Marco Roffi, MD

• Lecturer in Cardiology
• Zurich Medical School
• Staff Cardiologist
• University Hospital
• Zurich, Switzerland

The lesser trochanter is a small blood pressure medication best time to take discount 50 mg moduretic with visa, bony prominence that lies on the medial aspect of the femur untreated prehypertension purchase 50 mg moduretic free shipping, just below the neck arteria maxilar generic 50 mg moduretic free shipping. Running between the greater and lesser trochanters on the anterior side of the femur is the roughened intertrochanteric line arteria subclavia buy moduretic 50 mg line. The trochanters are also connected on the posterior side of the femur by the larger intertrochanteric crest pulse pressure graph buy cheap moduretic 50 mg. At its proximal end, the posterior shaft has the gluteal tuberosity, a roughened area extending inferiorly from the greater trochanter. More inferiorly, the gluteal tuberosity becomes continuous with the linea aspera ("rough line"). This is the roughened ridge that passes distally along the posterior side of the mid-femur. Multiple muscles of the hip and thigh regions make long, thin attachments to the femur along the linea aspera. On the lateral side, the smooth portion that covers the distal and posterior aspects of the lateral expansion is the lateral condyle of the femur. The roughened area on the outer, lateral side of the condyle is the lateral epicondyle of the femur. Similarly, the smooth region of the distal and posterior medial femur is the medial condyle of the femur, and the irregular outer, medial side of this is the medial epicondyle of the femur. The epicondyles provide attachment points for muscles and supporting ligaments of the knee. The adductor tubercle is a small bump located at the superior margin of the medial epicondyle. Posteriorly, the medial and lateral condyles are separated by a deep depression called the intercondylar fossa. Anteriorly, the smooth surfaces of the condyles join together to form a wide groove called the patellar surface, which provides for articulation with the patella bone. The combination of the medial and lateral condyles with the patellar surface gives the distal end of the femur a horseshoe (U) shape. A sesamoid bone is a bone that is incorporated into the tendon of a muscle where that tendon crosses a joint. A sesamoid bone functions to articulate with the underlying bones to prevent damage to the muscle tendon due to rubbing against the bones during joint movement. The patella is found in the tendon of the quadriceps femoris muscle, the large muscle of the anterior thigh that passes across the anterior knee to attach to the tibia. The patella articulates with the patellar surface of the femur and thus prevents rubbing of the muscle tendon against the distal femur. The patella also lifts the tendon away from the knee joint, which increases the leverage power of the quadriceps femoris muscle as it acts across the knee. The tibia is the main weight-bearing bone of the lower leg and the second longest bone of the body, after the femur. The medial side of the tibia is located immediately under the skin, allowing it to be easily palpated down the entire length of the medial leg. The two sides of this expansion form the medial condyle of the tibia and the lateral condyle of the tibia. These areas articulate with the medial and lateral condyles of the femur to form the knee joint. Between the articulating surfaces of the tibial condyles is the intercondylar eminence, an irregular, elevated area that serves as the inferior attachment point for two supporting ligaments of the knee. The tibial tuberosity is an elevated area on the anterior side of the tibia, near its proximal end. It is the final site of attachment for the muscle tendon associated with the patella. The anterior apex of this triangle forms the anterior border of the tibia, which begins at the tibial tuberosity and runs inferiorly along the length of the tibia. Both the anterior border and the medial side of the triangular shaft are located immediately under the skin and can be easily palpated along the entire length of the tibia. A small ridge running down the lateral side of the tibial shaft is the interosseous border of the tibia. This is the attachment site of the interosseous membrane of the leg, the sheet of dense connective tissue that connects the tibia and fibula bones. Located on the posterior side of the tibia is the soleal line, a diagonally running, roughened ridge that begins below the base of the lateral condyle and runs down and medially across the proximal third of the posterior tibia. The large expansion found on the medial side of the distal tibia is the medial malleolus ("little hammer"). Both the smooth surface on the inside of the medial malleolus and the smooth area at the distal end of the tibia articulate with the talus bone of the foot as part of the ankle joint. On the lateral side of the distal tibia is a wide groove called the fibular notch. This area articulates with the distal end of the fibula, forming the distal tibiofibular joint. It serves primarily for muscle attachments and thus is largely surrounded by muscles. It articulates with the inferior aspect of the lateral tibial condyle, forming the proximal tibiofibular joint. The thin shaft of the fibula has the interosseous border of the fibula, a narrow ridge running down its medial side for the attachment of the interosseous membrane that spans the fibula and tibia. The distal end of the fibula forms the lateral malleolus, which forms the easily palpated bony bump on the lateral side of the ankle. The deep (medial) side of the lateral malleolus articulates with the talus bone of the foot as part