Microbiology Immunology by Rachna Churasia and Anshul Jain

Microbiology Immunology by Rachna Churasia and Anshul Jain




Microbiology, immunology, microbiology and immunology

Microbiology Immunology by Rachna Churasia and Anshul Jain


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Rapid review BIOCHEMISTRY by John W. Pelley and Edward F. Goljan

Rapid review BIOCHEMISTRY by John W. Pelley and Edward F. Goljan



Rapid review biochemistry, Biochemistry
Rapid review BIOCHEMISTRY by John W. Pelley ,Edward F. Goljan



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T.M.J. (Temporomendibular joint)



T.M.J. (Temporomendibular joint)

Type: condylar type of synovial joint.

Bones: Temporal and mandible.

Ligaments: Capsular ligament and temporomendibular ligament.

TMJ, temporomandibular joint, joint TMJ
Articular surface of the left temporomendibular joint


Movements: 

Protraction - pterigoid muscle

Retraction  - Digastric muscle, Massater muscle.

Dipration (Opening of mouth) - Lateral pterigoid muscle, infra hyoid muscle, digastric muscle.

Elevation of mandible - All muscles of the mastication.

Side to side movement of mandible -ipsilateral
pterigoid acting alternately.
Capsule of TMJ, Fibrous capsule and lateral ligament of the TMJ
Fibrous capsule and lateral ligament of the temporomandibular joint




Nerve supply: auriculo temporal nerve, Massetric nerve.

Applied: 
1. Dislocation.
2. Fracture.
3. Damage to auriculotemporal nerve.

Lungs Anatomy



Lungs

  • Lungs are essential organ of respiration.
  • Shape of lungs are like half-cone.
  • Lungs has an Apex & Base and 2 Surfaces and 3 Borders.
  • Two lungs are present in every human body.

Front of lungs, lungs with trachea
The trachea and lungs as seen from the front


Base - 

  • It is deeply concave and faces downwards.
  • It rest over the dom of diaphragm.

Apex - 

  • It is conical & directed upwards, towards the root of the neck.

Borders (3) -

Anterior Border

  • It is sharp and related to the anterior thoracic wall.
  • It's lower part has deep concavity of the left side which is called as cardiac notch.

Posterior Border

  • It is rounded & found the junction of costal and medial surface.
  • It corresponds with the head of the ribs.

Inferior Border

  • It is convex and sharp, it faces downwards.

Surfaces (2) -

Costal Surface

  • This surface is related to rib cage & sternum.

Medial Surface

It is divided into two parts...

1. Vertibral part - it is the posterior part of the medial surface and related to the vertibral bodies.

2. Mediastnal part - this surface is marked by hilum ( Hilum - it is depression from which structure enters or exit from here).
It is the large anterior part of the medial surface which is related to the mediastinum.

Side Determination -

  • Sharp anterior border faces forward.
  • Deep concave faces inferiorly.
  • Surface having hilum faces medially.

Right Lung - 

  • It has 2 fissures (Oblique, Transverse).
  • It has 3 lobes ( Superior, Middle and Inferior).

Mediastinal surface of right lung
Impression on the mediastinal surface of right lung


Left Lung -

  • It has only one fissure ( Oblique).
  • It has 2 lobes (Superior and Inferior).
  • The lower part of superior lobe is also called as lingula, which correspond with middle lobe of the right lung.

Mediastinal surface of left lung
Impression on the mediastinal surface of left lung


Difference between Right and Left Lung...

                   Right Lung                       Left Lung

1. Weight-  625gm                    -  565gm
2. Size -      Shorter & broader- longer & narrower
3. Fissure- Two                          -  one
4. Lobes -   Three                       - Two
5. Lingula - absent                    - present 
6. Cardiac notch - absent         - present 
7. BPS -      10                              - 8

Broncho pulmonary segments (BPS) 

  • It is difine as the developmental structural and functional unit of the lungs.
  • It consists of tersory bronchus and lungs tissue.


Right lung (10 - BPS)

  • Superior lobe has 3 BPS
  • Middle lobe has 2 BPS
  • Inferior lobe has 5 BPS

Left lung ( 8 - BPS)

  • Superior lobe has 3 BPS
  • Inferior lobe has 5 BPS

Bronchiopulmonary segments, BPS, segments of lungs
Bronchiopulmonary segments


Arterial Supply of Lungs

1. Pulmonary Arteries - one on each side ( Right and Left lungs).
2. Bronchial Arteries - one for right lung and two for left lung.

