Hence, morphological changes in the carina are important diagnostic signs to bronchoscopists in assisting with the differential diagnosis of respiratory disease. Pancreas the pancreas is an elongated, accessory digestive gland that lies retroperitoneally, overlying and transversely crossing the bodies of the L1 and L2 vertebra (the level of the transpyloric plane) on the posterior abdominal wall. Origin and distribution of presynaptic and postsynaptic sympathetic and parasympathetic fibers, and the ganglia 1241 involved in supplying abdominal viscera are shown. The elastic lamina (black) stops at the arrows, and the wall of the dilated aneurysm is composed of connective tissue with some atherosclerotic intimal thickening. Visualizing Pathology Breast Structure and Examination of the breasts by medical imaging is one of the techniques used to detect breast abnormalities, distinguishing cysts and neoplastic masses from variations in breast architecture. The retromandibular vein runs posterior to the ramus of the mandible within the substance of the parotid gland, superficial to the external carotid artery and deep to the facial nerve. Its relocation out of the abdomen into the perineum through the inguinal canal accounts for many of the structural features of the region. The integrity of the bony arches of the foot is maintained by both passive 1836 factors and dynamic supports. The lymphatic vessels from the superior parts of the seminal glands and prostate terminate chiefly in the internal iliac lymph nodes, but some drainage from the latter may pass to the sacral nodes. As a result, rotation occurs around a mostly transverse axis that traverses the intra-articular ligament and the head and neck of the rib. The anatomical basis for stretching of the ulnar nerve is that it passes posterior to the medial epicondyle before entering the forearm. Feasibility of cell therapy in multiple sclerosis: a systematic review of 83 studies. The right and left coronary arteries arise from the corresponding aortic sinuses at the proximal part of the ascending aorta, just superior to the aortic valve, and pass around opposite sides of the pulmonary trunk. Lymph from the right two thirds of the inferior third of the stomach drains along the right gastro-omental vessels to the pyloric lymph nodes. The frequency of locally formed thrombi in these arteries proved to be much lower than had been estimated previously. In approximately 1 in 600 fetuses, the inferior poles (rarely, the superior poles) of the kidneys fuse to form a horseshoe kidney. At normal pO2 values, over 98 per cent of the oxygen-carrying sites on the haemoglobin molecule are occupied by oxygen in arterial blood, with most molecules having all four sites occupied by O2 and only a few having three O2 molecules. It is the covering of visceral peritoneum (often referred to clinically as the serosa) that makes watertight end-to-end anastomoses of intraperitoneal organs, such as the small intestine, relatively easy to achieve. The remains of the processus vaginalis have formed the tunica vaginalis of the testis. Endometrium-the inner mucous layer-is firmly adhered to the underlying myometrium. If the area of the calvaria is thick at the site of impact, the bone may bend inward without fracturing. When it is hardened and enlarged to approximately three times its normal size, it moves inferior to the left costal margin, and its superior (notched) border lies inferomedially (see the Clinical Box "Splenectomy and Splenomegaly," p. Along the round ligament of the liver to the umbilicus and lymphatics of the anterior abdominal wall. The femoral sheath lining the vascular compartment is subdivided internally into three smaller compartments by vertical septa of extraperitoneal connective tissue that extend from the abdomen along the femoral vessels. Inferiorly, the linea aspera divides into medial and lateral supracondylar lines, which lead to the medial and lateral femoral condyles. This may amount to small protrusions of cortex through cranial burr holes, but if a larger cerebral decompression has been undertaken, major portions of the cerebral hemisphere may herniate through the calvarial defects. The endocardium and some subendocardial tissue located immediately external to the endocardium receive oxygen and nutrients by diffusion or microvasculature directly from the chambers of the heart. As a rule, an ectopic thyroid gland in the median plane of the neck is the only thyroid tissue present. Myometrium-the middle layer of smooth muscle-becomes greatly distended (more extensive but much thinner) during pregnancy. In lacerations of the lip, pressure must be applied on both sides of the cut to stop the bleeding.
