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(BQ) Part 2 book Human anatomy presents the following contents: The nervous system - the spinal cord and spinal nerves, the nervous system - the brain and cranial nerves, the nervous system - autonomic nervous system, the nervous system - general and special senses, the endocrine system, the respiratory system, the lymphoid system,...
The Nervous System The Spinal Cord and Spinal Nerves Student Learning Outcomes After completing this chapter, you should be able to the following: Discuss the structure and functions of the spinal cord Locate the spinal meninges, describe their structure, and compare and contrast their functions Discuss the structure and location of gray matter and white matter, and compare and contrast the roles of both in processing and relaying sensory and motor information Identify the regional groups of spinal nerves Discuss the connective tissue layers associated with a spinal nerve Describe the various branches of a representative spinal nerve Define dermatomes and explain their significance Define nerve plexus and compare and contrast the anatomical organization of the four main spinal nerve plexuses Identify the spinal nerves originating at the four major nerve plexuses, list their major branches, and analyze their primary functions 10 Describe the structures and steps involved in a neural reflex, classify reflexes, and differentiate among their structural components 11 Explain the types of motor responses produced by spinal reflexes 368 Introduction 368 Gross Anatomy of the Spinal Cord 368 Spinal Meninges 373 Sectional Anatomy of the Spinal Cord 375 Spinal Nerves 386 Reflexes 368 The Nervous System THE CENTRAL NERVOUS SYSTEM (CNS) CONSISTS of the spinal cord and brain Despite the fact that the two are anatomically connected, the spinal cord and brain show significant degrees of functional independence The spinal cord is far more than just a highway for information traveling to or from the brain Although most sensory data is relayed to the brain, the spinal cord also integrates and processes information on its own This chapter describes the anatomy of the spinal cord and examines the integrative activities that occur in this portion of the CNS Gross Anatomy of the Spinal Cord [Figures 14.1 to 14.3] The adult spinal cord (Figure 14.1a) measures approximately 45 cm (18 in.) in length and extends from the foramen magnum of the skull to the inferior border of the first lumbar vertebra (L1) The dorsal surface of the spinal cord bears a shallow longitudinal groove, the posterior median sulcus The deep crease along the ventral surface is the anterior median fissure (Figure 14.1d) Each region of the spinal cord (cervical, thoracic, lumbar, and sacral) contains tracts involved with that particular segment and those associated with it Figure 14.1d provides a series of sectional views that demonstrate the variations in the relative mass of gray matter versus white matter along the length of the spinal cord The amount of gray matter is increased substantially in segments of the spinal cord concerned with the sensory and motor innervation of the limbs These areas contain interneurons responsible for relaying arriving sensory information and coordinating the activities of the somatic motor neurons that control the complex muscles of the limbs These areas of the spinal cord are expanded to form the enlargements of the spinal cord seen in Figure 14.1a The cervical enlargement supplies nerves to the pectoral girdle and upper limbs; the lumbosacral enlargement provides innervation to structures of the pelvis and lower limbs Inferior to the lumbosacral enlargement, the spinal cord tapers to a conical tip called the conus medullaris, at or inferior to the level of the first lumbar vertebra A slender strand of fibrous tissue, the filum terminale (“terminal thread”), extends from the inferior tip of the conus medullaris along the length of the vertebral canal as far as the dorsum of the coccyx (Figure 14.1a,c) There it provides longitudinal support to the spinal cord as a component of the coccygeal ligament The entire spinal cord can be divided into 31 segments Each segment is identified by a letter and number designation For example, C3 is the third cervical segment (Figures 14.1a and 14.3) Every spinal segment is associated with a pair of dorsal root ganglia that contain the cell bodies of sensory neurons These sensory ganglia lie between the pedicles of adjacent vertebrae ∞ pp 167–168 On either side of the spinal cord, a typical dorsal root contains the axons of the sensory neurons in the dorsal root ganglion (Figure 14.1b,c) Anterior to the dorsal root, a ventral root leaves the spinal cord The ventral root contains the axons of somatic motor neurons and, at some levels, visceral motor neurons that control peripheral effectors The dorsal and ventral roots of each segment enter and leave the vertebral canal between adjacent vertebrae at the intervertebral foramina ∞ p 168 The dorsal roots are usually thicker than the ventral roots Distal to each dorsal root ganglion, the sensory and motor fibers form a single spinal nerve (Figures 14.1d, 14.2c, and 14.3) Spinal nerves are classified as mixed nerves because they contain both afferent (sensory) and efferent (motor) fibers Figure 14.3 shows the spinal nerves as they emerge from intervertebral foramina The spinal cord continues to enlarge and elongate until an individual is approximately years old Up to that time, enlargement of the spinal cord keeps pace with the growth of the vertebral column, and the segments of the spinal cord are aligned with the corresponding vertebrae The ventral and dorsal roots are short, and leave the vertebral canal through the adjacent intervertebral foramina After age the vertebral column continues to grow, but the spinal cord does not This vertebral growth carries the dorsal root ganglia and spinal nerves farther and farther away from their original position relative to the spinal cord As a result, the dorsal and ventral roots gradually elongate The adult spinal cord extends only to the level of the first or second lumbar vertebra; thus spinal cord segment S2 lies at the level of vertebra L1 (Figure 14.1a) When seen in gross dissection, the filum terminale and the long ventral and dorsal roots that extend caudal to the conus medullaris reminded early anatomists of a horse’s tail With this in mind the complex was called the cauda equina (KAW-da ek-WI-na; cauda, tail ϩ equus, horse) (Figure 14.1a,c) Spinal Meninges [Figures 14.1b,c • 14.2 • 14.3] The vertebral column and its surrounding ligaments, tendons, and muscles isolate the spinal cord from the external