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The Warrior & the Surgeon

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Presentation on theme: "The Warrior & the Surgeon"— Presentation transcript:

1 The Warrior & the Surgeon
FOCUS Foundation - firm Observation – landmarks Concentration – in the moment, mindfulness Understanding – data, information, knowledge, mastery, wisdom Systematic – Thought process of expert The Warrior & the Surgeon 13 July 2009 Dr. Frank C.T. Voon

2 Medical Diagnosis Symptoms Signs Investigations

3 Medical Education Signs Symptoms Structures Systems Specialties
Regional Anatomy Functional Anatomy Specialties Imaging Anatomy

4 Structures Bones Joints Muscles Nerves Arteries Veins Lymphatics
Organs Structures Compartments

5 Systems Skeletal Articular Muscular Nervous Endocrine
Circulatory – cardiovascular Immune - lymphatic Respiratory Digestive Excretory - renal Reproductive – female & male Integumentary

6 The Analytically Anatomical Approach
Recognize the region(6) & subregion Determine the perspective Anterior, posterior, sagittal, superior, inferior Locate the level Superficial (skin) to deep (bones) Vertical levels (vertebra or plane) Select the structure B J M N A V L O S C Choose the format

7 Regions Head & neck Upper limb Thorax Abdomen Pelvis Lower limb

8 Region - Head Face Scalp Temporal region Infratemporal region Orbit
Nasal cavity Oral cavity Ear - outer

9 Region - Neck Suprahyoid, infrahyoid Triangles – anterior & posterior
Pharynx Larynx Carotid sheath

10 Region - Upper limb Shoulder Arm Forearm Hand
pectoral, scapular Arm Flexor and extensor compartments Forearm Hand Thenar, intermediate, hypothenar compartments The free upper limb, pectoral girdle

11 Region - Lower limb Gluteal region Thigh Leg Foot
Anterior compartment - extensor Medial compartment - adductor Posterior compartment - flexor Leg Lateral compartment - peroneal Foot Layers of the foot Muscle Tendon Bone

12 Region - Thorax Boundaries Contents Walls Roof – thoracic inlet/outlet
Anterior – manubrium, sternum, xiphisternum, costal cartilages Lateral – ribs, intercostal spaces Posterior – vertebrae, intervertebral discs, erector spinae Roof – thoracic inlet/outlet Floor – thoracic outlet/diaphragm Contents Pleural cavities Mediastinum Superior Trachea, arch of aorta, esophagus, superior vena cava, brachiocepalic trunk, left common carotid artery, left subclavian artery Inferior Anterior – thymus, internal thoracic vessels Middle – pericardium, heart, pulmonary trunk, ascending aorta Posterior – esophagus, descending aorta, azygos system, thoracic duct

13 Region - Abdomen Boundaries Contents Anterolateral abdominal wall
rectus abdominis external oblique, internal oblique, transversus abdominis Posterior abdominal wall Psoas major, quadratus lumborum Inguinal region Contents Compartments Peritoneal cavity Organs Gut – foregut, midgut, hindgut Liver, pancreas, spleen Kidneys

14 Region - Pelvis Boundaries Contents Perineum
Anterolateral abdominal wall rectus abdominis external oblique, internal oblique, transversus abdominis Posterior abdominal wall Psoas major, quadratus lumborum Inguinal region Contents Compartments Pouch of Douglas, rectovesical pouch, uterovesical pouch Organs Urinary bladder, prostate, seminal vesicles Uterus, vagina Rectum Perineum Anal triangle, urogenital triangle, urogenital diaphragm

15 Bones Type Upper end, lower end, shaft
Long short flat irregular sesamoid Upper end, lower end, shaft Projections – tuberosities, condyles, neck Right or left – all 3 dimensions Ossification – endochondral, intramembranous

16 Bones Mandible – temporomandibular joint, parts
Vertebrae – cervical, thoracic, lumbar, sacrum Rib – typical, 1st Clavicle – intramembranous, sternoclavicular joint Scapula – muscles, rotation 60 degrees Humerus – surgical neck, midshaft, supratrochlear, medial epicondyle Radius – pivot joint, tuberosity (biceps) Carpus – scaphoid, trapezium, capitate, hamate Femur – neck, head, lesser trochanter (iliopsoas) Fibula – lateral malleolus (key to orientation) Patella – sesamoid bone, larger lateral facet Tarsus – talus (ball bearing)

17 Joints Definition From outside in Capsule Synovial membrane
Articulation between 2 or more bones From outside in Capsule Synovial membrane Articular cartilage Ligaments Movements allowed

18 Joints TMJ - dislocation
Atlanto-occipital – flexion/extension & lateral flexion, condyloid joint Atlanto-axial - pivot joint Intervertebral – cartilaginous joint Sternoclavicular – double plane Thoracic cage – bucket handle, pump handle Shoulder, wrist, elbow – ball & socket, ellipsoid, hinge Hip, knee, ankle 1st carpometacarpal Axis of movements Supination, pronation, inversion, eversion