of the ankle joint. This has a relatively square-shaped, upper surface that articulates with the tibia and fibula to form the ankle joint. Three areas of articulation form the ankle joint: the superomedial surface of the talus articulates with the medial malleolus of the tibia, the top of the talus articulates with the distal end of the tibia, and the lateral side of the talus articulates with the lateral malleolus of the fibula. Inferiorly, the talus articulates with the calcaneus, the largest bone of the foot, which forms the heel. Body weight is transferred from the tibia to the talus to the calcaneus, which rests on the ground. The medial calcaneus has a prominent bony extension called the sustentaculum tali ("support for the talus") that supports the medial side of the talus bone. The cuboid has a deep groove running across its inferior surface, which provides passage for a muscle tendon. The talus bone articulates anteriorly with the navicular bone, which in turn articulates anteriorly with the three cuneiform ("wedgeshaped") bones. These bones are the medial cuneiform, the intermediate cuneiform, and the lateral cuneiform. Each of these bones has a broad superior surface and a narrow inferior surface, which together produce the transverse (medial-lateral) curvature of the foot. The navicular and lateral cuneiform bones also articulate with the medial side of the cuboid bone. These elongated bones are numbered 1­5, starting with the medial side of the foot. The base of the fifth metatarsal has a large, lateral expansion that provides for muscle attachments. This expanded base of the fifth metatarsal can be felt as a bony bump at the midpoint along the lateral border of the foot. Each metatarsal bone articulates with the proximal phalanx of a toe to form a metatarsophalangeal joint. The heads of the metatarsal bones also rest on the ground and form the ball (anterior end) of the foot. The toes are numbered 1­5, starting with the big toe (hallux) on the medial side of the foot. Using the disarticulated bones and/or partial skeletons in lab, use the provided structure lists to label the bones and bone features. Write the number that corresponds to each bone or bone feature from the lists below on a piece of colored tape or post-it. When you have labeled all structures from the list, take the designated pictures that allow all labeled structures to be clearly seen. Label the following structures of the fibula: # 1 2 Bone feature Head Lateral malleolus 6. Check your understanding Lesson 9: the Lower Limb ­ Muscles Created by Gabriella Sandberg Introduction the muscles of the leg position and stabilize the pelvic girdle and work with the bones of the leg to allow you to stand, walk, and run. In this lesson, students will identify the muscles of the leg and work to understand their function via muscle attachments, actions, and innervation. Identify muscles of the leg on a model, figure, diagram, and/or dissected material. Background Information the previous lesson described the bones of the pelvic girdle whose major function is to stabilize and support the body. That function is reflected in the structure of the pelvic girdle which allows very little movement because of its connection with the sacrum at the base of the axial skeleton. If the pelvic girdle, which attaches the lower limbs to the torso, were capable of the same range of motion as the pectoral girdle then walking would expend more energy and simple tasks such as standing up would be much more difficult. Some of the largest and most powerful muscles in the body are the gluteal muscles. The gluteus maximus is the largest of the gluteal muscles, and also the most superficial. The gluteus medius is just deep to the gluteus maximus, and the gluteus minimus is deep to the gluteus medius. The psoas (pronounced so-as) major and iliacus muscles merge to become the iliopsoas at the lesser trochanter. The tensor fascia latae is a thick, square-shaped muscle in the superior aspect of the lateral thigh. It acts as a synergist of the gluteus medius and iliopsoas in flexing and abducting the thigh. Deep to the gluteus maximus, the piriformis, obturator internus, obturator externus, superior gemellus, inferior gemellus, and quadratus femoris laterally rotate the femur at the hip. The adductor longus, adductor brevis, and adductor magnus can both medially and laterally rotate the thigh depending on the placement of the foot. The pectineus is located in the femoral triangle, which is formed at the junction between the hip and the leg, and includes the femoral nerve, the femoral artery, the femoral vein, and the deep inguinal lymph nodes. The muscles in the medial compartment of the thigh are responsible for adducting the femur at the hip. Along with the adductor longus, adductor brevis, adductor magnus, and pectineus, the strap-like gracilis adducts the thigh in addition to flexing the leg at the knee. The muscles of the anterior compartment of the thigh flex the thigh and extend the leg. This compartment contains the quadriceps femoris group, which actually comprises four muscles that extend and stabilize the knee. The rectus femoris is on the anterior aspect of the thigh, the vastus lateralis is on the lateral aspect of the thigh, the vastus medialis is on the medial aspect of the thigh, and the vastus intermedius is between the vastus lateralis and vastus medialis and deep to the rectus femoris. The tendon common to all four is the quadriceps tendon, which inserts on to the patella and continues to become the patellar ligament. In addition to the quadriceps femoris, the sartorius is a band-like muscle that extends from the anterior superior iliac spine to the medial side of the proximal