from the postolivary sulcus (dorsal to the olive)
• CN X (Vagus): emerges from the postolivary sulcus, just below CN IX
• CN XI (Accessory): cranial root from the postolivary sulcus below the vagus, plus a spinal root from
the upper cervical spinal cord that ascends through the foramen magnum
• CN XII (Hypoglossal): emerges from the preolivary sulcus (between the pyramid and the olive)
8. Venous Drainage of the Brain
Cerebral veins have no valves and drain into the dural venous sinuses, which ultimately empty into the
internal jugular veins.
Superficial (external) cerebral veins
• Superior cerebral veins: drain the superolateral and medial surfaces of the hemisphere into the
superior sagittal sinus
• Superficial middle cerebral vein: drains the lateral surface into the cavernous sinus (or
sphenoparietal sinus)
• Vein of Trolard (superior anastomotic vein) connects the superficial middle cerebral vein to the
superior sagittal sinus; vein of Labbé (inferior anastomotic vein) connects it to the transverse sinus
Deep cerebral veins
• Internal cerebral veins (paired) drain deep structures (basal ganglia, thalamus, choroid plexus) and
unite to form the great cerebral vein of Galen
• The basal vein of Rosenthal also drains into the vein of Galen
• The great cerebral vein joins the inferior sagittal sinus to form the straight sinus
Dural venous sinus pathway
The superior sagittal sinus and straight sinus drain to the confluence of sinuses, then into paired
transverse sinuses, sigmoid sinuses, and finally the internal jugular veins. The cavernous sinuses drain
via superior and inferior petrosal sinuses into the transverse/sigmoid sinuses and internal jugular vein
respectively.
9. Blood Supply of the Spinal Cord
Longitudinal (intrinsic) arteries
• One anterior spinal artery: formed by branches of both vertebral arteries near the foramen
magnum; runs in the anterior median fissure and supplies the anterior two-thirds of the cord
(anterior horns, spinothalamic tracts, corticospinal tracts)
• Two posterior spinal arteries: arise from the vertebral arteries (or posterior inferior cerebellar
arteries); supply the posterior one-third of the cord (dorsal columns, dorsal horns), reinforced by a
rich pial plexus
Segmental reinforcement
Because the spinal arteries alone cannot supply the entire length of the cord, they are reinforced at
intervals by radicular and segmental medullary arteries arising from vertebral, deep cervical, posterior
intercostal and lumbar arteries.
• The great anterior segmental medullary artery (artery of Adamkiewicz) is the largest, usually
arising between T9–L2 on the left, and is critical for perfusion of the lower two-thirds of the cord
— vulnerable during aortic surgery, causing anterior spinal artery syndrome if compromised
Venous drainage
Anterior and posterior spinal veins drain into a venous plexus which communicates with the internal
vertebral venous (Batson's) plexus, then to segmental veins and ultimately the azygos system.
10. The Spinothalamic and Dorsal Column–Medial Lemniscus Pathways
Anterolateral (spinothalamic) system — pain, temperature and crude touch
• 1st order neuron: cell body in the dorsal root ganglion; peripheral fibre from receptor, central fibre
enters the dorsal horn and synapses within 1–2 segments
• 2nd order neuron: cell body in the dorsal horn (substantia gelatinosa/nucleus proprius); axon
crosses immediately in the anterior white commissure and ascends contralaterally as the
spinothalamic tract
• 3rd order neuron: synapses in the ventral posterolateral (VPL) nucleus of the thalamus, then
projects to the primary somatosensory cortex (postcentral gyrus)
Dorsal column–medial lemniscus (DCML) pathway — fine touch, vibration, proprioception
• 1st order neuron: dorsal root ganglion cell; central process ascends ipsilaterally in the dorsal
column (fasciculus gracilis below T6, fasciculus cuneatus above T6) without synapsing at the level
of entry
• 2nd order neuron: synapses in the gracile or cuneate nucleus of the lower medulla; axon crosses
the midline as internal arcuate fibres, forming the contralateral medial lemniscus
• 3rd order neuron: synapses in the VPL nucleus of the thalamus, then projects to the postcentral
gyrus
The key clinical distinction is the level of decussation: DCML crosses in the medulla, whereas the
spinothalamic tract crosses at spinal cord level shortly after entry — this underlies the different patterns
of sensory loss seen in cord hemisection (Brown-Séquard syndrome) versus brainstem/thalamic lesions.
