Femur

Femur

• The femur is a latin word it means thigh.
• Femur is the longest and strongest bone of the body.
• Femur has 27% length of total body length.
• Weight of femur is about 380gm in males and 279gm in females.
• Quantity of femur are two in number.

Side Determination

1. Head directed medially.

2. Medial and lateral condyle (lower end) inferiorly.

3. Cylindrical shaft is convex forward.

Joint Formation 

1. Hip joint - between head of femur and acetabulum of Hip bone.

2. Knee joint - between lower end of femur and upper end of Tibia.

Features 

It has upper end, lower end and shaft.

Right femur anterior aspect

Upper end

• It has head, neck, greater trochanter ( Greek- runner), lesser trochanter, intertrochantric line and intertrochantric crest.

Head - 

• It forms more than half a sphere and is directed madially, upwards and slightly forwards.
• It articulates with the acetabulum to form hip joint.
• It has a pit that is called fovea.

Neck -

• It is about 3.7cm long.
• It connects the head with the shaft.
• It has two border ( upper,lower) and two surfaces ( anterior, posterior).
• It meet the shaft at the intertrochantric crest.
• The neck makes the angle with the shaft called Neck-shaft angle which is about 125⁰, it is less in female due to their wider pelvis.
• Trochanter-shaft angle is about 8⁰ in adults.
• The angle of femoral torsion or angle of anteversion it forms between transverse axes of the upper and lower end, which is about 15⁰.
• Blood supply of the neck through retinacular arteries and medial circumflex of femoral arteries.

Greater Trochanter - 

• It is large quadrangular prominence located at the upper part of the junction of the neck with the shaft.
• It has an upper border with an apex, and three surfaces (anterior, Medial and Lateral).
• Medial surface has fossa called trochantric fossa.

Lesser Trochanter -

• It is a conical eminence directed medially and backwards from the junction of the posteroinferior part of the neck with the shaft.

Intertrochanteric line - 

• It marks the junction of the anterior surface of the neck with the shaft.

Intertrochanteric crest -

• It marks the junction of the posterior surface of the neck with the shaft.

Right femur Posterior aspect

Shaft

• The shaft is more or less cylindrical.
• It is narrowest in middle, and is more expanded inferiorly than superiorly.
• It is convex forward.
• In the middle one-third,  the shaft has three borders ( Medial, Lateral and posterior ) and three surfaces ( anterior, Medial and Lateral).
• Posterior border has a roughned ridge called linea aspera (latin- rough line).

• In the upper one-third of the shaft, the two lips of the linea aspera diverge to enclose an additional posterior surface
• Thus this part has...Four borders ( Medial, Lateral, Spiral line and The lateral lip of the gluteal tuberosity), Four surfaces ( Anterior, Medial, Lateral, Posterior).

• In the lower one-third of the shaft, the two lips of the linea aspera diverge as supracondylar lines to enclose the additional , popliteal surface
• Thus this part has... Four borders ( Medial, Lateral, Medial supracondylar line and Lateral supra condylar line), Four surfaces ( Anterior, Medial, Lateral and Popliteal).

Lower end

• The lower end of the femur is widely expanded to form two large condyle (Medial and Lateral).
• Anteriorly the two condyle united are in line with the front of the shaft.
• Posteriorly these condyle are separated by a deep gap called Intercondylar fossa or intercondylar notch.

Articular surface - 

• The articular surface for Patella covers by the anterior surface of both condyle.
• The articular surface for Tibia covers by the inferior and posterior surface of both condyle.

Lateral condyle -

• The lateral condyle is flat laterally, and is more in line with the shaft.
• Tough it is less prominent than the medial condyle, it is stouter and stronger.

Lateral aspect has...

• a. A prominence called the Lateral Epicondyle.
• b. Popliteal Groove which lies just below the epicondyle. It has deeper anterior part and shallower posterior part.
• c. A Muscular Impression posterosuperior to the epicondyle.

Medial Condyle

• The condyle is convex medially.
• The most prominent point on it called Medial Epicondyle.
• It has a projection called Adductor Tubercle which is located posterosuperior to the epicondyle. This tubercle is an important landmark, epiphyseal line for the lower end of the femur passes through it.