Ambient oxygen, however, can be zero, as for example on inhalation of pure nitrogen,449 in drowning939 and in an unscheduled space walk. The examination also provides a clue to tenderness, which can indicate inflammation of the auricle and/or the meatus. A coronal section of the ear, with an accompanying orientation figure, demonstrates that the ear has three parts: external, middle, and internal. The lines of pull of the rotators of the hip are indicated by arrows, demonstrating the antagonistic relationship resulting from their positions relative to the lever and the center of rotation (fulcrum). The genotype T807 was shown to be an independent risk factor for stroke in young patients (<50 years). Similarly, following a partial colectomy, a colostomy or sigmoidostomy is performed to create an artificial cutaneous opening for the terminal part of the colon. As there are modified sebaceous glands in the prepuce, the oily secretions of cheesy consistency (smegma) from them accumulate in the preputial sac, the space between the glans and prepuce, causing irritation. The three compartments of the thigh are demonstrated in different shades of color. However, direct observation by endoscopy in living persons does not support this description. Note that all of these muscles also pull the head and neck of the femur medially into the acetabulum, strengthening the joint. Almost always, supination and pronation are accompanied by synergistic movements of the glenohumeral and elbow joints that produce simultaneous movement of the ulna, except when the elbow is flexed. In varicose vein operations, it is obviously important to identify the great saphenous vein correctly, and not tie off the femoral vein by mistake. Central transtentorial herniation this form of herniation occurs particularly in response to frontal and parietal lesions or to bilateral expanding lesions such as chronic subdural hematomas. This dissection of the left side shows the deep cervical lymph nodes and the termination of the thoracic duct at the junction of the subclavian and internal jugular veins (left venous angle). The vertical dimension (height) of the central part of the thoracic cavity increases during inspiration as contraction of the diaphragm causes it to descend, compressing the abdominal viscera. The arteries of the superior tibiofibular joint are from the inferior lateral genicular and anterior tibial recurrent arteries. The skin and fasciae are removed proximally, revealing the tendons and neurovascular structures. The pain is most severe during flexion of the forearm because of pressure exerted on the inflamed subtendinous olecranon bursa by the triceps tendon. The superior and inferior longitudinal muscles act together to make the tongue short and thick and to retract the protruded tongue. The acetabular rim and lunate surface form approximately three quarters of a circle; the missing inferior segment of the circle is the acetabular notch. Nasolacrimal duct: conveys the lacrimal fluid to the inferior nasal meatus (a cavity below the inferior nasal concha, the lowest of three downward-curving ridges on the lateral wall of the nasal cavity). The paired parietal branches of the thoracic aorta that arise posterolaterally are the nine posterior intercostal arteries that supply all but the upper two intercostal spaces and the subcostal arteries. The cleft may involve only the uvula, giving it a fishtail appearance, or it may extend through the soft and hard regions of the palate. The cruciate ligaments are located in the center of the joint and cross each other obliquely, like the letter X. It thickens superiorly to form the lateral arcuate ligament and is adherent inferiorly to the iliolumbar ligaments. En route to the face, the infra-orbital nerve gives off palatine branches, branches to the mucosa of the maxillary sinus, and branches to the middle and anterior upper teeth. The posterior fontanelle begins to close during the first few months after birth, and by the end of the 1st year, it is small and no longer clinically palpable.