11. The Vision and Hearing Pathways
Visual pathway
• Light is focused on the retina; photoreceptors (rods and cones) synapse with bipolar cells, which
synapse with retinal ganglion cells
• Ganglion cell axons form the optic nerve (CN II)
• At the optic chiasm, fibres from the nasal (medial) half of each retina decussate, while temporal
fibres remain uncrossed — this means each optic tract carries the contralateral visual field from
both eyes
• The optic tract synapses in the lateral geniculate nucleus (LGN) of the thalamus
• LGN neurons project via the optic radiations — the superior fibres (parietal lobe, carrying inferior
visual field) and inferior fibres (Meyer's loop, temporal lobe, carrying superior visual field) — to the
primary visual cortex in the occipital lobe (banks of the calcarine sulcus)
Hearing pathway
• Sound vibrations are transduced by hair cells in the organ of Corti (cochlea) into nerve impulses
carried by the cochlear nerve (part of CN VIII)
• Fibres synapse in the cochlear nuclei (dorsal and ventral) at the pontomedullary junction
• From here, pathways ascend bilaterally (partially crossing at the trapezoid body) via the superior
olivary nuclei — this bilateral projection allows sound localisation and means unilateral central
lesions rarely cause complete deafness
• Fibres ascend in the lateral lemniscus to the inferior colliculus, then to the medial geniculate
nucleus (MGN) of the thalamus
• MGN neurons project via the auditory radiation to the primary auditory cortex in the superior
temporal gyrus (transverse temporal/Heschl's gyri)
12. Muscles of the Spine and Their Function
Superficial (extrinsic) back muscles
Trapezius, latissimus dorsi, rhomboids and levator scapulae connect the axial skeleton to the upper limb
and act mainly on the scapula/humerus rather than the vertebral column itself.
Intermediate group
Serratus posterior superior and inferior assist in respiration (minor role).
Deep (intrinsic/true back) muscles — act on the vertebral column
• Erector spinae group (iliocostalis, longissimus, spinalis) — the main extensors of the vertebral
column; bilateral contraction extends the spine, unilateral contraction produces lateral flexion
• Transversospinalis group (semispinalis, multifidus, rotatores) — deep to erector spinae; bilateral
contraction extends the spine, unilateral contraction rotates the vertebral column to the opposite
side and assists lateral flexion; multifidus is particularly important for segmental stabilisation
• Segmental/minor muscles (interspinales, intertransversarii) — fine postural adjustment and
proprioceptive feedback between adjacent vertebrae
• Suboccipital muscles (rectus capitis posterior major/minor, obliquus capitis superior/inferior) —
fine control of head movement at the atlanto-occipital and atlanto-axial joints, extension and
rotation of the head
Functionally, these muscles maintain upright posture against gravity, control and produce movements of
extension, flexion, lateral flexion and rotation of the vertebral column, and stabilise individual spinal
segments during movement.
13. Innervation Controlling the Micturition and Defecation Pathways
Micturition (bladder)
• Parasympathetic (pelvic splanchnic nerves, S2–S4): stimulates contraction of the detrusor muscle
and relaxation of the internal urethral sphincter — promotes voiding
• Sympathetic (hypogastric nerve, T11–L2): relaxes the detrusor and contracts the internal urethral
sphincter (in males, also prevents retrograde ejaculation) — promotes storage/continence
• Somatic (pudendal nerve, S2–S4): voluntary control of the external urethral sphincter (skeletal
muscle)
• Higher control: the pontine micturition centre coordinates detrusor contraction with sphincter
relaxation; cortical centres allow voluntary inhibition until socially appropriate
Defecation
• Parasympathetic (pelvic splanchnic nerves, S2–S4): increases peristalsis of the descending colon,
sigmoid colon and rectum, and relaxes the internal anal sphincter
• Sympathetic (lumbar splanchnics/hypogastric plexus, L1–L2): decreases motility and maintains
tone of the internal anal sphincter (smooth muscle, involuntary)
• Somatic (pudendal nerve, S2–S4, inferior rectal branch): voluntary control of the external anal
sphincter (skeletal muscle)
In both reflexes, rectal or bladder distension is sensed by stretch receptors, triggering a spinal reflex arc
that can be voluntarily overridden via descending cortical input acting on the somatic sphincters.
14. Four Regions of Portal-Systemic Anastomosis
Portal-systemic anastomoses become clinically important in portal hypertension, where portal blood is
diverted through these channels causing varices.