Intercondylar Fossa or Intercondylar notch

• This notch separates the and posterior parts of the two condyles.
• It is limited anteriorly by the patellar articular surface, and posteriorly by the intercondylar line which separates the notch from the popliteal surface.

Attachment on the femur

Attachment on the anterior aspect (Right femur

Fovea on the head of femur

It provide attachment to the Ligament of the head of femur / Round ligament / Ligamentum teres / Ligamentum femoris.

Attachment on the Posterior aspect (Right femur )

Greater trochanter

Insertion - Piriformis, Gluteus minimus, Obturator internus, Two gemelli, Obturator externus and Gluteus medius.

The trochantric bursa of gluteus maximus lies behind the ridge.

Upper end of the right femur (a) Medial aspect (b) Lateral aspect

Lessor trochantor

Insertion - Psoas major and Iliacus.

Lesser trochantor is covered by a bursa that lies deep to the upper horizontal fibres of the adductor magnus.

Intertrochanteric line

Attached - capsular ligament ,iliofemoral ligament.

Origin - vastus lateralis.

Quadrate tubercle

Quadratus femoris insert on it.

Shaft

Origin - Gastrocnemius, vastus lateralis, vastus medialis, vastus intermedius, articularis grnu,

short head of biceps femoris, plantaris.

Insertion - Gluteus maximus, adductor longus, adductor brevis, adductor magnus, pectineus  intermuscular septa.

Presenting part - Supra patellar bursa.

Attachment on the linea aspera

Lateral condyle

Fibulo co-lateral ligament are attach on it.
Origin - Popliteus, lateral head of the gastrocnemius.

Medial condyle

Tibial co-lateral ligament attach on it.

Insertion - Hamstring or ischial head of the adductor magnus.

Intercondylar notch

Attached - Anterior cruciate ligament, posterior cruciate ligament, capsular ligament (intercondylar line), infrapatellar synovial fold.

Nutrient artery to the Femur

• Nutrient artery derived from the second perforating artery, branch of profunda femoris artery.
• The nutrient foramen is located on the medial side of the linea aspera.

Ossification

• Femur ossifies from one primary (for shaft ) and four secondary centre (one for lesser trochanter, one for greater trochanter, one for head and one for lower end).

Ossification of femur

Applied

• Fracture of the shaft.
• Fracture of the neck of femur.

Digestion of lipid

Digestion of lipid

Definition of digestion

Brocken down of big food particles into small food particles, which can be absorbed and use as a nutrients for the body.

Classification of lipid

1. Simp;e fat -

a. Triglyceride / Neutral fat 

b.  cholesterol .

2. Compound fat -

a. Phospholipid

b. Glycolipid

c. Lipoprotein

3. Derived fat -

a. Prostaglandin

b. Leuketrin

• We are lipid intake with food in the form of triglyceride mostly while some parts of cholesterol and cholesterol ester.

• The enzyme which help in digestion of lipid called lipolytic  enzyme.  

Digestion of lipid in mouth

Saliva contain a lipolytic enzyme called lingual lipase, but this enzyme not act on food in mouth and engulfed with food.

Digestion of lipid in stomach

Gastric juice contain a lipolytic enzyme called gastric lipase, which act on triglyceride and converts into fatty acids and glycerol.

Digestion of lipid in small intestine

Intestine have two juices...

1. Pancreatic juice

2. Intestinal juice / succus entericus

Pancreatic juice

It contain enzymes...

1. Pancreatic lipase - it act on triglyceride and convert into fatty acids.

2. Cholesterol ester hydrolase - it act on cholesterol ester  and convert  into free cholesterol.

3. Phospholipase - it act on phospholipid and converts into free phospholipid and fatty acid.

4. Bile salt activated lipase - it activate bile for emulsification of fat. This enzyme act firstly and activated bile for emulsification of fat like fatty acid and cholesterol  because these are insoluble in water where as phospholipid are soluble in water.    

Intestinal juice / succus entericus

It contain only a lipolytic enzyme called intestinal lipase (weak enzyme) , which act on triglyceride and convert into fatty acid and glycerol ( it's function is negligible ).

Absorption

Lipid absorbed from small intestine.

• Less then 12 carbon fatty acid absorb in the form of micelles.
• More then 12 carbon fatty acids absorb in the form of chylomicrons.