environment ∞ p 221 The delicate neural tissues also must be protected against damaging contacts with the surrounding bony walls of the vertebral canal Specialized membranes, collectively known as the spinal meninges (men-IN-jez), provide protection, physical stability, and shock absorption (Figure 14.1b,c) The spinal meninges cover the spinal cord and surround the spinal nerve roots (Figure 14.2) Blood vessels branching within these layers also deliver oxygen and nutrients to the spinal cord There are three meningeal layers: the dura mater, the arachnoid mater, and the pia mater At the foramen magnum of the skull, the spinal meninges are continuous with the cranial meninges that surround the brain (The cranial meninges, which have the same three layers, will be described in Chapter 16.) The Dura Mater [Figures 14.1b,c • 14.2] The tough, fibrous dura mater (DOO-ra MA-ter; dura, hard ϩ mater, mother) forms the outermost covering of the spinal cord and brain (Figure 14.1b,c) The dura mater of the spinal cord consists of a layer of dense irregular connective tissue whose outer and inner surfaces are covered by a simple squamous epithelium The outer epithelium is not bound to the bony walls of the vertebral canal, and the intervening epidural space contains areolar tissue, blood vessels, and adipose tissue (Figure 14.2b,d) Localized attachments of the dura mater to the edge of the foramen magnum of the skull, the second and third cervical vertebrae, the sacrum, and to the posterior longitudinal ligament serve to stabilize the spinal cord within the vertebral canal Caudally, the spinal dura mater tapers from a sheath to a dense cord of collagen fibers that ultimately blend with components of the filum terminale to form the coccygeal ligament The coccygeal ligament extends along the sacral canal and is interwoven into the periosteum of the sacrum and coccyx The cranial and sacral attachments provide longitudinal stability Lateral support is provided by the connective tissues within the epidural space and by the extensions of the dura mater that accompany the spinal nerve roots as they pass through the intervertebral foramina Distally, the connective tissue of the spinal dura mater is continuous with the connective tissue sheath that surrounds each spinal nerve (Figure 14.2a,c,d) Chapter 14 • The Nervous System: The Spinal Cord and Spinal Nerves Figure 14.1 Gross Anatomy of the Spinal Cord The spinal cord extends inferiorly from the base of the brain along the vertebral canal Posterior median sulcus Dorsal root Dorsal root ganglion Cervical spinal cord Rootlets of C8 Cervical spinal nerves Dorsal root ganglion of C8 Dura mater Dorsal root ganglia of T4 and T5 C1 C2 C3 C4 C5 C6 C7 C8 T1 T2 T3 T4 T5 T6 White matter Gray matter Central canal Cervical enlargement Spinal nerve Ventral root Anterior median fissure C3 T7 Thoracic spinal nerves T8 T9 Posterior median sulcus T10 b Posterior view of a dissection T11 of the cervical spinal cord Lumbosacral enlargement T3 T12 L1 Conus medullaris of spinal cord Cauda equina Dura mater Conus medullaris L2 Lumbar spinal nerves L3 L4 Inferior tip of spinal cord Cauda equina L5 Dorsal root ganglia of L2 and L3 Sacral spinal nerves 1st sacral nerve root Sacrum (cut) Filum terminale c Posterior view of a dissection of the conus medullaris, cauda equina, filum terminale, and associated spinal nerve root L1 S1 S2 S3 S4 S5 Coccygeal nerve (Co1) Filum terminale (in coccygeal ligament) S2 d Inferior views of cross sections a Superficial anatomy and orientation of the adult spinal cord The numbers to the left identify the spinal nerves and indicate where the nerve roots leave the vertebral canal The spinal cord, however, extends from the brain only to the level of vertebrae L1–L2 through representative segments of the spinal cord showing the arrangement of gray and white matter 369 370 The Nervous System Figure 14.2 The Spinal Cord and Spinal Meninges Spinal cord Anterior median fissure Gray matter White matter Ventral root Pia mater Spinal nerve Dorsal root Dorsal root ganglion Pia mater Denticulate ligaments Arachnoid mater Dura mater Arachnoid mater (reflected) Dura mater (reflected) Spinal blood vessel Dorsal root of sixth cervical nerve c Ventral root of sixth cervical nerve Posterior view of the spinal cord showing the meningeal layers, superficial landmarks, and distribution of gray and white matter a Anterior view of spinal cord showing meninges and spinal nerves For this Dura mater view, the dura and arachnoid membranes have been cut longitudinally and retracted (pulled aside); notice the blood vessels that run in the subarachnoid space, bound to the outer surface of the delicate pia mater Arachnoid mater ANTERIOR Subarachnoid space Vertebral body Autonomic (sympathetic) ganglion Spinal cord Pia mater Ventral root of spinal nerve Rami communicantes Ventra ramus Filum terminale L5 vertebra Subarachnoid space containing cerebrospinal fluid and spinal nerve roots Terminal portion of filum terminale S2 vertebra b An MRI scan of the inferior portion of the spinal cord showing its relationship to the vertebral column Dorsal ramus Spinal cord Adipose tissue in epidural space Denticulate ligament Dorsal root ganglion POSTERIOR d Sectional view through the spinal cord and meninges showing the peripheral distribution of the spinal nerves Chapter 14 • The Nervous System: The Spinal Cord and Spinal Nerves Figure 14.3 Posterior View of Vertebral Column and Spinal Nerves Occipital bone Spinal cord emerging from foramen magnum Cervical plexus (C1–C5) Cervical spinal nerves (C1–C8) Brachial plexus (C5–T1) Sacral plexus (L4–S4) Coccygeal nerves (Co1) In most anatomical and histological preparations, a narrow subdural space separates the dura mater from deeper meningeal layers It is likely, however, that in life no such space exists, and the inner surface of the dura is in contact with the outer surface of the arachnoid (a-RAK-noyd; arachne, spider) mater (Figure 14.2a,c,d) The arachnoid mater, the middle meningeal layer, consists of a simple squamous epithelium It is separated from the innermost layer, the pia mater, by the subarachnoid space This space contains cerebrospinal fluid (CSF) that acts as a shock absorber as well as a diffusion medium for dissolved gases, nutrients, chemical messengers, and waste products The cerebrospinal fluid flows through a meshwork of collagen and elastin fibers produced by modified fibroblasts Bundles of fibers, known as arachnoid trabeculae, extend from the inner surface of the arachnoid mater to the outer surface of the pia mater The subarachnoid space and the role of cerebrospinal fluid will be discussed in Chapter 16 The subarachnoid space of