surgery 14

8/3/2019 Surgery 14

1/97

Relationship ofRelationship of

AnatomyAnatomywith Surgerywith Surgery

Dr E S J Prabhu Kiran M.D (Hom)

Professor & H.O.D.

Department of Anatomy, FMHMC, Mangalore

8/3/2019 Surgery 14

2/97

1. Introduction

Anatomy

Study of structure of the body

External

Internal

2www.similima.com

8/3/2019 Surgery 14

3/97

Branches of Anatomy

Gross anatomy

Microscopic anatomy

Developmental anatomy

Surface anatomy

Clinical anatomy Radigraphic anatomy

3www.similima.com

8/3/2019 Surgery 14

4/97

To provide the understanding of themorphological, physiological and

psychologicalprincipleswhich determine

and influence the man as a functioning

unit.

To co-relate and interpret the structuralorganism and normal physiology of the human

body and thus toprovide the data in which

disturbances of function are anticipated.

OBJECTIVES

4www.similima.com

8/3/2019 Surgery 14

5/97

To enable the student to recognize the

anatomical basis of the clinical signs and

symptoms of disorders due to injury,

disease and mal-development. Enable the student to understand the factors

involved in the development of

pathological processes and the possible

complications which may arise there from.

OBJECTIVES

5www.similima.com

8/3/2019 Surgery 14

6/97

To impart such knowledge of pre-clinical subjects

which will enable the student to employ (orjudging and recommending in cases of

surgery) competently and rationally all the

common methods of examination andtreatment (including surgery)

To enable the student to find out strange and

uncommon symptoms from pathognomonic

symptoms for individualization of patients anddrugs for the purpose of applying the law of similar

in homoeopathic practice

OBJECTIVES

6www.similima.com

8/3/2019 Surgery 14

7/97

1. Understanding the principles

that determine and influence theman as a functioning unit

8/3/2019 Surgery 14

8/97

MAN

Vital ForceVital Force MindMind

BodyBody

8www.similima.com

8/3/2019 Surgery 14

9/97

BODY

The body is composed of3 basicelements

1. Cells

2. Intercellular substance (Matrix)

And3. Body fluids

9www.similima.com

8/3/2019 Surgery 14

10/97

Cells

Tissue

Organs

Systems

Man10www.similima.com

8/3/2019 Surgery 14

11/97

Basic TissuesBasic Tissues

A group of similar cells specialized toperform a common function form a

tissue

The basic tissues are

Epithelial tissue

Connective tissueMuscular tissue

Nervous tissue11www.similima.com

8/3/2019 Surgery 14

12/97

Epithelial Tissue

Cells are compact form the covering

of all body

surfaces, linebody cavities andhollow organs,and are the

functional part inglands.

They are formed from all the 3 Germ layers

Squamous cells

12www.similima.com

8/3/2019 Surgery 14

13/97

Connective tissue

The types of connective tissue include loose

connective tissue, adipose tissue, dense fibrousconnective tissue, elastic connective tissue,cartilage, osseous tissue (bone), and blood.

Connective tissue is derived from the

Mesoderm 13www.similima.com

8/3/2019 Surgery 14

14/97

Muscle tissue

Muscle tissue is composedof cells that shorten orcontract to producemovement of the

body parts.3 Types -

Skeletal muscle tissue,

Smooth muscle tissue,and Cardiac muscle tissue

Develops from Mesoderm

14www.similima.com

8/3/2019 Surgery 14

15/97

Nervous tissue

It is responsible forcoordinating and

controlling many body

activities.

It stimulates muscle

contraction, creates an

awareness of the

environment, and plays amajor role in emotions,

memory, and reasoning.

15www.similima.com

8/3/2019 Surgery 14

16/97

Nervous tissue:NeuronsNeurons

Neurons generate electrical impulses to

carry out the functions

16www.similima.com

8/3/2019 Surgery 14

17/97

Nervous tissue:

Neuroglia

The neurons are

supported by

Neuroglia, theconnective tissue in

the CNS

Nervous tissue develops from Neuro-ectoderm17www.similima.com

8/3/2019 Surgery 14

18/97

Cells

Tissue

Organs

Systems

Man

18www.similima.com

8/3/2019 Surgery 14

19/97

The

4basic tissues

Organs

Systems

MAN (BODY)19www.similima.com

8/3/2019 Surgery 14

20/97

1. Recognizing the anatomical

basis of the clinical signs

and symptoms of disorders

due to

injury,disease and

mal-development.