• 1. Oesophageal (gastro-oesophageal junction): left gastric vein (portal) anastomoses with the
oesophageal veins draining to the azygos vein (systemic) — dilation produces oesophageal varices,
a major cause of life-threatening upper GI bleeding
• 2. Rectal/anal canal: superior rectal vein (portal, via inferior mesenteric vein) anastomoses with
middle and inferior rectal veins (systemic, via internal iliac and internal pudendal veins) — dilation
produces internal haemorrhoids
• 3. Paraumbilical (anterior abdominal wall): paraumbilical veins (portal, running in the ligamentum
teres to the left branch of the portal vein) anastomose with superficial epigastric and
thoracoepigastric veins (systemic) — dilation produces the classic 'caput medusae'
• 4. Retroperitoneal (bare area anastomoses): veins of the ascending and descending colon,
duodenum, pancreas and liver (portal tributaries) anastomose with retroperitoneal systemic veins
(renal, lumbar, phrenic) where these organs are in direct contact with the posterior abdominal wall
— clinically less prominent but relevant in portal hypertension
15. Accessory Organs of the G.I.T and Their Functions
• Salivary glands (parotid, submandibular, sublingual): secrete saliva containing amylase (starch
digestion), lubrication (mucin) and antimicrobial substances
• Liver: produces bile (emulsifies fats for digestion/absorption), metabolises
carbohydrates/proteins/fats, detoxifies drugs and metabolic waste, synthesises plasma proteins
and clotting factors, stores glycogen and vitamins
• Gallbladder: stores and concentrates bile between meals, releases it into the duodenum via the
cystic and common bile ducts in response to cholecystokinin (CCK) when fat enters the duodenum
• Pancreas (exocrine function): secretes digestive enzymes (amylase, lipase, proteases such as
trypsinogen/chymotrypsinogen) and bicarbonate-rich fluid into the duodenum via the pancreatic
duct, neutralising gastric acid and enabling enzymatic digestion; (endocrine function): islets of
Langerhans secrete insulin and glucagon regulating blood glucose
Together these accessory organs supply the enzymes, bile and buffering capacity needed for chemical
digestion and absorption of nutrients, complementing the mechanical and enzymatic work of the GIT
proper.
16. Functions of the Lobes of the Brain and Associated Blood Vessels
• Frontal lobe: voluntary motor control (primary motor cortex, precentral gyrus), executive function,
personality, Broca's area (expressive speech, usually left hemisphere), voluntary eye movements.
Supplied mainly by the anterior cerebral artery (medial and superior surfaces) and middle cerebral
artery (lateral surface)
• Parietal lobe: primary somatosensory cortex (postcentral gyrus), sensory integration, spatial
awareness, calculation, language comprehension (in the dominant hemisphere). Supplied by the
middle cerebral artery (lateral surface) and anterior cerebral artery (medial surface)
• Temporal lobe: primary auditory cortex, Wernicke's area (language comprehension, usually left
hemisphere), memory (hippocampus), emotional processing (amygdala). Supplied mainly by the
middle cerebral artery, with the inferior/medial parts supplied by the posterior cerebral artery
• Occipital lobe: primary visual cortex and visual processing. Supplied by the posterior cerebral
artery
Clinically, this vascular territory mapping explains stroke syndromes: MCA strokes classically cause
contralateral face/arm-predominant weakness and (if dominant hemisphere) aphasia; ACA strokes
cause contralateral leg-predominant weakness; PCA strokes cause contralateral homonymous
hemianopia.
17. Brain Homunculus and Its Clinical Relevance
The homunculus ("little man") is a somatotopic map showing how different body parts are represented
along the primary motor cortex (precentral gyrus) and primary somatosensory cortex (postcentral
gyrus). It is typically drawn as a distorted human figure draped over the cortical surface.
• The amount of cortex devoted to a body part reflects the fineness of motor control or sensory
discrimination required, not the physical size of the part — hence the hands, face and lips (fine
motor control/high sensory discrimination) are grossly enlarged, while the trunk and legs are
comparatively small
• The representation runs mediolaterally along the gyrus: the leg and foot are represented on the
medial surface (supplied by the anterior cerebral artery), while the face, hand and arm are
represented on the lateral convexity (supplied by the middle cerebral artery)
Clinical relevance
• Localises lesions: the pattern of motor or sensory deficit (e.g. face and arm affected more than leg,
versus leg affected more than face/arm) helps predict which vascular territory or cortical region is
involved, e.g. a leg-predominant deficit suggests an anterior cerebral artery infarct
• Explains focal (Jacksonian) seizures, where abnormal electrical activity spreads across the motor
homunculus producing a characteristic 'march' of twitching from one body part to adjacent ones
• Guides neurosurgical planning, such as avoiding eloquent cortex (e.g. hand area) during tumour
resection, using intraoperative cortical mapping
18. Blood Supply and Venous Drainage of the Heart
Arterial supply
• Right coronary artery (RCA): arises from the right aortic sinus; runs in the right atrioventricular
groove; typically gives the sinoatrial nodal artery (~60% of people), right marginal artery, and
posterior interventricular (posterior descending) artery in most people ('right dominant'
circulation), supplying the right atrium, right ventricle, and (via the PDA) the inferior wall of the left
ventricle and posterior third of the interventricular septum
• Left coronary artery (LCA): arises from the left aortic sinus; short left main stem divides into: the
anterior interventricular artery (LAD) — runs in the anterior interventricular groove, supplying the
anterior left ventricle, anterior septum and apex; and the circumflex artery — runs in the left
atrioventricular groove, supplying the left atrium and lateral/posterior left ventricle
• The atrioventricular nodal artery usually arises from the RCA (~90%), reflecting right coronary
dominance in most individuals
Venous drainage
Most cardiac venous blood drains via the coronary sinus, which lies in the posterior atrioventricular
groove and empties into the right atrium. Its main tributaries are the great cardiac vein (accompanies
the LAD), middle cardiac vein (accompanies the posterior interventricular artery), and small cardiac vein
(accompanies the right marginal artery).