the spinal meninges can be accessed easily between L3 and L4 (Figure 14.2 and Clinical Note on p 372) for the clinical examination of cerebrospinal fluid or for the administration of anesthetics The Pia Mater [Figure 14.2] Thoracic spinal nerves (T1–T12) Lumbar spinal nerves (L1–L5) The Arachnoid Mater [Figures 14.2a,c,d • 14.3] Lumbar plexus (T12–L4) The subarachnoid space bridges the gap between the arachnoid epithelium and the innermost meningeal layer, the pia mater (pia, delicate ϩ mater, mother) as seen in Figure 14.2a,c,d The elastic and collagen fibers of the pia mater are interwoven with those of the arachnoid trabeculae The blood vessels supplying the spinal cord are found here The pia mater is firmly bound to the underlying neural tissue, conforming to its bulges and fissures The surface of the spinal cord consists of a thin layer of astrocytes, and cytoplasmic extensions of these glial cells lock the collagen fibers of the spinal pia mater in place Along the length of the spinal cord, paired denticulate ligaments are extensions of the spinal pia mater that connect the pia mater and spinal arachnoid mater to the dura mater (Figure 14.2a,d) These ligaments originate along either side of the spinal cord, between the ventral and dorsal roots They begin at the foramen magnum of the skull, and collectively they help prevent side-to-side movement and inferior movement of the spinal cord The connective tissue fibers of the spinal pia mater continue from the inferior tip of the conus medullaris as the filum terminale As noted earlier, the filum terminale blends into the coccygeal ligament; this arrangement prevents superior movement of the spinal cord The spinal meninges surround the dorsal and ventral roots within the intervertebral foramina As seen in Figure 14.2c,d, the meningeal membranes are continuous with the connective tissues surrounding the spinal nerves and their peripheral branches Concept Check Sciatic nerve Sacral spinal nerves (S1–S5) emerging from sacral foramina See the blue ANSWERS tab at the back of the book Damage to which root of a spinal nerve would interfere with motor function? Identify the location of the cerebrospinal fluid that surrounds the spinal cord What are the two spinal enlargements? Why are these regions of the spinal cord increased in diameter? What is found within a dorsal root ganglion? 371 372 The Nervous System C L I N I C A L N OT E Spinal Taps and Spinal Anesthesia TISSUE SAMPLES, OR BIOPSIES, are taken from many organs to assist in diagnosis Samples are seldom removed from nervous tissue because any extracted or damaged neurons will not be replaced Instead, small volumes of cerebrospinal fluid (CSF) are collected and analyzed CSF is intimately associated with the neural tissue of the CNS, and pathogens, cell debris, and metabolic wastes in the CNS are detectable in the CSF The withdrawal of cerebrospinal fluid, known as a spinal tap, must be done with care to avoid injuring the spinal cord The adult spinal cord extends only as far as vertebra L1 or L2 Between vertebra L2 and the sacrum, the meningeal layers remain intact, but they enclose only the relatively sturdy components of the cauda equina and a significant quantity of CSF With the vertebral column flexed, a needle can be inserted between the lower lumbar vertebrae and into the subarachnoid space with minimal risk to the cauda equina In this procedure, known as a lumbar puncture (LP), 3–9 ml of fluid are taken from the subarachnoid space between vertebrae L3 and L4 Spinal taps are performed when CNS infection is suspected or when diagnosing severe headaches, disc problems, some types of strokes, and other altered mental states Spinal Taps Dura mater Epidural space Body of third lumbar vertebra Interspinous ligament Lumbar puncture needle Cauda equina in subarachnoid space Filum terminale The position of the lumbar puncture needle is in the subarachnoid space, near the nerves of the cauda equina The needle has been inserted in the midline between the third and fourth lumbar vertebral spines, pointing at a superior angle toward the umbilicus Once the needle correctly punctures the dura and enters the subarachnoid space, a sample of CSF may be obtained Anesthetics can be used to control the functioning of spinal nerves in specific locations Injecting a local anesthetic around a spinal nerve produces a temporary blockage of sensory and motor nerve function This procedure can be done peripherally, as when skin lacerations are sewn up, or at sites around the spinal cord to obtain more widespread anesthetic effects An epidural block—the injection of an anesthetic into the epidural space of the spinal cord—has the advantage of (1) affecting only the spinal nerves in the immediate area of the injection, and (2) providing mainly sensory anesthesia If a catheter is left in place, continued injection allows sustained anesthesia Epidural anesthesia can be difficult to achieve in the upper cervical and midthoracic regions, where the epidural space is extremely narrow It is more effective in the lower lumbar region, inferior to the conus medullaris, because the epidural space is somewhat broader Chapter 14 • The Nervous System: The Spinal Cord and Spinal Nerves Sectional Anatomy of the Spinal Cord [Figure 14.4] The anterior median fissure and the posterior median sulcus are longitudinal landmarks that follow the division between the left and right sides of the spinal cord (Figure 14.4) There is a central, H-shaped mass of gray matter, dominated by the cell bodies of neurons and glial cells The gray matter surrounds the narrow central canal, which is located in the horizontal bar of the H The projections of gray matter toward the outer surface of the spinal cord are called horns (Figure 14.4a,b) The peripherally situated white matter contains large numbers of myelinated and unmyelinated axons organized in tracts and columns ∞ pp 348, 351 direction Small commissural tracts carry sensory or motor signals between segments of the spinal cord; other, larger tracts connect the spinal cord with the brain Ascending tracts carry sensory information toward the brain, and descending tracts convey motor commands into the spinal cord Within each column, the tracts are segregated according to the destination of the motor information or the source of the sensory information being carried As a result, the tracts show a regional organization comparable to that found in the nuclei of the gray matter (Figure 14.4b,c) The identities of the major CNS tracts will be discussed when we consider sensory and motor pathways in Chapter 15 C L I N I C A L N OT E Organization of Gray Matter [Figure 14.4b,c] The cell bodies of neurons in