— STRUCTURAL PRINCIPLEContents GROSS ANATOMY |. Anatomical terms ~ 8. Nervous System GENERAL HISTOLOGY 1. Covering or Lining Epithelium ~ 2. Glandular Epithelium ~ 3. Connective Tissue 4. Ground Bone -- 5. Cartilages 6. Blood Vessels 7. Muscles --- 8. Nervous Tissue ~ GENERAL EMBRYOLOGY 1. Gametogenesis 2. Ovarian Cycle ~ 3. Uterine Cycle ~ 4. Fertilization 5. Cleavage 6 7. 8. . Implantation -- . Bilaminar Germ Layer ~ 3. Trilaminar Germ Layer -~ . Fetal Membrane 10. Teratogenesis 11. Fetal Period 12, Multiple Pregnancy -SP-1 1. ANATOMICAL TERMS | a necAL TERMS Anatomical Position Is standing erect and facing forwards, ‘Upper limbs by the side with the palms facing anteriorly, and » Lower limb together with the toes pointing anteriorly Four Imaginary Planes + Median (midsagittal) plane — passes longi into right and left halves * Sagittal plane ~ any vertical planes parallel with the median plane * Coronal (frontal) plane — passes at right angle to the median plane and divides the body into anterior (front) and posterior (back) * Horizontal (transverse) plane ~ passes at right angles to both median and sagittal planes, dividing the body into superior (upper) and inferior (lower) parts © Sections of the Body * Longitudinal sections — run parallel to the long axis of the body or of any of its parts, regardless of the position of the body * Transverse sections or cross sections — cut at right angles to the longitudinal axis of the body or of any of its parts * Oblique sections ~ not cut along the previously listed anatomical planes, they are slightly oblique a i _ Ww ff 4SP-2 Terms of Relationship and Comparison + Superior (cranial) ~ nearer to the head + Inferior (caudal) — nearer to the feet + Posterior (dorsal) — nearer to the back + Anterior (ventral) — nearer to the front + Central — towards the center of the mass * Peripheral — away from the center of the mass * Median — along the median plane * Medial — nearer to the median plane of the body * Lateral — farther away from the median plane * Extemal — outside of or farther from the center of an organ or cavity ‘Internal — inside or closer to the center ‘+ Superficial — nearer to the surface ‘+ Deep — farther from the surface + Proximal — nearer to the trunk or point of ® py = AN ni ‘Terms of Laterality © Bilateral — paired structures having right and left members ‘© Unilateral — occurring on one side only ‘© Ipsilateral — occurring on the same side of the body as another structure ‘© Contralateral - occurring on the opposite side of the body relative to another structure 6 : & h Ny Jy)’ fi \ Unilateral: Ipsilateral: (Contralateral: Bilateral : Opposte Si nm One Side Same Sid Sree Sides of BodySP-3 Terms of Movement Flexion — bending or decreasing the angle between the bones or parts ofthe body (Dossiflexion ~ flexion at the ankle joint, Plantarflexion — bends the foot and toes toward the ground) Extension — straightening or increasing the angle between the bones or parts of the body. ‘Abduction — moving away from the median plane ‘Adduction ~ moving toward the median plane Circumduction — circular movement that involves sequential flexion, abduction, extension, and adduction (or in the opposite order) Medial rotation (internal rotation) — brings the anterior surface of a limb closer to the median plane Lateral rotation (external rotation) — takes the anterior surface away from the median plane Pronation — rot ion of the radius medially so that the palm of the hand faces posteriorly and its dorsum faces anteriorly Supination ~ rotation of the radius laterally and uncrossing it from the ulna, returning, the pronated forearm to the anatomical position Eversion — movement of the sole of the foot in which the sole faces outwards and laterally Inversion — movement of the sole of the foot in which the sole faces inwards and medially Opposition — movement by which the 1* digit (thumb) is brought to another di Reposition — movement of the 1" digit from opposition back to its anatomical position Protrusion (protraction) — movement in which a part of the body moves forwards on @ plane parallel to the ground Retrusion (retraction) ~ movement in which a part of the body moves backwards on a plane parallel to the ground Elevation — raises or moves a part superiorly ‘a Depression ~ lowers or moves a part inferiorly = iS { i iSP-4 2. FASCIA Fascia is connective tissue layer that wrapping, packing and insulating materials of the deep structures of the body. ‘There are two basic layers — superficial and deep layers, Superficial Fascia (loose areolar tissue) It isa subcutaneous layer which unites dermis of skin to the underlying deep fascia. thas a superficial fatty layer (fat, cutaneous vessels, nerves, lymphatics and glands) and a deep membranous layer. ‘The superficial fascia almost contains fat except in the: 1. Eyelids 2. Extemal ear 3. Penis 4, Scrotum 5. Flexion creases of the digits ‘The amount of fat in superficial fascia is more in females and children. In mature females, it tends to accumulate in the breasts, anterior abdominal wall below the umbilicus, gluteal and lumbar region, post-deltoid region, cervical thoracic region and thighs. In males, subcutaneous fat accumulates in the lower abdominal wall, Functions of superficial fasci 1. Thermal insulation (water and fat) provides an effective barrier against rapid loss of body heat. 2. Protective cushion (stored fat and water) provide protection against mechanical shock. Eg. Buttocks 3. Conduction (nerves, vessels and lymphatics) which are transported to and from the skin above. Applied anatomy = Subcutaneous injections are painful due to presence of pain receptors in it. Drugs administered by this route are absorbed slowly and only small doses (0.5-1 ml) are given. = The ideal sites of subcutaneous injections are ‘© Anterior abdominal wall © Anterior aspect of thigh oe © Posterior aspect of armSP-5 Deep Fascia The deep fascia is a dense, organized connective tissue layer, devoid of fat, that covers most of the body deep to the skin and subcutaneous tissue. It keeps the soft tissues in place and maintains the shape ofthe body. The deep fascia is best marked inthe limbs and neck.(Eg. Cervical fascia, liotibial tract) Sites where deep fascia is absent- " 1. Face . Breast ‘Anterior abdominal wall Penis and scrotum Ischiorectal fossa Functions of the deep fascia ares 1. Deep fascia thickens to form retinaculum to retain the tendon of long muscles in place and prevent their bowstringing during action of these muscles, Eg. Flexor and Extensor retinacula around wrist and ankle joint. 2. In palms and soles it thickens to form palmar and plantar aponeurosis to protect the underlying structures. 3. Deep fascia is modified to form interosseous membranes in the forearm and leg. 4. It splits to enclose certain glands to form their capsule. Eg. Parotid gland, Submandibular gland, Thyroid gland, etc. 5. The ligaments of joints are considered as localized thickened bands of the deep fasci 6. Deep fascia condenses to form a sheath around neurovascular bundles and provides pathway for their passage of vessels and nerves. Eg. Carotid sheath and Axillary me a | Wy \ we apnaSP-6 7. Deep fascia forms fibrous flexor sheath around the long flexor tendons so that tendons may move freely over one another frictionlessly. QRewy; 8. Provides origins and insertions of muscles. Eg. Temporalis, Subscapularis and Infraspinatus 9. Muscles or groups of muscles are separated by intermuscular septa (prolongations of deep fascia). Subseapularis: muscle . Fascial investment of the muscles prevents bulging of muscle during contraction by serving as an elastic stocking. Deep fascia, contracting muscles and venous valves work togefher as a musculo-venous pump to return blood to the heart. Eg, Fascia packing the calf muscle . The presapce of numerous proprioceptive endings in aponeurosis and retinacula suggest that fascia have a kinesthetic as well as mechanical function, i shat museularpump, Nerve supply of deep fascia - Nerves supplying overlapping kin. - Nerves supplying enclosed myscles Epidermisof Skin Dermis of SkinSP-7 Applied Anatomy : 1. The tension lines (or Langer lines) are caused by parallel arrangement of collagen and clastic fibers in skin, 2. Fascial planes between the muscles prevent the spread of infection by limiting areas and thus controlling pus or fluid from tracking freely to other sites. Deep fascia can be used in repair of hernia apertures and tendinous or aponeurotic em Common carotid Jugular vein Space 3A Space 3 Stemomastoid muscle Omohyoid muscle Visceral fascia Stemothyroid muscle Sternohyoid muscle. Anterior layer, deep cervical fasciaSP-8 3. BONE Definition A living structure composed of highly vascular and mineralized connective tissue cucpegeo co cect Constituents of bone ; Cells - Connective tissue cells called osteocyte, osteoblast — Intercellular substance ~ 1/3 organic (collagen fibres, amorphous mucopolysaccharide) + 2/3 inorganic (calcium and phosphate ions) + Others (blood vessels, lymphatics, nerves) Functions zy 1. Bony framework for form and support 3 2. Lever for movements in locomotion 3. Areas for attachment of muscles and ligaments 4. Protection of viscerae 5. Production of blood cells (by bone marrow) 6. Storage of calcium and phosphate ions 7. Transmission of weight and force <22s Classification of Bones 1. According to development a, Membranous bone - Developed from mesenchymal membrane - Eg. Skull bb, Endochondral (gartilaginous) bone - Developed from the cartilaginous model - Eg. Limb bones 2. According to structure ‘a, Compact bone - Shaft of long bones b. Spongy bone - Ends of long bones, short bones 3. According to region a. Axial bone - Skull, vertebra, ribs b. Appendicular bone - Bones of limbs and girdles 4, According to maturation a, Immature bone - Fetal bone bb, Meture bone - Adult bone 5. According to Shape a, Long bones ~ Length greater than breadth and thickness - Tubular with marrow cavity inside - Develops in cartilage (exception — claviele)SP-9 = Eg. Only found in bones of limbs b. Short bones = Dimensions nearly equal ~ Cuboid in shape = Spongy bore and marrow cavity enclosed by a thin compact bone - Develops in cartilage ~ Eg. Carpals, Tarsals Compact ©. Flat bones bone cancellous - Two layers of compact bone with spongy bone and marrow cavity betweehthem, (like a sandwich) ~ Spongy layer in bones of the skull vault is called diploe. ~ Eg. Sternum, Scapula, most skull bones 4. Irregular bones - Irregular in shape ~ Eg. Vertebra, Hip bone, Temporal bone 6. Others a. Sesamoid bone - Nodules of bones embedded in some tendons exposed to pressure and friction - Eg. Patella b. Accessory bone = Bones that are not regularly present = Eg. Supernumerary digit, Sutural bones of skull c. Pneumatic bone - Skull bones with air cavities ~ Eg. Ethmoid bone 4, Heterotopic bone = Pieces of bones found in places other than normal sites - Eg, Scars, Calcified tendons avd Neo enna a) AtSP-10 Parts of a Young Long Bone ~ Each long bone has a shaft (diaphysis) and two ends (epiphyses) iaphysis ~ Thick-walled tube made up of compact bone surrounding a medullary (marrow) cavity ~ Marrow cavity contains red or yellow marrow = Red marrow in most of the long bones in a child ~ Replaced by yellow marrow with age + Site of primary ossification Metaphysis ~ End of diaphysis adjacent to epiphysis ~ Separated from epiphysis by epiphyseal dise ~ Growth zone of the bone where growth in length occurs ~ When the growth in length ceases the epiphyseal plates become bone Epiphyses - Usually wider than the shaft ~ Made up of spongy bone covered with a thin compact bone ~ Sites of secondary ossification ~ Anticular surfaces are covered by articular cartilage (hyaline cartilage) Coverings a. Periosteum ~ Connective tissue covering outer surface of long bone except at articular surfaces - Has outer fibrous limiting membrane and inner cellular Inyer (for new bone formation) b. Endosteum - Thin cellular membrane Ii spongy bone ng marrow cavity of compact bone and trabecular spaces of ‘Structure of a Long BoneSP-11 Blood Supply of a Long Bone Arterial supply 1. Nutrient artery = Usually a branch of a larger artery running adjacent to the bone ters the shaft through nutrient foramen = Divides into proximal and distal branches - Supplies spongy bone and inner part of compact bone up to metaphysis. 2. Branches of periosteal arteries ~ Supplies outer part of compact bone of the shaft 3. Epiphyseal and metaphyseal arteries ~ Supply epiphysis, metaphysic and joint capsule ~ Ina young growing bone, metaphyseal and epiphyseal arteries are separated by the epiphyseal disc. + In mature bone, they anastomose freely with each other. Venous drainage ~ Venous blood drains into medullary sinusoids and then into a large central venous sinus, ~ This sinus is drained by venae commitantes of nutrient, articular and periosteal arteries, Lymphatic Drainage and Nerve Supply Lymphatic drainage ~ Lymph vessels in periosteum and peri-vascular Lymph spaces Nerve supply ~ Many nerves in bone accompanying the vessels (mainly vasomotor) - Sensory fibres in periosteum which is sensitive to tension and tearSP-12 Development of Bones 1. Types of ossification #, Membranous ossific: - Direct ossification of mesenchymal cells (skull, mandible, clavicle, terminal b. Endochondral (cartilaginous) ossification ~ Hyaline cartilage model replaced by bone = Occurs in all long bones except the clavicle 2. Ossification centers a. Primary ossification center First to appear before birth ~ Appears at about 8" intra-uterine week and situated at middle of shaft in long bones b. Secondary ossification center ~ Appears after primary center or appears for the first time after birth + Situated in epiphyses and appears at 1*~2™ year of life in a long bone 3. Law of ossification ~Epiphysis which is first to appear is the last to unite (Exception ~ fibula) ~Epiphysis of non-growing end unites with diaphysis at about 18 - 19 year of age -Epiphysis of growing end unites with diaphysis at about 21 year of age 4. Types of epiphysis a. Pressure epiphysis - Transmits the body weight and protects the epiphyseal cartilage - Eg. Head of femur, Head of humerus b. Traction epiphysis - Produced by pull of the attached muscle ~ Eg. Greater and lesser trochanters of the femur c. Atavistic epiphysis - Eg. Coracoid process of scapula 4. Aberrant epiphysis - Not always present -Eg. Additional epiphysis in distal end of the first metacarpal (which usually has epiphysis in the proximal end) 5. Growing end of a long bone - Responsible for growth in the length of that bone -Is the end where epiphysis unites late with the diaphysis than the other. 6. Direction of nutrient artery - Usually points away from growing end of a long bone Applied Anatomy |, Fracture =A break in the continuity of a bone a. Simple (closed) fracture - Fracture not connected with the skin woundSP-13, b. Compound (open) fracture racture that communicates with the skin wound 2. Extensive blood supply of bones ~ Difficult to interrupt blood supply to kill the bone due to extensive blood supply ~ So metal pins can be inserted into medullary cavity in fractures 3. Avascular necrosis ~ Loss of blood supply to a part of bone leading to death of bone tissue 4. Epiphyseal cartilage in X-ray - Seen as epiphyseal line ~ May be mistaken as a fracture 5. Bone marrow biopsy ~ For examination of bone marrow for various clinical c disorders. 6. Bone tumours - Benign or malignant tumours may occur 4. CARTILAGE ~ Avascular, tough, resilient connective tissue Structure ~ Cells and fibres embedded in firm, gel-like intercellular substance som a. Cells - Chondrocyte, chondroblast b. Fibres - Collagen fibres, elastic fibres ¢. Amorphous intercellular substance - Mucopolysaccharides — Functions 1. Support of soft tissue 2. Sliding surface of joints for movements 3. For growth of long bones Types 1, Hyaline cartilage - Translucent, white, resilient in macroscopic appearance - Bony precursor in cartilaginous ossification Eg. - Articular cartilages (in synovial joints) - Costal cartilage - Cartilages of nose Larynx, trachea, bronchi iSP-14 2. Fibrocartilage = Tough, strong, resilient opaque ~ Found in place where tough support and tensile strength is needed Eg, - Intervertebral dises ~ Articulardises oar 3. Elastic cartilage idan) aetedar ds + Yellowish in colour - Found in place where stiffness together with elasticity is needed Eg, - External ear (auricle) -Extemal acoustic meatus ~ Eustachian (auditory) tube -Epiglottis Growth - By both interstitial and appositional growths - Slow growth in adult cartilage = Poor regeneration (regenerates with difficulty) after injury a. Interstitial growth - New cells formed within the substance of cartilage b. Appositional growth = New cells formed from perichondrium are deposited onto the existing cartilage surface Blood and Nerve supply al - No blood vessel, lymphatics and nerves (nutrition by diffusion) win = Applied anatomy = ae - If damaged, cartilage repairs itself slowly like other fibrous tissues. = Cartilage transplant Perichondrium ‘New matrix = [/,) Formation of new chondrocytes \SP-15 DIFFERENCES BETWEEN BONE AND CARTILAGE b) protect vital organs | ©) haemopoietic function 4) provide lever for locomotion ©) provide area for m/s attachment Bone 1. Definition Itis highly vascular and Itis a tough, resilient connective mineralized connective tissue. _| tissue composed of cell and fibres ‘embedded in intercellular matrix. 2. Types 3) compact bone a) hyaline cartilage ) spongy bone b) fibrocartilage ©) elastic cartilage 3. Functions «) provide framework @) support soft tissues b) provide sliding surface for joint and facilitate movement ©) necessary for growth of long bone 4. Blood Supply | highly vascular lymph vis & N@) devoid oF blood, Iymph & N ‘S.Metabolic Rate | high Tow 6. Growth rapid, by appositional growth slow, By appositional and interstitial growth internally ~ endosteum 7. Regeneration | + difficulty Ability replaced by lamella united by connective tissue 8. Covering ‘externally — periosteum perichondrium except fibrocartilage 9. Histology | collagen fibers Tosteoeyte in each lacuna Intercellular substance contain less mucopolysaccharide and more More than T chondrocyte in lacunae Intercellular substance contain more mucopolysaccharide and less collagen fibers 10. Medicolegal | determination of sex nutritional disorder anthropology from blood vessels [radio-opaque Importance | diagnosis of endocrine and epiphyseal plate in long bone are used to access the age by diffusion method radio-lucentSP-16 5. JOINTS Definition: The sites where two bones come together are called joints. Classification 1. Soli joints (No cavity and components are held together by sues) ) ibrous joints (¢ Suture (Found only between the bones of skull) Bg, Sagittal suture ii, Syndesmosis (United by a fibrous interosseous membrane) Eg. Joint between radius and ulna Joint between tibia and fibula iii. Gomphosis (Peg and socket articulation ) Eg. Between root ofthe teeth and alveolar processes of the maxillary and mandibular bones iv, Schindylesis (Tongue and groove type ) Eg. Vomer of nasal septum fitting into the rostrum of the body of sphenoid bone == an. cesegamh= -—- [Ee] “= w oie oe Sehindylesie b. Cartilaginous joints i, Primary cartilaginous joint (or) Synchondrosis Eg, Joints between epiphyses and diaphysis of long bone — Costochondral junction = ii, Secondary cartilaginous joint (or) Symphyses Eg. Symphysis pubis Between the joints of vertebral bodies ne et Normal spine sy bone, N —_.SP-17 IL. Synovial joint (Separated by cavity) A. According to the Number of Articulating Surfaces 1. Simple —has only one pair of articulating surfaces. geet Eg. Joints of the fingers 2. Compound —has more than one p: . Eg. Elbow joint 3. Complex — The joint cavity is completely or partially divided by a disc or meniscus. Eg. Knee joint f articulating surfaces. B. According to the Number of Axes 1. Uniaxial joint thas only one degree of freedom. Eg. Hinge joint or Pivot joint 2. Bi- axial joint ‘There are 2 axes of movement, 2 degree of freedom. Eg. Saddle joint, Ellipsoidal joint 3. Multi - axial or poly - axial joint <> Ithas 3 degree of freedom and has axes in all planes. Eg. Ball and socket joint. = aie C. According to the Shape of the Articulating Surfaces 1. Plane Joint ‘The opposing surfaces are almost flat and allow movement in one plane only. Itis uni - axial with one degree of freedom. Eg, Intercarpal joints, Intertarsal jointSP-18 2. Hinge Joint or Ginglymus thas one opposing surface slightly concave and the other slightly convex. Eg, Humero - ulnar joint (Elbow joint) 3. Pivot Joint ‘One of the opposing bones is encircled at the joint end by a fibrous ring or cuff, enabling, the bone within the cuff to rotate along the vertical axis allows one degree of freedom. Eg. Proximal radio - ulnar joint Dens of the axis and the atlas (Atlanto - axial joint) Oot A ee 4, Ellipsoidal Joint ‘The articulating surfaces are much longer in one direction than the other. allows two degree of freedom, biaxial. Eg. Radio carpal joint (Wrist joint) 5. Saddle Joint ‘The opposing bony surfaces are reciprocally curved in a saddle shape Atallows movement in two planes, bi - axial. Eg, Carpo - metacarpal joint of thumb Aa 6, Ball and Socket Joint (Ong opposing pony surface is ball - shaped and other is reciprocal socket ‘Thus allowing movement in all planes, Eg, Shoulder jpint, Hip joint. 