9 ANATOMY

CHAPTER

SSA SVE SVA GSA GVE GVA GSE

Special senses Muscles of Swaad General To glands Autonomic To muscles
pharyngeal arch Taste Sensory sensations

NTS
1 5 - 5
Trigeminal
3 Nucleus tactus 3,4,6
Smell solitarius Extra-ocular muscles
Face
LR⁶SO⁴O³
2 7 7 7 7 7
Vision Ant 2/3
12
8 9 9 9
Jacobson's
9 9 Hypoglossal
Tongue
Vestibulo- Post 1/3
(middle ear)
cochlear
nerve
10 10 10 10 10 11
Posterior most Arnold's Spinal Acc. nerve
(uvula & soft palate) (External ear) Trapezius

Motor
Afferent Efferent Columns for 3rd CN : GVE and GSE
Sensory For 7, 9, 10 CN : All except first and last (SSA and GSE)

Olfactory, Optic, Vestibulo-cochlear

EOM, Hypoglossal

7,9,10 + SAN + trigeminal

GVE/Parasympathetic supply

Cranial nerve Preganglionic Postganglionic Structures supplied

parasympathetic Ganglion parasympatehtic
nucleus

Edinger-Westphal Ciliary ganglion Nasociliary nerve Ciliary muscles

nucleus CN III Short ciliary nerves
Pterygopalatine Lacrimal gland
ganglion Maxillary nerve
Superior salivatory
CN VII Sublingual and
nucleus Submandibular Lingual nerve
ganglion submandibular glands

Inferior salivatory Auriculotemporal Parotid gland

CN IX Otic ganglion
nucleus nerve (Frey's Sx) "Par-Otic gland"
Dorsal motor
CN X Vagal Nerve Heart, lungs upper GI
nucleus
 EW nucleus Ciliary Ganglion
III nerve
Sphincter pupillae & Ciliaris muscles

Pterygopalatine Ganglion
GPN
Sup. Sal. Nu Lacrimal gland
VII nerve

Chorda tympani nv Submandibular & sublingual gland

Submandibular Ganglion
Inf. Sal. Nu
Otic Ganglion
IX nerve
Parotid gland

Dorsal nu of X

X nerve
Smooth muscles & glands of thorax and abdomen

Parasympathetic outflow-craniosacral outflow-III, VII,IX, X, S2, S3, S4

Sympathetic outflow-thoracolumbar outflow-T1 to L2 nerve

Gray and white mater communicantis

Gray is post-ganglonic and unmyelinated
White is myelinated and preganglionic

Gray vs White Mater

Contains neuronal Contains myelin
cell bodies sheath (fibres)
Outer part in Brain Inner part in brain
Inner part in Spinal Ouer part in spinal
cord cord

Trigeminal Nuclei

Centre for jaw reflex

Mesencephalic nu. Proprioception
Only site for pseudo-unipolar neuron in CNS

Principal sensory nu. Touch & pressure

Touch in face is more sensitive- hence principal nucleus

Spinal nu. Pain & temperature

Spine - pain
 Posterior triangle of neck

Facial branch Mastoid branch

Great auricular nerve

GAN thickened in Leprosy patient
Root value: C2-C3
Runs with EJV
Supplies lobule of ear
Supplies skin at angle of mandible & parotid region
In Frey’s syndrome- ATN communicates to GAN
Injured in parotid Sx - sensory loss in shaving area

Spinal accessory nerve

Runs between investing layer and pre-vertebral layer
Injury in posterior triangle
SCM spared and Trapezius affected
Difficulty in shrugging of shoulder
Difficulty in retraction of scapula
Difficulty in overhead abduction

Cross section at neck

RLN –Tracheo-esophageal groove

X nerve-Inside carotid sheath

Sympathetic chain-between carotid sheath and prevertebral fascia

Phrenic nerve - Ant to scalenus anterior & posterior to PVF

Roots of brachial plexus - between Scalenus anterior and medius

Ansa cervicalis (most commonly damaged in

injury to carotid sheath)

Contents
CCA IJV 1. CCA
2. ICA
X 3. IJV
4. X nerve

Sympathetic chain

Investing layer of deep

Modifications of deep cervical fasica of neck cervcal fascia: : Rule of 2
1. Pre-tracheal fascia : encloses the trachea and thyroid gland 2 muscles: SCM & Trapezius
2. Investing layer 2 glands: Parotid & Submandibular
3. Pre-vertebral layer : Surrounds the vertebral coloumn and scalene muscles 2 ligaments: Stylomandibular &
4. Carotid sheath
Sphenomandibular
2 spaces: Suprasternal & Supraclavicular
2 pulleys: Digastric and omohyoid
Cavernous Sinus

Through the walls Through the sinus

CN 3 (oculomotor) CN 6 (Abducens)
CN 4 (trochlear) ICA
CN 5¹ (Opthalmic div) Carotidocavernous fistula
CN 5² (Maxillary )

Pulsatile proptosis

Sella turcica
Sellar mass : Pitutary adenoma
Supra-sellar mass : Craniopharyngioma

II

III

IV

VI

XII
IX, X, XI
Sphenoid bone

Lesser
Greater wing wing
Maxillary branch of
Sella turcica F. Rotundum trigeminal nerve nerve (V²)

F. Lacerum
F.ovale
MALE through ovale
F. Spinosum
Mandibular branch of
trigeminal nerve (V³)
Acc. meningial artery
Lesser petrosal nerve
Emissary veins
Middle meningial artery
(Injured in EDH)
Nervus spinosum

EDH
Injury to anterior MMA
Landmark : Pterion
Lemon shaped
Doesn't cross suture lines
Crosses midline

Parietal Frontal

Pterion
Sup. Orbital fissure
Between greater and lesser
wing of sphenoid

LFT Outside SoNIA Inside Squamous part of

temporal bone
Greater wing of Sphenoid

Lacrimal n Sup. Oculomotor

Relations-
Frontal n Naso'ciliary
Trochlear n Inf. Oculomotor
+ Abducens
Opthalmic Anterior division of the middle
vein meningeal vessels
Middle cerebral vessels
Optic canal Sylvain fissure
In lesser wing of sphenoid Insula
Optic nerve Broca's motor speech area (on the left)
Opthalmic artery
Temporal bone

Bill's bar

7
Sup
vest n
Squamous
part Falciform
t
crest
tr
ou
sp
ar
Cochlear Inferior
Pe
n vest n

External acoustic
meatus
Squamous part of
Tympamic part of temporal bone
temporal bone
Zygomatic process
Mastoid part of
temporal bone
Styloid process
Mastoid process

Occipital bone

Jugular foramen divided by jugular spine

CT : Jugular foramen
Pars nervosa : 9th CN + Inf petrosal sinus
Pars vascularis : 10th CN, 11th CN and IJV

Phelp's sign
Destruction of Jugular spine in Glomus Jugulare
 Anatomy BTR by Dr. Zainab Vora

Cranial Foramina

Cribriform plate (olfactory n.)

Optic canal
Sup. Orbital fissure
Rotundum
Ovale

Spinosum

F. Lacerum
F.
Magnum
Int. Aud. Meatus

Jugular foramen

Hypoglossal canal.
12th CN

FORAMEN LACERUM

At junction of
1. Sphenoid bone
2. Apex of the petrous temporal bone
3. Basilar part of the occipital bone

Traversing structures Fills UP

1. Meningeal branches 1. ICA
of ascending 2. Sympathetic plexus
pharyngeal art. 3. DPN
2. Emissary veins 4. GPN

Cranial Nerves

Trochlear nerve
Dorsal origin
Longest intra-dural : Abducents Nerve (dorello's canal)
Internal decussation
Longest intra-osseus : Facial Nerve
Longest intracranial course
Thinnest and smallest

Rule of 17
12 + 5 palsy : Ipsilateral deviation Messi and Ronaldo
10 + 7 palsy : Contralateral deviation cross contra-lateral
 Anatomy BTR by Dr. Zainab Vora

Pharyngeal clefts and pouches

Clefts

Obliterates

Cleft → Mesoderm Pouch →

Ectoderm endoderm

Persistence Only 1st cleft forms

External auditory canal
Branchial cyst Outer layer of tympanic
membrane

Pharyngeal membrane :
Site where cleft meets pouch
(1st pharyngeal memb. forms tymp membrane)