the gray matter of the spinal cord are organized into groups, called nuclei, with specific functions Sensory nuclei receive and relay sensory information from peripheral receptors, such as touch receptors located in the skin Motor nuclei issue motor commands to peripheral effectors, such as skeletal muscles (Figure 14.4b) Sensory and motor nuclei may extend for a considerable distance along the length of the spinal cord A frontal section along the axis of the central canal separates the sensory (dorsal) nuclei from the motor (ventral) nuclei The posterior (dorsal) gray horns contain somatic and visceral sensory nuclei, whereas the anterior (ventral) gray horns contain neurons concerned with somatic motor control Lateral gray horns (intermediate horns), found between segments T1 and L2, contain visceral motor neurons The gray commissures (commissura, a joining together) contain axons crossing from one side of the cord to the other before reaching a destination within the gray matter (Figure 14.4b) There are two gray commissures, one posterior to and one anterior to the central canal Figure 14.4b shows the relationship between the function of a particular nucleus (sensory or motor) and its relative position within the gray matter of the spinal cord Sensory nuclei are arranged within the white matter such that fibers entering the spinal cord more inferiorly (such as from the leg or hip) are located more medially than fibers entering at a higher level (trunk or arm) The nuclei within each gray horn are also highly organized Motor nuclei are organized such that nerves innervating skeletal muscles of more proximal structures (such as the trunk and shoulder) would be located more medially within the gray matter than nuclei innervating the skeletal muscles of more distal structures (forearm and hand) Figure 14.4b,c illustrates the distribution of somatic motor nuclei in the anterior gray horns of the cervical enlargement The size of the anterior horns varies with the number of skeletal muscles innervated by that segment Thus, the anterior horns are largest in cervical and lumbar regions, which control the muscles associated with the limbs Organization of White Matter [Figure 14.4] The white matter can be divided into regions, or columns (also termed funiculi, singular, funiculus) (Figure 14.4c) The posterior white columns are sandwiched between the posterior gray horns and the posterior median sulcus The anterior white columns lie between the anterior gray horns and the anterior median fissure; they are interconnected by the anterior white commissure The white matter on either side between the anterior and posterior columns represents the lateral white columns Each column contains tracts, or fasciculi, whose axons share functional and structural characteristics (specific tracts are detailed in Chapter 15) A specific tract conveys either sensory information or motor commands, and the axons within a tract are relatively uniform with respect to diameter, myelination, and conduction speed All of the axons within a tract relay information in the same Spinal Cord Injuries INJURIES AFFECTING THE SPINAL CORD produce symptoms of sensory loss or motor paralysis that reflect the specific nuclei and tracts involved At the outset, any severe injury to the spinal cord produces a period of sensory and motor paralysis termed spinal shock The skeletal muscles become flaccid; neither somatic nor visceral reflexes function; and the brain no longer receives sensations of touch, pain, heat, or cold The location and severity of the injury determine the extent and duration of these symptoms and how much recovery takes place Violent jolts, such as those associated with blows or gunshot wounds, may cause spinal concussion without visibly damaging the spinal cord Spinal concussion produces a period of spinal shock, but the symptoms are only temporary and recovery may be complete in a matter of hours More serious injuries, such as whiplash or falls, usually involve physical damage to the spinal cord In a spinal contusion, hemorrhages occur in the meninges and within the spinal cord, pressure rises in the cerebrospinal fluid, and the white matter of the spinal cord may degenerate at the site of injury Gradual recovery over a period of weeks may leave some functional losses Recovery from a spinal laceration by vertebral fragments or other foreign bodies will usually be far slower and less complete Spinal compression occurs when the spinal cord becomes physically squeezed or distorted within the vertebral canal In a spinal transection the spinal cord is completely severed Current surgical procedures cannot repair a severed spinal cord, but experimental techniques have restored partial function in laboratory rats Spinal injuries often involve some combination of compression, laceration, contusion, and partial transection Relieving pressure and stabilizing the affected area through surgery may prevent further damage and allow the injured spinal cord to recover as much as possible Extensive damage at or above the fourth or fifth cervical vertebra will eliminate sensation and motor control of the upper and lower limbs The extensive paralysis produced is called quadriplegia If the damage extends from C3 to C5, the motor paralysis will include all of the major respiratory muscles, and the patient will usually need mechanical assistance in breathing Paraplegia, the loss of motor control of the lower limbs, may follow damage to the thoracic vertebrae and spinal cord Injuries to the inferior lumbar vertebrae may compress or distort the elements of the cauda equina, causing problems with peripheral nerve function 373 374 The Nervous System Figure 14.4 Sectional Organization of the Spinal Cord POSTERIOR Posterior median sulcus Posterior gray commissure Dura mater Posterior gray horn Arachnoid mater (broken) Lateral gray horn Dorsal root Central canal Anterior gray horn Anterior gray commissure Anterior median fissure Pia mater Dorsal root ganglion ANTERIOR a Histology of the spinal cord, Ventral root transverse section Posterior median sulcus From dorsal root Posterior gray horn Posterior gray commissure Somatic Visceral Lateral gray horn Visceral Anterior gray horn Somatic b The left half of this sectional view shows important anatomical landmarks; the right half indicates the functional organization of the gray matter in the anterior, lateral, and posterior gray horns To ventral root Anterior gray commissure Anterior median fissure Leg Posterior white column (funiculus) Hip Trunk Arm c The left half of this sectional view shows the major columns of white matter The right half indicates the anatomical organization of sensory tracts in the