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THE BIG PICTURE GROSS ANATOMY Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts...

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THE BIG PICTURE GROSS ANATOMY

Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

THE BIG PICTURE GROSS ANATOMY

David A. Morton, PhD Associate Professor Anatomy Director Department of Neurobiology and Anatomy University of Utah School of Medicine Salt Lake City, Utah

K. Bo Foreman, PhD, PT Assistant Professor Anatomy Director University of Utah College of Health Salt Lake City, Utah

Kurt H. Albertine, PhD Professor of Pediatrics, Medicine, and Neurobiology and Anatomy Associate Dean of Faculty Administration Editor-In-Chief, The Anatomical Record University of Utah School of Medicine Salt Lake City, Utah

New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto

  
 

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DEDICATION To Jared, Ireland, Gabriel, Max, and Jack; and their cousins Lia, Sophia, Joshua, Cayden, Ethan, Nathan, Kelsey, Robert, Stefani, Ella, Reid, Roman, Marcus, Jared, Hannah, Tanner, Liam, Maia, Riley, Sydney, Luke, Cole, Desiree, Celeste, Connlan, Isabelle, Nathan, Simon, Thomas, Alexandre, Lyla, Logan and Andilynn. I could not ask for a better family. —David A. Morton

To my devoted family: my wife, Cindy, and our two daughters Hannah and Kaia. —K. Bo Foreman

To Erik, Kristin, and Laura. Thank you for your patience with and understanding of my efforts to contribute to biomedical education and research. —Kurt H. Albertine

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CONTENTS Preface

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . xii About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . xiv

SECTION 1: BACK CHAPTER 1 Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Skin of the Back Superficial Back Muscles Deep Back Muscles Vertebral Column Spinal Meninges Spinal Cord Spinal Roots, Spinal Nerves, and Rami Study Questions Answers

4 6 8 10 12 14 16 20 21

CHAPTER 5 Superior and Posterior Mediastina

CHAPTER 2 Anterior Thoracic Wall . . . . . . . . . . . . . 25 Surface Anatomy The Breast Thoracic Muscles Thoracic Skeleton Vessels and Lymphatics of the Thoracic Wall Diaphragm

CHAPTER 3 Lungs

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pleura Anatomy of the Lung Hilum of the Lung Respiration

26 28 30 32 34 36

41 42 44 46 48

CHAPTER 4 Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Pericardium Overview of the Heart Coronary Circulation Chambers of the Heart Innervation of the Heart Circulatory Pathway Through the Heart

52 52 54 56 58 60

63 64 66 68 70 72 74 76

SECTION 3: ABDOMEN, PELVIS, AND PERINEUM CHAPTER 6 Overview of the Abdomen, Pelvis, and Perineum . . . . . . . . . . . . . . . 79 Osteologic Overview Gut Tube

CHAPTER 7 Anterior Abdominal Wall SECTION 2: THORAX

. .

Divisions of the Mediastina Sympathetic Trunk and Associated Branches Azygos Veins, Thoracic Duct, and Thoracic Aorta Esophagus Superior Mediastinum Study Questions Answers

80 82 . . . . . . . . . .

Partitioning of the Abdominal Region Superficial Layers of the Anterior Abdominal Wall Deep Layers of the Anterior Abdominal Wall Vascular Supply and Innervation of the Anterior Abdominal Wall Inguinal Canal Scrotum and Spermatic Cord

85 86 86 88 90 92 94

CHAPTER 8 Serous Membranes of the Abdominal Cavity . . . . . . . . . . . . . . . . . 97 Peritoneum

CHAPTER 9 Foregut

. . . . . . . . . . . . . . . . . . . . . . . . . .

Big Picture Liver and Gallbladder Pancreas and Spleen Vascular Supply of the Foregut

98

101 102 104 106 108

CHAPTER 10 Midgut and Hindgut . . . . . . . . . . . . . . 111 Midgut Hindgut Innervation of the Midgut and Hindgut Portal System

112 114 116 118

viii

Contents

CHAPTER 11 Posterior Abdominal Wall. . . . . . . . . . 121 Muscles Vessels of the Posterior Abdominal Wall Somatic Nerves of the Posterior Abdominal Wall Autonomics of the Posterior Abdominal Wall Adrenal Glands, Kidneys, and Ureters

CHAPTER 12 Pelvis and Perineum

. . . . . . . . . . . . . .