Pouches
1st pouch - Middle ear cavity, eustachian tube & mastoid antrum

2nd pouch - Palatine 2onsil

Most common micro-
3rd pouch- Thymus & inferior parathyroid gland deletion syndrome
DiGeorge syndrome
4th pouch- Superior parathyroid gland
(22q11 deletion syndrome)
Remnant of 5th pouch - Ultimobranchial body
Pharyngeal arches and derivatives

1st arch (M) 2nd arch (S) 3rd arch

Mandibular nerve (V3) Facial nerve (VII) Glossopharyngeal nerve (IX)
Maxillary artery Stapedial artery CCA and ICA

Maxilla and Mandible

Malleus and Incus Stapes (Stapedius muscle) Body and greater horn of hyoid
ZygoMatic bone Styloid process Stylopharyngeus
SphenoMandibular ligament Lesser horn of Hyoid

Muscles of mastication Muscles of facial expression, Buccinator

Mylohyoid Stylohyoid
Anterior belly of digastric Posterior belly of digastric
Tensor veli palatini Platysma, Stapedius

4th arch 6th arch

Vagus and SLN Vagus and RLN
On left : ARCH of Aorta Pulmonary artery
On right : Proximal part of subclavian artery Ductus arteriosus on left side

All soft palate muscles (except TVP) All muscles of Larynx (except Cricothyroid
All muscles of pharynx (except - stylopharyngeus by 4th arch)
by 3rd and cricopharyngues by 6th) Cricopharyngeus
Cricothyroid

Stylo-pharyngeus
3rd arch
4th arch

6th arch
Crico-pharyngeus 🔁 Crico-thyroid

Dysphagia lusoria Zenker's Diverticulum

Aberrant right subclavian artery
Pulsion pseudo diverticulum in Killian's
Defect in 4th arch
dehiscence
Seen in elderly
Boyce sign
Because thyropharyngeus and
cricopharyngeus have different nerve
supply (Different origin)
T/t : Dohlman Procedure

Crico-thyroid
Only Tensor and Adductor of vocal cords
Because 4th arch derivative, supplied by SLN (other muscles by RLN)
In b/l RLN palsy, there is unopposed adduction - Emergency
 BTR by Dr. Zainab Vora Anatomy

Tongue

Genioglossus aka Safety muscle of tongue

(doesn't allow tongue to fall back)
Hyoglossus is the only depressor
(towards hyoid)
All muscles supplied by 12th CN except
Palatoglossus (supplied by pharyngeal plexus)

Safety muscles
Tongue - Genioglossus (Genie)
Larynx - Posterior crico arytenoid (ACP)

Development of tongue
MUSCLES - Occipital myotomes (except palatoglossus)
Genio-hyoid Anterior 2/3 : 1st arch (along with tuberculum impar)
Genio-glossus Posterior 1/3 : 3rd arch (hypobranchial eminence)
Hyo-glossus Posterior most : 4th arch (hypobranchial eminence)
Stylo-glossus

Lingual Nerve

Posterior most (4th arch)

Both taste and sensation by
Vagus nerve

Posterior 1/3rd (3rd arch)

Both taste and sensation by
glossopharyngeal nerve

Anterior 2/3rd (1st arch)

Division of mandibular nerve
Taste : Chorda tympani
Moves along with chorda tympani (both supply Sensation : Lingual nerve
ant 2/3 tongue)
Most likey to get damaged in sub-mandibular Anterior → Posterior
gland resection
Inserts into hyoglossus muscle
7 → 9 →10
 BTR by Dr. Zainab Vora Anatomy

Muscles of mastication

Temporalis Lateral pterygoid

Masseter
Medial pterygoid

All derived from 1st pharyngeal arch

All supplied by Mandibular nerve except → Medial pterygoid (Trigeminal)
All elevators except Lateral pterygoid (LP Lowers)
All protractors except Temporalis (retractor)
Accessory masticator muscle is Buccinator
 Anatomy BTR by Dr. Zainab Vora

Sagittal Section of Brain

Roof of 3rd ventricle

Body of fornix
Corpus callosum
Anterior relations Body Choroid plexus
of 3rd ventricle Septum
pellucidum
Anterior commissure Posterior relations of 3rd ventricle
First commisure to develop
Corpus
Lamina terminalis callosum
Remnant of ant. neuropore spleenium Habenular commissure
III VENTRICLE Pineal gland (epithalamus)
Posterior commissure
mid- SC
Floor of 3rd ventricle
brain IC
Aqueduct
Optic chiasma
Infundibulum
MB Pons
IVth
Post perforating ventricle
substance
Medulla

Str. on posterior wall of 3rd ventricle

Famous VIP
F Fornix
V Vellum interpositum
I Int. cerebral vein
P Pineal gland
Fornix
Above pineal gland : Habenular commisure
3rd Ventricle Below pineal gland : Posterior commisure

MB IV nerve

Pitutary VII nerve

Sphenoid Pons
sinus

Medulla
Basilar artery

Fornix connects Hippocampus to Mamillary body

 Anatomy BTR by Dr. Zainab Vora

Types of White Mater fibres

Commisural (Connects two hemispheres) Parts of corpus callosum

Corpus callosum
Ant. Commisure
Post. Commisure RGBS
Habenular commisure R Rostrum
Hippocamp. fibres of fornix
G Genu
Assocaition (within same hemisphere) B Body
Arcuate fasciculus S Spleenium
Sup/inf longitudinal fasciculi
Fornix
Cingulum
Forceps Minor
Genus of
Projection (Cortex to deeper structures) corpus callosum

Cortico-spinal tracts Corona radiata Corona radiata

(cut surface) (cut surface)
Cortico-bulbar tract
Optic radiation
Internal capsule
Corona radiata

Splenium of
corpus callosum
Forceps major

Limbic System

Papez circuit
A neural circuit for the control of
emotional expression and memory.
1. Fornix
2. Hippocampus
3. Mamillary body
4. Cingulate gyrus
5. Subiculum
6. Anterior thalamic nuclei
TERMINATION OF FORNIX

Went to single, ORIGIN OF FORNIX

wanted to buy "sab"
but met aunty.
 BTR by Dr. Zainab Vora Anatomy

Coronal Section of Brain

Septum pellucidum

Corona radiata Body of Caudate nucleus

Fornix & Choroid plexus

Thalamus

Substantia Nigra

Lentiform nucleus

Forceps minor

Insula

Caudate nucleus
Lentiform nu
Internal capsule
Thalamus

Tapetum

Forceps major

Bulb of post horn of

lateral ventricle
 Anatomy BTR by Dr. Zainab Vora

Vascular anatomy of brain

Anterior
Doesn't participate in Middle Cerebral
Circle of Willis Cerebral A2 artery
artery
Enters Lateral sulcus
A1

Direct branch of ICA

Posterior P1 Part of Anterior
Cerebral artery circulation
P2

Superior Cerebellar artery

Anterior Inferior
Cerebellar artery

Runs in internal
acoustic meatus
Posterior Inferior
Cerebellar artery

COW aneurysms
ACA and ACOM
Most common location of Berry aneurysm
(aka Saccular aneurysm)
Pressure on optic chiasma can lead to BTHA

PCA and PCOM

Most common aneurysms to "rupture"
Pressure on 3rd CN that runs between PCA and SCA
(Ipsilateral down and out eye)
Blood Supply

Blood supply of Cerebral Cortex

ACA
ACA
MCA

PCA
PCA
MCA

Corpus Callosum supplied by

ACA along with ACOM

Blood supply of internal capsule

ACA : Recurrent artery of Heubner (longest)

MCA : Lenticulo striate branch aka Charcot's

ACA and MCA same as anterior limb

Direct branch from internal carotid

MCA : Charcot's artery

Anterior choroidal artery
(branch of Int. Carotid)
Posterolateral branches of PCA

MCA supplies all

Blood supply of dura mater

Anterior cranial fossa : MMA

Middle cranial fossa : MMA
Posterior cranial fossa : Posterior meningial
artery (branch of asce. pharyngeal artery)
Spinal Tracts

Descending tracts Ascending tracts

Pyramidal tract
Cortico - spinal : Voluntary motor control
Cortico- bulbar : Voluntary motor of face, Spino-thalmaic tracts
head, neck. (Antero-lateral system)
Pain, temperature, crude touch
Crosses over at level of spinal cord
Extra-pyramidal CS tratcs
Rubro-spinal : Fine motor
Tecto-spinal : Head-coordination
(tecto : Head in Greek)
Reticulo-spinal : Maintains tone
Vestibulo-spinal : Balance