Venous drainage 

1. Pulmonary vein - two from right and two from left lungs (a superior and a inferior).
2. Bronchial vein - one from each lung.

Lymphatic drainage 

1. Pulmonary limph node.
2. Hilar limph node.
3. Trachiobronchial limph node.
4. Paratrachial limph node.

Nerve Supply 

  • Sympathetic - anterior and posterior pulmonary plexus.
  • Parasympathetic - vagus nerve.

Applied 

1. Pneumonectomy - removal of whole lung.
2. Lobectomy - removal of lobe.
3. Segmental resection - removal of BPS.








BRS Gross Anatomy by Kyung W. Chung, Harold M. Chung and Nancy L. Halliday

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BRS Gross Anatomy by Kyung W. Chung, Harold M. Chung and Nancy L. Halliday



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HAMETOLOGY Lecture Notes by Christian Hatton, Deborah Hay and David M. Keeling

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Principles of Anatomy and Physiology by Geraro J. Tortora and Bryan Derrickson



Principles of Anatomy and Physiology by Geraro J. Tortora and Bryan Derrickson



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Text book of Medical Physiology by Gyton and Hall



Text book of Medical Physiology by Gyton and Hall


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Human Anatomy vol-3 ( Head-Neck and Brain) by BD Chourasia's

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Human Anatomy vol-3 ( Head-Neck and Brain) by BD Chourasia's


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B D Chourasia's Human Anatomy Vol-2

B D Chourasia's Human Anatomy vol-2 ( Lower limb, Abdomen and pelvis) 6th edition


B D Chourasia's Human Anatomy Vol-2

CONTENTS....

SECTION : 1  LOWER LIMB

01 : Introduction (P-003)
02 : Bones of Lower Limb (P-006)
03 : Front of Thigh (P-040)
04 : Media Side of Thigh (P-059)
05 : Gluteal Region (P-065)
06 : Popliteal Fossa (P-076)
07 : Back of Thigh (P-083)
08 : Front, Lateral and Medial Sides of Leg and Dorsum of Foot (P-090)
09 : Back of Leg (P-103)
10 : Sole of Foot (P-113)
11 : Venous and Lymphatic Drainage Segmental Innervation, and Comparison of Lower and Upper Limbs (P-124)
12 : Joints of Lower Limb (P-136)
13 : Arches of Foot (P-159)
14 : Surface and Radiological Anatomy (P-165)
Appendix (P-172)

SECTION : 2  ABDOMEN AND PELVIS

15 : introduction and Osteology (P-183)
16 : Anterior Abdominal Wall (P-196)
17 : Male External Genital Organs (P-219)
18 : Abdominal Cavity and Peritoneum (P-229)
19 : Abdominal Part of Oesophagus and Stomach (P-248)
20 : Small and Large Intestines (P-257)
21 : Large Blood Vessels of the Gut (P-275)
22 : Extrahepatic Biliary Apparatus (P-287)
23 : Spleen, Pancreas and Liver (P-294)
24 : Kidney and Ureter (P-312)
25 : Suprarenal Gland and Chromaffin System (P-326)
26 : Diaphragm (P-331)
27 : Posterior Abdominal Wall (P-337)
28 : Perineum (P-350)
29 : Preliminary Consideration of Boundaries and Contents of Pelvis (P-367)
30 : Urinary Bladder and Urethra (P-372)
31 : Female Reproductive Organs (P-382)
32 : Male Reproductive Organs (P- 399)
33 : Rectum and /Anal Canal (P-407)
34 : Walls of Pelvis (P-419)
35 : Surface Marking of Abdomen and Pelvis (P-431)
36 : Radiological and Imaging Procedures (P-436)
Appendix 2 (P-441)


ABOUT BOOK

Name Book

B D Chourasia’s Human Anatomy (Vol. 2) 6th edition

Author/ Editior (6th edition)

B D Chourasia

Type

pdf.

Size

52.9 MB

Pages

910

Pages type

Colored

Quality (Good/average/bad)

Good






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Hip bone



Hip bone

Names: innominate, irregular, Hip bone.