Pelvic Floor Perineum Pelvic Vasculature Pelvic Innervation Rectum and Anal Canal Ureters and Urinary Bladder

122 124 126 128 132

135 136 138 140 142 144 146

CHAPTER 13 Male Reproductive System . . . . . . . . . 149 Male Reproductive System Male Sex Act

150 154

CHAPTER 14 Female Reproductive System

. . . . . .

Female Reproductive System Study Questions Answers

157 158 162 165

CN V: Trigeminal Nerve CN VII: Facial Nerve CN VIII: Vestibulocochlear Nerve CN IX: Glossopharyngeal Nerve CN X: Vagus Nerve CN XI: Spinal Accessory Nerve CN XII: Hypoglossal Nerve Autonomic Innervation of the Head

CHAPTER 18 Orbit

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Orbital Region The Eye Extraocular Muscle Movement Innervation of the Orbit Vascular Supply of the Orbit

CHAPTER 19 Ear

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The Ear

196 198 198 200 202 204 204 206

211 212 214 216 220 222

225 226

CHAPTER 20 Superficial Face

. . . . . . . . . . . . . . . . . .

Cutaneous Innervation and Vasculature of the Face Muscles and Innervation of the Face Parotid Gland

231 232 234 236

CHAPTER 21 Infratemporal Fossa . . . . . . . . . . . . . . . 239 SECTION 4: HEAD CHAPTER 15 Scalp, Skull, and Meninges

. . . . . . . .

Anatomy of the Scalp Skull Cranial Fossae Meninges

CHAPTER 16 Brain

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anatomy of the Brain Ventricular System of the Brain Blood Supply to the Brain

CHAPTER 17 Cranial Nerves

. . . . . . . . . . . . . . . . . .

Overview of the Cranial Nerves CN I: Olfactory Nerve CN II: Optic Nerve CN III: Oculomotor Nerve CN IV: Trochlear Nerve CN VI: Abducens Nerve

169 170 172 174 176

181 182 184 186

189 190 192 192 194 194 194

Overview of the Infratemporal Fossa Temporomandibular Joint Innervation and Vascular Supply of the Infratemporal Fossa

CHAPTER 22 Pterygopalatine Fossa

. . . . . . . . . . . . .

Overview of the Pterygopalatine Fossa

CHAPTER 23 Nasal Cavity

. . . . . . . . . . . . . . . . . . . . .

Overview of the Nasal Cavity Paranasal Sinuses

CHAPTER 24 Oral Cavity

. . . . . . . . . . . . . . . . . . . . . .

Overview of the Oral Cavity Palate Tongue Salivary Glands Teeth and Gingivae Study Questions Answers

240 240 242

245 246

249 250 254

257 258 258 260 260 262 264 268

ix

Contents

SECTION 5: NECK

CHAPTER 31 Arm

CHAPTER 25 Overview of the Neck

. . . . . . . . . . . . .

Fascia of the Neck Muscles of the Neck Vessels of the Neck Innervation of the Neck

274 276 280 282

CHAPTER 26 Triangles and Root of the Neck

. . . .

Posterior Triangle of the Neck Anterior Triangle of the Neck Visceral Triangle of the Neck Root of the Neck

CHAPTER 27 Pharynx

285 286 288 290 290

. . . . . . . . . . . . . . . . . . . . . . . . .

Overview of the Pharynx Functions of the Pharynx Neurovascular Supply of the Pharynx

CHAPTER 28 Larynx

273

. . . . . . . . . . . . . . . . . . . . . . . . . .

Laryngeal Framework Function of the Larynx Vascular Supply and Innervation of the Larynx Study Questions Answers

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arm Muscles of the Arm Terminal Branches of the Brachial Plexus in the Arm Vascularization of the Arm Joints Connecting the Arm and Forearm

CHAPTER 32 Forearm

. . . . . . . . . . . . . . . . . . . . . . . . .

Muscles of the Forearm Terminal Branches of the Brachial Plexus in the Forearm Vascularization of the Forearm Joints Connecting the Forearm and Hand

343 344 344 346 346 348

351 352 356 358 360

293 294 296 298

301 302 304 306 308 310

CHAPTER 33 Hand

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Organization of the Fascia of the Hand Actions of the Fingers and Thumb Muscles of the Hand Terminal Branches of the Brachial Plexus in the Hand Vascularization of the Hand Joints of the Hand Study Questions Answers

365 366 368 370 372 374 376 379 382

SECTION 7: LOWER LIMB SECTION 6: UPPER LIMB CHAPTER 34 Overview of the Lower Limb CHAPTER 29 Overview of the Upper Limb

. . . . . .