8/3/2019 Surgery 14

21/97

INJURIES OF THE BRACHIAL PLEXUS

Anatomical basis of the

clinical signs and symptoms

of disorders due to

InjuryInjury

8/3/2019 Surgery 14

22/97

Brachial Plexus

22www.similima.com

8/3/2019 Surgery 14

23/97

Injuries of the Brachial Plexus

Causes

Trauma

Compression

Malignancy of Breast

23www.similima.com

8/3/2019 Surgery 14

24/97

Forceps delivery

Gun-shot or stab

injuries

Fall from a

height Automobile

accidents

Traumatic causes of brachial plexus

injury

24www.similima.com
http://upload.wikimedia.org/wikipedia/commons/4/46/Car_Accident.jpghttp://upload.wikimedia.org/wikipedia/commons/4/46/Car_Accident.jpg

8/3/2019 Surgery 14

25/97

Total brachial plexus injury

Upper limb is paralyzed with total loss of

sensation

Damage to T1 ventral ramus involvespreganglionic sympathetic fibres for head

and face resulting in Horners syndrome on

the affected side

25www.similima.com

8/3/2019 Surgery 14

26/97

Horners syndrome

Partial ptosis due to paralysis of mullersmuscle

Constriction of pupil due to paralysis ofdilator pupillae

Loss of sweating due to loss of sudomotor

nerve supply Flushing of the face due to loss ofvasomotor supply

26www.similima.com

8/3/2019 Surgery 14

27/97

Erbs palsy

Upper trunk or Erbs palsy in newborn is

due to trauma during a forceps delivery,

during which there may be forcefulseparation of neck and shoulder with

stretching of the upper trunk.

May occur due to accidental trauma

27www.similima.com

8/3/2019 Surgery 14

28/97

Erbs point

Meeting point of 6nervesVentral rami of C5 and

C6, suprascapularnerve and nerve tosubclavius branches ofthe upper trunk and

anterior and posteriordivisions of the uppertrunk

28www.similima.com

8/3/2019 Surgery 14

29/97

Erbs point

The deformity isPolicemans tiphand, in which the

arm is adducted andmedially rotated theforearm is extended

and pronated.

29www.similima.com

8/3/2019 Surgery 14

30/97

Policemans tip hand

Position Paralysis of Over action of

Adduction of arm Supraspinatus &

Deltoid

Adductors of

shoulder joint

Medial rotation of

arm

Teres minor and

infraspinatus

Medial rotators of

shoulder

Extension of fore

arm

Biceps brachii,

Brachialis &Brachioradialis

Extensors of

elbow

Pronation of

forearm

Biceps brachii &

Supinator

Pranators of

forearm30www.similima.com

8/3/2019 Surgery 14

31/97

Causes

Traction on thelower trunk due to a

cervical rib

Forcible hyper-

abduction in a fall

from a height

Malignant

infiltration of thelower trunk

Post-fixed brachial

plexus

Klumpkes Paralysis

31www.similima.com

8/3/2019 Surgery 14

32/97

Klumpkes Paralysis

Deformity

Claw hand: slow

progressive weakness

in interossei and

lumbricals supplied by

C8 & T1 roots via

median and ulnar

nerves

32www.similima.com

8/3/2019 Surgery 14

33/97

Claw hand

Fingers hyper extended atmetacarpophalangeal joints and hyper flexed

at interphalangeal joints due to paralsysis of

interossei and lumbricals. Wrist is hyperextended due to paralysis of

flexors of wrist and over action of extensors.