Bones: ilium ( latin- loin) superiorly , ischium (greek- hip joint) posteroinferiorly, pubis ( latin- genital area) anteroinferiorly.

Joint formation: 
Hip joint - joint between head of femur and acetabulum.
Pubic symphysis - between two hip bone anteriorly.

Site determination: 
1. The acetabulum is directed laterally.
2. Ilium situated superiorly.
3. The obturator foramen lies below the acetabulum.

Anatomical position:
1. The pubic tubercle and anterior superior iliac spine lie in the same coronal plane.
2. The pelvic surface of the body of the pubis is directed backwards and upwards.
3. Symphyseal surface lies medialy.

Hip- bone,Hip bone medial view
Hip bone

             Inner surface of right hip bone




Hip bone, Hip bone lateral view
Hip bone
Outer surface of right hip bone



Ilium

Ilium or flank form upper expanded plate like part of hip bone. It forms upper two fifth(2/5) of the acetabulum.

It has...
Three borders: anterior, posterior, medial.
Three surface: gluteal surface, iliac surface or iliac fossa, sacropelvic surface.
One upper end called iliac crest.
One lower end which is smaller and is fused with the pubis and the ischium at the acetabulum.

Iliac crest: 

It is a broad convex ridge forming upper end of the ilium.

The highest point of the iliac crest - it is situated a little behind the mid point of the crest. It lies at the level of interval between the spines of vertebrae L3- L4.


Borders
Anterior border - two prominent parts present here... a. Anterior superior iliac spine.
b. Anterior inferior iliac spine.

Posterior border - it contain two prominent parts and a notch...
a. posterior superior iliac spine.
b. Posterior inferior iliac spine.
c. Greater sciatic notch.

Medial border - it extend inner or pelvic surface of the ilium from the iliac crest to the iliopubic eminence. It separate the iliac fossa from the sacropelvic surface. Its lower part rounded  forms the iliac part of the arcuate line or inlet of pelvis.


Surfaces


Gluteal surface - it is the outer surface of the ilium, which is convex in front and concave behind like the iliac crest.

                    It is divided into four areas by three gluteal line...
a. Posterior gluteal line.
b. Anterior gluteal line.
c. Inferior gluteal line.

Iliac surface - it is the large concave area on the inner surface of the ilium, situated in front of its medial border. It forms the lateral wall of false pelvis.


Sacropelvic surface - it is the uneven area on the inner surface of the ilium, situated bhind the its medial border.

It is subdivided into three parts...
a. Iliac tuberosity - it is the upper larged roughened area.
b. Auricular surface - it is articular but pitted.
c. Pelvic surface - it is smooth and lies anteroinferior to the auricular surface. It forms a part of lateral wall of true pelvis. Along the upper border of greater sciatic notch, this surface is marked by the preauricular sulcus. This sulcus is deeper in female than in male.

Attachment of the ilium



Hip bone, iliac crest
Hip bone iliac crest


1. Anterior superior iliac spine:

a. Lateral end of inguinal ligament.
b. It gives origin sartorius muscle, the origin extends onto the upper half of the notch below the supine.

2. Outer lip of iliac crest:

a. Fascia lata attach here.
b. Origin to the tensor fascia lata in front of the tubercle.
c. Insertion to the external oblique muscle in its anterior two-third.
d. Origin to latissimus dorsi just behind highest point of the crest.
e. Iliotibial tract attach here.

3. Intermediate area of iliac crest:

a. Origin internal oblique muscle from its anterior two-third.

4. Inner lip of the iliac crest:

a. Origin to the transversus abdominis from its anterior two-third.
b. Fascia iliaca and fascia transversalis attach on lts anterior two-third.
c. Origin to the quadratus lumborum from its posterior one-third.
d. Attachment of the thoracolumbar fascia around the attachment of the quadratus lumborum.

5. Dorsl segment of iliac crest:

a. Origin to the gluteus maximus from its lateral slope.
b. Origin to the erector spinae from its medial slope.
c. Interosseous and sacroiliac ligaments are attach to the medial margin deep to the attachment of the erector spinae.

6. Upper half of the anterior superior iliac spine:

a. Origin to the straight head of the rectus femoris. 
b. Its lower part gives attachment to the iliofemoral ligament.