General anatomy (Handbook) by BD Chourasia

General anatomy (Handbook) by BD Chourasia

General anatomy (Handbook) by BD Chourasia

Download book pdf

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Language - English

Digestion of protein

Digestion of protein

Definition

Broken down of big food particles into small food particles by the chemical process, which can be absorbed and use as a nutrients.

• The enzyme which help in protein digestion called proteolytic enzyme.

Enzymes of protein digestion

Digestion of protein in mouth

Saliva secrets in the mouth which don't have any proteolytic enzymes, so protein digestion not occur in the mouth.

Protein digestion in stomach

Gastric juice contain a proteolytic enzyme called pepsin. Pepsin act on protein and converts into protease, peptone and polypeptide. pepsin act in highly acidic medium.

Digestion of protein in small intestine

Small intestine contain two juices...

1. Pancreatic juice

2. Succus entericus

Pancreatic juice

Pancreatic juice have carboxy peptidase and endo-peptidase ( trypsin and chymotrypsin ) enzymes, these enzyme are proteolytic enzyme.

• Trypsin act on protein and convert into di-peptide.
• Chymotrypsin act on peptone and convert into tri-peptides and poly-peptide.
• Carboxy-peptidase act on dipeptide, tri-peptide and poly-peptide and converts into amino-acids.

Succus entericus

It has many enzymes...

• Mono-peptidase - it act on mono-peptide and convert into amino-acids.
• Di-peptidase - it act on dipeptide and convert into amino-acids.
• Tri-peptidase - it act on tri-peptide and convert into amino-acids.
• Poly-peptidase - it act on poly-peptide and convert into amino-acids.

• Protein absorbed with sodium in the form of amino-acids from small intestine.
• Protein fastly absorbed and duodenum and jejunum and slowly in the ilium.

 

Digestion of carbohydrate

Digestion of carbohydrate

Definition

Brockendown of  big food particles into small food particles by the chemical process, which can be absorb and use as a nutrients.

The enzyme which help in digestion of carbohydrate called amylolytic enzyme.

Classification of carbohydrates

1. Monosaccharide - Hexoxes ( glucose ) , Pantoses.
2. Disaccharide - Sucrose ( Glucose + Fructose ), Lactose ( Glucose + Galactose )
3. Polysaccharide - Starch, Glycogen, Amylose.

Enzymes of digestion of carbohydrate

Digestion in mouth

Mouth secrets saliva which contain salivary amylase/ ptylin /ptyalin. This enzyme act as amylolytic enzyme. This enzyme acts on starch and converts into dextrose and maltose.
Ptyalin inactive in highly acidic medium, so when food reach in stomach then ptyalin is inactive due to increase acidity.

Digestion in stomach  

Gastric juice contain a enzyme called gastric amylase, which is a very weak enzyme so it's function is negligible in stomach.

Digestion in intestine

Intestine have two juices...
1. Pancreatic juice
2. Succus entericus / Intestinal juice

Pancreatic juice

It contain pancreatic amylase which act on starch and converts into maltose and dextrose.

Intestinal juice

This juice contain many enzymes...
1. Sucrase - it act on sucrose and convert into glucose
2. Maltase - it act on maltose and convert into glucose
3. Lactase - it act on lactose and convert into glucose and galactose
4. Dextrinase - it act on dextrose and convert into glucose

• Carbohydrate absorb from small intestine in the form of glucose (80%), fructose and galactose (20%). 

Cardiac cycle

Cardiac cycle

Definition

The change occur in heart during one heart beat, this process continue repeated in sequence manor called cardiac cycle.

Duration of cycle

• Heart rate - 70 - 80 / min.
• Average - 75 /  min.
• One heart beat - 60/75 = 0.8 sec.

Each cardiac cycle is starts from spontaneous generation of impulses by SA node, this impulse travel from SA node to AV node through intermodal fibers than bundle of his than right and left bundle branch than purkinge fibers than it distributes all myocardium.