posterior white column for comparison with the organization of motor nuclei in the anterior gray horn Note that both sensory and motor components of the spinal cord have a definite regional organization Lateral white column (funiculus) Flexors Extensors Hand Forearm Arm Shoulder Trunk Anterior white column (funiculus) Anterior white commissure Sensory nuclei Motor nuclei 375 Chapter 14 • The Nervous System: The Spinal Cord and Spinal Nerves Concept Check See the blue ANSWERS tab at the back of the book A patient with polio has lost the use of his leg muscles In what area of the spinal cord would you expect to locate the virally infected motor neurons in this individual? How is white matter organized within the spinal cord? What is the term used to describe the projections of gray matter toward the outer surface of the spinal cord? What is the difference between ascending tracts and descending tracts in the white matter? Figure 14.5 Anatomy of a Peripheral Nerve A peripheral nerve consists of an outer epineurium enclosing a variable number of fascicles (bundles of nerve fibers) The fascicles are wrapped by the perineurium, and within each fascicle the individual axons, which are ensheathed by Schwann cells, are surrounded by the endoneurium Blood vessels Connective Tissue Layers Spinal Nerves [Figures 14.1 • 14.5] There are 31 pairs of spinal nerves: cervical spinal nerves, 12 thoracic, lumbar, sacral, and coccygeal spinal nerve Each can be identified by its association with adjacent vertebrae Every spinal nerve has a regional number, as indicated in Figure 14.1, p 369 In the cervical region the first pair of spinal nerves, C1, exits between the skull and the first cervical vertebra For this reason, cervical nerves take their names from the vertebra immediately following them In other words, cervical nerve C2 precedes vertebra C2, and the same system is used for the rest of the cervical spinal nerves The transition from this identification method occurs between the last cervical and first thoracic vertebrae The spinal nerve lying between these two vertebrae has been designated C8 and is shown in Figure 14.1b Thus, there are seven cervical vertebrae but eight cervical nerves Spinal nerves caudal to the first thoracic vertebra take their names from the vertebra immediately preceding them Thus, the spinal nerve T1 emerges immediately caudal to vertebra T1, spinal nerve T2 follows vertebra T2, and so forth Each peripheral nerve has three layers of connective tissue: an outer epineurium, a central perineurium, and an inner endoneurium (Figure 14.5) These are comparable to the connective tissue layers associated with skeletal muscles ∞ p 244 The epineurium is a tough fibrous sheath that forms the outermost layer of a peripheral nerve It consists of dense irregular connective tissue primarily composed of collagen fibers and fibrocytes At each intervertebral foramen, the epineurium of a spinal nerve becomes continuous with the dura mater of the spinal cord The perineurium is composed of collagenous fibers, elastic fibers, and fibrocytes The perineurium divides the nerve into a series of compartments that contain bundles of axons A single bundle of axons is known as a fascicle, or fasciculus Peripheral nerves must be isolated and protected from the chemical components of the interstitial fluid and the general circulation The blood–nerve barrier, formed by the connective tissue fibers and fibrocyte cells of the epineurium, serves as this diffusion barrier The endoneurium consists of loose, irregularly arranged connective tissue composed of delicate collagenous and elastic connective tissue fibers and a few isolated fibrocytes that surround individual axons Capillaries leaving the perineurium branch in the endoneurium and provide oxygen and nutrients to the axons and Schwann cells of the nerve Peripheral Distribution of Spinal Nerves [Figures 14.2a,c,d • 14.6 • 14.7] Each spinal nerve forms through the fusion of dorsal and ventral nerve roots as those roots pass through an intervertebral foramen; the only exceptions are at C1 and Co1, where some people lack dorsal roots (Figure 14.2a,c,d, p 370) Distally, Epineurium covering peripheral nerve Perineurium (around one fascicle) Endoneurium Schwann cell Myelinated axon a A typical peripheral nerve Fascicle and its connective tissue wrappings Blood vessels Perineurium (around one fascicle) Endoneurium b A scanning electron micrograph showing the various layers in great detail (SEM ϫ 340) [Dr Richard Kessel & Dr Randy Kardon/Tissues & Organs/Visuals Unlimited/Corbis] 376 The Nervous System the spinal nerve divides into several branches All spinal nerves form two branches, a dorsal ramus and a ventral ramus For spinal nerves T1 to L2 there are four branches: a white ramus and a gray ramus, collectively known as the rami communicantes (“communicating branches”), a dorsal ramus, and a ventral ramus (Figure 14.6) The rami communicantes carry visceral motor fibers to and from a nearby autonomic ganglion associated with the sympathetic division of the ANS (We will examine this division in Chapter 17.) Because preganglionic axons are myelinated, the branch carrying those fibers to the ganglion has a light color, and it is known as the white ramus (ramus, branch) Two groups of unmyelinated postganglionic fibers leave the ganglion Those innervating glands and smooth muscles in the body wall or limbs form a second branch, the gray ramus, that rejoins the spinal nerve The gray ramus is typically proximal to the white ramus Preganglionic or postganglionic fibers that innervate internal organs not rejoin the spinal nerves Instead, they form a series of separate autonomic nerves, such as the splanchnic nerves, involved with regulating the activities of organs in the abdominopelvic cavity The dorsal ramus of each spinal nerve provides sensory innervation from, and motor innervation to, a specific segment of the skin and muscles of the neck and back The region innervated resembles a horizontal band that begins at the origin of the spinal nerve The relatively large ventral ramus supplies the ventrolateral body surface, structures in the body wall, and the limbs The distribution of the sensory fibers within the dorsal and ventral rami illustrates the segmental division of labor along the length of the spinal cord (Figure 14.6b) Each pair of spinal nerves monitors a specific region of the body surface, an area known as a dermatome (Figure 14.7) Dermatomes are clinically important because damage to either a spinal nerve or dorsal root ganglion will produce a characteristic loss of sensation in specific areas of the skin Figure 14.6 Peripheral Distribution of Spinal Nerves Diagrammatic