Brown Sequard Syndrome

Hemi-section of spinal cord

Contra-lateral spino thalamic tract affected

below the level (crosses at level of spinal cord) DCML pathway
Ipsi-lateral dorsal coloumn affected Fine touch, vibration
Conscious proprioception,
UMN below the level Crosses at level of medulla
LMN at level of lesion

Spino-cerebellar pathway
Unconscious proprioception
Cerebellum

Cerebellar Cortex
Cerebellar Cortex is the largest collection of inhibitory fibres.
Deep Cerebellar
Granny (granular cells) is excited to meet mausi (mossy)
Nuclei
Afferents
1. Olivocerebellar & paraolivocerebellar tract are CLIMBING FIBRES
D Dentate
2. Rest all are MOSSY E Emboliform
olives (like grapes)
"Mausi will only go to excited are climbers G Globose
granny, who stays in ground floor" F Fastigeal
Efferents most commonly
are via Dentate nucleus
Efferents Fastigeal is the oldest
deep Cerebellar nuclei
Purkinje Cells ➡️ Deep Cerebellar Nuclei ➡️ Efferent from cerebellum

Cerebellar Peduncles
Superior Cerebellar Peduncle Molecular layer : Basket and stellate cells
Dentato-thalamic and Dentato-rubro-thalamic tracts Purkinje Layer : Purkinje cells
Ventral spinocerebellar tract Granular layer : Granule cell and Golgi cells

Middle Cerebellar Peduncle

Largest Peduncle
Purely afferent (Cortico-ponto-cerebellar tract)

Inferior Cerebellar Peduncle

Everything else

PURKINJE CELLS

Central part of cerebellum

↓
Vermis
(Maintains truncal balance)

Lateral part of cerebellum

↓
Hemispheres
(Fine movement of limbs)
Basal Ganglia

Cerebral cortex

Caudate nucleus
Striatum
Putamen

Thalamus
Athetosis : Globus Pallidus
Globus pallidus
Chorea : Caudate (Striatum)
Hemiballismus : Sub tHalamic nucleus
Subthalamic nucleus

Substantia nigra

Direct pathway
Dopamine acts on D-1 receptor (+)
Striatum inhibits GpI
GpI doesn't inhibit thalamus : Movement
(Double negative is positive)

Indirect pathway
Dopamine acts on D-2 receptor (-) GPi (interns
Striatum via a long path excites GpI
inform the GPe (externs
GpI inhibits thalamus : No movement
thalamus) take more time
and do nothing)

Parkinsonism
Dopamine : Acetylcholine balance distorted
Direct pathway reduced and indirect pathway increased

Huntington's Chorea
Indirect pathway affected
Tri nucleotide repeat disorder (CAG)
 Thalamic Connections

Papez circuit ECOLIMA

Cingulate Medial nuclei Inferior col
gyrus
ina Auditory
Internal medullary lam MGB
ATN cortex
Mamillary
bodies Vision
LGB Visual cortex
VP
VA VL VPL
VPM
Superior col.
Ventro-
anterior Ventro- Sensory
Ventro- posterior
lateral Cortex
Basal
Ganglia
Spinothalamic
Pre Motor Motor tract
Cortex Sup Cortex
Cerebellar Sensory
Efferents from peduncle VPM : very painful mouth
basal ganglia VPL : very painful limbs
Efferents from
cerebellum
Dentato-thalamic
Dentato-rubro-thalamic
From superior Cerebellar peduncle

Hypothalamic Nuclei
Lateral Nucelus Supraoptic nucleus
Hunger and Anger (Ghrelin) ADH release
"Makes you grow laterally" SAD POX

Venteromedial Nucelus Para-ventricular nucleus

Satiety (Leptin) Oxytocin release
Opposite of Lateral nucleus SAD POX
Neurohypophysis
Anterioir Nucelus SupraChiasmatic nucleus
Cooling Melatonin release
AC - Anterioir cooling Circadian - Chiasmatic
Adenohypophysis

Posterior Nucelus Pre-Optic nucleus

Heat generation GnRH release Anterioir pitutary - Surface ectoderm
Opposite of anterior Pre gonadotropin hormone Posterior pitutary - Neuro ectoderm
 Brain Stem - Ventral aspect

Crus cerebri
Connects pons to
cerebral hemispheres
Midbrain

III
CN 4 originates from dorsal side
IV On midline : 3,4,6,12 (Multiples of 12)
CN 11 : Spinal acc. Nerve (supplies
Pons
SCM and Trapezius)
V VI
VII
VIII
IX
Pyramids
Olives

X
XI

XII

Midbrain stroke syndromes

Involves 3rd CN (Ipsilateral down and out pupil) Multiples of 12
PCA stroke
1. Weber's (only 3rd CN involved) eber's
3

Spino-thalamic tract
3,4

Spino -cerebellar tract

Sympathetic coloum
2. Benedict (3rd CN + Red nucleus) Red hair Benedict 3,4
Dorsal coloumn
Cortico-spinal

3. Claude (3rd CN + Red + hemi-ataxia) A + B + C

4. Parinaud (upward gaze palsy) Pari is above
MLF

6 5,7,8
5,6,7,8

Pontine stroke Syndromes 12 9,10,11

1. Millard + Gubbler (6th + 7th) Count letters 9,10,11,12
2. Foville (6th +7th + 8th + INO) Fov-ALL
3. Raymond (only 6th) 6th is common like Raymond

Medulla stroke Syndromes M S

Medial medullary syndrome MLF (INO) Sensory
Dejerine Sx Motor : Cort-spinal (Spinothalamic)
I/L tongue deviation (12th) (weakness) Spino-cerebellar
Anterioir spinal artery > Vertebral artery Medial lemniscus Sympathetic
coloumn (Horner's)
Lateral medullary syndrome
WaLLenberg Sx
10th cranial nerve symptoms
Vertebral artery > PICA
 Brain Stem - Dorsal aspect (Floor of ventricles)

SC
Quadrigeminal
plate
IC
IV

Abducens nuclei is surrounded by

SCP LMN of 7th nerve
Injury to this area causes LMN palsy
MCP Facial colliculus of facial nerve
Vestibular area
XII Trigone
MCP doesn't ICP
form boundary Xth trigone
6-8-12-10

Cranial Nuclei at the floor of 4th ventricle

VI, VIII, X & XII (not 7th)

Dural venous sinus anatomy

Internal cerebral veins
( Deep veins)
⬇️
Combine with
Vein of Rosenthal
⬇️
Vein of Galen
(aka great cerebral vein)
⬇️
Combines with ISS
⬇️
IJV TOSS Straight sinus
⬇️
Vein of Galen malformation Transverse sinus
Occipital sinus Confluence of
sinuses
Straight sinus
Sup. sagittal sinus ⬇️
Transverse sinus
⬇️
Sigmoid sinus
⬇️
Combines with superior
and inferior petrosal
sinus to drain into IJV
Cerebral Cortex

Primary motor cortex (4) Primary somatosensory

cortex (3,1,2)

Frontal eye field (8)

Broca's
Broca's speech area of Primary Visual Start seeing
left hemisphere (44, 45) cortex (17) people at 17

auditory association cortex (22)

Wernicke's
Primary auditory cortex (41,42)
Heschl's Gyrus

Brodman area 22
Brodman area 44/45 Superior temporal gyrus
Inferior frontal gyrus Inferior branch of MCA
Superior branch of MCA
Wacky speech,
"Broken speech" can't understand,
but can understand hence can't say
Fluency → Frontal lobe
 Fertilisation and implantation

Day 1 Zygote

Day 4 Morula (16 celled)

Day 5 Blastocyst (fluid filled)
Day 6 Zona hatching
Day 7 Implantation

Inner cell mass forms epiblast and Endometrium

hypoblast (bilaminar embryonic disc)

Epiblast forms Amniotic cavity

Hypoblast forms primitive Yolk sac

Blastocyst cavity
(forms yolk sac)
GASTRULATION -3rd week
Epiblast replaces hypoblast via primitive Hypoblast
streak to form endoderm and mesoderm Embryonic disc
Epiblast
Epiblast cells then form the ectoderm
Amnion
Amniotic cavity

Trophoblast Cytotrophoblast
Syncytiotrophoblast

Sacro-coccygeal teratoma
Persistence of cells in primitive streak

NEURULATION - 4th week

Cells of primitive streak in mesoderm get
modified to form notochord
(blastospore - n. process - n.canal - n. plate)
Notochord stimulates ectoderm to form
neural tube