The main cause of the decline is the reduced incidence of stroke284 but the case fatality rates have also decreased as a result of lesser stroke severity or improved management. Rupture of the appendix results in infection of the peritoneum (peritonitis), increased abdominal pain, nausea and/or vomiting, and abdominal rigidity (stiffness of abdominal muscles). Corneal Reflex During a neurological examination, the examiner touches the cornea with a wisp of cotton. It begins at the aortic hiatus in the diaphragm at the level of the T12 vertebra and ends at the level of the L4 vertebra by dividing into the right and left common iliac arteries. The most inferior branches of the posterior cutaneous nerve of the thigh supply the skin that overlies the popliteal fossa. Most lesions are less than 1 mm in length and the vasculitis does not necessarily affect the whole circumference of the artery. The parietal layer of the tunica vaginalis, adjacent to the internal spermatic fascia, is more extensive than the visceral layer and extends superiorly for a short distance onto the distal part of the spermatic cord. If large branches of both coronary arteries are partially obstructed, an extracardiac collateral circulation may be used to supply blood to the heart. The absolute flow values at these thresholds depend on the species, being higher in smaller animals, and influenced by physiological variables such as brain temperature. This foramen is filled by the structures that traverse it, including the piriformis muscle. The greater supraclavicular fossa is clinically important because subclavian arterial pulsations can be palpated here in most people. It is located between the distal ends of the tibia and the fibula and the superior part of the talus. The intersections, indicated by grooves in the skin between the muscular bulges, usually occur at the level of the xiphoid process, at the umbilicus, and halfway between these structures. The stomach acts as a food blender and reservoir; its chief function is enzymatic digestion. The dolichoectatic basilar artery is often S-shaped, with a luminal diameter exceeding 4. Enlargement of the deep infrapatellar bursa obliterates the dimples normally occurring on each side of the patellar ligament when the leg is extended. Several muscles participate in both flexion and adduction (pectineus and gracilis as well all three "adductor" muscles). The sphenomandibular ligament passively bears the weight of the lower jaw and is the "swinging hinge" of the mandible, permitting protrusion and retrusion as well as elevation and depression. The skin of the transitional zone is hairless and thin, increasing its sensitivity and causing its color to be different (because of underlying capillary beds) from that of the adjacent skin of the face. Thick parts of the fibrous layer form the ligaments of the hip joint, which pass in a spiral fashion from the pelvis to the femur. As part of an orgasm, the sympathetic system stimulates contraction of the internal urethral sphincter to prevent retrograde ejaculation. Because the tendons of the 2nd, 3rd, and 4th fingers nearly always have separate synovial sheaths, the infection is usually confined to the infected finger. Fabella in Gastrocnemius Close to its proximal attachment, the lateral head of the gastrocnemius may contain a sesamoid bone, the fabella (L. The same structures covering its posterior aspect are considered to belong to the back. The joint was disarticulated by cutting the ligament of the head of the femur and retracting the head from the acetabulum. Deeper dissection of the superficial pouch (right side) reveals the bulbs of the vestibule and the greater vestibular glands. With unyielding structures on three sides (the two bones and the interosseous membrane) and a dense fascia on the remaining side, the relatively small anterior compartment is especially confined and therefore most susceptible to compartment syndromes (see the clinical box "Containment and Spread of Compartmental Infections in the Leg"). This injury may be caused by acute trauma or repetitive microtraumas that place increased shearing stress on the epiphysis, especially with abduction and lateral rotation of the thigh.
A fat pad in the acetabular fossa fills the part of the acetabular fossa that is not occupied by the ligament of the femoral head. The muscular floor of the femoral triangle is formed by the iliopsoas laterally and the pectineus medially. In persons with large indirect inguinal hernias, for example, the intestine may enter the scrotum, making it as large as a soccer 1506 ball. The inferior part of the iliac fascia is often tense and raises a fold that passes to the internal aspect of the iliac crest. The extensors of the hip and flexors of the knee contract eccentrically at the end of swing phase (terminal swing;. The pelvic cavity is bounded posteriorly by the coccyx and inferiormost sacrum, with the superior part of the sacrum forming a roof over the posterior half of the cavity. The tumor begins in the vestibular nerve while it is in the internal acoustic meatus. The round head of the femur makes up two thirds of a sphere that is covered with articular cartilage, except for a medially placed depression or pit, the fovea for the ligament of the head. These individuals cannot move their 1st digit away from their 2nd digit because the sesamoids under the head of the 1st metatarsal are usually displaced and lie in the space between the heads of the 1st and 2nd metatarsals. Folds on the internal surface of the ciliary body, the ciliary processes, secrete aqueous humor. The omental bursa communicates with the greater sac through the