19 Muscles Origin – bone, then part Insertion – bone, then part
Joint/s involved Movements possible – use the joint axis Nerve supply Blood supply – arteries, veins, anastomosis Relations - Applied/clinical anatomy – major function,

20 Muscles – H&N Muscles of mastication – 1st arch
Muscles of facial expression – 2nd arch Extra-ocular muscles – LR6,SO4 Soft palate Tongue Supra- & infra- hyoid muscles Sternocleidomastoid & trapezius Scalenus anterior & medius

21 Muscles – UL Upper – shoulder & arm Lower – forearm & hand
Scapular group Triceps Flexors Coracoid process Pectoral girdle & humeral Lower – forearm & hand Flexors – superficial & deep Extensors – lateral, thumb, digits, elbow Thenar, intermediate, hypothenar

22 Muscles – LL Thigh – extensors, adductors, flexors
Gluteal & lateral rotators Leg - extensors, peronei, flexors Foot – muscle, tendon, muscle, bone

23 Muscles – Trunk Intercostals Diaphragm
Obliques & transversus abdominis Pelvic diaphragm Urogenital diaphragm Erector spinae

24 Muscles – smooth & cardiac
Intrinsic muscles of the eye Stapedius & tensor tympani Musculi pectinati, trabeculae carneae, Detrusor Gut – colic, outer longitudinal, inner circular Oesophagus – skeletal to smooth, 1/3 Sphincters of urethra & anal canal

25 Nerves Origin Root levels Branches Distribution Clinical - palsies

26 Nerves Cranial - trigeminal, facial & vagus Spinal Autonomic ARMUM
FOGS Tibial; common, superficial & deep peroneal Plantar – medial & lateral Autonomic COPS Splanchnics - greater, lesser & least; pelvic

27 Arteries Begins Ends (as above) Middle Relationships
A continuation of Location, usually bony part nearby Ends (as above) Middle If 3 parts, middle related to a muscle 4 parts (vertebral artery) branches distribution Relationships V-A-N Histological layers Endothelium, muscle (smooth), adventitia (elastic) Applied Anastomosis, clinical procedures

28 Arteries External carotid Internal carotid - circle of Willis
Soft palm ST,L,F,O,PA,AP,ST,Mx Internal carotid - circle of Willis Aorta – ascending, arch, descending, abdominal Internal iliac Femoral, tibial, popliteal, plantar Brachiocephalic, subclavian, axillary, brachial, radial, ulnar, palmar arches (superficial & deep) Coronary arteries Choroid plexuses, anastomoses, coarctation of the aorta, medial umbilical ligaments (obliterated umbilical arteries)

29 Veins Superficial or deep Begins Ends Middle Relationships
A combination of Location, usually bony part nearby Ends Drains into Location (surface marking) Middle Vessels that drain into it Area of drainage & organs or structures drained by it Relationships V-A-N Valves, venous plexus Applied Plexuses, clinical procedures (cut down), conditions (haemorrhoids) Venous sinues

30 Veins Cranial cavity - venous sinuses
Superior & Inferior vena cava - tributaries Upper limb – superficial & deep Lower limb – superficial, deep & perforators Portal vein – varices & haemorrhoids Falciform ligament (ligamentum teres of the liver - obliterated left umbilical vein), caput medusae

31 Lymphatics Lymph nodes Thoracic duct Cisterna chyli
Spread of infections & tumors

32 Organs Form – shape, size Location Arterial input Venous drainage
Organization – nervous or humoral Relations Special or uniqueness

33 Organs Thyroid Parotid, submandibular, sublingual glands
Larynx, pharynx Heart, lungs, esophagus Liver, pancreas, spleen, kidneys, suprarenals Testes, prostate, ovaries, uterus, vagina

34 Compartments Spaces Shape Boundaries Contents Examples
2 dimensional – femoral triangle 3 dimensional - pyramid, 3-sided, 4-sided, truncated, wedge Boundaries Walls, roof, floor Contents Arteries, veins, nerves, lymph nodes Examples axilla, mediastinum, cubital fossa, popliteal fossa, ischiorectal fossa, cranial fossae, carpal tunnel, subsartorial (Hunter’s) canal, pouch of Douglas, nasal cavity, fascial compartments (of arm & leg)

35 Structures - extra Miscellaneous structures
ureter, urethra (male, female) flexor retinaculum (carpal tunnel) extensor expansion (dorsum of fingers) fascia lata (gluteus maximus & tensor fascia lata) plantar aponeurosis (longitudinal arch of foot) perineal body (central tendon cf diaphragm)

36 Integration Images Visual (observational) Radiological - Xrays
skin clinical photographs Dupuytren’s contracture videos Radiological - Xrays Scans – Ultrasound, CAT Imaging – MRI, PET


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