Heart starts beating in 4th week of development

Pre-chordal plate Pre-embryonic phase : 1st 2 weeks
Modification of endoderm near the cranial end.
Cap of sperm :Golgi apparatus
Forms buccopharyngeal membrane that forms oral cavity
Anterioir neuropore : Lamina terminalis
Posterioir neuropore : Terminal ventricle
 Embryology

NCC Remnants of Notochord

Nucleus pulposus
Apical ligament of Dens
Tectorial membrane

Intermediate
mesoderm Para-axial Lateral plate
Notochord
⬇️ mesoderm mesoderm
Forms ⬇️ ⬇️
urogenital Axial skeleton SOMATO-PLEURIC
system Skeletal muscles Appendicular skeleton
(except pharyngeal arches) Dermis of front
Dermis of back
SPLANCHNO-PLEURIC
Smooth muscles
Dura mater
Cardiac muscles
RES - Spleen, Microglia

Somites

Adrenal cortex : Mesoderm

Neuro-ectoderm derivatives NCC derivatives Adrenal medulla : NCC
Brain & spinal cord
M Melanocytes Dura : Mesoderm
Oligodendrocytes (myelination in CNS)
O Odontoblasts (tooth) Leptomeninges : NCC
Astrocytes (various functions)
Ependymal cells (production of CSF)
T Tracheal cartilages
E ECL cells (stomach) Anterioir pitutary : Surface-ect.
Retina & pigment L Leptomeninges Posterior pitutary : Neuro-ect.
Iris and its muscles
P PNS ganglia (Hirschprung dis.) Enamel/Ameloblast : Surface-ect.
Pineal gland Dentin/Odontoblast : NCC
A Adrenal medulla
Posterior pitutary (SAD POX) S Schwann cells
Sphincter/dilator pupillae : Neuro-ect
S Spiral septum Cilliaris : NCC
E Endo-cardial cushions EOM : Mesoderm
Surface-ectoderm derivatives S Skull cartilages
Lens Everything in brain from
Epithelium of Cornea, Conjunctiva neuroectoderm, except Microglia
Lacrimal, Tarsal glands (macrophages in brain)
Everything in abdomen from
PSM glands (Parotid, Sweat, Mammary)
All three derm layers endoderm, except Spleen
Anterioir pitutary Tympanic membrane
Macro-glial cells : Neuro-ectoderm
Vitreous Humor
Micro-glial cells : Lateral plate
Anal canal below pectinate line
mesoderm
Epidermis
Schwann cells : NCC
Olfactory epithelium
Enamel
 Urogenital system development

Development of Kidneys
A region of intermediate mesoderm, known as the
urogenital ridge, gives rise to urogenital system.

Pronephros formed initially in cervical region of the

embryo (degenerates eventually)
Mesonephros forms -
(a) Mesonephric duct (Wollfian duct)
(b) Ureteric bud (forms collecting system)
Ureteric bud induces formation of metanephric blastema
(forms the excretory part)

The definitive kidney (metanephros) develops in the

pelvic region before ascending into the abdomen.

Development of Bladder and Urethra

The bladder and urethra are derived from cloaca – a hindgut Allantois
structure (endoderm)
Cloaca Urorectal
The cloaca is divided by uro-rectal septum into urogenital sinus septum
(anterioir) and anal canal (posterioir) Cloacal
Hindgut
membrane
Uro-genital sinus
Upper part forms the bladder (except trigone, which is formed by
collecting system)
Pelvic part forms entire urethra in female, posterioir urethra in
males
Phallic part forms the anterioir urethra in males

Allantois
The urinary bladder is initially drained by the allantois.
Obliterated during fetal development and becomes a
fibrous cord – the urachus
Urachus forms : median umbilical ligament

Mullerian : Paramesonephric (females) Genital swelling (sac) Summary

Wolffian : Mesonephric (males) Scrotum
Kidney till DCT : Metanephric blastema
Labia majora
Collecting system and trigone of
Wolffian Mullerian
Genital ridge (rizz) bladder : Mesonephric duct
Seminal vesicles Fallopian tube Testes Bladder, urethra : Uro-genital sinus
Ejac. duct Uterus Ovaries
Trigone Cervix
Post. urethra Upper 2/3 of vagina Genital fold (2° sac)
Para-oopheron Ventral urethra Umbilical ligaments
Prostatic utricle Labia minora
Ep-oopheron Median : Urachus
Appendix of testes
Gartner's cyst (hydatid of Morgagni) MediAL : Umbilical artery
Genital tubercle (tube)
Glans penis Lateral : Inf. Epigastric artery
Peg PAT
Clitoris
Lig teres hepatis : Left umb. vein
 CVS Embryology

Ventricles
Rough part of left : Primitive ventricle
Rough part of right : Bulbus cordis
Smooth part of both : Bulbus cordis

Atria
Rough part of both : Primitive atria
Smooth part of right : Sinus venosus + Right horn
Smooth part of left : Primitive pulmonary veins

Other structures
Left horn : Coronary Sinus
Truncus arteriosus : Roots of great arteries

Inter - atrial septum

Septum primum formed first Inter - ventricular septum
Osteum primum is the opening between septum
primum and endocardial cushions (crucial for right
to left shunt in fetal circulation)

Ventricular septum has "2 components"

Eventually osteum primum is obscured.
Osteum secundum formed in upper part of septum Muscular component
primum as fnestrations Cardiac muscles

Membranous component (NCC derivatives)

Spiral septum : IV septum
Endocardial cushions : AV septum

New septum secundum formed that covers osteum

secundum.
This forms a one way valve known as foramen ovale

Surrounded by ➡️
(limbus fossa
ovalis)

Depression ➡️
(fossa ovalis)

When left atrial pressure increases on birth,

foramen ovale is closed.
Fossa ovalis is a depression formed by osteum Depression ➡️ fossa ovalis
secundum (has septum primum as base) Surrounded by ➡️ limbus fossa ovalis
Limbus fossa ovalis formed by septum secundum
(surrounds fossa ovalis)
IVC development

Supracardinal
Infra-renal IVC
Azygous vein
Hemi-azygous vein
Sub cardinal vein
Sub supra anastomosis
Sub cardinal vein Supracardinal
Supra-renal IVC
Gonadal veins
Cardinal veins
Left renal vein

Sub supra anastomosis

Renal IVC

Left Inferior Phrenic vein

Right Inferior Phrenic vein

Hepatic Veins
Right Supra-renal Vein
Left Supra-renal Vein

Right Renal Vein.

Left Renal Vein

Left Gonadal Vein

Right Gonadal Vein-

Right Lumbar Veins Left Lumbar Veins

Median Sacral
Vein
Common Iliac
Veins
 GI embryology

Foregut
Till second part of duodenum
Vagus nerve
Stomach rotates by 90°

Midgut
Till 2/3 of transverse colon
At transpyloric plane
Vagus nerve
Rotates 270° anticlockwise (90+180)
Physiological herniation at 6 weeks and
back by 12 weeks

Hindgut
Pelvic plexus
Till Pectinate line of rectum

Superior rectal a.
(branch of IMA) Superior rectal v.
Trans-pyloric plane (L 1) Drain to internal
Visceral innervation
iliac LN
Sub-costal plane (L 3)

Umbilicus (L4- L5)

Inter- tubercular plane
(L 5)

Pectinate
line

Trans-Pyloric plane (L¹)

Origin of (Renal arteries, SMA, Portal vein)
Neck of pancreas Somatic innervation Inferior Inferior Drain to
(Pudendal nerve) rectal a. rectal v. superficial
Hilum of kidney
(branch of inguinal LN
Duodeno-Jejunal flexure pudendal artery)
Termination of spinal cord

Rotation of stomach
The rotation of stomach leads to formation
of greater and lesser sac.
Connection between greater and lesser sac
is known as epiploic foramen

Boundaries of epiploic foramen

(aka Foramen of Winslow)
Superioirly Caudate lobe of liver
Inferioirly 1st part of duodenum
Anteriorly hepato-duodenal ligament
Posteriorly IVC, adrenals
Pringle's manuevere
 Development of Diaphragm