Events of cardiac cycle

Events of cardiac cycle

Atrial events ( 0.8 sec )

1. Atrial systole  ( 0.1 sec ).
2. Atrial diastole ( 0.7 sec ).

Ventricular events ( 0.8 sec )

1. Ventricular systole ( 0.3 sec ).
2. Ventricular diastole ( 0.5 sec ).

Ventricular systole ( 0.3 sec )

1. Isovolumetric phase ( 0.05 sec ).

2. Rapid ejection phase ( 0.1 sec ).

3. Reduce ejection phase ( 0.15 sec ).

1. Iso-volumetric phase ( 0.05 sec )

• Valve - close all valves.
• Heart sound - 1st heart sound produce.
• Ejection - not start.
• Contraction - begins.
• Volume - same ( not change ).

2. Rapid ejection phase ( 0.1 sec )

• Valve - semilunar valve are open and atrio-ventricular (AV) valve are remain closed.
• Heart sound - no.
• Ejection - rapidly.
• Contraction - continue.
• Volume - reduced fastly.

 3. Reduced ejection phase ( 0.15 sec )

• Valve - semilunar valve are open and AV valve remain closed.
• Heart sound - no.
• Ejection - slowly-slowly.
• Contraction - continue.
• Volume - reduced.

Ventricular diastole ( 0.5 sec )

1. Proto-diastolic phase ( 0.04 sec ).

2. Iso-volumetric relaxation ( 0.06 sec ).

3. Rapid filling phase ( 0.1 sec ).

4. Slow filling phase ( 0.2 sec ).

5. Last rapid filling phase ( 0.1 sec ).

1. Proto-diastolic phase ( 0.04 sec )

• Valve - closer of semilunar valve and AV valve are already closed.
• Heart sound - 2nd heart sound produce.
• Filling - not starts.
• Relaxation - ready to beginning.
• Volume - remain end diastolic volume ( 60ml ).

2. Iso-volumetric relaxation ( 0.06 sec )

• Valve - all valves are closed.
• Heart sound - no.
• Filling - not start.
• Relaxation - ventricle relaxed.
• volume - no change.

3. Rapid filling phase ( 0.1 sec )

• Valve - open AV valves.
• Heart sound - 3rd heart sound produce.
• Filling - rapidly
• Relaxation - already relaxed.
• Volume - increase ( 70% filling ).

4. Slow filling phase ( 0.2 sec )

• Valve - AV valve remain open and semilunar valve are closed.
• Heart sound - no.
• Filling - slowly-slowly.
• Relaxation - already relaxed.
• Volume - ( 20% filling only in this phase ).

5. Last rapid filling phase ( 0.1 sec )

• Valve - AV already open and semilunar remain closed.
• Heart sound - 4th heart sound produce.
• Filling - rapidly.
• Relaxation - already relaxed .
• Volume - both chamber complete filled ( 10% filling only in this phase ).

Mediastinum

Mediastinum

It is the medial septum of the thorax between two lungs and include mediastinal pleura.

Boundaries of mediastinum

Anteriorly - Sternum.
Posteriorly - Vertebral column.
Superiorly -Thoracic inlet.
Inferiorly - Diaphragm.
On each side - Mediastinal pleura.

Subdivisions of the mediastinum

Division of mediastinum

Mediastinum divided into two parts...
1. Superior mediastinum
2. Inferior mediastinum
inferior mediastinum further divided into 3 parts...
a. Anterior mediastinum
b. Middle mediastinum
c. Posterior mediastinum

Superior Mediastinum

Boundaries

Anteriorly - Manubrium sterni.
Posteriorly - Upper four thoracic vertebra.
Superiorly - Thoracic inlet.
Inferiorly - An imaginary plane ( passing through the sternal angle and the lower border of 4th thoracic vertebra).
On each side - Mediastinal pleura.

Contents

1. Trachea and oesophagus.

2. Muscles - Origin of ...(i. Sternohyoid, ii.Sternothyroid, iii. Lower end of longus colli ).

3. Arteries -( i. Arch of aorta, ii. Brachiocephalic artery, iii. Left common carotid artery, Left subclavian artery ).

4. Veins -( i. Right and left brachiocephalic veins, ii. Upper half of the superior vena cava, iii. Left superior intercostal vein ).

5. Nerves - ( i. Vagus, ii. Phrenic, iii. Cardiac nerves of both side, iv. Left recurrent laryngeal nerve ).

6. Thymus.

7. Thoracic duct.

8. Lymph nodes.

Anterior Mediastinum

It is a very narrow space in front of pericardium.
It is continue to the superior mediastinum.