tibia. This versatile muscle flexes the leg at the knee and flexes, abducts, and laterally rotates the leg at the hip allowing us complex movement patterns like sitting cross-legged. The posterior compartment of the thigh includes muscles that flex the leg and extend the thigh. The three long muscles on the back of the knee function to flex the knee and are commonly known as the hamstring group ­ the biceps femoris, semitendinosus, and semimembranosus. The tendons of these muscles form the popliteal fossa, the diamond-shaped space at the back of the knee. The muscles in the anterior compartment of the leg all contribute to raising the front of the foot when they contract and are the tibialis anterior (a long and thick muscle on the lateral surface of the tibia), the extensor hallucis longus (deep under the tibialis anterior), and the extensor digitorum longus (lateral to the tibialis anterior). The superficial muscles in the posterior compartment of the leg all insert onto the calcaneal tendon (Achilles tendon), a strong tendon that inserts into the calcaneal bone of the ankle. The muscles in this compartment are large and strong and play an important role in our upright posture. The plantaris runs obliquely between the two and is another good example of anatomical variation between individuals: some people may have two of these muscles, whereas no plantaris is observed in about seven percent of other cadaver dissections. The plantaris tendon is commonly used as a substitute for the fascia latae in hernia repair, tendon transplants, and repair of ligaments. There are four deep muscles in the posterior compartment of the leg: the popliteus, flexor digitorum longus, flexor hallucis longus, and tibialis posterior. The foot has intrinsic muscles, which originate and insert within it (similar to the intrinsic muscles of the hand). The principal support for the longitudinal arch of the foot is a deep fascia called plantar aponeurosis, which runs from the calcaneus bone to the toes (inflammation of this tissue is the cause of "plantar fasciitis," which is a common affliction for runners). Required Materials · Colored tape or post-it notes · Sharpie or marker · Leg model of the lower limb Procedure this activity will be completed individually or in small groups. Using the leg models in lab, use the provided structure lists to label the muscles. When you have labeled all muscles from the list, take the designated pictures that allow all labeled muscles to be clearly seen. During the practical you could either be provided with a set of actions and asked to identify the muscle or be provided with a muscle name and asked to provide one example of an action. If you are asked to provide one example of an action for a given muscle then you must be specific and precise with your language.

Observe also the right and left (paravertebral) sympathetic chains and associated structures (ganglia pulse pressure with exercise cheap moduretic 50 mg line, white and grey rami communicantes) as well as the thoracic splanchnic nerves pre hypertension natural cure buy moduretic 50 mg overnight delivery. Recall that preganglionic sympathetic fibers travel in greater splanchnic nerve (T5-9) hypertension food moduretic 50 mg order with visa, lesser splanchnic nerve (T10-11) pulse pressure is calculated by 50 mg moduretic order mastercard, and least splanchnic nerve (T12) arteria arcuata purchase 50 mg moduretic mastercard. D Center for Anatomical Studies and Education Department of Regenerative Medicine and Cell Biology College of Medicine Medical University of South Carolina Slide 1. In this lecture, we will discuss the gross anatomical structures of the respiratory system, namely the trachea, the bronchi, the lungs and the pleurae. In this slide, please visualize the structures that will be discussed during the course of this lecture. The trachea is an approximately 5 inches long, 1 inch wide, mobile cartilaginous and membranous tube starting at the lower border of the cricoid cartilage and ending by bifurcating (branching) into the right and the left main (primary) bronchi at the level of the sternal angle. Recall that the cricoid cartilage (upper end of the trachea) is at the level of the C6 vertebra and the sternal angle (lower end of the trachea) is at the lower level of the 4th thoracic vertebra. Note that during a bronchoscopy, a keelshaped anatomical structure, the carina can be observed at the level of the bifurcation. In this cross-section of the trachea, we can observe that the trachea: - Has a fibroelastic wall with an embedded series of U-shaped bars of hyaline cartilage keeping the lumen patent (open) - Has a mucosa lining the inside lumen - Has a band of smooth muscle, the trachealis muscle, closing the posterior free end of the U-shaped cartilage. In terms of relationship, the trachea is surrounded by: - Anteriorly: the brachiocephalic trunk and the arch of the aorta (the sternum, the thymus, the left common carotid artery, and left brachiocephalic vein) - Posteriorly: the esophagus and the left recurrent laryngeal nerve. In terms of relationship, the trachea is surrounded by: - On the right side: the azygos vein, the right vagus nerve and the pleura - On the left side: the arch of the aorta, the left common carotid and left subclavian arteries, the left vagus, left phrenic nerve and pleura. The trachea receives its innervation through branches of: - the vagus and the recurrent laryngeal nerves - the sympathetic trunks these branches are distributed to the: - the trachealis muscle - the mucous membrane lining the trachea. Understand that the right lung divides into 3 lobes, the superior, the middle and the inferior lobe whereas the left lobe divides in 2 