Relationship of Anatomy with Surgery

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Relationship of Anatomy with Surgery

• Dr E S J Prabhu Kiran M.D (Hom)
• Professor H.O.D.
• Department of Anatomy, FMHMC, Mangalore

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Introduction

• Anatomy
• Study of structure of the body
• External
• Internal

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Branches of Anatomy

• Gross anatomy
• Microscopic anatomy
• Developmental anatomy
• Surface anatomy
• Clinical anatomy
• Radigraphic anatomy

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OBJECTIVES

• To provide the understanding of the
  morphological, physiological and psychological
  principles which determine and influence the man
  as a functioning unit.
• To co-relate and interpret the structural
  organism and normal physiology of the human body
  and thus to provide the data in which
  disturbances of function are anticipated.

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OBJECTIVES

• 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.

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OBJECTIVES

• 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
  of examination and treatment (including surgery)
• To enable the student to find out strange and
  uncommon symptoms from pathognomonic symptoms for
  individualization of patients and drugs for the
  purpose of applying the law of similar in
  homoeopathic practice

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Understanding the principles that determine and
influence the man as a functioning unit
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MAN

• Vital Force
• Mind
• Body

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BODY

• The body is composed of 3 basic elements
• Cells
• Intercellular substance (Matrix) And
• Body fluids

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Basic Tissues

• A group of similar cells specialized to perform
  a common function form a tissue
• The basic tissues are
• Epithelial tissue
• Connective tissue
• Muscular tissue
• Nervous tissue

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Epithelial Tissue

• Cells are compact
• form the covering of all body surfaces, line body
  cavities and hollow organs, and are the
  functional part in glands.

Squamous cells
They are formed from all the 3 Germ layers
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Connective tissue

• The types of connective tissue include loose
  connective tissue, adipose tissue, dense fibrous
  connective tissue, elastic connective tissue,
  cartilage, osseous tissue (bone), and blood.
• Connective tissue is derived from the Mesoderm

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Muscle tissue

• Muscle tissue is composed of cells that shorten
  or contract to produce movement of the
• body parts.
• 3 Types -
• Skeletal muscle tissue, Smooth muscle tissue,
  and Cardiac muscle tissue
• Develops from Mesoderm

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Nervous tissue

• It is responsible for coordinating and
  controlling many body activities.
• It stimulates muscle contraction, creates an
  awareness of the environment, and plays a major
  role in emotions, memory, and reasoning.

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Nervous tissue Neurons

• Neurons generate electrical impulses to carry
  out the functions

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Nervous tissue Neuroglia

• The neurons are supported by Neuroglia, the
  connective tissue in the CNS

Nervous tissue develops from Neuro-ectoderm
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• The 4 basic tissues
• Organs
• Systems
• MAN (BODY)

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Recognizing the anatomical basis of the clinical
signs and symptoms of disorders due to injury,
disease and mal-development.
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Anatomical basis of the clinical signs and
symptoms of disorders due to Injury

• INJURIES OF THE BRACHIAL PLEXUS

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Brachial Plexus
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Injuries of the Brachial Plexus

• Causes
• Trauma
• Compression
• Malignancy of Breast

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Traumatic causes of brachial plexus injury

• Forceps delivery
• Gun-shot or stab injuries
• Fall from a height
• Automobile accidents

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Total brachial plexus injury

• Upper limb is paralyzed with total loss of
  sensation
• Damage to T1 ventral ramus involves preganglionic
  sympathetic fibres for head and face resulting in
  Horners syndrome on the affected side

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Horners syndrome

• Partial ptosis due to paralysis of mullers
  muscle
• Constriction of pupil due to paralysis of
  dilator pupillae
• Loss of sweating due to loss of sudomotor nerve
  supply
• Flushing of the face due to loss of vasomotor
  supply

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Erbs palsy

• Upper trunk or Erbs palsy in newborn is due to
  trauma during a forceps delivery, during which
  there may be forceful separation of neck and
  shoulder with stretching of the upper trunk.
• May occur due to accidental trauma

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Erbs point

• Meeting point of 6 nerves
• Ventral rami of C5 and C6, suprascapular nerve
  and nerve to subclavius branches of the upper
  trunk and anterior and posterior divisions of the
  upper trunk

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Erbs point

• The deformity is Policemans tip hand, in which
  the arm is adducted and medially rotated the
  forearm is extended and pronated.