Central Tendon

Crura

Pleuro-
peritoneal
Body wall membrane
mesoderm

Embryologic origin
I 8 IVC (T8) + Rt phrenic nerve Muscular part : Body wall mesoderm
Central tendon Central tendon : Septum transversum
Crura : Dorsal mesentery of esophagus
10 Esophagus (T10) + both Vagus
eggs + Gastric artery (lt) Persistence of Pleuroperitoneal canal
Muscular part
Bochdalek foramen
AT Aorta, Thoracic duct (T12) +
12 Azygous and hemiazygous vein
Crura Congenital Diaphragmatic Hernia
•Common on left side
•Complication→left lung Hypoplasia

Derivatives of mesogastrium
Derivatives of
ventral mesogastrium Diaphragm Derivatives of
dorsal mesogastrium

1. Triangular ligaments 1. Gastrophrenic ligament

2. Coronary ligaments 2. Gastrosplenic ligament.
3. Falciform ligament
3. Lienorenal ligament
4. Greater omentum
Lesser FaCT Bile duct
4. Lesser omentum Posterior abdominal wall
Phrenico-colic ligament
Prevents the vertical and
Ligamentum teres hepatis downward descent of spleen
(obliterated left umbilical vein)
 Cleft lip and palate

Frontonasal prominence
Intermaxillary
Medial nasal process process

Nasal pit

Lateral nasal process

Maxillary prominence
Philtrum
Mandibular prominence

Medial nasal process forms the inter-maxillary process

The intermaxillary process fuses with maxillary process to form Philtrum
Failure of fusion of medial nasal process with maxillary prominence causes cleft lip
Midline cleft lip : failure of fusion of medial nasal processes to form inter-maxillary
process.

Couinaud's Liver Segments

Portal vein divides the liver horizontally

Cantlie's line separates liver into left and right
Imaginary line
aka Cholecysto-vena caval line

7 8 4a 2
Portal vein

6 5 4b 3
Cantlie's line

4b 3 4a 2
5 Portal vein 8 IVC
IVC

6 Kidney 7 Spleen

Portal vein + IVC : Inferior Only IVC : Superior

Shoulder Joint

ess
oid proc
c
Greater Cora
tubercle
⬇️
Lesser
tubercle

Coracoid process palpated below

⬆️ clavicle (type of atavastic epiphysis)
Base of
bicipital
groove

Short head of biceps Pectoralis minor

Coraco-brachialis

SIT muscles
Supra-spinatus
Infra-spinatus
Teres minor

Adduction + Ext. rotation

Except supra-spinatus : Abduction 0-15°

MLM
Sub-capsularis
Pect major aka Forgotten Tendon
Latt. Dorsi
Teres major
Adduction + Int. rotation

Clavipectoral Fascia

Structures Piercing the Clavipectoral Fascia

1. Thoraco-acromial artery. T
2. Lateral pectoral nerve. L
3. Cephalic vein C
Lateral pectoral nerve supplies P. major

Muscles enclosed : P Minor and Subclavius

Subclavian artery
Divided into 3 parts by anterior scalene muscle

1st part
Vertebral artery
Internal-thoracic artery VIT
Thyro-cervical trunk

2nd part
Costo-cervical trunk C
3rd part
Dorso-scapular artery D

Branches of thyro-cervical trunk

Supra-scapular
Transverse cervical STI
Inferior thyroid

Superior thyroid artery is a branch of ECA

Transverse cervical ➡️ Trapezius and SCM Scalenus

(Supplied by SAN) Anterior muscle
⬇️
Suprascapular ➡️ Supra-spinatus and infra-spinatus I
T
(supplied by supra-scapular nerve)
S
Phrenic nerve
(anterior to scalene
anterior muscle)

Axillary artery
Divided into 3 parts by Pectoralis minor muscle

1st segment - 1 branch

Superior thoracic 1st rib divides subclavian from axillary artery
3rd segment supplies the surgical neck of humerus
2nd segment - 2 branches
Thoraco-acromial artery
Lateral thoracic artery

3rd segment - 3 branches

Sub-scapular artery
Ant circumflex humoral
Post. circumflex humoral
Brachial artery
Divided into radial and ulnar artery at cubital fossa
Profunda brachii artery : First and largest branch of brachial artery
Ulnar artery forms the common inter-osseus artery which forms the recurrent-inter osseus artery

Cubital Fossa

MP Medial
lateral

MBBR
Medial - Lateral
(nerve artery muscle nerve)

Median cubital vein (aka anti cubital vein)

is preferred for blood draw.

Anatomical snuff box

Medial boundary : Ex P L
Lateral boundary : Ab P L, Ex P B Ab pee le
ex bhi pee

Only content: Radial artery

Roof : Cephalic vein, Superficial br of radial n.
Also the area supplied by radial nerve
Brachial Plexus

C5 Re
tro Musculocutaneous nv.
-cl
C6 av Supplies
icu
lar Biceps
Brachialis
C7 Coracobrachialis

C8 Continues as lateral
cutaneous nerve of forearm
T1

Musculocutaneous nv.
Axillary nerve
Radial nv.
Median nerve
Ulnar nv.

Erb's Palsy

Upper trunk

C⁵ - C⁶

Axillary nerve Musculocutaneous nerve

Biceps brachi Flexion,

Deltoid BBC muscles Brachialis Supination
Abduction 15-90° Coracobrachialis
Klumpke’s palsy
Adducted Extended elbow
Lower trunk shoulder Pronated forearm

C8, T1
Medial and ulnar nerve Policeman’s tip hand
Intrinsic muscles of hand

Hyperextension at MCP
joints Flexion at IP joints
(Reverse of Lumbricals action)
CLAW HAND

T/t : Knuckle bender splint

 Ulnar Nerve

Motor Sensory
All interossei Medial 1.5 fingers (both
3rd and 4th lumbricals dorsal and palmar)
Hypothenars
cUbital tunnel Adductor policis
(GraveyADD)

FDP (Medial half)

Ulnar Paradox
More prominent claw hand when injury at lower levels
than at upper level.
At upper levels (more proximal injury) FDP is paralysed -
gUyon's canal lesser flexion and hence lesser prominent claw hand

Book test (Froment Sign)

Thumb can't adduct but
flex (Add policis affected)

Median Nerve

Motor Sensory
All flexors of forearm Lateral 3.5 fingers
AIN - deeper muscles, pure (palmar side)
motor Tips of fingers of lateral
1st and 2nd lumbricals 3.5 on dorsal side
Thenars (except Adductor
pollicis)

FDP (Lateral half) Anterior inter-

osseus nerve
FPL
"weak OK sign"
FDS
Weak OK sign Hand of Benediction Ape thumb
Palmar Thumb can adduct but Can't flex lateral finger
cutaneous Flexor retinaculum
branch won't flex (FPL affected) (FDP/Lumbricals affected)
 Radial Nerve (C5-T1) entire brachial plexus

Motor Sensory
All extensors of arm Lateral 3.5 fingers
PIN- deeper muscles (dorsal side)
(purely motor)
TRICEPS
Extension of
elbow

ECRL
Wrist extensor
supplied from M
above the elbow

PIN M U
U R
SUPERFICIAL BRANCH
Cutaneous branch,
supplies the skin
(Lateral 3.5 of hand)

Nerve injuries in humeral fractures

Axillary nerve injury

Surgical neck Regimental badge sensory loss
Loss of abduction (15-90°) → supplies deltoid

Spiral groove Radial nerve injury

Innervates all Extensor muscles of arm & forearm
Causes wrist drop
Treatment : Cock up splint

Median nerve (AIN injury)

Not directly related to Most of the Flexor muscles of forearm
humerus
Intrinsic muscles in hand
labourer's nerve

Medial epicondyle

Ulnar nerve injury

FCU (ulnar deviation ) & part of FDP (forearm)
Intrinsic muscles in hand
Lateral epicondyle Musician's nerve
Tardy Ulnar nerve injury
(LCH) Cubitus valgus deformity
 ULNAR NERVE MEDIAN NERVE
Supplies hand muscles mostly Supplies forearm flexors mostly
(musician's nerve) (Labourer's nerve)

Adductor Pollicis
Book test
Flexor digiti minimi Flexor pollicis brevis Weak OK sign
(Froment Sign)
Can't add. thumb Abductor digiti minimi Can't flex thumb
Abductor pollicis brevis
FPL intact FPL affected
Add. Longus Opponens digiti minimi Opponens pollicis Add. Longus intact
(present deeper)
affected Palmaris brevis
(subcutaneous)