Boundaries

Anteriorly - Body of sternum.
Posteriorly - Pericardium.
Superiorly - an imaginary line passing through the sternal angle and the lower border of 4th thoracic vertebra ( inferior border of superior mediastinum ).
Inferiorly - Diaphragm.
On each side - Mediastinal Pleura.

Contents

1. Sternopericardial ligaments.

2. Lymph nodes with lymphatics.

3. Small mediastinal branches of internal thoracic artery.

4. The lowest part of the thymus.

5. Areolar tissue.

Middle Mediastinum

Boundaries

Anteriorly - Sternopericardial ligaments ( Posterior border of anterior mediastinum).
Posteriorly - Anterior border of the posterior mediastinum.
Superiorly - Lower border of superior mediastinum.
Inferiorly - Diaphragm.
On each side - Mediastinal pleura.

Contents

1. Heart and pericardium.

2. Arteries - ( i. Ascending aorta, ii. Pulmonary trunk, iii. Two pulmonary arteries ).

3. Veins - ( i. Lower half of superior vena cava, ii. Terminal part of azygos vein, iii. Right and left pulmonary vein ).

4. Nerves - ( i. Phrenic nerves, ii. Deep cardiac plexus ).

5. Lymph nodes - Tracheobronchial lymph nodes.

6. Right and left principal bronchi.

Posterior Mediastinum

Boundaries

Anteriorly - Pericardium and bifurcation of trachea ( Posterior border of middle mediastinum).
Posteriorly - Lower eight thoracic vertebra.
Superiorly - Lower border of superior mediastinum.
Inferiorly - Diaphragm.
On each side - Mediastinal pleura.

Contents

1. Oesophagus.

2. Descending aorta.

3. veins - ( i. Azygos, ii. Hemiazygos, iii. Accessory hemiazygos ).

4. Nerves - ( i. Vagus, ii. Splanchnic nerves ).

5. Lymph nodes - ( i. Posterior medistinal lymph node, ii. Thoracic duct  ).

Applied

1. Mediastinal syndrome.
2. Mediastinal shift.

Clavicle

Clavicle 

Synonames

Collar bone, Beauty bone.

Anatomical position

• It extends laterally and horizontally at the root of the neck

Side Determination 

1. Flattend end laterally.

2. Medial two-third of clavicle is convex anteriorly.

3. Rough area on the lateral side faces inferiorly.

Special Features 

• It is only long bone which lies horizontally.
• It has no medullary cavity (Bone marrow).
• It is the first bone to ossifies in the body ( second bone to ossifies Mandible).
• Almost whole clavicle visible through skin can be palpable.
• It has the only long bone which has two primary center of ossification.
• It has only long bone which ossifies in membrane.

General features of right clavicle (a) Superior aspect (b) Inferior aspect

Features

It has 2 ends (Medial or Sternal, Lateral or Acromial end) and a shaft.

Lateral end 

• It is flattend from above downwards.
• It articulate with the acromian process of scapula to form acromioclavicular joint.

Medial end

• It articulate with the sternum ( Manubrium sterni ) to form a joint which is called Sternoclavicular joint.
• It receives attachment of interaclavicular ligament.

Shaft

It is divided into two parts anatomically...

1. Lateral one-third of clavicle.

2. Medial two-third of clavicle.

Lateral one-third of clavicle

• It is flattend from above downwards.
• It has 2 surfaces ( Superior and Inferior ) and 2 borders ( Anterior and Posterior ).

Superior Surface

• It is subcutaneous.

Inferior Surface

• It has coroid tubercle and trapizoid ridge, which gives attachment to the coroid and trapizoid part of the coracoclavicular ligament.

Anterior Border

• It is concave anteriorly.
• It provide attachment to the deltoid muscle.

Posterior Surface

• It is convex backwards.
• It gives attachment to the trapizeus.

Medial two-third of clavicle

• It is quadrilateral in shape.
• It has 4 surfaces ( Anterior, Posterior, Superior and Inferior ).

Anterior Surface

• It is convex forwards.
• It receives attachment of clavicular head of pectoralis major.

Posterior Surface

• It is concave backwards.
• It related to the internal jugular vein, subclavian vein and brachiocephalic vein.
• Sternohyoid muscles originate from here.