Pain along the medial side of the arm,forearm and medial one and half fingers

33www.similima.com

Injury to the posterior cord of

8/3/2019 Surgery 14

34/97


brachial plexus

Deficiency Paralysis of Nerve supply

Loss of extension

of shoulder

Posterior fibres of

Deltoid

Axillary nerve

Teres major Subscapular nerve

Latissimus dorsi Thoracodorsal

nerve

Loss of extension

of elbow,wrist and

thumb

Triceps and

extensors of wrist

and thumb

Radial nerve

34www.similima.com


8/3/2019 Surgery 14

35/97


brachial plexus

Deficiency Paralysis of Nerve supply

Loss of abduction

at shoulder beyond

20o

Deltoid Axillary nerve

Weakness of

supination

Supinator Deep branch of

radial nerve

Weakness ofmedial rotation

Subscapularis Subscapular nerve

35www.similima.com

8/3/2019 Surgery 14

36/97

CARPAL TUNNEL SYNDROME


clinical signs and symptomsof disorders due to

Disease

8/3/2019 Surgery 14

37/97

Anatomy of Flexor retinaculum

and Carpal Tunnel Syndrome

37www.similima.com

8/3/2019 Surgery 14

38/97

Carpal Tunnel Syndrome (CTS)

Repetitive stress injury

Due to inflammation of the tissues around the

median nerve

Results in reduced nerve transmission; pain,

numbness, and tingling in wrist, hand, and

fingers (except little finger)

38www.similima.com

8/3/2019 Surgery 14

39/97

Causes of CTS

Work-related

Repetition

High force

Awkward joint

posture

Direct pressure

Vibration

Prolongedconstrained posture

Medically-related

Fractures

Arthritis

Diabetes

Obesity

Acromegaly

Long term

hemodialysisPregnancy

39www.similima.com

8/3/2019 Surgery 14

40/97

Symptoms

Pain in wrist and hand

Numbness and tingling

in fingers Weakened grip

Feeling of swelling in

hand Worsened pain at nightwith rest

40www.similima.com

8/3/2019 Surgery 14

41/97

Diagnosis

Medical HistoryJob

SymptomsMedical conditions

Physical Exam

Tinels sign (tapping median nerve)Phalens test (compression of nerve)

Muscle strength (thenar strength)

