Saturday, June 28, 2008

Answer to Quiz - 1

Itai-itai disease

This disease occurs due to cadmium poisoning.

-One of the main effects of this painful cadmium poisoning are very weak and brittle bones.

-Other complications include coughing, anemia, and kidney failure, leading to death.

-Renal Failure resembles Fanconi's Syndrome.

Friday, June 27, 2008

Quiz - 1

This disease in Japanese literally means "Ouch-ouch" . The patients have pathological fractures and their bone may show mixed pattern of osteomalacia and osteoporosis. They have renal failure and it resembles Fanconi's Syndrome. It occurs due to a heavy metal poisoning. What is the disease am i talking about??

Answer will be posted two days later......

Monday, June 16, 2008




- Asending aorta branches

n Right coronary artery

n Left coronary artery

- Arch of aorta:

n Brachiocephalic

--- Right subclavian

--- Right common carotid artery

n Left subclavian artery

n Left common carotid artery

- Descending aorta branches (at chest):

n Lower 9 posterior intercostals (3-11) arteries

n subcostal artery

n Bronchial arteries (right + left)

n Esophageal artery

n Pericardial artery

- Descending aorta branches (at abdomen + pelvis):

n 3 anterior visceral (single)

--- Ciliac artery

--- Superior mesenteric artery

--- Inferior mesenteric artery

n 3 lateral visceral (paired)

--- Renal artery

---- Suprarenal branch

---- Anterior branch (apical, upper, middle, lower branches)

---- Posterior branch

---- Ureteric branches

--- Suprarenal artery

--- Gonadal artery

n 5 lateral abdominal wall (paired)

--- Inferior phrenic artery

---- Phrenic branch

---- Suprarenal branch

--- 4 lumbar arteries

n 3 terminal branches

--- Right common iliac

--- Left common iliac

--- Median sacral artery

Coronary arteries:

- Right Coronary arteries

n Right marginal

--- Sinuatrial nodal branch

--- Right atrial

--- Right clonus branch

--- left atrial

n Posterior interventricular artery

--- Atrioventricular nodal branch

--- Septal branches

- Left coronary arteries

n Circumflex branches

--- left marginal

n Anterior interventricular artery

--- Left conus branch

--- Septal branches

--- Diagonal branch

Subclavian artery branches: (in left, direct from aorta. In right, from brachiocephalic artery)

- First part:

1- Internal thoracic artery

--- (1-6) anterior intercostals arteries

--- pericardiophrenic artery

--- Superior epigastric artery

--- musculophrenic

---- (7-9) anterior intercostals arteries

---- Phrenic branch

2- Vertebral artery

--- Meningeal arteries

--- Anterior + posterior spinal arteries

--- postroinferior cerebellar artery

--- medullary arteries

- Second part

1- Costocervical trunk

--- Intercostals artery

--- Deep cervical artery

2- Superior intercostals artery

--- Posterior intercostals artery of 1st + 2nd IC spaces

3- Deep cervical artery

- Third part

1- Superficial cervical artery

2- Suprasccapular artery

Axillary artery branches: (continuation of subclavian artery, ends as brachial artery)

- First part

1- Highest thoracic artery (superior)

- Second part

1- Thoracoacromial trunk

2- Lateral thoracic artery

- Third part

1- Subscapular artery

2- Anterior circumflex humeral artery

3- Posterior circumflex humeral artery

Brachial artery branches: (continuation of Axillary artery, ends as radial + ulnar arteries)

1- Muscular branches (front of arm)

2- Nutrient artery to humerus

3- Profunda brachii artery

4- Superior ulnar collateral artery

5- Inferior ulnar collateral artery

Radial artery branches: (continuation of brachial ends as deep palmar arch)

1- Muscular branches (front of forearm)

2- Recurrent branch (anastomosis around elbow joint)

3- Superficial palmar branch (to join superficial palmar arch)

4- Dorsal digital arteries

n Arteria radialis indicis (to index)

n Arteria princeps pollicis (to thumb)

5- Deep palmar arch

n Branches to wrist joint

n Branches tp join the digital branches of thr r superficial palmar arch

Ulnar artery branches: (branch of brachial artery, ends as superficial palmar arch)

1- Muscular branches (front of forearm)

2- Anterior ulnar recurrent artery

3- Posterior ulnar recurrent artery

4- Common interosseous

n Anterior interosseous

--- perforating branch

n Posterior interosseous

5- Deep branch (to join deep palmar arch)

6- Superficial palmar arch

n 4 digital arteries

Celiac trunk (arise from aorta at T12)

1- Left gastric artery:

--- Gives few esphogeal branches

2- Splenic artery:

--- Pancreatic branches

--- Left gastroepiploic artery

--- Short gastric arteries

--- Splenic branches

3- Common Hepatic artery:

--- Right gastric artery

--- Gastroduodenal artery:

---- Right gastroepiploic

---- Superior pancreaticoduodenal artery:

---- Posterior branch

---- Anterior branch

--- Left hepatic artery

--- Right hepatic artery:

---- Cystic artery

Superior mesenteric artery branches: (arise from aorta just below celiac artery)

1- Inferior pancreaticoduodenal artery

2- Middle colic artery (gives right + left branches)

3- Right colic artery (gives ascending + descending branches)

4- Ileocolic artery:

n Superior branch

n Inferior branch:

--- Anterior cecal arteries

--- Posterior cecal arteries:

---- appendicular artery

5- Jejuna branches (arcades)

6- Ileal branches (arcades)

Inferior mesenteric artery branches: (arise from aorta before its bifurcation by 3.8 cm)

1- Left colic artery (gives ascending + descending branches)

2- Sigmoid arteries

3- Superior rectal artery

External iliac artery: (branch of common iliac artery)

- deep circumflex iliac artery

- inferior epigastric artery

--- Pubic branch

--- cremastric artery

Internal iliac artery: (branch of common iliac artery)

- Anterior division branches

n Umbilical artery

--- Superior vesical artery

n Obturator artery

n Inferior vesicle artery

--- Artery to vas deference

n Middle rectal artery

n Internal pudendal artery

--- Inferior rectal artery

--- Deep artery of penis

--- Dorsal artery of penis

--- Urethral

--- Perineal

--- Artery to bulb

n Inferior gluteal artery

n Uterine artery

n Vaginal artery

- Posterior division branches:

n Iliolumbar artery (lumbar + iliac branches)

n Lateral sacral arteries

n Superior gluteal artery (superficial + deep branches)

Femoral artery: (continuation of external iliac artery)

- Superficial branches

1- Superficial circumflex iliac artery

2- Superficial epigastric artery

3- Superficial external pudendal artery

- Deep branches

1- Profunda femoris artery

--- Medial femoral circumflex

--- Lateral femoral circumflex

--- The perforating arteries

--- ends as 4th perforating artery

2- Descending genicular artery

Popliteal artery (continuation of femoral artery)

- Muscular branches

- Articular branches

n Superior medial genicular artery

n Superior lateral genicular artery

n Inferior medial genicular artery

n Inferior lateral genicular artery

n Middle genicular artery

- Terminal

n Anterior tibial artery

n Posterior tibial artery

- Sural artery

Anterior tibial artery (anterior compartment of the leg)

- Muscular branches

- Anastomotic branches (around knee, ankle, joints)

- Ends as dorsalis pedis artery:

--- Lateral tarsal artery

--- arcuate artery

--- First dorsal metatarsal artery

Posterior tibial artery (posterior compartment of leg)

1- Peroneal artery

n Muscular branches (to lateral compartment)

n Nutrient arteries to fibula

n Perforating branches

2- Muscular branches (to posterior compartment)

3- Nutrient arteries to tibia

4- Anastomotic branches

5- Medial + lateral planter arteries

Spinal Cord

Elongated and cylindrical part of the central nervous system which is contained in the upper two-third of the vertebral canal.

Integration and association of sensory modalities.

Extent :

Begin as continuation of the medulla oblongata at the level of the upper border of posterior arch of Atlas above (rostral) to first pair of cervical nerve , cuts middle of dens Axis vertebrae and end as a pointed end -conus medularis at the level of L1.

Dimension :
Length - 45cm in male and 42 cm in female
Weight- 30 gm

Enlargements :
Cervical C4-T2
Lumbosacral L1-S3

Part of the spinal cord where a pair of spinal nerves is attached.

Duramater (endosteal + meningeal)
Acachnoid mater

Contents of epidural space
connective tissue
internal vertebral venous plexus

Filum terminale:
Continuation of piamater .
starts from the lower end of spinal cord at level of L1.
Has 2 parts : Filum terminale internum-15cm and filum terminale externum-5cm

Best site for lumbar puncture :
Adult : between L3-L4
Infant: between L4-L5

Protection of spinal cord
Vertebral canal
Hydrostatic pressure of CSF
Filum terminale
Ligamentum denticulatum

Arterial supply of spinal cord.

2 sources
1. Longitudinally oriented vessels
anterior spinal artery
posterior spinal artery

2. segmental spinal arteries derived from:
verterbral artery
deep cervical arteries
posterior intercostal arteries
lumbar arteries

Structure of spinal cord :

Inner core of the Grey matter and outer white matter

Nerve cell groups in :

Anterior grey column
alpha efferent
gamma efferent

Posterior grey column
substantia Gelatinosa
Nucleus proprius
Nucleus dorsalis
Visceral affarent nucleus