A smaller amount of blood drains via anterior cardiac veins, which drain the anterior right ventricle
directly into the right atrium (bypassing the coronary sinus), and via the smallest cardiac (thebesian)
veins, which drain directly into all four cardiac chambers.
19. Development of the Pharyngeal Arches
Pharyngeal (branchial) arches are bars of mesenchyme (with a neural crest contribution) that appear in
the fourth to fifth week of development, separated externally by pharyngeal clefts and internally by
pharyngeal pouches. Each arch has its own cartilage, muscle, nerve and artery, giving a consistent
developmental pattern across arches.
• 1st arch (mandibular): cartilage — Meckel's cartilage (forms malleus, incus, sphenomandibular
ligament; mandible forms by intramembranous ossification around it); muscles — muscles of
mastication, mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini; nerve —
trigeminal nerve (CN V, mandibular division); artery — maxillary artery
• 2nd arch (hyoid): cartilage — Reichert's cartilage (stapes, styloid process, stylohyoid ligament,
lesser horn and upper body of hyoid); muscles — muscles of facial expression, stapedius,
stylohyoid, posterior belly of digastric; nerve — facial nerve (CN VII); artery — stapedial artery
(largely regresses)
• 3rd arch: cartilage — greater horn and lower body of hyoid; muscle — stylopharyngeus; nerve —
glossopharyngeal nerve (CN IX); artery — common carotid artery and proximal internal carotid
artery
• 4th arch: cartilage — thyroid, cricoid, arytenoid and other laryngeal cartilages; muscles —
pharyngeal constrictors, cricothyroid, levator veli palatini; nerve — vagus nerve, superior laryngeal
branch; artery — on the right, proximal subclavian artery; on the left, arch of the aorta
• 6th arch (5th arch is rudimentary/absent in humans): cartilage — laryngeal cartilages (with 4th
arch); muscles — intrinsic muscles of the larynx (except cricothyroid); nerve — vagus nerve,
recurrent laryngeal branch; artery — on the right, proximal pulmonary artery; on the left, ductus
arteriosus
Pharyngeal pouches give rise to endocrine and lymphoid structures (e.g. middle ear/eustachian tube,
palatine tonsil, thymus, inferior and superior parathyroid glands), while pharyngeal clefts largely
disappear except the first, which forms the external acoustic meatus.
20. Embryology of the G.I.T
The primitive gut tube forms during the fourth week as the embryo folds cranio-caudally and laterally,
incorporating part of the yolk sac. It is divided into foregut, midgut and hindgut, each with its own blood
supply, matching the adult arterial pattern (coeliac trunk, superior mesenteric artery, inferior
mesenteric artery respectively).
Foregut derivatives (coeliac trunk)
Pharynx (partly), oesophagus, stomach, duodenum (proximal to the bile duct opening), liver, gallbladder,
pancreas, and the biliary system, plus the lower respiratory tract as an outgrowth of the foregut.
Midgut derivatives (superior mesenteric artery)
Duodenum (distal to bile duct opening), jejunum, ileum, caecum, appendix, ascending colon, and
proximal two-thirds of the transverse colon.
• A key event is physiological umbilical herniation (the midgut loop herniates into the umbilical cord
in week 6 because the abdominal cavity is too small), followed by a total 270° counter-clockwise
rotation around the axis of the superior mesenteric artery, and return of the gut to the abdominal
cavity by week 10 — failure of this process causes malrotation, volvulus, or omphalocele
Hindgut derivatives (inferior mesenteric artery)
Distal third of the transverse colon, descending colon, sigmoid colon, rectum, and upper part of the anal
canal (above the pectinate line); the hindgut also gives rise to the epithelial lining of the bladder and
urethra via the urorectal septum, which divides the cloaca into the urogenital sinus (anteriorly) and
anorectal canal (posteriorly).
The lower anal canal (below the pectinate line) develops from ectoderm (the proctodeum), which
explains its different arterial supply, venous/lymphatic drainage, innervation, and epithelial type
compared with the upper anal canal.