Lumbricals and Inter-ossei

Numbering from lateral to medial
Lumbricals originate from FDP (flexor digitorum profundus) ALL INTEROSSEI-ULNAR NERVE
Inter-ossei as the name says are from bone to bone vowels stick

Lumbricals Inter-ossei

Bi-pinnate Uni-pinnate
ULNAR NERVE MEDIAN NERVE

3rd Lumbrical 2nd Lumbrical

4th Lumbrical 1st Lumbrical Palmar Dorsal

interossei interossei
muscles muscles

PAD DAB
Unipennate Bipennate
Absent on middle finger Middle finger has 2
Test - CARD test Test - EGAWA test

Knuckle bender splint

 Wrist Joint
Radio-Carpal joint
Distal end of ulna doesn't participate E Elbow
in formation of wrist Joint S Shoulder
16 yrs H Hip
Involves 1. Radius A Ankle
2. Art. Disc
3. SLT carpals 17-19 yrs Ki Knee

Fuses at last 19 years 19 yrs Wrist Wrist

Carpal bones
Scaphoid - Lunate
Triquetrum - Pisiform
Hamate - Capitate
Trapezoid - Trapezium
The
Here Comes
Thumb Appearance of ossification centres
Pinky Capitate : 1 month (earliest)
To Long Hamate : 2 months
So
Tri-quetrum : 3 years
Lunate : 4 years
Scaphoid : 5 years

Trapezium, Trapezoid : 6 years

Pisiform : 12 years (most late)

Elbow Joint

Medial epicondyle
Lateral epicondyle

Capitulum of humerus
Trochlea of humerus Lateral Medial Olecranon process
Olecranon process epicondyle epicondyle
Trochlear notch
Coronoid process
Radial head Appearance of oss. centres Fusion
Radial notch
2 yrs C Capitellum 14 yrs L Lateral epic.
Neck
4 yrs R Radial head 15 yrs M Medial epic.
Tuberosity of ulna 6 yrs I Internal epic. (medial) 16 yrs O Olecranon
Radial tuberosity 8 yrs T Trochlear
10 yrs O Olecranon
12 yrs E External epic. (lateral)
 Appendicular muscles of back

Dorsal
"scapular"
nerve

Levator Arm abduction

scapulae
Trapezius
Rhomboid
Trapezius and
minor serr. anterior
SAN
SAN
LTN
Rhomboid
major

Deltoid
Latissimus Thoraco Axillary n.
dorsi "dorsal"
nerve
Supra-spinatus
Supra-scapular nerve

Winging of scapula
Inferior border of scapula moves medially or laterally.

Medial winging
Serratus anterior muscle weakness.
Long thoracic nerve dysfunction

Lateral winging
Trapezius muscle weakness.
Spinal accessory nerve dysfunction
 Iliacus and psoas major

Psoas Major
Iliacus

Psoas abscess
Ilio-psoas tendon
(Seen in TB)
(inserts at lesser trochanter)

Lumbar plexus

Sub-costal nerve
Vulnerable to injury
behind kidney
Ilio-inguinal and ilio-hypogastric nerve

Genito-femoral nerve (on psoas)

Vulnerable to injury
Lateral cutaneous nerve of thigh (on iliacus)
behind caecum
Femoral nerve (lateral to psoas)
Obturator nerve (medial to psoas)

Genitofemoral nerve LCNT in Laproscopic hernia repair

Ilio-inguinal in open repair
Genital branch Gen-fem nerve (L1-L2)
Ilio-hypogastric in mesH hernioplasty
Efferent for cremasteric reflex
Sensory over anterior scrotum Genital branch
Femoral branch
Femoral branch
Afferent for cremasteric reflex
Sensory over medial thigh
(over femoral triangle) Femoral and Obturator nerve
L2-L4
Lateral cut. nerve of thigh Obturator (medial to psoas)
supplies medial compartment
Can get compressed deep to LCNT (L2-L3)
of thigh.
inguinal ligament
Femoral (lateral to psoas)
Leads to meralgia parasthetica
supplies anterior compartment
of thigh.

Burning sensation in lateral thigh

 Hip Joint

ANTERIOR
ASIS

AIIS

Greater
trochanter POSTERIOR
PIN
Gluteus minimum structures
Gluteus medius
Pudendal nerve
Int. Pudendal vessels
AbIR at hip
Nerve to Obturator int
(Weakness causes
Trendelenberg gait) Ischial spine

Superior gluteal nerve

Gluteal tuberosity
Lesser trochanter
Gluteus maximus
Ilio-psoas
Extension and ER of hip
Inferior gluteal nerve

SGN and
vessels
IGN and Piriformis
vessels
Sciatic
nerve
Gluteus medius

Piriformis

Gemellus superior
Obturator internus
Gemellus inferior
Greater sciatic foramen
Quadratus femoris
Above piriformis
Superior gluteal nerve and vessels
Below piriformis
Inferior gluteal nerve and vessels
Sciatic nerve
Nerve to quad. Femoris
Femoral cutaneous nerve SGN supplies
PIN structures Glut medius and minimus
TFL (tensor fascia lata)

IGN supplies
Lesser sciatic foramen Gluteus maximus
PIN structures
Tendon to Obturator internus Sciatic Nerve
Largest nerve of sacral plexus
Posterioir comp. of thigh
 Anterior compartment of thigh
1. Tensor fascia lata
2. Sartorius
3. Quadriceps femoris
→ Vastus lateralis TFL
→ Vastus medialis
Gluteus maximus
→ Vastus intermedia (deep)
→ Rectus femoris Inserts on ITB

Main action : Flexion at hip joint

Iliotibial band Contracture in Polio
Rectus femoris has additional Modification of
action of extension at knee joint. Fascia Lata of thigh

Hip joint- FABER Knee joint -FER

Nerve : Femoral nerve

Femoral triangle

AS
IS CUS
ILIA R
Pectineus AJO
AS M
PSO
EUS
TIN
ING
. LIG PEC
.
PUBIC
Sartorius TUBERCLE
Flexion at hip

Sar
tor
Flexion at knee
ius

MEDIAL
Vastus -ADDUCT
OR
Rectus femoris
LATERAL

S
lateralis LONGU
Flexion at hip
Vastus Extension at knee
medialis

Extension at knee

IS
AS
FEMORAL NERVE

Femoral nerve
FEMORAL ARTERY
FEMORAL VEIN
LYMPH NODES
L2 L3 L4

Iliacus
Pectineus
MEDIAL

Inguinal lig
LATERAL

PD AD
Hip joint Sartorius
Quadriceps Medial cut. nerve of thigh
femoris Intermediate cut. nerve
of thigh
Sartorius forms Lateral boundary
Great saphenous vein

(isn't a part of femoral triangle)

Saphenous nerve Adductor longus forms medial boundary
Skin of medial side of leg & foot (Is a part of base )
Femoral sheath has femoral artery and vein
Medial to lateral (VAN)
surAL - LAteral Cloquet lymph nodes present (most medial)
 Posterior compartment of thigh

}
Biceps femoris
Semi-membranosus Hamstring muscles
Semi-tendinosus

Popliteal fossa
Membranous-Medial

Boundaries
Supero -Medial : Semi-membranosus
Supero - Lateral : Tendon of biceps femoris
Inferiorly : medial and lateral head of gastrocnemius

Contents
Tibial nerve (sciatic divides into tibial and CPN)
Common peroneal nerve
(hooks around fibula → foot drop → steppage gait)
Popliteal vein and artery

Sciatic nerve
L4, L5, S1, S2, S3

Largest branch of sacral plexus Deep to Piriformis

Hamstrings
n
mo e
a com nerv
ak ular
fib TIBIAL NERVE
Neck of
fibula

Superficial Deep Tibia is medial, hence

peroneal Tibialis causes inversion
peroneal nerve nerve
Pernoeus longus Dorsi-flexors Plantar-flexors
(evertors) (invertors) Tibial nerve injury
Pernoeus brevis Plantar flexors and inverters
Tibialis Tibialis affected
anterior posterior Dorsi-flexed and everted foot

Common peroneal nerve injury

Dorsi flexors and evertors
Skin over affected
MPN LPN Foot drop and inverted foot
dorsum
High steppage gait
Skin over 1st web space
 Compartments of leg