omental foramen (epiploic foramen), an opening situated posterior to the free edge of the lesser omentum (hepatoduodenal ligament). The closed oval foramen is represented in the postnatal interatrial septum by the depressed oval fossa. Coronary Angioplasty Cardiologists or interventional radiologists use percutaneous transluminal coronary angioplasty in which they pass a catheter with a small inflatable balloon attached to its tip into the obstructed coronary artery. Each rib has a spongy interior containing bone marrow (hematopoietic tissue), which forms blood cells. At the inferior end of the membrane is a smaller hiatus through which the perforating branch of the fibular artery passes. Acquired flat feet ("fallen arches") are likely to be secondary to dysfunction of the tibialis posterior (dynamic arch support) owing to trauma, degeneration with age, or denervation. The canals have only five openings into the vestibule because the anterior and posterior canals have one limb common to both. This action forces air from the lungs and creates an artificial cough that usually expels the foreign object. The mammary glands are modified sweat glands; therefore, they have no capsule or sheath. Patella the patella (knee cap) is a large sesamoid bone that is formed in the tendon of the quadriceps femoris muscle after birth. Cell death during the subacute phase is associated mainly with peri-infarct spreading depression, which exacerbates the imbalance between metabolic demand and haemodynamic capacity in the penumbra. Sprouting and induction of further angiogenesis in mature vessels require destabilization of endothelium and pericyte contacts by angiopoetin-2 (Ang-2), an antagonist of Ang-1. You do not sit on your gluteus maximus; you sit on the fatty fibrous tissue and the ischial bursa that lie between the ischial tuberosity and skin. The superior mesenteric artery, through its branch, the inferior pancreaticoduodenal artery, supplies the duodenum distal to the entry of the bile duct. It enters the rectus sheath superiorly through its posterior layer and supplies the superior part of the rectus abdominis and anastomoses with the inferior epigastric artery approximately in the umbilical region. The bacteria erode the protective mucous lining of the stomach, inflaming the mucosa and making it vulnerable to the effects of the gastric acid and digestive enzymes (pepsin) produced by the stomach. When intra-abdominal pressure is increased, the uterus is pressed against the bladder. Appendectomy Surgical removal of the appendix (appendectomy) may be performed through a transverse or gridiron (muscle-splitting) incision centered at the McBurney point in the right lower quadrant (see the Clinical Box "Abdominal Surgical Incisions," p.
Inferior to the pectinate line, the anal canal is somatic, supplied by the inferior anal (rectal) nerves containing somatic sensory fibers. The palmar skin presents several more or less constant flexion creases, where the skin is firmly bound to the deep fascia, that help locate palmar wounds and underlying structures. The lateral walls of the contralateral orbits are nearly perpendicular to each other. Of the three pharyngeal constrictor muscles, the inferior muscle overlaps the middle one and the middle one overlaps the superior one. Although branchial cysts may be present in infants and children, they may not enlarge and become visible until early adulthood. These ducts run obliquely through the wall of this part of the duodenum, where they unite, forming a dilation, the hepatopancreatic ampulla. It is specialized for the accumulation of ingested food, which it chemically and mechanically prepares for digestion and passage into the duodenum. Proximally, perforating branches of the anterior tibial artery penetrate the anterior intermuscular septum. An inflammation-related humoral factor is thought to induce repeated endothelial damage and intimal thickening. Aqueous humor is produced in the posterior chamber by the ciliary processes of the ciliary body. Occasionally, gaps exist where these fiber exchanges occur-for example, in the midline or in the transition from aponeurosis to rectus sheath. Lymphatic drainage from the specific pelvic organs is described following the description of the pelvic viscera. The maxillary nerve enters the pterygopalatine fossa, where it gives off branches to the pterygopalatine ganglion and continues anteriorly, entering the orbit through the inferior orbital fissure. The 1st intercostal space is that superior to the 2nd costal cartilage-that is, intercostal spaces are numbered according to the rib forming their superior boundary. The sciatic nerve is so large that it receives a named branch of the inferior gluteal artery, the artery to the sciatic nerve. The domed diaphragmatic surface of the liver conforms to the inferior surface of the diaphragm. The compartments are anterior or extensor, medial or adductor, and posterior or flexor, so named on the basis of their location or action at the knee joint. On the medial aspect of the inferior part of the thigh, the gracilis and sartorius muscles form a well-marked prominence, which is separated by a depression from the large bulge formed by the vastus medialis. In current clinical use, the cystohepatic triangle is defined inferiorly by the cystic duct, medially by the common hepatic duct, and superiorly by the inferior surface of the liver. The inferior (arcuate) pubic ligament is a thick arch of fibers that connects the inferior aspects of the joint components, rounding off the subpubic angle as it forms the apex of the pubic arch. Dorsal and plantar cuneonavicular ligaments Inversion and