view illustrating the distribution of fibers in the major branches of a representative thoracic spinal nerve Motor Commands Postganglionic fibers to smooth muscles, glands, etc., of back Dorsal root ganglion Dorsal root Visceral Somatic motor motor Dorsal ramus Ventral ramus To skeletal muscles of body wall, limbs Ventral root Postganglionic fibers to smooth muscles, glands, etc., of body wall, limbs Spinal nerve Sympathetic ganglion Gray ramus (postganglionic) Rami communicantes Postganglionic fibers to smooth muscles, glands, visceral organs in thoracic cavity White ramus (preganglionic) Sympathetic nerve KEY Preganglionic fibers to sympathetic ganglia innervating abdominopelvic viscera Somatic motor commands Visceral motor commands a The distribution of motor neurons in the spinal cord and motor fibers within the spinal nerve and its branches Although the gray ramus is typically proximal to the white ramus, this simplified diagrammatic view makes it easier to follow the relationships between preganglionic and postganglionic fibers Sensory Information From interoceptors of back Nerve Plexuses [Figures 14.3 • 14.6 • 14.8] The distribution pattern illustrated in Figure 14.6 applies to spinal nerves T1–L2 White and gray rami communicantes are found only in these segments; however, gray rami, dorsal rami, and ventral rami are characteristic of all spinal nerves The dorsal rami provide roughly segmental sensory innervation, as evidenced by the pattern of dermatomes The segmental alignment isn’t exact, because the boundaries are imprecise, and there is some overlap between adjacent dermatomes But in segments controlling the skeletal musculature of the neck and the upper and lower limbs, the peripheral distribution of the ventral rami does not proceed directly to their peripheral targets Instead, the ventral rami of adjacent spinal nerves blend their fibers to produce a series of compound nerve trunks Such a complex interwoven network of nerves is called a nerve plexus (PLEK-sus, “braid”) Nerve plexuses form during development as small skeletal muscles fuse with their neighbors to form larger To skeletal muscles of back From exteroceptors, proprioceptors of back Dorsal root Somatic sensory Visceral sensory Dorsal ramus Ventral ramus From exteroceptors, proprioceptors of body wall, limbs Dorsal root ganglion From interoceptors of body wall, limbs Rami communicantes KEY Ventral root Somatic sensations Visceral sensations From interoceptors of visceral organs b A comparable view detailing the distribution of sensory neurons and sensory fibers Index 856 Index Gastrocnemius muscle, 314, 315 Gastrocolic ligament, 681 Gastroduodenal artery, 589, 673 Gastroepiploic artery, left/right, 589, 673 Gastroepiploic vein, 598, 673 Gastroesophageal reflux disease (GERD), 286, 668 Gastrosplenic ligament, 623 Gastrulation, 755 Gated channels, 32 G cells, 675 Gemelli muscles, 310 Gender differences pelvis, 199 skeleton, 207 General senses chemoreceptors, 475 mechanoreceptors, 473–475 nociceptors, 472 overview, 471, 472, 503 thermoreceptors, 473 Genicular artery, descending, 589 Geniculate ganglion, 443 Genioglossus muscle, 260, 275 Geniohyoid muscles, 277, 278 Genital ridges, 795 Genital swelling, 795 Genital tubercle, 795, 796 Genitofemoral nerves, 382, 383, 717, 720 GERD (gastroesophageal reflux disease), 286, 668 Germ cells (gametes; sex cells), 28, 46, 717 Germinal center, 615 Germinal epithelium, 729 Germinative cells See Stem (basal; germinative) cells Germ layers, 82, 86, 755 Gestation, 751 Gigantism (giantism), 127, 136, 520 Gingivae, 664 Gingival sulcus, 666 Gingivitis, 666 Girdles, 181 Gland cells, 55 Glands See also specific glands aging and, 107 modes of secretion, 62–63 skin, 102–106 structure, 61–62 types of secretion, 61 Glands of Zeis, 491 Glandular epithelium functions, 61, 87 modes of secretion, 62–63 structure, 61–62 types of secretion, 61 Glans, penis, 727 Glassy membrane, hair follicle, 99 Glaucoma, 498 Glenohumeral joint See Shoulder (glenohumeral joint) Glenohumeral ligaments, 223 Glenoid cavity (glenoid fossa), scapula, 182 Glenoid labrum, 223 Glial cells See Neuroglia Gliding (plane) joints, 218, 219 Gliding motion, 215, 216 Glioma, 81 Globulins, 532 Globus pallidus, 431, 432 Glomerular capsule (Bowman’s capsule), 701 Glomerular (visceral) epithelium, 701, 702 Glomerular filtrate, 700 Glomerulus, 700 Glossopharyngeal nerve (N IX), 436, 444, 478 Glottis, 635 Glucagon, 519 Glucocorticoids, 511, 520 Gluteal artery, superior, 589 Gluteal lines, hip bones, 192 Gluteal muscles, 192, 308, 310 Gluteal nerve, 383 Gluteal tuberosity, femur, 199 Gluteal vein, 596 Gluteus maximus muscle, 199, 308, 310, 311 Gluteus medius muscle, 308, 310, 311 Gluteus minimus muscle, 308, 310 Glycine, 411 Glycocalyx, 32 Glycosaminoglycans, 45 Glycosuria, 519 Goblet cells, 62 Goiter, 521, 525 Golgi apparatus (Golgi complex), 30, 31, 43–44 Golgi tendon organs, 475 Gomphosis, 212, 213, 666 Gonadal artery, 589 Gonadal vein, 596 Gonadotropes, 511 Gonadotropin-releasing hormone (GnRH), 734 Gonadotropins, 511 Gonads, 717 Goose bumps, 101 G0 phase, 46–47 G1 phase, 47 G2 phase, 48 Graafian follicle (mature ovarian follicle), 733 Gracilis muscle, 309, 310 Granulation tissue, 104, 112 Granulocytes (granular leukocytes), 534, 536–537 Granulosa cells, 732 Gray commissures, 373 Gray horns, anterior/lateral/posterior, 373 Gray matter cerebellum, 424 characteristics, 348, 351, 355 medulla oblongata, 416 mesencephalon, 418 organization, 408 pons, 417 spinal cord, 373–374 Gray ramus, 376, 454 Great auricular nerve, 378 Great cerebral vein, 592 Greater curvature, stomach, 670 Greater horns, hyoid bone, 159, 160, 163 Greater omentum, 662, 673 Greater palatine groove, 156 Greater pelvis, 193 Greater tubercle, humerus, 185 Greater vestibular glands (Bartholin’s glands), 741 Greater wings, sphenoid, 153 Great saphenous vein, 598 Greenstick fracture, 133 Groin, pulled, 309 Groove (bone marking) hip bones, obturator, 192 humerus intertubercular, 185 radial, 185 lacrimal bones, lacrimal, 157, 161 maxilla infra-orbital, 154 nasolacrimal, 163 nail, 106 palatine, greater, 156 rib, costal, 175 sphenoid, optic, 153 Gross anatomy, 2, 24 Ground substance, 64, 66 Growth hormone (GH), 129, 510, 520, 743 Gubernaculum testis, 717 Gustation (taste), 477–478, 503, 760, 781 Gustatory cells, 477 Gustatory cortex, 428 Gustatory pathways, 478 Gustatory receptors, 477 Gynecomastia, 520 Gyri, cerebrum, 408, 426 H Hair, 98–99 color, 101 functions, 99–100 growth and replacement, 101–102 production, 99 structure, 99, 100 See also Hair follicle types, 101 Hair bulb, 99 Hair cells, 482 Hair follicle aging and, 107 development, 767 functions, 8, 91 structure, 99, 100 