Deep peroneal n
Ant tibial artery

Has no neuro-
vascular bundle

Tibial nerve
Posterior tibial vessels

Ischiorectal fossa

Obturator
internus
Obturator fascia
Ext anal sphincter

Pudendal canal

• Pudendal nerve
• Internal pudendal vessels

Contents of IRF
1. Fat
2. Pudendal canal and its contents
3. Inferioir rectal veins and nerves
↓
Can be injured in drainage
of IRF infections
 Lungs

Lobes of lungs
Left lung has 2 lobes and a cardiac notch
Right lung has 3 lobes (additional middle lobe)
Left lung can have a small lobe below cardiac notch
known as lingula
Hila of lungs
Right lung has 2 bronchi (ep-arterial and hypo-
arterial) above and below pulmonary artery
Left lung has only one bronchi
Anterior ro Posterior : VAB
Phrenic nerve passes anterior to the hila of lungs to
supply the diaphragm

Eparterial
bronchus
Right pulmonary Left pulmonary
Bronchial
artery artery
arteries
Superior pulmonary vein Hyparterial Superior pulmonary vein
bronchus
Inferior pulmonary vein Left principal Inferior pulmonary vein
bronchus

Pulmonary
ligament

Heart

Transverse pericardial sinus

Separates the arterial end of the heart tube from
the venous end.
Aorta and pulmonary trunk lie anterior to the sinus
and the superior vena cava lies posterior to it.
Therefore, during surgery, a clamp passed through
the transverse sinus stops the blood flow from the
aorta and pulmonary trunk.

Area posterior to sternum

Right ventricle
Right atria forms the right lateral
margin along with SVC
 Conduction system of heart

SA Node
Located at the upper part of the crista terminalis, at the
junction of the superior vena cava opening to the right
atrium.
This is also the junction between the parts of the right
atrium derived from sinus venosus and primitive atria.

AV Node
Located at interatrial septum near the opening of the
coronary sinus.
It is located in the center of the Koch triangle.

Coronary Circulation

Anterior Posterior
aortic sinus aortic sinus

RCA LCA
Conus
AV groove Anterior MI : LAD
branch
Lateral MI : LCX

PDA LAD Inferior MI : RCA

Posterior Left Anterior Posterior MI : PDA
descending artery descending
(Decides dominance) (widow's artery)
Supplies Posterioir LV wall Supplies Anterior LV wall
Posterior 1/3 of septum Anterior 2/3 of septum

Right Marginal artery

Left Circumflex (LCX)
(Acute)
⬇️
Venous Drainage Left Marginal artery
Everything drains into Coronary Sinus (obtuse)
except Anterior Cardiac vein (ACV)
 Intercostal Arteries and Veins

Upper 9 ICS Anterior intercostal arteries

2 anterior intercostal arteries 1 - 6 ICS, internal thoracic artery branches
1 posterior intercostal artery 7 - 9 ICS, musculophrenic artery branches
10 - 11 ICS, no anterioir intercostal artery
10th and 11th ICS
No anterior intercostal arteries Posterioir intercostal arteries
1 posterior intercostal artery There are 11 pairs of posterior intercostal arteries.
The first 2 pairs are branches of the superior
intercostal artery, a branch of the costocervical trunk.
The lower 9 pairs are branches of the descending
Subclavian artery thoracic aorta.
The right posterior intercostal arteries are longer than
Internal thoracic those on the left (because aorta is on left)
artery
Posterior intercostal arteries are responsible for
Anterior intercostal rib nothing in coarctation of aorta.
arteries

Right and Left

brachiocephalic

Musculophrenic
artery Left superior
intercostal
Superior epigastric Right superior
artery intercostal

Azygos Accessory
vein hemiazygos

Hemiazygos

Intercostal Nerves

Derived from the thoracic vertebrae - T1 to T11.

They lie between the internal intercostal and
innermost intercostal muscles. VAN
T3-T6 are known as typical intercostal nerves
(supply only thoracic wall) while atypicals supply
other structures as well
T1 and T2 supply upper limb
T7-T11 supply the abdominal wall
 Major arterial branches
Abdominal aorta
Celiac trunk Left gastric art.
Right gastric art.

⬇️
Common Splenic art.
Gastro-

⬇️
Rt. gastro- hepatic art. Branches to the spleen and pancreas
duodenal
⬇️ Left gastro-epiploic artery
epiploic artery artery
Proper hepatic
Superior
artery
pancreaticoduo
denal artery Right and left hepatic art.
Cystic artery (from rt. Hepatic)
Right gastric art.

Common hepatic art.

Abdominal aorta

Celiac axis
Splenic
Left gastro-epiploic artery
arterty
Left gastric art.

Proper help. artery

Gastroduodenal artery
Right gastric art.
Superior pancreaticoduodenal artery
Duodenal branches
Right gastro- epiploic artery

Pancreatic branches
Inferior panreatico-
duodenal artery
(branch of SMA)
Lesser curve Greater curve
(small name) (Large name)
Lt. Gastric Lt. Gastro-epiploic
Rt. Gastric Rt. Gastro-epiploic

Internal iliac artery

Anterior branch Posterior branch
(everything else) SIL
Sup. Gluteal art
Iliolumbar artery
Lateral sacral artery
 Abdominal Wall

Flat muscles (lateral) Vertical muscles

Ext oblique Int oblique Trans. Abdominis Rectus abdominis Pyramidalis

Largest and most Fibres Deepest Long paired muscle Small triangular
superficial flat perpendicular Deeper to this Split by linea alba muscle
muscle. to ext. oblique muscle is (formed by tendons of
forms inguinal transversalis fascia lateral muscles)
ligament

Lower fibres of int. oblique and trans abdominis form conjoint tendon

Rectus sheath Anterior wall of rectus sheath (thick)

Rectus Abd
The rectus sheath is formed by the aponeuroses of the EO
IO
three flat muscles and encloses the vertical muscles. TA Posterior wall of rectus
sheath (deficient)

Arcuate line
Approximately midway between the umbilicus and the
pubic symphysis, all the aponeuroses move to the
anterior wall of the rectus sheath.
At this point, there is no posterior wall to the sheath
and rectus abdominis is in direct contact with the
transversalis fascia.

Anterior wall fascia Ext. oblique modifications

P
Inguinal ligament
No deep fascia (hence can distend) Pectineal ligament
At umbilicus splits into : superficial •Ligament of Poupart
•Modification of External oblique aponeurosis Linea alba
Camper and deep fibrous Scarpa.
Scarpa continue to cover scrotum and
I Inguinal ligament

labia majora.
L Lacunar ligament

ASIS Ligament of Cooper

Pectineal ligament

Inguinal ligament
Reflected part of
inguinal ligament

Pubic tubercle
Lacunar ligament
• Gimbernat’s Ligament
• Medial to femoral ring
 Inguinal canal
Passasge for Spermatic cord in males and Round ligament of uterus in females.
Ilioinguinal nerve enters the canal through the side and not through the deep ring.
Hernia via inguinal canal : Indirect hernia

2 Muscles (int. oblique, trans. abdominis) Superior wall

2 Aponeurosis (int. and external oblique) Anterior wall
2 Ligaments (Inguinal, lacunar) Lower wall
2 Ts (Transversalis fascia, Conjoint tendon) PosTerior wall
↓
Lower fibres of int. oblique and
trans abdominis fused

External spermatic fascia

aster mus
em c Internal spermatic fascia
Cr

le

Vas. Def and its artery. Spermatic cord enters

Cremasteric
artery Deep inguinal ring
A defect in fascia
transversalis
3 arteries: testicular, ductus deferens, Poster
Anterio ior wa
cremasteric r wall ll
3 nerves: genital branch of genitofemoral,
cremasteric, autonomics
Superficial inguinal ring
3 other things: vas deferens, pampiniform
Floor
plexus, lymphatics
Spermatic cord exits

Inguinal lymph nodes

Superficial inguinal lymph nodes Deep inquinal lymph nodes

Horizontal group along the lower Along the femoral vein
border of inguinal ligament
Vertical group along Great
saphenous vein
 Pelvis

Modifications of Pubococcygeus
Levator ani

Pelvic diaphragm
1. Pubo-urethralis
Pubo-coccygeus Bladder
Obturator internus
2. Pubo-vaginalis
Ilio-coccygeus
Pelvic diaphragm
3. Pubo-rectalis Ischio-coccygeus Deep
Urogenital diaphragm
space

Ischiocavernosus
Muscle of continence Bulbospongiosus Superficial
over crus
over bulb Superficial perineal space
fascia
(Colle's Fascia)