eversion of loot, circumduction Anterior tibial artery via lateral tarsal artery, a bra. It also carries proprioceptive fibers from the muscles it innervates, although the muscles of facial expression include relatively few muscle spindles (mechanoreceptors for muscle stretch), so proprioceptive sensory fibers are fewer than in other motor nerves (Haines, 2013). In the absence of recent bleeding, a site of previous haemorrhage is often marked by orange-brown discolouration of the pial surface and arachnoid. In quadrupeds, the trunk is suspended between essentially vertical limbs, requiring simultaneous support from each side. The ovaries also develop in the superior lumbar region of the posterior abdominal wall and relocate to the lateral wall of the pelvis. Increased intra-abdominal (and intrathoracic) pressure is also involved in heavy lifting, the resulting force sometimes producing a hernia. Note also the dilation (dolichoectasia) of the internal carotid arteries (arrows). Inferior to the pectinate line, the lymphatic vessels drain superficially into the superficial inguinal lymph nodes, as does most of the perineum. Relaxation of ligaments is not limited to the pelvis, and the possibility of joint dislocation increases during late pregnancy. The epididymis is formed by minute convolutions of the duct of the epididymis, so tightly compacted that they appear solid. The possible presence of this artery must be considered when performing procedures in the midline of the neck inferior to the isthmus, because it is a potential source of bleeding (see the clinical box "Tracheostomy" in this chapter). These fibrous bands are the thickened inferolateral-most portions of the external oblique and aponeurosis and the inferior margin of the transversalis fascia.
Some trumpeters (notably the late Dizzy Gillespie) stretch their buccinators and other cheek muscles so much that their cheeks balloon out when they blow forcibly on their instruments. Because of the rich blood supply of the tonsil, bleeding commonly arises from the large external palatine vein. The temporary inability to breathe due to chest wall compression during a vertex delivery is normal if the umbilical cord is supplying oxygenated blood, as are physiological decelerations in fetal heart rate. The hamstring part of the adductor magnus is supplied by the tibial part of the sciatic nerve (L4). The nasopharynx has a respiratory function; it is the posterior extension of 2318 the nasal cavities. After the pericardial sac is opened anteriorly, a finger can be passed through the transverse pericardial sinus posterior to the ascending aorta and pulmonary trunk. Together, the metatarsus and phalanges make up the anterior half of the foot (forefoot). The same muscles also rotate (advance) the contralateral side of the pelvis forward, concurrent with the swing of its free limb. The lingual nerve is closely related to the medial aspect of the 3rd molar teeth; therefore, caution is taken to avoid injuring this nerve during their extraction. Distal to the superior fibular retinaculum, the common sheath shared by the fibular muscles splits to extend through separate compartments deep to the inferior fibular retinaculum. When there is a lateral cutaneous branch, it supplies the skin of the axilla and may communicate with either the intercostobrachial nerve or the medial cutaneous nerve of the arm. The right and left superior and inferior thyroid arteries anastomose extensively within the gland, ensuring its supply while providing potential collateral circulation between the subclavian and external carotid arteries. Fractures of the greater trochanter and femoral shaft usually result from direct trauma (direct blows sustained by the bone resulting from falls or being hit) and are most common during the more active years. Circumduction of the upper limb requires coordinated movements of the pectoral girdle and glenohumeral joint. The individual adducts the thigh against resistance, and if the adductors are normal, the proximal ends of the gracilis and adductor longus can easily be palpated. Wedge shaped in transverse section, the menisci are firmly attached at their ends to the intercondylar area of the tibia. The incidence of stroke varies greatly according to the age distribution of the population under study. Indirect traumatic injury that displaces the orbital walls is called a blowout fracture of the orbit. Proximally, its tendinous attachment to the lateral aspect of the lateral femoral condyle and its broader attachment to the lateral meniscus occur between the fibrous layer and the synovial membrane of the joint capsule of the knee. Attempts have been made to determine its physiological characteristics at different time intervals after the ischaemic insult. A transverse slice through the bed of the parotid gland demonstrates the relationship of the gland to the surrounding structures. During embryogenesis, the pleural cavities become separated from the pericardial and peritoneal cavities. The ascending colon is narrower than the cecum and is secondarily retroperitoneal along the right side of the posterior abdominal wall. Because the superior half of the tympanic membrane is much more vascular than the inferior half, incisions to release pus from a middle ear abscess (myringotomy), for example, are made postero-inferiorly through the 2208 membrane. Complete sternal cleft is an uncommon anomaly through which the heart may protrude (ectopia cordis). Before the median sacral artery enters the lesser pelvis, it sometimes gives rise to a pair of L5 arteries. The cartilages increase in length through the first 7 and then gradually decrease.