7. Condyloid (Bigondylar) Joint The articular surface of each bone consists of two distinct articular surfaces, each called a condyle, It is a modified hinge joint, Eg. Knee and T - M jointSP-19 Characteristic Features of Synovial Joint ‘Synovial joint is freely movable joint and is typical of nearly all joints of upper and lower limbs. 1. Articular Surfaces ‘The articular surfaces of the opposing bones are coated with hyaline cartilage. This layer contains no blood vessels nor nerves and nourished from epiphyseal vessels. 2, Joint Cavity ‘The area or space between the articular surfaces of the opposing bones. 3. Capsule and Capsular Ligament Always covers the joint and attaches to the circumference of both bones to completely enclose the joint cavity. ‘Some of the capsular ligaments are thickened to form ligaments of joint. Ligaments are sensitive to pain because these are highly innervated and the blood vessel is, scanty. Collagen fibers in the capsule run in a spiral form which can re 4, Synovial Membrane Lines the inner aspect of the joint cavity except articular cartilage. It consists of loose connective tissue richly supplied with blood capillaries. It secretes a lubricating fluid, called syno\ 0 the joint cavity. It is composed of blood plasma plus a mucin called hyaluronic acid. 5. Dise Some joint contains dise between the articular surfaces dividing the joint cavity into two compartments. The dise is composed of fibro cartilage, the periphery of which is attached to capsule. It is also covered with synovial membrane except in places where it is subjected to constant pressure. Its function is to ensure perfect contact between the moving surfaces and helps to maintain perfect lubrication This type of syno\ Joint compartment. Eg. TM joint torsion or twisting. joint generally allows two types of movement, one for each sub-divided Bone ‘Synovial membraneSP-20 Stability of Joints Factors contributing to the stability of joints consist of bony, ligamentous and muscular factor. ‘Atmospheric pressure is a negligible factor in most joints. 1, Bony Contours Bony contours play an important part, Eg. Hip or ankle joint But in most joints (Eg. shoulder, knee, arches of foot) they contribute nothing at all to stability 2. Ligaments Ligaments are an important factor in most joints Preventing over-movement and in guarding against sudden accidental stresses. They are no value in guarding against continuous stress (Eg.in supporting the arches of the foot) Since they are composed of collagen fibers which remain elongated after stretching. Elastic tissue in ligaments shorten after elongation. 3. Muscles In almost al joints muscles are the most important. In many joints an indispensable factor in maintaining stability Eg. The short muscles ofthe scapula are indispensable as fixators of the shoulder joint in all ‘movements of the upper limb. 4, Degree of Movement Increase degree of movement may cause the articulating surfaces to loose contact and thus become unstable. 5, Posture Posture of the limbs determine stability Eg. Hip joint is unstable when the leg is crossed atthe knee, in this case the articulating surface is in least apposition. Nerve Supply Hilton's Law The same trunk of nerve, whose branches supply the groups of muscles moving @ joint, also the skin overlying the insertions of such muscle and the interior of the joint, supplySP-21 Clinical Application Arthritis - inflammation of joints i Joint replacement \ Joint replacement is undertaken for a variety of reasons, a It includes degenerative joint disease and joint destruction, stv¥weiee sea espa Joints that have severely degenerated or lack their normal function are painful, and in otherwise can restrict activities of daily living, Arthroscopy Arthroscopy is a technique of visualizing the inside of a joint using a small camera placed ‘through a tiny incision in the skin, Arthroscopy can be performed in the knee, shoulder, ankle, and hip joints. conse - ‘ — finer (psc) \ 6. GROSS ANATOMY OF BLOOD VESSELS “The cardiovascular system consists of the heart, which pumps blood throughout the body, and the blood vessels, which are a closed network of tubes that transport the blood. Circulation ‘The Pulmonary Circulation ‘The blood passes from the heart through the pulmonary arteries (CO2) to the lungs and returns through the pulmonary veins (O2) to the heart. ‘The Systemic Circulation From the heart, the blood passes through the aorta gy to all parts of the body and returns tothe heart through venue the superior and inferior vena cava and cardiac VEINS sayysP.22 There are three types of blood vessels: Arteries = ransport blood away from the heart; Veins = transport blood toward the heart; Capillaries connect the arteries and veins Arteries Arteries have thicker wall than accompanying veins except for the arteries within the cranium and vertebral canal where they are thin ‘Their lumen is narrower than accompanying veins. Arteries have no valves. An artery is usually accompanied by vein and nerve to form the neurovascular bundle which is surrounded ty a neurovascular sheath, Different Types of Arteries 1, Large or Elastic or Conducting Arteries ‘Their walls contain large amount of elastic fibers, ‘The elasticity of the wall of the aorta permits considerable expansion. Eg, Aorta with its main branches (brachiocephalic trunk, left common carotid and left subclavian artery) and pulmonary arteries. ‘The aorta acts as a reservoir, and converts the intermittent flow of blood from the heart into @ continuous pulsatile stream. 2. Medium- Size or Muscular or Distributing Arteries ‘They are the branghes and the continuations of the elastic arteries. relatively less elastic tissue and more smooth muscled) tole Most of the arterigg of the body are of this type. sy Eg, Brachial artery, Femoral artery, Radial artery Endo 3. Arterioles (smallest division of the arteries) ‘Their Siametris ps than 100 jm (0.1 mm). conta N ‘Their Walls are refptively thick in relation to the small lumen and contain mostly of smooth muscle, ‘The arterioles proyide the greatest resistance to the flow of blood, and their constrietion serves to reduce thy pressure of the blood before it enters the capillarigs 4. Metartérioles ‘A metarteriole is a vessel that emerges from an arteriole, ro ‘traverses the capillary network, and empties into venule. u ‘At the junction of the metarteriole and capillary is the wou, precapillary sphincter, which regulates the blood flow in capillaries.SP-23 5. Cavernous tissue Its the numerous blood-filled spaces ined with endothelium and separated by fibrous septa containing smooth muscle, ‘They are found in erectile tissue of the external genitalia and lining of the nasal cavity. 6. Vasa vasorum Vasa vasorum are blood vessels that supply nutrient to the blood vessels External Roaring 7. Arterio-Venous Anastomosis or Shunt In some regions, arterioles communicate directly with venules (by-pass the capillaries). They do not permit the exchange of material and they prevent loss of heat in the skin and the intestines. ‘They are found in skin of the palm of the hand, skin of terminal phalanges or fingertips (Glomus bodies), skin of nose, lips and eyelids, tip of the tongue and in the intestine. 8. End Arteries Anatomical End Artery Arteries that do not anastomose with neighboring arteries. Serious nutritional disturbances resulting in death (necrosis) ofthe tissues if i Eg. Central retinal artery occlusion result in blindness, Functional End Artery ig So poorly with neighboring artery that an adequate blood supply is not maintained after its occlusion. Eg, Arteries supplying segments of the brain, kidney, heart. is occluded, anatomical end artery functional end arterySP-24 Veins Veins vary considerably in structure. Their walls are thinner and their caliber is greater than those of corresponding arteries. Superficial veins run independently of arteries in the subcutaneous tissue. Deep veins accompany the arteries and have the same name. Medium sized arteries usually below the elbow and knee are often accompanied by two veins, one on each side called venae commitantes. Valves often are present in veins, particularly in peripheral vessels inferior to the level of the heart, ‘These are usually paired cusps that facilitate blood flow toward the heart. Different Types of Veins Large veins contain some smooth muscle in the tunica media, but the thickest layer is the tunica externa, Eg. Superior vena cava, Inferior vena cava, and Portal vein Small and medium sized veins contain small amounts of smooth muscle, and the thickest layer is the tunica externa. Eg. Superficial veins in the upper and lower limbs and deeper veins of the leg and forearm Venules are the smallest veins and drain the capillaries. bicuspic valve of vin Venae Commitantes Capillaries Capillaries form the communicating link between arterioles and small venules. Their walls act as a semipermeable membrane, which permits the passage of water, crystalloid and some plasma protein, but impermeable to large molecules. ‘The capillaries is about 0.5 - Imm long and large enough (74 or more) to allow the passage of the red blood cells in sing Endothelium capillarySP.25 Different Types of Capill Continuous capillaries = have a continuous endothelial lining + are found in muscle Fenestrated capillaries = have pores in the endothelial cells ~ are found in the kidney, endocrine gland and intestine, Discontinuous capillaries (sinusoid) ~ Sinusoids are wider and more tortuous than capillaries, *merme ~ Unlike the capiares, thei ining cells (endothelial cells) are phagocytic. w~ ~ Lining epithelium is interrupted. 