Bones of the Shoulder and Arm Bones of the Forearm and Hand Fascial Planes and Muscles Innervation of the Upper Limb by the Brachial Plexus Sensory Innervation of the Upper Limb Vascularization of the Upper Limb

CHAPTER 30 Shoulder and Axilla

. . . . . . . . . . . . . . .

Shoulder Complex Muscles of the Shoulder Complex Brachial Plexus of the Shoulder Vascularization of the Shoulder and Axilla Lymphatics of the Shoulder and Axilla Glenohumeral Joint

313 314 316 318 320 322 324

327 328 330 334 336 338 340

. . . . . .

Bones of the Pelvic Region and Thigh Bones of the Leg and Foot Fascial Planes and Muscles Innervation of the Lower Limb Sensory Innervation Vascularization

CHAPTER 35 Gluteal Region and Hip

. . . . . . . . . . .

Gluteal Region Muscles of the Gluteal Region Sacral Plexus Vascularization of the Gluteal Region Joints of the Gluteal Region

387 388 390 392 394 396 398

401 402 402 404 406 408

x

Contents

CHAPTER 36 Thigh

. . . . . . . . . . . . . . . . . . . . . . . . . . .

Thigh Muscles of the Thigh Femoral Triangle Lumbar Plexus Vascularization of the Thigh Knee Complex

CHAPTER 37 Leg

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Muscles of the Leg Innervation of the Leg Vascularization of the Leg Joints of the Leg

411

CHAPTER 38 Foot

412 412 416 416 418 420

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Joints of the Digits and Fascia of the Foot Muscles of the Foot Innervation of the Foot Vascularization of the Foot Study Questions . Answers .

441 442 444 446 446 449 452

427 428 436 436 438

SECTION 8: FINAL EXAMINATION CHAPTER 39 Study Questions and Answers . . . . . . 457 Directions 457 Answers 469 Index

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

475

xi

PREFACE If you were asked to give a friend directions from your office to a restaurant down the street, your instructions may sound something like this—turn right at the office door, walk to the exit at the end of the hall, walk to the bottom of the stairs, take a left, exit out of the front of the building, walk across the bridge, continue straight for two blocks passing the post office and library, and you will see the restaurant on your right. If you pass the gas station, you have gone too far. The task is to get to the restaurant. The landmarks guide your friend along the way to complete the task. Now, imagine if an anatomist were to give directions from the office to the restaurant in the same way most anatomy textbooks are written. Details would be relayed on the dimensions of the office, paint color, carpet thread count, position and dimensions of the desk in relation to the book shelf along the wall, including the number, types, and sizes of books lining the shelves, and door dimensions and office door material in relation to the other doors in the same building. This would occur over the course of 10 pages—and the friend still would not have left the office. The difference between you giving a friend directions to a restaurant and the anatomist giving directions to the same restaurant can be compared with the difference between many anatomy textbooks and this Big Picture textbook—either getting to the restaurant with succinct relevant directions or taking a long time to get to the restaurant or possibly not finding it. The purpose of this textbook is to provide students with the necessary landmarks to accomplish their task—to understand

the big picture of human anatomy in the context of health care, bypassing the minutia. The landmarks used to accomplish this task are text and illustrations. They are complete, yet concise and both figuratively and literally provide the “Big Picture” of human anatomy. The format of the book is simple. Each page-spread consists of text on the left-hand page and associated illustrations on the right-hand page. In this way, students are able to grasp the big picture of individual anatomy principles in bite-sized pieces, a concept at a time. ■ Key structures are highlighted in bold when first mentioned. ■ Bullets and numbers are used to break down important concepts. ■ Approximately 450 full-color figures illustrate the essential anatomy. ■ High-yield clinically relevant concepts throughout the text are indicated by an icon. ■ Study questions and answers follow each section. ■ A final examination is provided at the end of the text. We hope you enjoy this text as much as we enjoyed writing it. —David A. Morton —K. Bo Foreman —Kurt H. Albertine

xii

ACKNOWLEDGMENTS Early in his life my father, Gordon Morton, went to art school. He purchased a copy of Gray’s Anatomy to help him draw the human form. That book sat on our families book shelf all throughout my life and I would continually look through its pages in wonder of the complexity and miracle of the human body. After I completed high school my father gave me that book which I have kept in my office ever since. I would like to acknowledge and thank my father and my mother (Gabriella Morton) for their influence in my life to bring this book to publication. Thank you to my coauthors, Dr. Foreman and Dr. Albertine—they are a joy to work with and I look forward to many years of collaborating with them. I express a warm thank you to Michael Weitz. His dedication, help, encouragement,...