7. Posterior border of the ilium:

a. Upper fibres of the sacrotuberous ligament attach above the greater sciatic notch.
b. Few fibres of piriformis origin from upper margin of the greater sciatic notch.

8. Gluteal surface:

a. Upper fibres of gluteus maximus origin from behind the gluteal line.
b. Gluteus medius arise from the area between the anterior and posterior gluteal line.
c. Gluteus minimus arise from the area between the anterior and inferior gluteal line.
d. The reflected head of the rectus femoris arise from the groove above the acetabulum.
e. The capsular ligament of the hip joint is attached along the margin of acetabulum.

9. Iliac fossa:

a. Origin to the iliacus from it's upper two third.
b. Lower groove is covered by the iliac bursa.

10. Iliac tuberosity:

a. Interosseous sacroiliac ligament in its greater part.
b. The dorsal sacroiliac ligament posteriorly.
c. Iliolumbar ligament superiorly.

11. Convex margin of the auricular surface:

a. It gives attachment to scroiliac ligaments.

12. Pelvic surface:

a. Lower fibre of the ventral sacroiliac ligament from preauricular sulcus.
b. Few fibres of the piriformis origin from lateral to the preauricular sulcus.
c. Upper half of the obturator internus origin from the pelvic surface.





Pubis

It forms the anteroinferior part of the hip bone and the anterior One- fifth of the acetabulum , forms the anterior boundary of the obturator foramen.

It has... 
A body superiorly.
A superior ramus superolaterally.
A inferior ramus inferolterally.

Body of pubis:

This is flattened from before backward, and has...

1. A superior border called pubic crest.
2. A pubic tubercle at the lateral end of the pubic crest.
3. Three surfaces anterior, posterior and medial.

Anterior surface -  it is directed downward, forwards and slightly laterally. it is rough superomedially and smooth elsewhere.


Posterior or pelvic surface - it is smooth. it is directed upwards and backwards. it forms the anterior wall of the true pelvis and is related to the urinary bladder.


Medial or symphyseal surface - it articulates with the opposite pubis to form the pubic symphysis.


Superior ramus :


It extends from the body of the pubis to the acetabulum above the obturator foramen.

It has...
a. Three borders.
b. Three surfaces.

Borders:

a. Superior border or pectineal line or pecten pubis.
b. Anterior border or obturator crest.
c. Inferior border.

Surfaces:

a. Pectineal surface.
b. Pelvic surface.
c. Obturator surface.

Inferior ramus: 

 it extends from the body of the pubis to the ramus of the ischium to form the conjoined ischiopubic rami.

Attachment and relations of the pubis:

1. Pubic tubercle - in males the tubercle is crossed by the spermatic cord.
a. Medial end of the inguinal ligament.
b. Ascending loops of the cremaster muscle.

2. The medial part of the pubic crest is crossed by the medial head of the rectus abdominis.

        Lateral head of the rectus abdominis and pyramedialis origin from lateral part of the crest.

3. Anterior surface of the body:

a. Anterior pubic ligament medially.
b. Origin adductor longus in the angle between crest and symphysis.
c. Origin to the gracilis and form the inferior ramus.
d. Origin to the adductor brevis lateral to the origin of the gracilis.
e. Origin to the obturator externus near the margin of the operator foramen.

4. Posterior surface of the body:

a. Origin to the levator ani from its middle part.
b. Origin to the obturator internus laterally.
c. Attachment to the puboprostatic / pubovesical ligament medial to the attachment of the levator ani.

5. Pectineal line:

a. The conjoint tendon at the medial end.
b. The lacunar ligament at the medial end, in front of the attachment of the conjoint tendon.
c. Pectineal ligament of cooper.
d. Pectineus muscle arise from here.
e. The fascia covering of the pectineus.
f. The psoas minor insert here.

6. Pectineal surface:

a. Pectineus from upper part.

7. Pelvic surface is  crossed by round ligament of the uterus in females and by the ductus deference in males.


8. The obturator groove transmits the obturator vessels and nerve.






Ischium


The ischium forms  the posteroinferior part of the hip bone and the adjoining two fifth of the acetabulum. It forms the posterior boundary of the oturator foramen. 


It has...

a. A body.
b. A ramus.

Body of the ischium: 

This is a thick and massive mass of bone that lies below and behind the acetabulum.