4 \ + They are found in liver and spleen and bone marrow. i 3) 4 The comes, the epidermis and hyaline cartilage are devoid of capillaries. LZ. Applied Anatomy Peripheral resistance in the circulatory tree hypertension Ischemia - inadequate blood supply to an organ or part of the body, especialy the heart muscle, 3. Infarction -a condition in which a localized area of muscular tissue is dead due to sufficient blood supply as occurs in a heart attack. Varicose veins- tortuous dilated veins that typically occur in the legs Obliterated arterial diseases of lower limb Atherosclerosis - chroni¢ inflammatory reaction in the walls of the arteries, with deposition of cholesterol and fatty proteins. Cet neat te owe pe a shseoen— Saat ) if il —_"SP-26 DIFFERENCES BETWEEN ARTERY AND VE! “Artery Vein Carry oxygenated blood away from the heart. (except pulmonary A) Carry deoxygenated blood towards the heart, (except pulmonary V) | Yellowish or bluish in color. Dark blue in color. | Walls are thick, | To withstand the pressure from the lumen, Walls are thinner. To withstand little pressure from lumen. | Diameter are small. Diameter are larger than those of ‘corresponding artery. ‘02 content is high. ‘Oz content is Tow. Blood spurt out when the artery is cut, Its cut ends retract and thus the bleeding stops Blood oozes out when vein is cut, Do not collapse after death, Collapse if blood drain out of them after death. Pulsation (*), Do not pulsate. No valves, Valves (#). Blood flow is more rapid Blood flow is slower. ‘Their structure is fairly constant and less numerous. ‘Their structure is less constant and ‘more numerous than artery. In inner part of the wall, no capillaries. Th inner part of the wall, low pressure capillaries (+). No lymphatics. Lymphatics (+). Cell in inner layer of the wall are nourished by diffusion that operate over long distance from the blood in the lumen and from the vasa vasorum that reaches upto adventitia only, Lo Cell in inner layer ofthe wall are nourished by diffusion that operate over short distance from the blood in the lumen and from the vasa vasorum that reaches upto the media,SP-27 7. MUSCLES Definition The muscle or flesh is a specialized tissue which has the ability to Contract 10 a great Extent Classification ‘There are 3 main types of muscles a. Skeletal muscle (Voluntary, striated muscles) b, Smooth muscle (Involuntary, non-striated muscle) ©. Cardiac muscle (Involuntary, st Voluntary Involuntary Centro} Control Control A. Skeletal Musele 1. General Characteristics of Skeletal Muscle = Form muscle of limb, body wall and face. - Attached to bone, typically cross at least one joint, except in facial muscles, sphincter _ muscles (around the entrance to the oral cavity, mouth and anus). - They contract to bring two bony parts close together, they act on joints producing movement. ~ Capable of rapid and powerful contraction for moderate period wi rehabilitation and also maintain prolonged state of tonus. intervals for Slopeteectt "auede Weights used 0 resistance Skeletal musde pulls ‘against the done, causing it to rebuild and become denserSP-28 2. Organization of Skeletal Muscle cell Muscle fibre Endomysium ~ connective tissue sheath surrounding each muscle fibre. Perimysium connective tissue sheath surrounding Eployrum comet sue bah carn wale une fh ‘Structure of a Skeletal Muscle =~ 7 Muscle ber Teen comin tm Each skeletal muscle fibre consists of elongated muscle cel They contain sarcoplasm (protoplasm of muscle) with several nuclei. Cell membrane is called sarcolemma, Swrcoplasm MUSCLE FIBER 3. Parts of a Muscle Flesh portion —belly Fibrous (or) endinous portion — round muscle attaches to bone by means of tendon while membranous type of muscle attaches by aponeurosis|SP-29 4. Arrangement of Muscle Fibres of Skeletal Muscle { a, Fibres parallel to the Long Axis of the Muscle i i, Muscle fibres may be parallel from end to end, Eg. Strap muscle (sartorius, sternohyoid, sternothyroid) ii, Musele fibres may converge to a tendon at one or both ends Eg. Fusiform muscles like biceps brachii CL . b. Fibres Oblique to the Long Axis of the Muscle 7 ‘The muscle fibres run obliquely to the pull of the muscle. A i. Unipennate Muscle ~ Has oblique fascicles arranged on one side of the tendon, ‘making the muscle look like a feather. ~ Eg, Flexor pollicis longus ii, Bipennate Muscle ~ Has oblique fascicles on both sides ofthe tendon. = Such muscle has an equal pull from both sides of the tendon. ~ Eg, Rectus femoris iii, Multipennate Muscle ~ Muscle has many oblique fascicles arranged along several tendons in the central axis ofthe muscle. ~ Eg. Deltoid muscle iv, Circumpennate Muscle = Muscle fibres converge from the wall ofa cylindrical space to a buried tendon, like a spoke of a wheel. ~ Eg. Tibialis anterior In general, pennate muscles have more fascicles directly attached to a tendon than non- eer 18k PO. pennate muscles do. Qa perme Asa resul, pennate muscles have greater power than muscles of another pate rooge v. Radial, Triangular or Fan-shaped Muscle ~ The fibres converge from a wide origin to apical insertion - Eg. Temporalis, Adductor longus Vi. Spiral-shaped Muscle + Muscles may exhibit a spiral or twisted arrangement (Eg, Latissimus dorsi) or may spiral around a bone - (Eg. Supinator) = Contains two oF more plane of fibres arranged in differing directions, type of spiral referred to as (Eg. StemocttiomastClassification of Skeletal Muscles according to Action Prime mover Itis the chief muscle responsible fora particular movement, Eg. Quadriceps femoris isa prime mover in extending of the knee joint. When a prime mover helps opposite action by active, controlled lengthening against gravity, it is known as action of paradox. Eg. When the hand lowers a heavy object, the extensor action ofthe triceps is replaced by gravity, and the movement is controlled by active lengthening of the biceps (paradoxical or eccentric action). Antagonist ‘Any muscle that opposes the action ofthe prime mover is an antagonist. Eg. Biceps femoris opposes the action of the quadriceps femoris when the knee joint is extended. Fixator 85:00: A fixator contracts isometricaly (ie., contraction increases the tone but does not in itself produce movernent) to stabilize the origin of the prime mover so that it can act efficiently. Ez, Rotator cuff muscles of the shoulder joint contract as fixators while the deltoid act as prime mover. |. Synergist In many locations, the prime mover muscle crosses several joints before it reaches the Joint at which its main action takes place. Groups of muscles called synergists contract and stabilize the intermediate joints to prevent unwanted movernents in these joints. Eg. Flexor and extensor muscles ofthe carpus contract to fix the wrist joint, and this allows the long flexor and the extensor muscles ofthe fingers to work efficiently. ‘Smooth Muscle General Characteristics of Smooth Muscle = They form the wall of hollow viscera and tubes. = They are supplied by autonomic ground plexus. = They act to expel the contents of hollow structure. = Capable of constant motion, contract at slow speed and goes on, Longa IneretonethSP-31 C. Cardine Muscle General Characteristies of Cardiac Muscle = Controlled by ANS and found in heart and roots of large vessels joining the heart. + Intercalated dises are present which serve as the site of attachment between cardiac muscle cells. = It works on steadily day with no absolute rest, yet it is flexible and capable of responding to temporary increased needs by working faster for limited period of time without being damaged. Cardiac Muscle Cross Section Applied Anatomy 1. Muscle Tone Determination of the tone of a muscle is an important clinical examination. 2. Duchenne Muscular Dystrophy It is the most common inherited muscle disease and characteristcally affects male children. 3. Muscle Atrophy Muscle Atrophy is the loss of skeletal muscle mass that can be caused by immobility, aging and malnutrition. 4, Rigor mortis Stiffness of the muscle after death caused chiefly by the loss of adenosine triphosphate from the muscle. te sem mie hi Decrease n Bien dc to male apySP-32 8. NERVOUS SYSTEM Nervous system is divided into two main parts; central nervous system (CNS) and peripheral nervous system (PNS). The central nervous system (CNS) ‘The central nervous system consists of brain and spinal cord. Brain The brain lies within the cranium. The brain receives information and controls the activities of the body mainly through the spinal cord. The brain is divided into: — Forebrain (cerebrum and diencephalons) —_=Midbrain and brain —Hindbrain (medulla oblongata, pons and cerebellum) \ f spinal cord Hindbrain Spinal cord The spinal cord lies within the upper two thirds of vertebral column and is continuous rostrally with the medulla oblongata of the brainstem. Afferent and efferent connections between the periphery and the spinal cord via spinal nerves. Both brain and spinal cord are protected by layers of meninges. 3 layers of meninges from without inwards are dura mater, arachnoid mater and pia mater. Space between arachnoid and pia mater is called subarachnoid space, containing cerebro- spinal fluid (CSF). CNS is organized into grey and white matter. Grey matter consists of bodies of neurons and neurog| White matter consists of nerve fibers embedded in neurogli Ithas a white colour due to presence of lipid material in myelin sheaths of many nerve fibers. Funetion of CNS Principal role of CNS is to integrate and coordinate incoming and outgoing neural signals for higher mental functions such as thinking and learning.SP-33 Dura mater (2 ayers) The peripheral nervous system (PNS) ‘The peripheral nervous system is composed of cranial nerves, spinal nerves and their associated ganglia. A peripheral nerve consists of bundles of nerve fibers or axons. ‘They are relatively unprotected and are commonly damaged by trauma. Cranial nerves Cranial nerves are the means by which the brain receives information from and controls the activities of the head and neck and to a lesser extent the thoracic and abdominal viscera. ‘There arc 12 pairs of cranial nerves that are individually named and numbered in a rostrocaudal sequence. Unlike spinal nerves, only some cranial nerves are mixed in function, carrying both sensory and motor fibres; others are purely sensory or purely motor. ‘They exit through foramina in the skull bone. Spinal nerves Spinal nerves are the means by which the CNS receives information from and controls the activites ofthe trunk and limbs. ‘There are 31 pairs of spinal nerves (8 cervieal, 12 thoracic, 5 lumbar, 5 sacral, coccygea!) and these contain a mixture of sensory and motor fibres. Spinal nerves exit from the vertebral canal via their corresponding intervertebral foramina,SP.34 Typical spinal nerve ‘A typical spinal nerve arises from the spinal cord by 2 roots ‘The dorsal root contains afferent nerve fibres from cell bodies located in dorsal root ganglia The ventral root contains efferent fibres from cell bodies located in the spinal grey matter. (motor neurons and preganglionic autonomic neurons) Dorsal and ventral roots unite to form a spinal nerve, which divides into ventral ramus and dorsal ramus. The ventral ramus innervates the limbs together with the muscles and skin of the anterior part of the trunk, ‘The dorsal ramus innervates the post-vertebral muscles and the skin of the back. Ventral and dorsal rami of spinal nerves contain 1. Motor or efferent fibers from ventral horn cells of spinal cord 2. Sensory or afferent fibers of dorsal root ganglion cells, 3. Autonomic fibre Function of PNS Conveys impulses from sense organs (eyes, ears) and sensory receptors (Eg. in muscle) to CNS, and from CNS