lobes, the superior and the inferior lobe with an additional structure not present in the right lung the lingual. Note how the right bronchus is wider, shorter and more vertical than the left bronchus. This is clinically important as small swallowed foreign objects (like peanuts, coins, etc. Observe that: the primary bronchi divide into secondary bronchi On the right side, the primary bronchus divides into a superior bronchus and an intermediate bronchus before entering the hilum of the right lung On the left side, the primary bronchus first enters the hilum of the left lung and then divides into a superior and an inferior bronchus the terms "secondary" and "lobar" bronchi are synonymous terms because the secondary bronchi ventilate the lobes of the right and left lungs. The secondary bronchi further divide into tertiary bronchi, also called segmental bronchi because they ventilate the bronchopulmonary segments of the lungs (see next). Note that the bronchi continue to undergo division until the level of the terminal bronchiole (up to a total of 27 divisions). They are separated by the heart, the great vessels and the other structures found in the mediastinum. Note that each lung: - Is conical in shape, covered with a visceral pleura and suspended by its root - Has an apex, a concave base that sits on the diaphragm, a convex costal surface and a concave mediastinal surface. As already described, the left lung has two lobes (superior and inferior) separated by a single oblique fissure. The root of the lung allows the passage through the hilum of the lung of the left pulmonary artery, the left pulmonary bronchus and the left pulmonary veins. The pulmonary ligament, an inferior extension of the sleeve of pleura (where the mediastinal fuses with the visceral layer) allows the up and down movement of the root of the lung during breathing. The lingula, found immediately anterior to the cardiac impression is the lowest and most anterior part of the superior lobe of the left lung. Note the additional horizontal fissure at the level of the 4th intercostal space, running on the lateral aspect of the lung to cross the oblique fissure at the level of the mid-axillary line. Note the structures in the root of the right lung: the right pulmonary artery, the right pulmonary bronchus, and the right pulmonary veins. Finally note the pulmonary ligament (see later) and the multiple impressions also present on the medial surface of the right lung. The pulmonary veins lie inferior and anterior in the roots of the left and the right lung. Note however how the left pulmonary artery lies superior in the left lung whereas the right pulmonary artery lies anterior to the right bronchi in the right lung. It receives a branch of the pulmonary artery, vein and has it own lymphatic vessels and autonomic nerve supply. Note that: - the apex projects one inch above the level of the clavicle - Anteriorly, the border starts under the sternoclavicular joint, then passes downward to the sternal angle, continue down to the level of the xiphisternal joint where it turns out laterally - Anteriorly, the lower border is at the level of 6th rib (at the midclavicular line) - Laterally, the lower border is at the level of the 8th rib - Posteriorly, the lower border is at the 10th rib - the horizontal fissure is at the level of the 4th rib. Note that: - the apex of the left lung also projects one inch above the level of the clavicle - Anteriorly, the border starts under sternoclavicular joint, passes downward to the sternal angle, but deviates laterally at the level of the 4th intercostal space (4th rib) - the anterior border then forms the cardiac notch by extending for a variable distance beyond the lateral margin of the sternum - It then continues down toward the level of the xiphisternal joint to form the lingula - Like for the left lung, the lower border can be found anteriorly at the 6th rib (midclavicular line), laterally at the 8th rib (midaxillary line) and posteriorly at the 10th rib - Note that the oblique fissure (on both lungs) starts at the root of the spine of the scapula and runs downward, laterally and anteriorly to the 6th rib. The U-shaped cartilages bars are gradually replaced by irregular plates of cartilage that finally disappear at the level of the bronchiole. At the level of the terminal bronchiole, the walls have no cartilage but consist of elastic fiber, smooth muscle and are lined by ciliated epithelium. The respiratory bronchioles are terminal bronchioles presenting with alveoli in their walls. These terminal bronchioles end by branching into alveolar ducts that lead into tubular passages with numerous thin-walled outpouchings called alveolar sacs. The gaseous exchange takes place between the air in the alveolar lumen and the blood in the capillaries surrounding the alveolar sacs. The pulmonary arteries (from the right side of the heart) bring the deoxygenated blood to a capillary bed in the wall of the alveoli where gaseous exchange takes place. The pulmonary veins then return the oxygenated blood to the left side of the heart. The bronchi and the connective tissue of the lungs (as well as the visceral pleura: see later) receive their blood supply from the bronchial arteries, branches of the descending aorta. The venous return is done by bronchial veins, which drain into the azygos vein on the right side and hemiazygos vein on the left side. Note that are not present in the alveolar wall:: - the superficial plexus drains below the visceral pleura toward the hilum, in the bronchopulmonary nodes - the deep plexus drains the bronchi and pulmonary vessels toward the hilum, in the pulmonary and then the bronchopulmonary nodes - the lymph then leaves the hilum to drain