Hair growth cycle, 101 Hair matrix, 99 Hair papilla, 99 Hair root, 99 Hallux, 205 Hamate bone, 190 Hamstrings, 313 Hand bones, 190–191 joints, 227–228, 241 muscles, 301–307 nerves, 379–382 Haploid, 721 Hard keratin, 99 Hard palate, 154, 634, 664 Hashimoto thyroiditis, 523–525 Haustra, 679 Haustral churning, 682 Haversian (central) canal, 118 Haversian system (osteon), 117, 118 Hb (hemoglobin), 534 H band, 249 HCG (human chorionic gonadotropin), 743 HCl (hydrochloric acid), 675 HDL (high-density lipoprotein), 626 Head epididymis, 724 pancreas, 688 spermatozoon, 723 Head (body region) arteries, 584–586 bones See Skull cross-sectional anatomy, 342, 343 lymphatic drainage, 618 muscles, 269–276, 288 nerves, 378 respiratory structures, 633–634 surface anatomy, 334–335 veins, 594 Head (bone marking), 134, 135 femur, 199 fibula, 202 humerus, 185 mandible, 157 radius, 187 rib, 174 ulna, 185 Headache, 349 Head fold, 756 Hearing See also Ear auditory pathways, 487, 490 cochlea, 487–489 development, 760, 782 loss, 490, 501–502 sound detection, 487 Heart age-related changes, 602 blood vessels, 558–561 borders, 552 development, 785 endocrine functions, 517 functions, 10 hormones produced by, 507 infection and inflammation, 553 internal anatomy, 554–561, 567–568 muscle tissue See Cardiac muscle orientation, 552 position, 549, 552 sectional anatomy, 555–556 superficial anatomy, 552–554, 567 valves, 556–558 wall structure, 550–551, 567 See also Cardiac muscle Heart attack (myocardial infarction), 565, 566 Heart failure, 566 Heart murmur, 558, 566 Heart rate, 566 Heavy-metal poisoning, 358 Heel bone (calcaneus), 205 Heimlich maneuver, 639, 653 Helicobacter pylori, 675 Helper T cells, 612 Hemacult, 691 Hematocrit, 532 Hematologic stem cell (bone marrow) transplant, 623 Hematologists, 541 Hematoma, 410 Heme, 534 Hemiazygos vein, 596 Hemidesmosomes, 46 Hemocytoblasts, 541, 615 Hemodialysis, 706, 713 Hemoglobin (Hb), 534 Hemolytic disease of the newborn, 543 Hemolytic uremic syndrome (HUS), 711–713 Hemolyze, 535 Hemophilia, 538, 543 Hemopoiesis, 541–543, 544–545 Hemorrhoids, 681, 689 Hemostasis, 540 Hemothorax, 176, 177 Heparin, 66 Hepatic artery, common, 589, 673 Hepatic artery proper, 683 Hepatic ducts, right/left/common, 687 Hepatic flexure, 681 Hepatic portal system, 598 Hepatic portal vein, 517, 683 Hepatic triads (portal areas), 683 Hepatic vein, 596, 598, 683 Hepatocytes, 682 Hepatopancreatic (duodenal) ampulla, 679 Hepatopancreatic sphincter (sphincter of Oddi), 687 Herniated disc, 222, 239 Heterotopic bones, 122 Hiatal hernia, 286 High-density lipoprotein (HDL), 626 Higher centers, 408 Hilum kidney, 696 lung, 638 lymph node, 617 ovarian, 729 Hindgut, 791 Hinge joints, 218, 219 Hip (coxal, innominate) bones, 192, 193–197, 237 Hip joint, 192 articular capsule, 228, 230 fracture, 237, 329–330 ligaments, 229 movement, 310–311 muscles, 308–311 stabilization, 229 structure, 228–229, 237, 241 Hippocampus, 433 Histamine, 66 Histology, 2, 24, 54 Histones, 40 Hodgkin’s disease, 623, 626 Holocrine secretion, 63 Homeostasis, 5, Homologous, 739 Homunculus motor, 398, 399, 400 sensory, 395, 396 Hooke, Robert, 28 Horizontal cells, retina, 497 Horizontal fissure, lung, 639 Horizontal plate, palatine bone, 156 Hormones See also specific hormones functions, 61 overview, 507 types, 507–508 Horner’s syndrome, 456, 467 Horns, spinal cord, 373 Hot Topics: What’s New in Anatomy bone erosion, 117 cardiomyocyte renewal, 550 cricothyropharyngeus muscle, 275 melatonin, 522 microtubule-targeted drugs (MTDs), 37 myelination process in oligodendrocytes, 351 podocytes, 705 postnatal oogenesis in mammals, 734 pulmonary fibrogenesis, 646 skin graft donor sites, 106 thymic function, 622 HPL (human placental lactogen), 743 Human chorionic gonadotropin (HCG), 743 Human growth hormone (GH), 129, 510, 520, 743 Human papillomavirus, 736 Human placental lactogen (HPL), 743 Humeral ligament, transverse, 225 Humeroradial joint, 185, 225 Humeroulnar joint, 185, 225 Humerus, 119, 185, 186–187, 231 Humoral (antibody-mediated) immunity, 613 HUS (hemolytic uremic syndrome), 711–713 Hyaline cartilage, 71, 73 Hyaluronan, 45, 65, 214 Hyaluronidase, 750, 754 Hydrocephalus, 426, 447 Hydrochloric acid (HCl), 675 Hydrocortisone (cortisol), 515 Hydrogen, in human body, Hydroxyapatite, 116 Hymen, 739 Hyoid arch, 769, 775 Hyoid bone, 159–160, 163 Hypaxial muscles, 775 Hyperextension, 217 Hyperglycemia, 519 Hyperkeratosis, 108, 112 Hyperpnea (forced breathing), 650 Hypertension, 744 Hypertrophy, muscle, 255 Hypervolemic, 530 Hypoaldosteronism, 520 Hypoblast, 755 Hypodermic needle, 98, 112 Hypodermis, 77, 92 Hypogastric plexus, 456, 464, 709, 720 Hypoglossal canals, occipital bone, 148, 161, 162 Hypoglossal nerve (N XII), 148, 275, 278, 436, 446 Hypoglossus muscle, 275 Hypogonadism, 520 Hyponychium, 106 Hypoparathyroidism, 520 Hypophyseal artery, 509 Hypophyseal portal system, 509, 511 Hypophysial fossa, sphenoid, 152 Hypophysis See Pituitary gland (hypophysis) Hypothalamus blood–brain barrier, 412 embryology, 406 endocrine control and, 508 functions, 402, 407, 408, 420, 421, 434 gross anatomy, 408, 420, 421 hormones produced by, 507 pituitary control by, 510 Hypovolemic, 530 Hysterectomy, 729, 736 Hysterosalpingogram, 736 I I band, 249 IH (inhibiting hormones), 508 Ileal papilla, 679 Ileocecal valve, 679 Ileocolic artery, 589 Ileocolic vein, 598 Ileum, 676, 679 Iliac artery internal/external/common, 589, 737 left/right, 589 Iliac crest, 192 Iliac fossa, hip bone, 192 Iliac notch, 192 Iliac spine, anterior/posterior, 192 Iliac tuberosity, hip bone, 192 Iliacus muscle, 309, 310 Iliac vein, internal/external/common, 596, 598 Iliococcygeus muscle, 287 Iliocostalis cervicis muscle, 279, 280 Iliocostalis lumborum muscle, 279, 280 Iliocostalis thoracis muscle, 279, 280 Iliofemoral ligament, 229 Iliohypogastric nerve, 383 Ilioinguinal nerve, 383, 717, 720 Iliopsoas muscle, 309 Iliotibial tract, 308 Ilium, 192 Immature delivery, 765 Immune response, 613, 614 Immune surveillance, 537 Immunity antibody-mediated, 613 cell-mediated, 613 specific, 537 Immunocompetence, 613 Immunocompetent, 614 Immunoglobulins (antibodies), 66, 532, 613 Immunological surveillance, 613 Impermeable membrane, 33 Implantation, 743, 750, 753–756 Incision, 104 Incisive canals, 154, 161 Incisive fossa, maxilla, 154 Incisors, 666 Inclusion bodies, 37 Inclusions, 37 Incontinence, 713 Incus, 479, 480 Infant, skull, 164, 165 Infarct, 565 Inferior, 17 Inferior ganglion glossopharyngeal nerve, 444 vagus nerve, 445 Inferior mesenteric artery, 589 Inferior mesenteric ganglion, 456, 458 Inferior mesenteric plexus, 464 Inferior mesenteric vein, 598 Inferior oblique muscle, 270, 273 Inferior rectus muscle, 270, 