to muscles and glands. ‘The functional activities of the nervous system are mediated through the somatic motor and the autonomic (visceral) nervous systems. Both CNS and PNS have somatic and autonomic components. Somatic component For innervation of striated muscle, tendons, Shatotal , muscle Autonomic component For innervation of involuntary structures (heart, smooth muscle and glands). WesSP-35 Division of somatic and autonomic components is clear cut in PNS but not in CNS. In both divisions, functional unit isa reflex are. This consists of: 1. Afferent or sensory neuron 2. An intercalated or interconnecting neuron 3. Efferent or motor neuron Differences between Somatic Nervous System and Autonomic Nervous System Facts ‘Somatic Nervous System | Autonomic Nervous System Celi bodies of motor | Anterior hom of spinal cord | Outside the CNS (Ganglia) | neuron ‘Motor endings Motor end plates of striated | Nerve plexus around smooth muscle fibers muscle fibers and glands Connector neuron | Wholly situated inside CNS | In lateral horn of spinal cord and in the nuclei of II, VII, IX and X cranial nerves ‘Somatic Motor NeuronSP-36 Autonomic Nervous System (visceral component of the nervous system) [ANS is divided into 3 major pats: 1. Sympathetic nervous system 2, Parasympathetic nervous system 3. Enteric nervous system Differences between Sympathetic and Parasympathetic Nervous Systems No. Facts ‘Sympathetic Parasympathetie 1] Outflow Thoracolumbar Craniosacral (-L) (IU, Vl, 1X, X, eraniel root of XI, and S234) Preganglionic neurone | Lateral horn of spinal cord | Brainstem and sacral segments of spinal cord 3. Location oF ganglia | Paraverebral and Terminal ganglia near the L ___| prevertebral ganglia viscus Distribution in body (oF | Throughout the body Limited (Do not supply body postganglionic fibres) wall and extremities) 3. | Preganglionie fiber | Short Long [&_[Posganglonic ber [Long Shor 7 Nearowransmiterat | Aveiyicholine (ely ‘Reetyleholine (Ach) preganglionic ending 8. | Neurotransmitter at | Norepinephrine (NE) ‘Acetylcholine (Ach) | postganglionic ending | (except Sudomotor, pilomotor and vasomotor) ‘Acion Prepares body for emergency | Conserves and restores energy | and stress situations 10. | Extent of effects ‘Widespread due to many Discrete action with few | ' postganglionic fibers | postganglionic fibers Sympathetic outflow Gap — junctions ~>- Paravertebral ‘or prevertebral 4 Postganglionic Proganglionic vaxon Parasympathetic outflow =o Corea! motor Intramural SQ Qvagal nucious ganglion PostganglionicSP-37 Enteric nervous system (gut brain or minibrain) Enteric nervous system consists of many millions of neurons and enteric glial cells grouped as ganglionated plexuses in the wall of the gastrointestinal tract. > ‘These are connected by bundles of axons to form myenteric and submucous plexuses that extend from the oesophagus to the anal sphincter. ‘They mediates numerous reflex functions including the contractions of the muscular coats of the gastrointestinal tract, secretion of gastric acid, intestinal transport of water and electrolytes and the regulation of mucosal blood flow. Although complex interactions occur between the enteric and sympathetic and parasympathetic nervous systems, the enteric nervous system is capable of sustaining local reflex activity independent of CNS. ‘A bundle of nerve fibers or axons in the PNS is called a nerve. Nerve plexus ‘A network of nerves is called nerve plexus. Eg, Brachial plexus (somatic) of upper limb; Coeliac plexus (autonomic) of abdomen, . Ganglion A.collection of nerve cells outside the CNS. Eg. Spinal ganglion Dorsal root ganglion tt, ‘Sympathetic gs Peripheral Nerve Coeliac plexuses . AA peripheral nerve conveys sensory input to CNS and motor output to muscle and glands.SP-38 Applied Anatomy 1. Head injuries and intracranial haemorrhage ‘Although the brain is cushioned by the surrounding cerebrospinal fluid in the subarachnoid space, any severe hemorrhage within the relatively rigid skull will ultimately exert pressure on the brain, Intracranial (epidural, subdural, subarachnoid and cerebral) haemorrhage may result from trauma or cerebral vascular lesions. 2. Injuries co the spinal cord Injury to the spinal cord may produce partial or complete loss of function at the level or below the level of the lesion. 3. Abnormal autonomic function The clinical features of autonomic dysfunction include postural hypotension, pupillary abnormalities and impaired sweating. ontHostaric HYPOTENSIONGENERAL HISTOLOGY Body has the 4 primary tissues 1. Epithelial tissue, 2. Connective tissue, 3. Muscular tissue and 4 . Nervous tissue. SP-39 Epithelial tissue Connective tissue Muscle tissue Epithelium Covering or Lining Glandular No, of cell layers One layer Many layers Seen to be many layers Simple ‘Transitional Stratified Pseudostratified Shape of cell Specialized | shape of cell in uppermost layer Flatcell Cubic cell Tall cell -—«“Fiatcell = Cubic.cell Tall cell siale Simple Simple Stratified Stratified Stratified Squamous cuboidal columnar‘ S@¥#MOUS cuboidal —_eolummnar Cilia + Dead. cat layer pels Ciliated Non ciliated | keratin tayer + 7 . : Ciliatea Non Keratinized Non keratinized ciliatedSP-40 1, COVERING OR LINING EPITHELIUM Epithelium has a continuous layer or layers of cells with very little oF no intercellular substances. The cells rest on basement membrane and they are avascular and alymphatic. They developed from all 3 germ layers. Its divided into 3 main types, according to the number of cel layers. Simple epithelium Stratified epithelium Pseudo- stratified epithelium ‘Simple epithelium (@) Simple squamous epithelium (b) Simple cuboidal epithelium ‘There is only one layer of cells. All the cells touch the basement membs ‘According to the shape of the cell, it divided into: Its composed of one layer of flat or squamous cells. ‘Nucleus is single, flat and central in position. Ithhas filtering or dialyzing function. Sites ~ Bowman's capsule of kidney, Lining of vessels and body cavity, Alveolar walls of Itis composed of single layer of cubic cells ‘Nucleus is single, round and central in position. Ithas protection and secretory function. Sites — Lining of thyroid follicle, Collecting tubules of kidney, Adult ovary, Choroid plexusSP-41 (©) Simple columnar epithelium = Itis composed of single layer of tall cells. ~ Nucleus is single, oval and basal in position + Ithas absorption, tining and secretory functions, = Sites— Lining of GIT Simple columnar ciliated - Ependyma, Uterine tubes, Oviduets, Small bronchioles Gi) Simple columnar non ciliated ~ Stomach, Small intestine, Large intestine Stratified epithelium ~ There are more than one layer of cells ~ Only the lowest layer touches the basement membrane. > Its main function is for protection. + Its divided into 4 types. (@) Stratified squamous epithelium = There are 3 types of cells (basal layer contain single layer of columnar cells (ii) middle layer contain few layer of polyhedral cells (Gli) superficial layer consists of few layer of flat or squamous cells, ~ This epithelium is subdivided into 2 types by the presence of kerati Stratified squamous keratinized epithelium — Skin Stratified squamous non keratinized epithelium — Palatine tonsil, Tounge, Oesophagus, Vagina(b) Stratified cuboidal epithelium + The superficial layer of cells are cuboidal in shape. = Ithas protective function. (©) Stratified columnar epithelium = The superficial layer of cells are columnar. + Ithas protective function. -s~ Conjunctiva, Cavernous portion of male urethra It fines the hollow organs that are subjective to tension. ~ Its appearance varies with degree of distension. = There is no obvious basement membrane. + There are 3 groups of cells. (superficial group contain umbrella shaped cells (Gi) middle group contain many layers of pear shaped cells, (iii) basal group contain many layers of polyhedral cells = Itallows stretching without breaking the cells apart from one another = There is no leakage of urine ~ Sites - Urinary bladder, Ureter, 1* part of urethra near the bladder Pseudo - stratified epithelium ~ There is only one layer of cells but it looks as if there are more than one layer. = Nuclei are located at different levels. + All the cells touch the basement membrane. + But notall the cells reach the surface. ~ Has single ayer of cells of different heights. (i) Pseudo- stratified columnar ciliated epithetium ~ Trachea,Bronchi (ii) Pseudo- stratified columnar non cifiated epithelium Penile urethrav Exocrine Gland SP-43 be Glandular Epithelium Duet + or not Endocrine Gland (ductless gland) No. of cells ‘Nature of secretion [— Only one cell —> Unicellular gland L_ Many cells —> Multicellutar gland [— Thick viscid fluid —> Mucous gland ‘Shape of secretory unit ‘Thin watery fluid —> Serous gland — Mixed —————> Mixed gland [— No cell damage ———> Merocrine gland | Mode of secretion | part of cell damage —> Apocrine gland L_ Whole cell damage —> Holocrine gland (— Test tube > Tubular Round > Alveolar Duct system {__ Round + Test tube —> Tubuloalveolar Straight [—Unbranched —> Simple rae Coiled ‘Alveolar Branched ‘—Branched —> Compound Tubuloalveolar‘SP-44 2, GLANDULAR _ EPITHELIUM = Glandular tissues are of 2 kinds — exocrine and endocrine gland Exocrine glands 1, According to the number of cells (a) Unicellular gland - a gland may consist of single cell. Eg. Goblet cell. (b) Multicetlular gland - most glands are composed of more than one cell 2. According to the nature of their secretion (@) Mucous glands = These glands secrete a thick, viscid material called mucin = Secretory acini are larger in size, ~The lumen are also large. ~ Mucous secreting cells are cuboidal in shape. - The nuclei are flattened and are situated at the base of the cells. = The cytoplasm appear vacuolated and basophilic due to (+) of numerous mucigin. = The cytoplasm between the base of the cell and nucleus is not deeply basophilic. = Eg. Sublingual salivary gland secretory Vesicles (b) Serous glands = These glands gecrete a clear, watery fluid. = Secretory acin| are small in size. ~The lumen are also small. = Serous secreting cells are triangular in shape. - The nuclei are rounded and situated subcentrally. - The cytoplasm appear granular and acidophilic due to (+) of numerous zymogen granules. = The cytoplasm between the base of the cell and nucleus stain deeply basophilic due to (+) of abundant RER, Fg, Parotid gland KON ; (SP-45 (©) Mixed glands = Secretory glands producing both serous and mucous types of secretion are termed mixed gland. + The serous secreting units appear as semi-lunar shaped structures which capped over the ‘mucous acini are called serous demilunes. + Eg. Submandibular salivary gland 3. According to the mode of secretion ——yummane (@) Merocrine gland = These are glands which discharge their secretory material without loss of any part of the secretory cells. - Eg. Sweat gland (b) Apocrine gland i210 1.0) = These are glands which discharge their part along with the secretory material. - Eg. Apocrine sweat gland of axilla, Mammary gland (©) Holocrine gland - These are glands which discharge their secretory material by total death of the. whole cell. - Eg. Sebaceous gland of the skin 4, According to the shape of the secretory unit (@) Tubular (b) Alveolar (c) Tubulo-alveolar 5. According to duct system (@) Single glands - The excretory duct is single and unbranched. ( (i) Simple tubular + Straight tubular — Eg. Intestinal crypt = Coiled tubular —Eg. Sweat gland ~ Branched tubular —Eg. Stomach oe ‘sp bares cr Simple alveolar ~ (iii)Simple branched alveolar — Eg, Sebaceous gland of the skin 3 gp Simple branched alveolar Small mucous glands of urethra Sepia coms simple alveolarSP-46 (b) Compound glands = Theexcretory duct is divided into branches. Compound tubular Eg. Kidney ii) Compound alveolar Eg. Mammary gland ii)Compound tubulo-alveolar__—-— Eg, Pancreas, Large salivary gland Endocrine glands + This group has no ducts of any kind. ~ Their secretion is released directly into the blood stream. ~ The secretion product of endocrine glands are named hormones. ~The cells of the glands are arranged in cords or plates. r ~ A few glands consists of epithelial sac or follicles. 