into the tracheobronchial nodes, the paratracheal nodes, and the bronchiomediastinal trunks - these bronchiomediastinal trunks drain either directly or indirectly into the brachiocephalic veins (through the inferior deep cervical nodes and the jugular lymphatic trunk on the right side and the thoracic duct on the left side). In this slide, observe the presence of a pulmonary plexus at the root of each lung (each pulmonary plexus has an anterior and a posterior component). Each plexus is composed of efferent and afferent autonomic fibers and is formed by branches of the sympathetic trunks and from the vagus nerve. The sympathetic efferent fibers induce bronchodilation of the bronchi and vasoconstriction. The parasympathetic efferent fibers induce bronchoconstriction, vasodilation and increased glandular secretion. The afferent fibers carry information from the mucous membranes and from stretch receptors in the alveolar walls to the central nervous system through both sympathetic and parasympathetic fibers. Observe how each pleura is composed of two layers: - A parietal pleura: lining the thoracic wall, covering the thoracic surface of the mediastinum and extending into the root of the lung - A visceral pleura: completely covering the outer surfaces of the lung and extending into the interlobar fissures. Note that these two layers become continuous with one another at the hilum of the lung, forming a pleural cuff. To allow for movement of the pulmonary vessels and bronchi during respiration, this cuff hangs down as a loose fold called the pulmonary ligament. On this slide, observe how the visceral pleura simply covers the lungs and how the parietal pleura can be divided in: - Cervical pleura: extending up in the neck - Costal pleura: lining the inner surfaces of the ribs, the costal cartilages, the intercostal spaces, the sides of the vertebral bodies and the back of the sternum - Diaphragmatic pleura: covering the thoracic surface of the diaphragm - Mediastinal pleura: covering (forming) the lateral border of the mediastinum. The parietal and visceral layers are separated by a slit-like space, the pleural cavity, containing a small amount of fluid called the pleural fluid. The costodiaphragmatic recesses are slit-like spaces between the costal and diaphragmatic pleurae. During inspiration, the lower borders of the lungs descend into these recesses, separating the costal and diaphragmatic pleurae. The costomediastinal recesses are slit-like spaces situated between the costal and mediastinal pleurae. Note that the parietal pleura is sensitive to pain, temperature, touch, and pressure. It is supplied by: - the phrenic nerve: to the mediastinal pleura and the dome of the diaphragmatic pleura - the intercostal nerves supply the costal pleura segmentally with the lowest 6th intercostal nerves innervating the periphery of the diaphragmatic pleura. Slide 32 As already discussed in this lecture, the 2 pleurae are able to slide on one another. Due the fact that, under normal conditions, the parietal pleura is tightly adherent to the chest wall and the lungs are tightly adherent to the internal aspect of the visceral pleura, any movement of the chest wall will translate in change in lung size. During breathing, the muscles acting on the chest wall will increase the following: - the anteroposterior diameter by raising the sternal end of the ribs (pump effect) - the transverse diameter by raising the ribs at the costo-vertebral joints (bucket handle) - the supero-inferior height by descending the diaphragm (see next slide). During the inspiration phase of breathing, the diaphragm will contract and descend, with the bifurcation of the trachea lowering as much as 2 vertebral levels. Under normal conditions, this process will decrease the pressure inside the lungs when compared to the outside atmosphere pressure and will draw air into the lungs. The muscles active during quiet inspiration are the diaphragm and the intercostal muscles. Additional muscles can also be recruited to assist with forced expiration: the intercostals, the abdominal muscles and the quadratus lumborum. Recall that the mediastinum is a movable partition extending superiorly to the thoracic outlet and the root of the neck and inferiorly to the diaphragm. It extends anteriorly to the sternum and posteriorly to the 12 thoracic vertebrae of the vertebral column. The mediastinum is divided into superior (1) and inferior mediastina, with the inferior mediastinum further divided into anterior (2), middle (3) and posterior mediastina (4). The superior border of the mediastinum is an imaginary line between the suprasternal notch and the upper border of T1 thoracic vertebra, with the inferior border being the diaphragm muscle. A line between the sternal angle and the disc between the T4 and T5 vertebrae divides the mediastinum into the superior and inferior compartments. Note how the inferior compartment is further subdivided by the pericardium into the anterior, middle and posterior compartments. The contents of each compartment of the mediastinum will be discussed in the next lecture. D Center for Anatomical Studies and Education Department of Regenerative Medicine and Cell Biology College of Medicine Medical University of South Carolina Slide 2. We will continue by having an introduction to the blood flow through the main chambers of the heart and will continue with a discussion of the great vessels, the pericardium, the contents of the main chambers, the coronary vessels and will finish the lecture with the innervation of the heart and it conduction system. The mediastinum is the partition within the thorax between the pleural cavities inferior to the thoracic inlet (first ribs) and above