41www.similima.com

8/3/2019 Surgery 14

42/97

FALLOTS TETROLOGY


clinical signs and symptoms

of disorders due to

Mal-DevelopmentMal-Development

8/3/2019 Surgery 14

43/97

Anatomical basis of theclinical signs and symptoms

of disorders due to

Mal-DevelopmentMal-Development

Congenital defects of Heart

8/3/2019 Surgery 14

44/97

1. Abnormal position

2. Atresia or Stenosis of the orifices

3. Defective formation of septa

4. Combined defects5. Abnormal relationship of the

chambers to the great vessels

44www.similima.com

8/3/2019 Surgery 14

45/97

1. Abnormalities of position

Dextrocardia

Ectopia cordis

45www.similima.com

8/3/2019 Surgery 14

46/97

Dextrocardia

The Chambers and

blood vessels of theheart are reversed

from side to side

Situs inversus totalis46www.similima.com

8/3/2019 Surgery 14

47/97

1. Atresia or Stenosis

In pulmonary stenosis the foramen ovale

and the ductus arteriosus remain patent

In aortic stenosis the ductus arteriosusremains patent

47www.similima.com

8/3/2019 Surgery 14

48/97

48www.similima.com

8/3/2019 Surgery 14

49/97

49www.similima.com

8/3/2019 Surgery 14

50/97

50www.similima.com

8/3/2019 Surgery 14

51/97

51www.similima.com

8/3/2019 Surgery 14

52/97

52www.similima.com

8/3/2019 Surgery 14

53/97

1. Defective formation of septa

Interatrial septal defects

Interventricular septal defects

Defects of spiral septum

AV canal defect

53www.similima.com


8/3/2019 Surgery 14

54/97


Osteum Primum defect

54www.similima.com


8/3/2019 Surgery 14

55/97


Osteum Secundum defect

55www.similima.com

8/3/2019 Surgery 14

56/97

8/3/2019 Surgery 14

57/97


Patent foramen ovale

57www.similima.com

8/3/2019 Surgery 14

58/97



58www.similima.com

8/3/2019 Surgery 14

59/97



59www.similima.com

8/3/2019 Surgery 14

60/97



60www.similima.com

I t t i l t l d f t

8/3/2019 Surgery 14

61/97

Interventricular septal defects

61www.similima.com

d iDefect of spiral septum

8/3/2019 Surgery 14

62/97

Patent ductus arteriosus

62www.similima.com

8/3/2019 Surgery 14

63/97

Patent ductus arteriosus

Defect of spiral septum

63www.similima.com

1 Combined defects:

8/3/2019 Surgery 14

64/97

1. Combined defects:

Fallots Tetralogy

Interventricular septal

defect

Overriding of Aorta

Pulmonary stenosis

Hypertrophy of the

right ventricle

64www.similima.com

8/3/2019 Surgery 14

65/97

Tetralogy of Fallot

65www.similima.com

8/3/2019 Surgery 14

66/97

66www.similima.com

8/3/2019 Surgery 14

67/97

67www.similima.com

8/3/2019 Surgery 14

68/97

1. Abnormal relationship

of chambers to great vessels Transpositions of great vessels

Taussig-Bing syndrome

68www.similima.com

8/3/2019 Surgery 14

69/97

69www.similima.com

8/3/2019 Surgery 14

70/97

Transposition of the great vessels

70www.similima.com

8/3/2019 Surgery 14

71/97

1. Enable the student to

understand the factors

involved in the development

of pathological processesand the possible

complications which mayarise there from

8/3/2019 Surgery 14

72/97

Normal Liver

72www.similima.com

8/3/2019 Surgery 14

73/97

Anatomy

1.5 kg, wedge shape

4 lobes, Right, left,

Caudate, Quadrate. Double blood supply

Hepatic arteries

Portal Venous blood

Acini / Portal triad.

Lobules central. V

73www.similima.com

8/3/2019 Surgery 14

74/97

74www.similima.com

8/3/2019 Surgery 14

75/97

Normal Liver - Microscopy

75www.similima.com

Acute viral Hepatitis:

8/3/2019 Surgery 14

76/97


76www.similima.com


8/3/2019 Surgery 14

77/97


77www.similima.com

Acute viral Hepatitis C:

8/3/2019 Surgery 14

78/97

Acute viral Hepatitis C:

78www.similima.com

8/3/2019 Surgery 14

79/97

Liver Cirrhosis

79www.similima.com

8/3/2019 Surgery 14

80/97

Steatosis in Alcoholism

80www.similima.com

8/3/2019 Surgery 14

81/97

81www.similima.com

8/3/2019 Surgery 14

82/97

Clinical signsof

Liver Failure

82www.similima.com

8/3/2019 Surgery 14

83/97

83www.similima.com

8/3/2019 Surgery 14

84/97

84www.similima.com

8/3/2019 Surgery 14

85/97

85www.similima.com

Portal veinSites of Porta-

8/3/2019 Surgery 14

86/97

Portal veinCaval

anastomosis

86www.similima.com

8/3/2019 Surgery 14

87/97

87www.similima.com

8/3/2019 Surgery 14

88/97

88www.similima.com

Stomach - structure

8/3/2019 Surgery 14

89/97

Stomach structure

89www.similima.com

G t i l

8/3/2019 Surgery 14

90/97

Gastric ulcer

90www.similima.com

8/3/2019 Surgery 14

91/97

91www.similima.com

8/3/2019 Surgery 14

92/97

92www.similima.com

1 To impart such knowledge of

8/3/2019 Surgery 14

93/97

1. To impart such knowledge of

pre-clinical subjects which will

enable the student to employ

(or judging and recommending

in cases of surgery)competently and rationally all

the common methods ofexamination and treatment

(including surgery)

S i l j i t

8/3/2019 Surgery 14

94/97

Synovial joint

94www.similima.com

Pathological changes in Rheumatoid

8/3/2019 Surgery 14

95/97

g g

arthritis

95www.similima.com

8/3/2019 Surgery 14

96/97

96www.similima.com

8/3/2019 Surgery 14

97/97

surgery 14

Documents