3 ~ Fa. Thyroid, Parathyroid, Supraenal and Pituitary glands 2SP-47 3. CONNECTIVE TISS! = Ithas 2 characteristics. = They all developed from embryonic mesenchyme. = Connective tissue possess a relatively large amount of intercellular substance. Functions 1.Mechanical function — Provide the connecting and supporting tissues of the body. 2. Nutritional function - Inter-cellular substance is responsible for nutritional exchange. Blood leucocytes and histiocytes defend the body against bacteria and foreign bodies. 3. Defensive function - Classification or Embryonic CT Aducorr eo type Mucotis type Ordinary GF Sp: cr Mesenchymal cell Wharton's jelly Loose C/T Dense C/T Haemopoietie €/T (RBC , WBC) Supporting C/T (Bone) Tonle type al type oa Joint Ligament ‘Aponeurosis ous Intercellular el oe cell tutes ad Amorphous Fibroblast Fibrocytes | Macrophage collagen fibres Plasma cell elastic fibres soft ground firm cement Mast cell recticular fibres synovial fluid of joint Fat cell ChromatophoreSP-48 Cells of Connective Tissue 1. Undifferentiated mesenchymal cell 2. Fibroblast ~ They are active cells and are responsible for the formation of Boer, ~ Fibrocytes are inactive cells. aA chyave ~ They are active in repair process. Be 3. Macrophage 3 = Cells have irregular outline Fibro + Cell processes are unusually short and blunt blast ~ They are important agents of defense by acting as scavengers. ~ Inactive forms of macrophage are called “histiocytes”. ~ One of the cell of RE system. 4. Plasma cells ~ They are numerous in pathological condition, ~ They are large, ovoid cells with a deeply basophilic cytoplasm. ~ Nucleus is large and spherical and eccentric in position with cart- wheel appearance of chroma Function ~ production of antibodies. 5. Mast celts ~ They are large ovoid cells. Plasma - They are present along the smalll blood vessels. cell cell = Cytoplasm contains numerous coarse, deeply basophilic secretory granules. = Nucleus is small, pale and spheroi Funetion — produces heparin and 6. Adipose celts or fat cells + They are normal components of areolar tissue. + They are large cells with a thin rim of cytoplasm and the inconspicuous nucleus is pushed to one side giving a signet ring appearance to the cell. Functions of adipose tissue (1) Nutrition [2] Act as soft cushion [3] Supporting function [4] Conservation of heat. 7. Others: leucocytes, reticulocytes and pigment cells Nucleus, Reticular altFibers of Connective Tis sP-49 Collagen fibers Elastic fibers Reticular fibers ‘Appearance | White fibers Yellow fibers Black fibers ‘Structure Coarse, straight, unbranched fibre Fine, branch fibre Fine, branch fibre strength is required Resistance to a stretching force. strength is required, Ability to be stretched | and return to its original | form, Bundle run in same | Network run in all Network direction direction | Distribution Found whenever great | Found in places where | Abundant in haemopoietic tissues. It forms the supportive framework of organs. resistant to boiling, dilute acids and alkali Eg. Tendons Eg. Blood vessel Eg. Liver | Ligaments. | Lung Spleen | Elastic tigament Lymph nodes Elasticity Flexible but inelastic | Capable of stretching to | Little cone and a half times their length, Refractive index | Low High Low Chemical Protein (gelatin) Protein (elastin) Protein (reticulin) composition resistant to weak acid and alkali ‘Staining reaction H&E Pink Van Gieson Red Silver stain Brown Hastic ber Macrophage Black4, HISTOLOGY OF GROUND BON! ‘The most characteristics feature of adult bone tissue is lamellar structure. ‘Small lacunae which are occupied by osteocytes lie in the intervals between the lamellae. ‘The lamellae are arranged in three series. Those lying parallel with the outer and inner surfaces of bone are called outer and inner circumferential lameliae ‘Those arranged in concentric pattern around a small central Haversian canal called Haversian lamellae. ‘Those lying in the intervals between the Haversian lamellae are the interstitial lamellae, ‘The Haversian system (osteon) is structural unit of compact bone, It has a central core where a small arteriole, a small venules, a few N fibril and a lymphatic vessels (+). The concentric lamellae surround this core. The lamellae are composed of an organic matrix which filled with calcium and phosphate ‘The fine collagen fibres are embedded in the matrix. Osteocytes lie in the lacunae, with their processes extend out in minute channels - the canaliculi. ‘The canaliculi pass from one lacuna to another and open into C/T of Haversian canal. ‘The Volkman's eanals run obliquely or right angle to the long axis of the bone. ‘They pass in or from the outer side of the bone carrying vessels which anastomose with the vessels in the Haversian canals. = ‘The vessels in the Haversian system anastomose with (a) vessels of the periosteum (b) vessels of the endosteum (©) vessels of other Haversian systems - Sharpey's fibres are collagenous fibres from the periosteum and embedded into the outer circumferential and interstitial lamellae. = Periosteum has an outer layer of dense C/T and an inner layer of collangenous bundles. + Endosteum is a thin C/T layer which lies the inner surface of the medullary cavity.Endosteum Sharpey's fibres Periosteum. Ground Bone Osteceyte calates mat Lacunae Canaeut Hyaline Cartilage (Bronchus) orem «| PS 2° Sa Fibrocartilage eo Elastic Cartilage (Auricle) (Intervertebral Disc) x40 Penchonacum i Matix wth last RovesSP-52 5. HISTOLOGY OF 3 TYPES OF CARTILAGES group (cell nests) has round basophilic nucleus Hyaline Cartilage | Elastic Cartilage | Fibro Cartilage | | T. Appearance |= glass like ~ yellow and = opaque more opaque 2. Location = commonly found in body | - found in places = found in where = most are converted i where elasticity is | tough support or bone required. tensile strength is Eg. Long bone Eg. External ear desirable = some will persist Epiglottis Eg, Intervertebral un-caleified state Some laryngeal | disc throughout life cartilages Articular dise | Eg. Costal cartilage ‘Tracheal cartilage 3. Microscopie | - chondrocytes lie in =" Tike hyaline ~ found in rows appearance lacunae cartilage between (a) cells + cells may lie singles or | - cellsare singly or | collagen bundles, in groups (©) Intercellular composed of mainly = also contain ~ ground substance substance collagen fibres and ground substance, | and bundles of mucopolysaccharide marked collagen | collagen fibres = amorphous intercellular | fibres and network | run in parallel. substance has same of branching refractive index as elastic fibres. collagen fibres, ~ 0, latter cannot be seen. | 4. Covering ~ 7 Perichondrium + + 7 Composed of outer collagen and inner | cellular | | [S. Funet on patency and support = elasticity = tough support or L tensile strengthSP-53 6. HISTOLOGY OF 3 TYPES OF ARTERIES T Elastic artery | Muscular artery Arteriole Layers (Eg. Aorta,CCA) | (Eg. Brachial A, | (thick wall relative Radial A) to lumen, diameter < 100 ») Tunica intima = innermost layer | (a) Endothelit ~ cells are polygonal | - consists of flatten = flattened in shape endothelium cells = lines the lumen. (®) Subendothelium | - thick = consists of delicate = © contain many elastic, C/T fibres elastic fibres, and few fibroblasts collagen fibres and some smooth muscles (© Internal elastic lamina contain collagen and elastic fibres is prominent > awavy band (+) due to muscle contraction, so TEL, is thrown into longitudinal fold ©), consists of clastic fibres Tunica media Tunica adventitia very thick coat ‘may present 80% of total thickness 40-60 bands of clastic tissue (+) in the aorta there are collagen fibres , fibrocytes and muscle cell thickest layer consists of almost entirely of smooth muscles fibres 40 layers may be (+) a few elastic, collagenous and reticular fibres are ow = thickest coat = consisting of 1- 5 layers of circularly arranged smooth muscles ~ scattered elastic fibres (+) relatively thin no distinctive external elastic lamina ‘composed chiefly of bundle of collagen fibres + vasa vasorum (+) ner layer than media extemal elastic membrane (+) inner portion is composed of elastic fibres outer portion contains vasa vasorum = usually thinner than medi = no definite extemal elastic membrane - composed imarily of collagenous and elastic fibresSP-54 Muscular Artery Lumen Sage Tenis intima a Se . ie T. mediaSP-55 HISTOLOGY OF 3 TYPES OF VEINS Large V. Median sized vein Venules Layers (Small Veins) (diameter from 1 mm_| (diameter between to lem) 0.2 and 1 mm) Eg. SVC, IVC, Eg. deeper veins of the portal vein and the | forearm and leg; veins main tributaries to | of the head, trunk and these trunks viscerae a = composed of ~ consists of = consists only of an (a) Endothelium polygonal shaped | polygonal cells endothelial lining | cells and its basement | membrane (b) Subendothelium |- is thicker = delicate and often [= © = consisting of many | lacking collagen fibres and a few elastic fibres (©) Internal elastic |= sometimes present |- elastic fibres vary | - () lamina from (-) to a dense net-like intemal elastic lamina = quite thin in large | thin layer > very thin layer veins = contains circularly | - composed mainly | = collagen fibres are arranged smooth of smooth dominant but a few | muscles separated muscles — 1 to 3 | smooth muscles byccollagenous and | layers thick are present elastic fibres. ~ elastic fibres are = vasa vasorum are coarse present in outer part Tunica adventitia |- very thick coat |= thickest part ~ thickest = discrete bundles of | - inner regions > consists almost smooth muscle contain a few completely of cells in a loose longitudinal smooth | longitudinally connective tissue | muscle fibres arranged groundwork ~ remainder of the collagenous fibres | ~ many fine elastic wall consists of and connective fibres run longitudinally tissue cells |= noextemal elastic | oriented bundles of | - a few elastic fibres | membrane collagenous and ‘are present ~ vasa vasorum (+) | elastic fibres + no external elastic membraneSP-56 HISTOLOGY OF CAPILLARD ‘These are endothelial tubes, interconnecting arterioles and venules. (Diameter - 7 to 9 p) ‘The only cellular component of the wall is endothelium, The cells are flattened, thin curving plate, bulging in the vicinity of the nucleus. In surface view the cells have serrated borders and interdigitate with one another. In very small capillary, a single endothelial cell may form the wall of a capillary. In wider capillary, 2 or 3 curved cells may present. In some body regions, the cells have pores that are notable for participation in fluid transport. Eg. Choroids plexus, Intestine, Endocrine and Renal glomerulus. In other regions the cells lack pores and fit close together. Eg. Muscles, Connective tissue, Lung and Brain, Therefore there are two types of capillaries structurally, a. Continuous type b. Fenestrated type Sinusoidal capillaries and sinusoids differ in a number of respects from ordinary capillaries. Structure of Capillaries ‘The capillary wallis formed by in oF PY [Sing aero [Has only Tunica Intima Lacks T Media and jherefore no smooth muscle cells Sinusoidal Capilliaries They are found in endocrine glands (Eg. Adrenal cortex, Anterior hypophysis and Thyroid) ‘They have larger diameter than ordinary capillaries. : ‘They have less adventitia so that they become more closely associated with the parenchymal cells of the gland, ‘Their endothelial cells are also attenuated and have pores, Sinusoids ; Sinusoids of liver, spleen and blood forming organs have larger diameter than sinusoidal capillaries of endocrine glands ‘Their lining cells are marked by phagocytes and belong to the R.E system. The lining cells lie in close apposition to the surrounding parenchyma. ‘The basement membrane is lacking; only a network of reticular fibers intervene. ‘They are lined with 2 types of cells phagocytes and flat endothelial cells.SP-57 NTG&GAS 7. HISTOLOGY OF 3 TYPES OF MUSGES- ‘Smooth muscle Skeletal muscle Cardiac muscle 1. Type Non - striated Cross striated Cross striated 2. Site = wall of hollow viscera = muscles attach to Theat : ~ vessels skeleton - root of great vessels ® ov - ducts of glands ~ abdominal muscles | At maturity, oocyte has diameter of about 120 p. ~ At 4™ week, primordial germ cells, appear in the wall of the yolk sac and migrate into indifferent gonad. Spermatogenesis ~ In the male, primordial germ cells remain dormant in the seminiferous tubules of the testes until puberty. + Atpuberty, primordial germ cells differentiate into spermatogonia. ~ After several mitotic divisions, spermatogonia grow and undergo gradual changes into primary spermatocytes. ~ Each primary spermatocytes subsequently undergo 1* meiotic division to form secondary spermatocytes. - Secondary spermatocytes undergo 2” meiotic vision to form 4 haploid spermatids. ‘These cells contain 46 double-structured Primary spermatocyte chromosomes after DNA replication First Maturation Division y, 23 double-structured dl chromosomes Secondary Jspermatocyte Second Maturation Division VEX 23 single chromosomes /1z2 + x) [eae SpormatidsSP-66 = The spermatids are gradually transformed into 4 mature sperms or spermatozoas by spermiogent Ir includes a) formation of the acrosome (cap) ) condensation of the nucleus (head) ©) formation of neck, middle piece and tail 4) shedding of most of the cytoplasm The entire process of spermatogenesis and spermiogenesis takes about 74 days. Sperms are transport to the epididymus where they are stored and become mature. Oo) Morphological characteristics of normal human spermatozoa Length 65 No. = 100 million/ mt Motility —> 80% Survival in the female genital tract — several days Amount of semen per ejaculate —2-3 ml Applied 1. Morphological anomalies ( Abnormal spermatozoa + large head small head 2or > tails 2 heads If > 20 % abnormality is seen in the semen, fertility is impaired. a= 2. Chromosomal abnormalit $ Structural and numerical abnormalities may occur during meiotic or mitotic division. Oogenesis ~ In the female, the primordial germ cells differentiate into oogonia as soon as they reach the indifferent gonad. + Although they begins before birth, it is completed only after puberty. ~ In early fetal life, oogonia proliferate by mitotic division and form primary oocytes. ~ By the 7" month, all primary oocytes have entered the | meiotic division and most of them form the primordial folliclesSP.67 ‘The primary oocytes do not finish theit 1% m stage until puberty. Atthe time of puberty, primordial follicles begin to mature with each ovarian cycle Primary oocytes begin to increase in size, and proliferate to form primary follicle. Primary follicles are surrounded by stromal cells that form theca folliculi. Granulosa cells and oocytes secrete, a layer of glycoproteins forming the zona pellucida. Theca folliculi consists of inner layer of cells, theca intera which produce estrogen and outer layer of cells, theca externa. As the development continues, ft cells is termed a secondary follicle With time, the antrum greatly enlarges and form greafian follicle. Each ovarian cycle, 5 - 15 begin to develop but only one reaches full maturity, other degenerate, AS soon as the follicle is mature, the primary oocyte resumes the I‘ meiotic division leading to formation of 2 daughter cells of unequal size but each with 23 chromosomes. ‘The secondary oocyte receives almost all the cytoplasm while the 1" polar receives very little eytoplasm, and then degenerates. Afier completion of the 1* maturation division, the cell enters the 2” maturation division without DNA replication, Ovulation occurs and secondary oocyte is shed from the ovary. ‘The 2" meiotic division is completed only if the oocyte is fertilized. ‘The fertilized oocyte or mature ovum retain most cytoplasm while 2™ polar body is small and non functional. About 700,000 to 2 million primary oocytes in the ovaries of a newborn female infant. Approximately 40,000 are (+) by beginning of puberty. 500 will be ovulated. 6: 6 ‘At Put y a fr St ie division, but remain in the diplotene filled spaces (antrum) appear between granulosaSP-68 Primary oocyte att NA replication ‘These cells contain 46 double-structured chromosomes First Maturation Division et 23 double-structured chromosomes, 6 Maturation 7 Divisi Mature a 23 single ry \ \, chromosomer Polar bodies: Applted (22 +X) 1. Morphological Anomalies - abnormal ovum — primordial follicle with 2 oocytes ~ trinucleated oocyte 2. Chromosomal anomalies Structural and numerical abnormalities during mitotic or meiotic division. Primordial follicle with two oocytes 2. OVARIAN CYCLE At puberty, the female begins to undergo regular monthly cycles. ‘These sexual cycles are controlled by the hypothalamus by producing GnRH. It acts on cells of the anterior pituitary gland to secrete gonadotrophins FSH and LH. - These produce cyclic changes in the ovaries. FSH promotes growth of several ovarian follicles (5-15) but usually only one forms a mature follicle, Others degenerate and become atretic forming corpus atreticum, During the growth, number of follicular and theca cells are formed. ‘These cells produced estrogen which stimulate the pituitary gland to secrete LH. LH is needed for the final stages of follicle maturation and induce the shedding of oocyte.SP-69 ~ Ovulation isthe rupture of the Graafian follicle and expulsion of the oocyte together with zona pellucida, + Wappears approximately 14 + or— 1 day before onset of next menstruation, > Fellowing ovulation, the granulosa cells remaining in the wall of the ruptured follicle develop a yellowish pigment and change into luteal cells forming corpus luteum, under the influence of LH. + They secrete progesterone. = Itreaches maximum development about 9 days after ovulation, > If fertilization fails to occur, corpus luteum degenerates and forms scar tissue known as compus albicans. + If fertilization takes place and it lasts for 4 months. = Itisalso called Corpus Gravidarum which produces progesterone. Applied 1. Symptoms of ovulation + sudden constant inferolateral pain in abdomen (Mittelschemerz). = slight ri 2. Ovulation can be inhibited by contraceptive compound contai amount of estrogen. Ovulation can be artificially stimulated by ovulating drugs such as clomiphene citrace. ig progesterone and small ¥_Hypetnatemic aa Prat nen + — a L> Owain __Corpuytuteun _ degenerating 2e@QS%OOHGSP-70 3. UTERINE CYCLE = The wall of the uterus consists of three layers, endometrium, myometrium and perimetrium. = From the puberty to menopause . the endometrium undergoes cyclical changes of approximately 28 days under hormonal control by the ovaries. During this menstrual cycle, the uterine endometrium passes through 3 stages, the follicular or proliferative phase, the secretory or progestational phase and the menstrual phase. + The proliferative phase begins at the end of menstrual phase, is under the influence of ‘estrogen and the parallel growth with the ovarian follicles. The secretory phase begins approximately 2 or 3 days after ovulation in response to progesterone produced by the corpus luteu ~ If fertilization does not occur, there is shedding of endometrium result in menstruation, If fertilization does occur, the endometrium assists in implantation and take part in formation of the placenta, Later in gestation, the placenta assumes the role of hormone production when the corpus luteum degenerates. At the time of implantation, the mucosa of the uterus is in the secretory phase during which the uterine glands and the arteries become coiled and lengthen. When the menstrual phase begins, blood escapes from superficial arteries and small pieces of stroma and glands break away. Following 3 or 4 days, the superficial layers are expelled from the uterus and the only the basal layer is retained. - This layer regenerated of glands and arteries in the proliferative phase. folie Ovulation Corpus