the diaphragm. The inferior section is further divided into anterior, middle, and posterior areas. The middle mediastinum is the space inferior to the transverse plane connecting the sternal angle to the T4/T5 intervertebral discs and superior to the diaphragm. The chambers are the right atrium, right ventricle, left atrium, and left ventricle. It passes through the tricuspid valve to enter the right ventricle and is pumped through the pulmonic valve and the pulmonary arteries to the lungs. The oxygenated blood from the lungs is carried back to the heart via the four pulmonary veins and enters the left atrium. Blood passes through the mitral valve to enter the left ventricle, and is then pumped though the aortic valve and aorta to enter systemic circulation. The right atrium is the most right lateral border while the right ventricle makes up the majority of the anterior surface (the sternocostal surface). The left atrium is the posterior surface of the heart while the left ventricle comprises the diaphragmatic surface. The superior aspect of the anterior surface of the heart is notable for a visualization of the origins of the great vessels: superior vena cava, aorta, and pulmonary trunk. The superior aspect of the posterior surface, the left atrium, is notable for the visualization of the four pulmonary veins. The orientation of the chambers can be further achieved by following the sulci or grooves formed from fusion of the muscular walls during development. The coronary sulcus is the groove separating the atriums from ventricles and can be seen in slide 6 running between the right auricle and the right edge of the pulmonary trunk. The anterior interventricular sulcus is the groove separating the ventricles on the anterior surface while the posterior interventricular sulcus separates the ventricles on the diaphragmatic surface. This slide shows the anterior and posterior views of the great veins as they enter the heart. The venous flow from the lower limbs, abdomen, and pelvis returns through the inferior vena cava and enters the right atrium. Newly oxygenated blood returns to the left atrium via the right and left superior and inferior pulmonary veins. These veins are unique in that they carry oxygenated blood unlike other adult veins. This slide shows the anterior and posterior views of the great arteries of the heart. The deoxygenated blood leaves the heart and travels to the lungs via the pulmonary trunk and the right and left pulmonary arteries. These arteries are also unique as they are the only adult arteries carrying deoxygenated blood. The blood is returned to the systemic circulation via the aorta arch which gives rise to the brachiocephalic trunk, the left common carotid artery, and left subclavian artery. The brachiocephalic trunk supplies blood to the right upper limb and head via the right subclavian artery and right common carotid artery respectively. The left common carotid artery then supplies the left head and neck while the left subclavian artery supplies the left upper limb. The pericardium is a fibroserous sac containing the heart and the origins of the great vessels. It is made up of an outer wall and an inner wall separated by a pericardial cavity. The outer wall is composed of an outer connective tissue layer called fibrous pericardium fused with an inner serous layer called the parietal layer of serous pericardium.

The ongoing balance between osteoblasts and osteoclasts is responsible for the constant but subtle reshaping of bone halou arrhythmia moduretic 50 mg purchase line. Spongy Bone the differences between compact and spongy bone are best explored via their histology blood pressure jadakiss cheap 50 mg moduretic amex. Compact bone is dense so that it can withstand compressive forces pulse pressure endocarditis buy discount moduretic 50 mg on line, while spongy bone has open spaces and supports shifts in weight distribution blood pressure medication and q10 moduretic 50 mg order free shipping. It can be found under the periosteum and in the diaphysis of long bones blood pressure kit buy generic moduretic 50 mg online, where it provides support and protection. The microscopic structural unit of compact bone is called an osteon, or Haversian system. Each osteon is composed of concentric rings of calcified matrix called lamellae (singular = lamella). Running down the center of each osteon is the central canal which contains blood vessels, nerves, and lymphatic vessels. These vessels and nerves branch off at right angles through a perforating canal to extend to the periosteum and endosteum. Osteocytes are located inside spaces called lacunae (singular = lacuna), found at the borders of adjacent lamellae. As described above, canaliculi connect with the canaliculi of other lacunae and eventually with the central canal. This system allows nutrients to be transported to osteocytes and wastes to be removed from them. The trabeculae may appear to be a random network, but each trabecula forms along lines of stress to provide strength to the bone. The spaces of the trabeculated network provide balance to the dense and heavy compact bone by making bones lighter so that muscles can move them more easily. In addition, the spaces in some spongy bones contain red marrow, protected by the trabeculae, where blood cell production occurs. Distinguish the axial skeleton from the appendicular skeleton in general structure & function Required Materials · Intact skeleton Procedure 1. Identify whether the following bones are a part of the axial or appendicular skeleton by writing the correct region on the provided blank. Provide one general function of the axial skeleton that is not a function of the appendicular skeleton. Classify