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Policemans tip hand
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Klumpkes Paralysis

• Causes
• Traction on the lower trunk due to a cervical rib
• Forcible hyper-abduction in a fall from a height
• Malignant infiltration of the lower trunk
• Post-fixed brachial plexus

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Klumpkes Paralysis

• Deformity
• Claw hand slow progressive weakness in
  interossei and lumbricals supplied by C8 T1
  roots via median and ulnar nerves

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Claw hand

• Fingers hyper extended at metacarpophalangeal
  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

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Injury to the posterior cord of brachial plexus
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Injury to the posterior cord of brachial plexus
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Anatomical basis of the clinical signs and
symptoms of disorders due to Disease

• CARPAL TUNNEL SYNDROME

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Anatomy of Flexor retinaculum and Carpal Tunnel
Syndrome
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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)

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Causes of CTS

• Medically-related
• Fractures
• Arthritis
• Diabetes
• Obesity
• Acromegaly
• Long term hemodialysis
• Pregnancy

• Work-related
• Repetition
• High force
• Awkward joint posture
• Direct pressure
• Vibration
• Prolonged constrained posture

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Symptoms

• Pain in wrist and hand
• Numbness and tingling in fingers
• Weakened grip
• Feeling of swelling in hand
• Worsened pain at night with rest

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Diagnosis

• Medical History
• Job
• Symptoms
• Medical conditions
• Physical Exam
• Tinels sign (tapping median nerve)
• Phalens test (compression of nerve)
• Muscle strength (thenar strength)

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Anatomical basis of the clinical signs and
symptoms of disorders due to Mal-Development

• FALLOTS TETROLOGY

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Anatomical basis of the clinical signs and
symptoms of disorders due to Mal-Development

• Congenital defects of Heart

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• Abnormal position
• Atresia or Stenosis of the orifices
• Defective formation of septa
• Combined defects
• Abnormal relationship of the chambers to the
  great vessels

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Abnormalities of position

• Dextrocardia
• Ectopia cordis

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Dextrocardia

• The Chambers and blood vessels of the heart are
  reversed from side to side
• Situs inversus totalis

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Atresia or Stenosis

• In pulmonary stenosis the foramen ovale and the
  ductus arteriosus remain patent
• In aortic stenosis the ductus arteriosus remains
  patent

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Defective formation of septa

• Interatrial septal defects
• Interventricular septal defects
• Defects of spiral septum
• AV canal defect

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Interatrial septal defectsOsteum Primum defect
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Interatrial septal defectsOsteum Secundum defect
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Interatrial septal defectsSinus venosus septal
defect
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Interatrial septal defectsPatent foramen ovale
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Interatrial septal defectsPatent foramen ovale
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Interatrial septal defectsPatent foramen ovale
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Interatrial septal defectsPatent foramen ovale
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Interventricular septal defects
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Patent ductus arteriosus

• Defect of spiral septum

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Patent ductus arteriosus

• Defect of spiral septum

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Combined defects Fallots Tetralogy

• Interventricular septal defect
• Overriding of Aorta
• Pulmonary stenosis
• Hypertrophy of the right ventricle

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Tetralogy of Fallot
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Abnormal relationship of chambers to great
vessels

• Transpositions of great vessels
• Taussig-Bing syndrome

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Transposition of the great vessels
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Enable the student to understand the factors
involved in the development of pathological
processes and the possible complications which
may arise there from
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Normal Liver
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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

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Normal Liver - Microscopy
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Acute viral Hepatitis
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Acute viral Hepatitis
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Acute viral Hepatitis C
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Liver Cirrhosis
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Steatosis in Alcoholism
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Clinical signs of Liver Failure
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Portal vein
Sites of Porta-Caval anastomosis
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Stomach - structure
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Gastric ulcer
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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
of examination and treatment (including surgery)
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Synovial joint
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Pathological changes in Rheumatoid arthritis
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