luteum Corpus tou o007G 060 0 4 14 28 ‘Menstrual phase Follicular or Progestational or Gravid phase proliferative phase secretory phaseSP-71 4, FERTILIZATION It is the process by which male and female gametes fuse to form a single cell, zygote. Site of fertilization : is ampullary part of the uterine tube Sperm transport vo ‘The spermatozoas pass rapidly from vagina into the uterus by (@) flagella activity (b) muscular contraction of tubes and uterus ‘om Ooeyte transport Itis expelled at ovulation from the ovary Plasmamembrane eis cared into the uterine tube by seos0Me — (@) sweeping movement of the fimbriae ‘membrane (b) motion of the cilia on the lining epithelium (©) muscular contraction of the tube acrosome reacted Maturation of sperm ‘The sperm arrive in female genital tract are not capable of fertilizing the oocyte. ‘They must undergo (@) capicitation = removal of glycoprotein coat (b) acrosome reaction _~ release of acrosomal enzyme to penetrate the zona pel ucida vi of gametes, = oveyte viable 24 hr after ovulation = spermatozoa may viable in female genital tract for several days (72 hr) Phases of fertilization Phase 1 - penetration of the corona radi by action of enzyme hyaluronidase Phase 2 ~ penetration of zona pellucida by action of enzyme acrosin Phase 3 ~ fusion of the oocyte and sperm cell membrane ~2 plasma membrane fuse and egg responds in (2) Cortical and zona reactions - oocyte membrane and ZP become impenetrable to prevent polyspermy (b) Resumption of the 2" meiotic division (€) Metabolic activation of egg for early embryogenesisResults of fer' Abnormal fertilization liza completion of 2 meiotic division formation of zygote restoration of diploid number of chromosomes determination of sex. ———— = initiation of cleavage | = perthenogenesis = superfecundation | 1 Fen condor + superfetation + dispermy and triploidy ie Applied anatomy ete. 1. Contraceptive methods ee sj 4 5 a a ~ Barrier techniques (condom in male , cervical cap in female) as = Oral Contraceptive = Depo provera | - Emergency Contraceptive pill (ECP) + Intra Uterine Contraceptive Device - Vasectomy and tubal ligation TV ~ Infertility \ Male infertility may be due to ~ Insufficient number of sperms - 5-20 million/ml of semen (cligozoospermia or oligospermia) ~ Absent of spermatozoa (azoospermia) 7 ~ Poor motility Severe male infertility can be overcome by intracytoplasmic sperm injection (ICSI) Female infertility may be due to — occluded oviduets, s —hostile cervical mucous teacoleton immunity to spermatozoa =() of ovulation IVF (In Vitro Fenilization) - GIFT —Gamete Intra Fallopian Transfer + ZIFT ~Zygote Intra Fallopian Transfer Preselection of Embryo's Sex “ranier Surrogate mother ~ IVF may be performed and the embryos are transferred to another woman uterus.SP-73 5. CLEAVAGE = Begins at about 30 hours afer fertilization, = 2celled stage zygote undergo a series of mitotic divisions, = About 3 days after fertilization, 16 cells stage zygote (morula) is formed. : + The morula contains cells known as blastomeres. = Ithas two distinetive cell types - outer cells — trophoblast, inner cells ~ embryoblast. = Itabsorbs uterine fluid and produces a central cavity known as the blastocyst. = About 4 days after fertilization, a fluid filled space appears inside the morula (blastocyst). = About 6 days after fertilization, blastocyst attaches to the endometrial wall. ~ It becomes implanted in the uterine wall after loss of the zona pellucida, t steam ‘iron : 6. IMPLANTATION Def: — burrowing and embedding of the early blastocyst into the deep layers of uterine endometrium by the end of the 1* week of development. Site ~ along the anterior and posterior wall ofthe body of the uterus near the fundus Uterus at the time of implantation — at the time of implantation , the mucosa of the uterus is in the secretory phaseSP-74 Abnormal sites of implantation 1. outside the uterus— in the Abdominal cavity in the ampullary region of the tube tubal implantation interstitial implantation ovarium implantation 2. within the uterus close to the internal os of the cervix , resulting in placenta previa. 1. Pre implantation diagnosis of genetic disorders using micromanipulation 2. Inhibition of implantation Post conception administration of high dose of hormone for several days prevent implantation of blastocyst 3. Tubal pregnancy detection by endovaginal or intravaginal ultrasound Pregnancy Tests 1 nosis test for pregnancy + high level of excretion of hCG (human chorionic gonadotrophin) hormone in the urine (by the end of 2 week), 2. Barly pregnancy Factor ~ isan immunosuppressant protein, secrete by the trophoblasts. ~ Itappears in the maternal serum within 24 to 48 hrs after fertilization. It forms the basic pregnancy test during the I* 10 days of development.SP-75 FORMATION OF GERM LAYERS Stages of Development 1. Pregerm layer or Predifferentiation stage «= from time of fertilization to formation of germ layers (end of 2"! week) 2, Embryonic period - 3" to 8" week (specific tissues and organs are formed) 3. Foetal period - 3 month to end of intrauterine life Date of delivery Average ~ 280 days from the beginning of the last menstrual period (LMP) True age of foetus Duration of pregnancy > 266 days or 38 weeks Gestation period Viable age of the foetus — 7" month A foetus may be born prematurely at 7 month, but itis capable of independent existence due to the establishment of pulmonary respiration, rmeation LMP ovulation dewvery 2e6daye 280 daysSP-76 11-12" day Rules of 2 in 2" week of development 2 cells in embryo ~ epiblasts, hypoblasts 2 cells in trophoblasts — cytotrophoblasts, syncytiotrophoblasts 2 cavities — amniotic cavity , chorionic cavity 2 yolk sacs — primary and secondary yolk sac 2 vill'— primary and secondary villSP-77 8" day 9” day W-1 13" day Blastocyst | Partially embedded | More deeply ‘Completely Surface defect embedded embedded healed Decidual reaction | Penetration defect | Surface epithelium | Implantation ~ edematous isclosed bya _| entirely covers the | bleeding highly vascular | fibrin coagulum | original defect = large tortuous glands Decidual reaction spreads throughout the endometrium Trophoblast | Differentiated into | Vacuoles ‘Syncytiotrophoblast | Proliferation of lacunae in penetrates deeper | cytotrophoblast into Outer syncytium into the stroma syncytiotrophoblast syncytiotrophoblast forming Primary Maternal capillaries Inner — form sinusoids cytotrophoblast Uteroplacental circulation begins. Embryoblast | Differentiated into | Cells from ‘Anew cell Hypoblast produced hypoblast form — | population derived | additional cells that Epiblast Heuser’s from the yolk sac | migrate inside the (exocoelomic) _| fills the space Heuser’s membrane Hypoblast membrane between inner forming the new surface of the cavity within the cytotrophoblast and | primary yolk sac outer surface of | - secondary yolk primary yolk sac, | sac form extraembryonic | Pinched off portion mesoderm or of primary yolk sac primary mesoderm | to form - exocoelomic cyst A small cavity It lines the inner | Large cavities in appears within the | surface of EEM become EEM lines inside epiblast. cytotrophoblast to | confluent and the cytotrophoblast form exocoelomic | formed —~ chorionic plate This cavity enlarges | cavity (Primitive | extraembryonic to become the amniotic cavity. yolk sac) coelom ( chorionic cavity ) EEM traversing the chorionic cavity ~ connecting stalkSP-78 8. Formation of Trilaminar Germ Disc in 3" week of development PRIMITIVE STREAK = At the beginning of 3" week, a narrow linear groove with slightly bulging margins appear on the surface of the epiblast, in the midline atthe caudal part of the embryo. = The cephalic end of the streak known as the primitive (Hensen’s) node consists of a small Pit, the primitive pit. = Cells of the epiblast migrate in the direction of the primitive streak. = On arrival in the region of the streak, they become flask shaped, detach from the epiblast and slip beneath . = Once the cells have invaginated, some displace the hypoblast and creating the embryonic endoderm. = Some migrate in lateral direction between the epiblast and hypoblast layer to form intraembryonic or secondary mesoderm. = Cells remaining in the epiblast form ectoderm ~ So, epiblast is the source of all 3 germs layer of embryo. Migration of the cells occur until the end of the 4"" week, after which it disappears. - Spread beyond the margin of the embryonic dise, come in contact with extra embryonic mesoderm covering the yolk sac and amnion = The secondary mesoderm extends over the whole of the embryonic disc except (@) in the region of notochord in the midline (b) at the prechordal plate = Cephalic to the prechordal plate, they pass cn each side of the plate and meet each other to form the cardiogenic or heart forming plate. Applied 1. 1* landmark that reveals the polarity of the embryo. enables identification of embryonic axes, cranial and caudal ends, top and bottom surfaces. 2. Acts as primary organizer and induces the differentiation of other cells. 3. Remnants may persists and gives rise to sacrococcygeal teratoma, Buccopharyngeal Se ‘membrane Cut ‘of amnion Prenotechordal cells Primitive node Primitive streak A ‘Cloacal membraneSP-79 iOTOCHORD ~ A median cellular cord (pre notochordal cells) migrating cranially from the primitive node is known as notochordal process. + Itmigrates until to reach prechordal plate, a small circular area of endodermal cells where. itis firmly attach to the overlying ectoderm. ~ This will later to form the buccopharyngeal membrane, located at the future site of the . oral cavity. ~ It grows between the epiblast and hypoblast cells. ~ The primitive pit extends into the notochordal process and forms the notochordal canal. ~The floor of the notochordal process fuses with the underlying intraembryonic endoderm of the yolk sac, ~ The fused layer gradually undergoes degeneration, resulting in the formation of openings in the floor of the notochordal process. ~The openings become confluent and the floor of the notochordal canal disappears. - A small passage, the neurenteric canal temporarily connects the yolk sa and the amt cavit ~The disappearance of the floor of the notochordal process converts it to a flatten mid ventral bar of mesoderm, called notochordal plate. = This plate detaches from the endoderm, and solid cord, the definitive notochord is Lace wural embryonic stalk) 7 orp wcloderre nolechordal | | prinive process notochord i rochordal | 8 ‘embryonic cN Piatordel | cael . i endoderm ae oo allontois ihoid rimive inno printve ot | ‘Grek etoeat smbrronic eure \ eee wedim pow “tons Z | natochordl EN roechordat | Bey cowed of section F notechordal ‘conal