bones into one of four groups based on shape (flat, long, short, or irregular) 6. Define and provide examples of bone feature types Required Materials · Disarticulated bones Procedure 1. Using the disarticulated bones in the lab, find at least two examples of each bone shape. Describe the microscopic structure of compact bone Required Materials · Virtual Microscope ­ Ground compact bone (93B) ­ Access a section of compact bone by following the link: virtualslides. Using the cross section of compact bone virtual microscope slide, identify osteons, concentric lamellae, interstitial lamellae, osteocytes, lacunae, and canaliculi. Zoom in as necessary to find a distinct osteon with identifiable lamellae, osteocytes, lacunae, and canaliculi and then take a screenshot of that view. Annotate the image to clearly identify the osteon, lamellae, osteocytes, lacunae, and canaliculi. Central canal Source Material University of Michigan Virtual Microscope: histology. Name, describe, and provide examples of each of the following types of joints: fibrous, cartilaginous, and synovial. The adult human body has 206 bones, and with the exception of the hyoid bone in the neck, each bone is connected to at least one other bone. Joints can allow for considerable movement between bones or allow little or no movement. Joint stability and movement are related to each other with stable joints allowing for little or no mobility between the adjacent bones while joints that provide the most movement between bones are the least stable. Understanding the relationship between joint structure and function will help to explain why particular types of joints are found in certain areas of the body. Joints can be classified based on structural characteristics (fibrous, cartilaginous, and synovial; described further below) or the amount of mobility allowed at the joint (synarthroses, amphiarthroses, diarthroses). Synarthroses are immobile or nearly immobile joints with adjacent bones strongly linked together. Examples include sutures of the skull and the joint between the manubrium and body of the sternum. Amphiarthroses are joints with limited mobility and include intervertebral discs and the pubic symphysis of the pelvis. Diarthroses are freely mobile joints and include all synovial joints such as the shoulder, knee, and ankle joints. Fibrous connective tissue strongly unites adjacent skull bones and, in adults, the skull bones are closely opposed preventing most movement between the bones leading to their classification as synarthroses. At a syndesmosis joint, the bones are more widely separated and are held together by a narrow band of fibrous connective tissue called a ligament or a wide sheet of connective tissue called an interosseous membrane. Syndemoses are typically classified as amphiarthroses because they allow limited movement while providing considerable strength and stability in structures like the ankle. Lastly, a gomphosis is the specialized fibrous, synarthrotic joint that connects each tooth to the jaw. Numerous short bands of dense connective tissue, each of which is called a periodontal ligament, anchors the root of a tooth into its bony socket within the jaw. Cartilaginous Joints As the name indicates, at a cartilaginous joint, adjacent bones are united by cartilage, a tough but flexible type of connective tissue. There are two types of cartilaginous joints based on the type of cartilage found in the joint. A synchondrosis is a cartilaginous joint where bones are joined together by hyaline cartilage, or where bone is united to hyaline cartilage. Due to the lack of movement between the bone and cartilage synchondroses are functionally classified as synarthroses. An example of a temporary synchondrosis is the epiphyseal plate (growth plate) of a growing long bone. The epiphyseal plate is the region of growing hyaline cartilage that unites the diaphysis (shaft) of the bone to the epiphysis (end of the bone). Bone lengthening involves growth of the epiphyseal plate cartilage and its replacement by bone, which adds to the diaphysis. During childhood growth, the rates of cartilage growth and bone formation are equal and thus the epiphyseal plate does not change in overall thickness as the bone lengthens. During the late teens or early 20s, growth of the cartilage slows and eventually stops. The epiphyseal plate is then completely replaced by bone, and the diaphysis and epiphysis portions of the bone fuse together to form a single adult bone. One example is the first sternocostal joint, where the first rib is anchored to the sternum by its costal cartilage. Unlike the temporary synchondroses of the epiphyseal plate, these permanent synchondroses retain their hyaline cartilage and thus do not ossify with age. A cartilaginous joint where the bones are joined by fibrocartilage is called a symphysis. Fibrocartilage is very strong because it contains numerous bundles of thick collagen fibers, thus giving it a much greater ability to resist pulling and bending forces when compared with hyaline cartilage. This gives symphyses the ability to strongly unite the adjacent bones, but can still allow for limited movement to occur. At the pubic symphysis, the pubic portions of the right and left hip bones of the pelvis are joined together by fibrocartilage across a narrow gap. The intervertebral symphysis is a wide symphysis located between the bodies of adjacent vertebrae of the vertebral column. Here a thick pad of fibrocartilage called an intervertebral disc strongly unites the adjacent vertebrae by filling the gap between them. The width of the intervertebral symphysis is important because it allows for small movements between the adjacent vertebrae. A key structural characteristic