Perineal membrane Bulb/ bulbospongiosus

Inferior layer of UGD
Crus/ Ischiocavernosus

Bladder
Obturator internus
Superficial transverse
perineal muscle
Perineal body Pelvic diaphragm
External anal sphincter
(10 muscles) Deep Urogenital
space diaphragm
Ischiocavernosus
Bulbospongiosus over crus
Superficial
Paired muscles (4) over bulb Superficial perineal space
1. Superficial transverse fascia
(Colle's Fascia)
perineal muscle
2. Deep transverse Unpaired muscles (2)
perineal muscle 1. External anal sphincter
3. Bulbospongiosus 2. Longitudinal muscles of
4. Levator ani anal canal

Pelvic diaphragm
Scarpa's fascia is a continuation of the anterior Superior layer of UGD
Scarpa’s fascia
abdominal fascia and forms Dartos muscle. DPP
Perineal membrane
Dartos continues as Colle's fascia which along with
perineal membrane forms Superficial peroneal pouch. SPP
Deep perineal pouch between perineal membrane and
superior layer of UGD.
Colle’s fascia

Dartos muscle

EXTRAVASATION OF URINE

In anterior trauma, urine can move into Bladder

Detrusor muscle
Space around penis
Internal sphincter
Scrotum Bulbar urethra
Ant. Abdominal wall Prostatic urethra Anterioir
Thigh Posterior
Penile urethra
In posterioir trauma, urine collects Membranous urethra
in deep perineal pouch External
sphincter
 Joints
Fibrous Syn-arthrosis : Fibrous joints (can't move)
Cartilaginous joints (primary and secondary) Amphi-arthrosis : Cartilaginous joints (some movement)
Synovial Diarthrosis : Synovial joints (freely movable)

Fibrous Joints SSG

Sutures Syndesmosis Gomphosis

Plain suture,
e.g. frontonasal suture am
ou
s
S q u u tu re
s
De
n
s u tic u
tu la
re te

Serrate suture Squamous suture,

between parietal temporal bone - parietal bone

Ala of Rostrum of
vomer sphenoid
Denticulate suture Schindylesis
Lambdoid suture of Sphenoid and ala of vomer
occipital bone

Cartilaginous Joints

Primary cartilaginous Secondary cartilaginous

Syn-chondrosis Symphysis
Bones are joined by hyaline cartilage (less rigid, Bones are joined by fibro cartilage (more rigid,
more flexible) less flexible)
Epiphyseal growth plates Pubic symphysis / IV discs / Sterno-manubrial
Costo-chondral joints (rib-cartilage) and 1st
costo-sternal joint (1st rib - sternum).
Synovial Joints

Ball and socket Condylar

Hip TM joint
Shoulder Knee joint
Incudo-stapedial (IS is BS)
Talo-Calacaneo-Navicular

Saddle Hinge
Incus- malleus Elbow
Calcaneo-cuboid Knee
1st carpo-metacarpal Inter-phalangeal
Sterno - clavicular

Ellipsoid Plane synovial

Atlanto-occipital (C0-C1) Acromio-clavicular
yELL YES first
Costo-vertebral
Costo-transverse
Costo-sternal

Inter-carpal
Pivot Inter-tarsal
Atlanto-axial (C1-c2)
Say NO second

Plane Saddle

Saddle
Icudo-malleolar joint

True ribs first 7

Ball and Socket
Incudo-stapedial joint Typical ribs 3-9
Floating ribs 11 and 12

Symphisis are manubrio-sternal and xiphi-sternal

Synchondrosis : 1st costo-sternal and all costo-chondral

Synovial : "TVS" Costo transverse, costo vertebral,

consto sternal (except 1st costo sternal)
 Dermatomes

T-2 : Axilla

T-4 : Nipples

C6 : Thumb
T-6 : siXphoid

T-10 : Umbilicus

T-12 : Inguinal Ligament

C5 - C6 - C7 - C8 - T1

C7 : Middle finger

L-2 : Mid Anterioir thigh

L-3 : Knee

L-4 : Medial Calf

L-5 : Lateral Calf +
Dorsum of foot
 Histology

GI Histology
Mouth and esophagus : Non keratinised stratified
squamous
Stomach : Simple squamous (with mucus cells)
Duodenum : Broad villi + Brunner's glands Duodenum Jejenum
Jejunum : Tongue shaped villi (Broad villi) (Tongue shaped villi)
Brunner's glands
Ileum : Flat villi + Peyer patches
Large intestine : Goblet cells
Anal canal (Above PL) : Simple coloumnar
Anal canal (Below PL) : Non keratinised stratified
squamous
Ileum Large intestine
(Flat villi) Goblet cells
Peyer's Patches

Paneth cells
(Produces substances
that kill bacteria) Mouth/Esophagus
Lamina propria
Connective tissue found below
basement membrane in mucous
lined tissues.

Tongue Histology

Circumvallate papillae Fungiform papillae Filliform papillae

Largest in size Has taste buds and Smallest and most
Placed near sulcus sensory cells numerous
terminalis Keratinised
No taste buds
 Respiratory Histology
PNS, Tracheal, Bronchus, Proximal bronchiole : Cilliated pseudo stratified coloumnar
Terminal bronchiole : Cilliated coloumnar
Respiratory bronchiole : Simple coloumnar
Alveolus : Simple squamous

Respiratory bronchiole Alveolar duct and sac Alveoli

Uro-genital tract
PCT, DCT : Simple Cuboidal
Ovary : Simple cuboidal
Collecting part : Transitional epithelium
Male structures : Pseudo strat coloumnar with
stereo cilia
Fallopian tube : Cilliated coloumnar Transitional epithelium Pseudo-strat columnar
Uterus + Endocervix : Simple Coloumnar Urinary bladder with stereo-cilia
Ectocervix + Vagina : Stratified Squamous Ureter Testes
Calyces Vas-deferens
Posterioir urethra Epididymis
Prostate gland

Cilliated coloumnar Simple cuboidal Squamo-coloumnar junction of cervix

Fallopian tube PCT, DCT Ectocervix + Vagina : Str squamous
Ovaries Endocervix + Uterus : Simple coloumnar
Cartilages

Elastic Hyaline Fibro-cartilage

Chondrocytes individually Chondrocytes Chondrocytes present

in lacunae forming cell nests in rows
No calcifications Calcification with old age Calcification with bone
Type 2 collagen Major articular cartilage repair
Type 2 collagen Type 1 collagen
Perichondrium present No perichondrium
(but absent in epiphyses All symphyses
and articulations)

Muscles

Skeletal muscle Cardiac muscle Smooth muscle

Striations Inter-calated discs
Lymphoid tissue
In Lymph nodes, lymphatic nodule in outer cortex
Spleen has a splenic arteriole inside lymphatic nodule
Tonsils have surface epithelium and a tonsilar crypt.
No nodule in thymus

Lymph node Spleen

le
Capsu
White pulp

Cortex Red Pulp

Trabeculae
Lymphatic nodule
(B Lymphocytes)
Medulla
Paracortex GC Lymphatic
(T Lymphocytes) nodule

Splenic arteriole
inside nodule

Palatine Tonsil
Hassal's Corpuscle
Thymus
Tonsilar
crypt

Cortex

Medulla

⬆️ Incomplete
Lymphatic septation
nodule

Pancreas and Thyroid

Pancreas Thyroid Follicles

Follicular Cells

Colloid
The clear space around the
colloid is a shrinkage
artifact.

Islets of Langerhans
Lightly stained clusters of
endocrine cells
Sebaceous glands
Apocrine
Mammary glands
Ceruminous glands (ear)
Moll's gland in eyelids (blockage causes stye)
Sweat glands in axilla and groin
Ecrine/merocrine
Sweat glands in rest of body
Tear glands
Salivary glands
Goblet cells
Holocrine
Sebaceous glands
Pear-shaped glands Seba Meibo
Meibomian glands
Pale staining cells that produce sebum
Holocrine secretion

Paneth Cells (Zymogen cells)

Found in deeper part of intestinal crypts
Rich in Zinc
Lysosomal action to destroy bacteria
 Cardiac muscle Skeletal muscle Muscular artery

Foliate Papilla Hyaline Cartilage Fibrous cartilage

Lymph node
Pancreas Striated Duct

Sebaceous gland Spleen Cerebellum

Thymus Elastic Cartilage

Circumvallate Papilla
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