The mesovarium is a 1411 subdivision of a larger mesentery of the uterus, the broad ligament. Lymphatic vessels from the scrotum carry lymph to the superficial inguinal lymph nodes (Table 6. The sagittal and lambdoid sutures meet at the lambda, which can often be felt as a depression in living persons. In these cases, the tibial nerve passes inferior to the piriformis, and the common fibular nerve pierces this muscle or passes superior to it. Other contributors to this important genicular anastomosis are the descending genicular artery, a branch of the femoral artery, superomedially. In sickle cell disease, children with seem to have a greater risk of ischaemic stroke, and adults, intracranial haemorrhage. Masses in the anterior segment of the right upper lobe of two different patients showing invasion of the pleural surface of the lung (A) and of the superior mediastinum (B). Cardiac percussion is performed at the 3rd, 4th, and 5th intercostal spaces from the left anterior axillary line to the right anterior axillary line. The abdominal cavity forms the superior and major part of the abdominopelvic cavity. Renal Transplantation Renal transplantation is the preferred treatment for selected cases of chronic renal failure. Endothelial hyperplasia may be prominent, and sometimes the blood vessel wall is necrotic, whereas the surrounding parenchyma may seem nearly normal. The utricle communicates with the saccule through the utriculosaccular duct, from which the endolymphatic duct arises. The long extensors also pass along and attach to the dorsal aspect of the digits and are thus extensors (elevators) of the toes. The greater trochanter, the most lateral bony point in the gluteal region, may be felt on the lateral aspect of the hip, especially its inferior part. Blood received by the confluence of sinuses is drained by the transverse sinuses, but rarely equally. In the forefoot only, a fourth compartment, the interosseous compartment of the foot, is surrounded by the plantar and dorsal interosseous fascias. Many vascular problems formerly treated with open repair, including aneurysm repair, are now being treated by means of endovascular catheterization procedures. It is a closed space when the eyelids are closed, but opens via an anterior aperture, the palpebral fissure (L. These strong ligaments are directed so that 683 the hand follows the radius during supination. Ventricles of brain: Each cerebral hemisphere includes a lateral ventricle in its core; otherwise, the ventricular system of the brain is an unpaired, median formation that communicates with the subarachnoid space surrounding the brain and spinal cord. The femoral nerve and vessels enter the base of the triangle superiorly and exit from its apex inferiorly. The artery runs anteriorly across the cartilage; then the cavernous part of the artery runs along the carotid grooves on the lateral side of the body of the sphenoid, traversing the cavernous sinus. The cervical pleura is reinforced by a fibrous extension of the endothoracic fascia, the suprapleural membrane (Sibson fascia). Mobile gallbladders are subject to vascular 1197 torsion and infarction (sudden insufficiency of arterial or venous blood supply). General anesthesia renders the mother unconscious; she is unaware of the labor and delivery. If a sinus contains excess fluid, a mass, or a thickened mucosa, the glow is decreased. The largest branch (brachiocephalic trunk) arises from the beginning of the arch, the next artery (left common carotid artery) arises from the superior part of the arch, and the third branch (left subclavian artery) arises from the arch approximately 1 cm distal to the left common carotid. The gracilis joins with two other two-joint muscles from the other two compartments (the sartorius and semitendinosus muscles). The ureters pass on each side of the cervix heading anteriorly toward the bladder. The soleus is thus an antigravity muscle (the predominant plantarflexor for standing and strolling), which contracts antagonistically but cooperatively (alternately) with the dorsiflexor muscles of the leg to maintain 1725 balance. Because an 2353 enlarged thyroid gland (goiter) may itself cause impaired innervation of the larynx by compressing the laryngeal nerves, the vocal folds are examined by laryngoscopy before an operation in this area.