for a synovial joint that is not seen at fibrous or cartilaginous joints is the presence of a joint cavity. This fluid-filled space is the site at which the articulating surfaces of the bones contact each other. Also unlike fibrous or cartilaginous joints, the articulating bone surfaces at a synovial joint are not directly connected to each other with fibrous connective tissue or cartilage. This gives the bones of a synovial joint the ability to move smoothly against each other, allowing for increased joint mobility. The joint is surrounded by an articular capsule that defines a joint cavity filled with synovial fluid. The articulating surfaces of the bones are covered by a thin layer of articular cartilage. Ligaments support the joint by holding the bones together and resisting excess or abnormal joint motions. Friction between the bones at a synovial joint is prevented by the presence of the articular cartilage, a thin layer of hyaline cartilage that covers the entire articulating surface of each bone. However, unlike at a cartilaginous joint, the articular cartilages of each bone are not continuous with each other. Instead, the articular cartilage acts as a smooth coating over the bone surface, allowing the articulating bones to move smoothly against each other without damaging the underlying bone tissue. The cells of this membrane secrete synovial fluid (synovia = "a thick fluid"), a thick, slimy fluid that provides lubrication to further reduce friction between the bones of the joint. This fluid also provides nourishment to the articular cartilage, which does not contain blood vessels. The ability of the bones to move smoothly against each other within the joint cavity, and the freedom of joint movement this provides, means that each synovial joint is functionally classified as a diarthrosis. Outside of their articulating surfaces, the bones are connected together by ligaments, which are strong bands of fibrous connective tissue. These strengthen and support the joint by anchoring the bones together and preventing their separation. Ligaments allow for normal movements at a joint, but limit the range of these motions, thus preventing excessive or abnormal joint movements. At many synovial joints, additional support is provided by the muscles and their tendons that act across the joint. As forces acting on a joint increase, the body will automatically increase the overall strength of contraction of the muscles crossing that joint, thus allowing the muscle and its tendon to serve as a "dynamic ligament" to resist forces and support the joint. This type of indirect support by muscles is very important at the shoulder joint, for example, where the ligaments are relatively weak. A few synovial joints of the body have a fibrocartilage structure located between the articulating bones to unite bones to each other, smooth movements between bones, or provide cushioning. This is called an articular disc, which is generally small and oval-shaped, or a meniscus, which is larger and C-shaped. Additional structures located outside of a synovial joint serve to prevent friction between the bones of the joint and the overlying muscle tendons or skin. A bursa (plural = bursae) is a thin connective tissue sac filled with lubricating liquid. It is a connective tissue sac that surrounds a muscle tendon at places where the tendon crosses a joint. Types of Synovial Joints Synovial joints are subdivided based on the shapes of the articulating surfaces of the bones that form each joint. An example of a pivot joint is the atlantoaxial joint, found between the C1 (atlas) and C2 (axis) vertebrae. Here, the upward projecting dens of the axis articulates with the inner aspect of the atlas, where it is held in place by a ligament. This type of joint allows only for bending and straightening motions along a single axis. A good example is the elbow joint, with the articulation between the trochlea of the humerus and the trochlear notch of the ulna. Other hinge joints of the body include the knee, ankle, and interphalangeal joints between the phalanx bones of the fingers and toes. The knuckle (metacarpophalangeal) joints of the hand between the distal end of a metacarpal bone and the proximal phalanx bone are condyloid joints. One movement involves the bending and straightening of the fingers and the second movement is a side-to-side movement, which allows you to spread your fingers apart and bring them together. The primary example is the first carpometacarpal joint, between the trapezium (a carpal bone) and the first metacarpal bone at the base of the thumb. This joint provides the thumb the ability to move away from the palm of the hand along two planes. Thus, the thumb can move within the same plane as the palm of the hand, or it can jut out anteriorly, perpendicular to the palm. This movement of the first carpometacarpal joint is what gives humans their distinctive "opposable" thumbs. The motion at this type of joint is usually small and tightly constrained by surrounding ligaments. Depending upon the specific joint of the body, a plane joint may exhibit only a single type of movement or several movements. Plane joints are found between the carpal bones (intercarpal joints) of the wrist or tarsal bones (intertarsal joints) of the foot, between the clavicle and acromion of the scapula (acromioclavicular joint), and between the superior and inferior articular processes of adjacent vertebrae (zygapophysial joints). Ball-and-Socket Joint the joint with the greatest range of motion is the ball-and-socket joint. The hip joint and the glenohumeral (shoulder) joint are the only ball-and-socket joints of the body.

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