It has...

a. Two ends - upper and lower.
b. Three borders - anterior, posterior and lateral.
c. Three surfaces - femoral, dorsal and pelvic.

Ends


1. Upper end - it forms the posteriinferior two- fifth of the acetabulum.


2. Lower end - it forms the ischial tuberosity. It gives off the ramus of the ischium which forms an acute angle with the body.


Borders


1. Anterior border - it forms the posterior margin of the obturator foramen.


2. Posterior border - it is continuous above with the posterior border of the ilium. It also form part of the greater sciatic notch. Below the notch posterior margin shows a projection called the ischial spine. below the spine the posterior border show a concavity is called the lesser sciatic notch.


3. Lateral border -  it forms the lateral margin of the ischial tuberosity except the upper end where it is rounded.


Surfaces

1. Femoral surface - it lies between the anterior and lateral borders.

2. Dorsal surface - it continuous above with the gluteal surface of the ilium.


3. Pelvic surface - it is smooth and forms part of the lateral wall of the true pelvis.


Ramus


The inferior ramus of the pubis unites with the ramus of the ischium on the medial side of the obturator foramen.


It has...

a. Two borders.
b. Two surfaces.

Borders

1. Upper border - it forms part of the margin of the obturator foramen.

2. Lower border - it forms the pubic arch along with the corresponding border of the bone of the opposite side.


Surfaces

1. Inner surface - it is convex and smooth. It is divided into three areas upper, middle and lower by two ridges.

2. Outer surface - it is rough for the attachment of the muscles.


Attachment and relations of the ischium


1. Ischial spine:

a. Attach sacrospinous ligament.
b. Origin for the posterior fibres of the levator ani.

2. Lesser sciatic notch:

a. Origin to the superior and inferior gemelli.

3. Femoral surface:

a. Obturator externus along the margin of the obturator foramen.
b. Quadratus femoris along the lateral border of the upper part of the ischial tuberosity.

4. Dorsal surface

a. Piriformis, the sciatic nerve and nerve of the quadratus femoris.

5. Ischial tuberosity:

a. Origin semimembranosus from superolateral area.
b. Semitendinosus and the long head of the biceps femoris from inferomedial area.
c. Adductor magnus from outer lower area.
d. Sacrotuberous ligament.
e. Ischiofemoral ligament.

6. Greater part of the pelvic surface:

a. Origin obturator internus.

7. Conjoined ischiopubic rami:

a. Obturator membrane attach on upper part.
b. Fascia lata and membranous layer of superficial fascia or colles'fascia of the perineum attach with lower border.
c. Origin obturator externus from near the obturator margin of both rami.
d. Origin adductor brevis and gracilis from pubic ramus.
e. Origin adductor magnus from the ischial ramus.
f. Perineal membrane is attach to the inner surface lower ridge.
g. Inner surface upper area gives origin to the obturator internus.
h. Inner surface middle area gives origin transvers perinei.
i. Lower area gives attachment to crus penis and gives origin ischiocavernosus and to the superficial transversus perinei.



Hip bone, Muscles attachment on lateral surface of hip bone
Hip bone Muscles attachment 


Hip bone, Muscles attachment on the medial surface of the hip bone
Hip bone Muscles attachment



Acetabulum


1.  it is a deep Cup shaped hemispherical cavity on the lateral aspect of the hip bone, about its centre.
2. It is directed laterally, downwards and forwards.
3. It has a margin deficient inferiorly, it is also called acetabular notch.
4. Non articular roughned floor is called acetabular fossa.
5.  horseshoe shaped articular surface or lunate surface is seen on the anterior, superior, and posterior part of the acetabulum. it is line with high lined cartilage, and articulates with the head of the femur to form the hip joint. the fibrocartilaginous acetabular labrum is attached to the margin of the acetabulum, is deepens the acetabular cavity.



Obturator foramen


1. This is a large gap in the hip bone, situated anteroinferior to the acetabulum, between the pubis and the ischium.
2. It is large and oval in males, and small and triangular in female.



Ossification 

It 's ossification is cartilaginous from three primary and five secondary centre. Complete bone ossified till 20-25 year of age.


Applied 


1. Iliac crest used for taking bone marrow biopsy in cases of anemia or leukemia.
2. Weaver's bottom -- person sitting for a long period of time may get inflammation of their ischial tuberosity.



               

Endomyocardial Fibrosis