Surface anatomy and effect of body type (bodily habitus) on disposition and shape of stomach. Contraction of the knee extensors is maintained through the heel strike into the loading phase to absorb shock and keep the knee from buckling until it reaches full extension. After ejaculation, the penis gradually returns to a flaccid state (remission), resulting from sympathetic stimulation, which causes constriction of the smooth muscle in the coiled helicine arteries. The thin platysma muscle spreads subcutaneously like a sheet, passes over the clavicles, and is pierced by cutaneous nerves. The serous pericardium is composed mainly of mesothelium, a single layer of flattened cells forming an epithelium that lines both the internal surface of the fibrous pericardium and the external surface of the heart. When a foreign object enters the vestibule of the larynx, the laryngeal muscles go into spasm, tensing the vocal folds. When the knee joint is infected and inflamed, the amount of synovial fluid may increase. The inferior belly of the omohyoid muscle can just barely be seen and palpated as it passes superomedially across the inferior part of the lateral cervical region. A psoas abscess should always be considered when edema occurs in the proximal part of the thigh. The compartments of the femoral sheath are the lateral compartment for the femoral artery. In approximately one-third of pathologically documented cases, however, no underlying vasculopathy has been noted. Astrocytes show 152 Chapter 2 Vascular Disease, Hypoxia and Related Conditions elongated perivascular foot processes. The bronchial arteries supply the supporting tissues of the lungs and visceral pleura. Although the dorsal venous arch drains primarily via the saphenous veins, perforating veins penetrate the deep fascia, forming and continually supplying an anterior tibial vein in the anterior leg. The right hip bone of a 13-year-old demonstrating the Y-shaped triradiate cartilage. At the ankle, the vessels and the deep fibular nerve lie midway between the malleoli and between the tendons of the long dorsiflexors of the toes. The blockage results in a lung or a sector of a lung that is ventilated with air but not perfused 835 with blood. In addition to its many metabolic activities, the liver stores glycogen and secretes bile, a yellowbrown or green fluid that aids in the emulsification of fat. Some inflammatory diseases produce pericardial effusion (passage of fluid from pericardial capillaries into the pericardial cavity, or an accumulation of pus). The ampulla receives and holds an accumulating fecal mass until it is expelled during defecation. The artery supplying the inner part of the retina (central retinal artery) and the choroid, which in turn nourishes the outer nonvascular layer of the retina, are shown. Inferior-Interlobar arteries Inferior phrenic artery Celiac trunk Superior mesenteric artery Segmental arteries: 5-Posterior =-Superior (apical) ~. Orientation drawing showing the adductor canal and the level of the section shown in B. Other reasons for this placement are the availability of major blood vessels and convenient access to the nearby bladder. Some peritoneal folds contain blood vessels and bleed if cut, such as the lateral umbilical folds, which contain the inferior epigastric arteries. The cycle consists of diastole (ventricular relaxation and filling) and systole (ventricular contraction and emptying). Conversely, the ligaments are weaker posteriorly where the medial rotators are abundant, stronger, and more mechanically advantaged. They lie on each side of the vestibule of the vagina, posterolateral to the vaginal orifice and inferior to the perineal membrane; thus, they are in the superficial perineal pouch.
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