Superior Surface

• The clavicular head of  sterno cleido mastoid originate from this surface.

Inferior Surface

• Several ligament attach on this surface like costoclavicular ligament and clavipectoral fascia.
• Nutrient foramen also present on this surface, nutrient artery of clavicle passes though it.

Attachment of the right clavicle (a) Superior aspect (b) Inferior aspect

Ossification

• It ossifies from 2 primary and one secondary center ( Primary center appear during 5-6th week of intrauterine life for for shaft. Secondary center appear in puberty).

Ossification 

Applied

• Most common fracture in this bone in road accident.
• Weight loss of a patient can be assist clavicle. 

 

Scapula

Scapula

Type - 

Flat

Quantity -

2 in numbers

Location 

• It is posterolateral aspect of the thorax, against 2-7th rib.

Side Determination

• Glenoid cavity looks laterally.
• Coracoid process is directed forwards anteriorly.
• Spinous process always posteriorly.

Features

Surfaces 

1. Costal Surface

2. Dorsal Surface

Costal Surface

• It is also called as subscapular fossa.
• It is concave.

Costal surface of right scapula

Dorsal Surface

A spine divide it (Dorsal Surface) into two parts...

1. Supra Spinous fossa or Surface.

2. Infra Spinous fossa or Surface.

Dorsal surface of right scapula

Borders

1. Superior Border.

2. Lateral Border.

3. Medial Border

Superior Border

• It is thin and shortest  border.
• Suprascapular notch present on it.

Lateral Border

It is the thickest border.

Medial Border

It is also called as vertebral border.

Angles

1. Superior Angle.

2. Inferior Angle.

3. Lateral Angle.

Superior Angle

It covered by trapizeus muscle.

Inferior Angle

It covered by latissimus dorsi.

Lateral Angle

• It bears glenoid cavity.
• It is also called as glenoid angle.
• It is also called as head of scapula.

Process

1. Spinus Process.

2. Acromial Process.

3. Coracoid Process.

Spinus Process

• It is also called as spine of scapula, which is divides dorsal surface into supra spinus fossa and infra spinus fossa.
• It has two surfaces (Superior and Inferior).

Acromial Process

• It projects forwards from lateral end of spine.
• It over hence the glenoid cavity.

Coracoid Process

• It is directed forwards and slightly lateraly.
• It arise from upper part of glenoid cavity.
• Pectoralis major insert on it.

Attachment

1. Subscapularis arise from the medial two-third of the subscapular fossa.

2. Supraspinatus arises from the medial two-third of the supraspinous fossa.

3. Infraspinatus arise from the medial two-third of the infraspinous fossa.

Costal aspect muscle attachment

4. Deltoid arise from the lower border of the crest of the spine.

5. Trapezius is inserted into the upper border of the crest of the spine.

6. Serratus anterior is inserted along the medial border of the costal surface.

7. Long head of the biceps brachii arises from the supraglenoid tubercle, and short head from the lateral part of the tip of the coracoid process.

8. Coracobrachialis arises from the medial part of the tip of the coracoid process.

9. Pectoralis minor insert on coracoid process.

Dorsal aspect muscle attachment

10. Long head of the triceps brachii arises from the infraglenoid tubercle.

11. Teres minor arises by two slips on the dorsal surface along the lateral border. Circumflex scapular artery lies between the two slips.

12. Teres major arises from the dorsal aspect of the lateral border.

13. Levator scapulae is inserted along the dorsal aspect of the medial border.

14. Rhomboid minor and rhomboid major inserted into the medial border.

Superior aspect of the right scapula

15. Interior belly of the omohyoid arises from the upper border near the scapular notch.

16. Glenoidal labrum attached to the margin of the glenoid cavity.

17. Capsule of the acromioclavicular joint attached margin of the facet on the medial aspect of the acromion.

18. Coracoacromial ligament is attached to the coracoid process and acromion process.

19. Coracohumeral ligament is attached to the root of the coracoid process.

20. Coracoclavicular ligament is attached to the coracoid process.

Ossification

• One primary center appear during 8th week of intrauterine life.
• Seven secondary center appear for scapula.
• All center fused up to age of 20 years.
• Scapula's fusion are membranous. 

Ossification of scapula

Applied

• Paralysis of the serratus anterior causes 'winging' of the scapular.