273 Inferior vena cava, 554, 596, 598 Inflammatory arthritis, 239 Inflammatory bowel disease, 690–691 Infraglenoid tubercle, scapula, 185 Infra-orbital foramen, 154, 161, 163 Infra-orbital groove, maxilla, 154 Infraspinatus muscle, 185, 294, 296 Infraspinous fossa, scapula, 185 Infundibulum hypothalamus, 420 pituitary gland, 508 uterine tube, 734 Inguinal canals, 286, 717 Inguinal hernia, 286, 288, 717 Inguinal lymph nodes, 619, 620 Inguinal rings, 717 Inhalation, 649, 650 Inhibin, 522, 723 Inhibiting hormones (IH), 508 Inhibitory interneurons, 358 Initial segment, axon, 356 Innate reflex, 386, 387 Inner cell mass, 82, 753 Inner ear, 481–485, 504 Innervation, 269 See also specific body regions Innominate (hip) bones, 192, 193–197 Insensible perspiration, 94 Insertion, muscle, 259, 260 Inspiratory center, 650–651 Insula, 428 Insulin, 519, 520 Insulin-dependent (type 1; juvenile-onset) diabetes mellitus (IDDM), 519, 525 Integral proteins, 32 Integrative centers, cerebrum, 428 Integumentary system accessory structures, 91, 92, 98–106 aging and, 107 clinical case (latex allergy), 110–111 dermis See Dermis development, 760, 766–767 epidermis See Epidermis glands, 102–106 hair See Hair hair follicle See Hair follicle local control of function, 106–107 nails, 91, 106 overview, 7, 8, 91 structure and function, 92 subcutaneous layer, 77, 92, 97, 98, 113, 766 Intention tremor, 424 Interarticular crest, rib, 175 Interatrial groove, 552 Interatrial septum, 554 Intercalated discs, 78, 550, 551 Intercarpal joint, 226, 228, 231 Intercarpal ligaments, 227 Intercellular attachment, 45–46, 50–51 Intercellular cement, 45 Interclavicular ligament, 223 Intercondylar eminence, tibia, 202 Intercondylar fossa, femur, 202 Intercostal artery, 587 Intercostal muscles, external/internal/transversus, 175, 281, 284, 648 Intercostal vein, 596 Interlobar artery, kidney, 698 Interlobar vein, kidney, 698 Interlobular artery, kidney, 698 Interlobular vein, kidney, 698 Intermediate fibers, 256, 257 Intermediate filaments, 36, 37 Intermediate hairs, 101 Intermuscular fascia, 77 Intermuscular septa lower limb, 327 upper limb, 324 Internal callus, bone, 136 Internal capsule, cerebral cortex, 431 Internal carotid artery, 414 Internal elastic membrane, 571 Internal jugular vein, 411 Internal os, uterus, 735 Internal root sheath, hair follicle, 99 Internal rotation, 217 Interneurons, 358 Internodal pathways, 562 Internodes, 351 ”Internus,” muscle name, 260 Interoceptors, 357, 472 Interosseous border fibula, 202 tibia, 202 Interosseous membrane arm, 185 leg, 202 Interosseous nerve, 382 Interphalangeal joints, 228, 231, 237 Interphase, 46–47, 48, 49 Interspinales muscle, 279, 280 Interspinous ligament, 221 Interstitial (pacesetter) cells, 660 Interstitial cells, testes (interstitial cells of Leydig), 522, 720 Interstitial fluid, 69, 71, 530, 533, 608 Interstitial growth, cartilage, 71, 123 Interstitial lamellae, 118 Intertarsal joint, 235, 237 Interthalamic adhesion (massa intermedia), 419 Intertransversarii muscle, 279, 280 Intertrochanteric crest, 199 Intertrochanteric line, 199 Intertubercular sulcus (groove), humerus, 185 857 Index Index Index 858 Index Interventricular foramen, 408, 414 Interventricular septum, 554, 555 Interventricular sulcus, 553 Intervertebral discs articulations, 212, 220–222, 227, 241 clinical note, 222 functions, 220–221 herniated, 222 ligaments, 221 structure, 167, 220–221 Intervertebral foramina, 168 Intervertebral muscles, 775 Intestinal artery, 589 Intestinal crypts (crypts of Lieberkühn), 678 Intestinal juice, 679 Intestinal lymph nodes, 619, 620 Intestinal reflex, 465 Intestinal trunk, 612 Intestinal vein, 598 Intestinal villi, 676 Intestine See Large intestine; Small intestine Intima, 571 Intracapsular ligament, 214 Intramembranous (dermal) ossification, 122–123 Intramural ganglia, 452 Intraperitoneal therapy, 729 Intrapulmonary bronchi, 639 Intravenous (I.V.) fluid and electrolyte replacement, 329 Intravenous pyelography (IVP), 707 ”Intrinsic,” muscle name, 260 Intrinsic factor, 675 Intrinsic ligament, 214 Inversion, 217, 218 Involuntary, 348 Involution, thymus, 621 Iodine, in human body, Ion pumps, 34 Iris, 495 Iron in hemoglobin, 34 in human body, Irregular bones, 131, 134 Irritability, Ischemia in compartment syndrome, 325 coronary, 560 definition, 325, 330 Ischial ramus, hip bone, 192 Ischial spine, hip bone, 192 Ischial tuberosity, hip bone, 192 Ischiocavernosus muscle, 287, 727 Ischiofemoral ligament, 229 Ischium, 192 Islets of Langerhans (pancreatic islets), 517, 689 Isotropic, 249 Isthmus thyroid gland, 512 uterine tube, 735 uterus, 735 I.V fluid and electrolyte replacement, 329 IVP (intravenous pyelography), 707 J Jejunum, 676, 679 Joint (articular) capsule, 120, 213, 228–229 Joint cavity, 213 Joints See also specific joints aging and, 237 classification, 212–214, 240 dynamic motion description, 215, 240 movements, 215–218, 240 strength vs mobility in, 214 synovial See Synovial joints Jugular foramen, occipital bone, 148, 161, 162 Jugular fossa, temporal bone, 152 Jugular ganglion, 444, 445 Jugular lymph sacs, 788 Jugular notch, sternum, 176, 182 Jugular trunk, 612 Jugular vein, internal/external, 148, 592, 594 Jugular venous pulse, 594 Juvenile-onset (insulin-dependent; type 1) diabetes mellitus, 519, 525 Juxtaglomerular cells, 705 Juxtaglomerular complex, 705 Juxtamedullary nephrons, 701, 703 K Keloid, 105, 112 Keratin, 93 Keratinization, 94 Keratinized epithelium, 58, 94 Keratinocytes, 92 Keratohyalin, 93 Keratohyalin granules, 93 Kidney blood supply, 698, 700, 701 endocrine functions, 10, 507, 517 excretory functions, 12 failure, 706 histology, 700–705 nephrons See Nephron nerves, 698 overview, 713–714 sectional anatomy, 696–698, 699 superficial anatomy, 696 transplantation, 706 Kidney stones, 710, 713 Kinocilium, 484 Knee joint articular capsule, 231 functions, 231 injuries, 75, 234 ligaments, 231 locking, 234 structure, 213, 231–233, 237, 241 Kupffer cells (stellate reticuloendothelial cells), 683 Kyphosis, 167, 177 L Labeled line, 471 Labia, 13, 664, 740, 741 ”Labial,” dental frame of reference, 668 Labia major, 741 Labia minora, 740 Labor and delivery, 762–764 Lacrimal apparatus, 492 Lacrimal bones, 157, 161, 163 Lacrimal canaliculi, 492 Lacrimal caruncle, 491 Lacrimal fossae, frontal bone, 148, 162 Lacrimal (tear) gland, 148, 491 Lacrimal groove (sulcus), lacrimal bone, 157, 161 Lacrimal puncta, inferior/superior, 492 Lacrimal sac, 492 Lactation, 741 Lacteals, 610, 678 Lactiferous duct, 742 Lactiferous sinus, 742 Lactotropes, 511 Lacunae bone, 72, 116 cartilage, 71 trophoblast, 755 Lambdoid suture, 148 Lamellae, 116, 118 Lamellated corpuscles, 98, 473, 474 Laminae, vertebrae, 168 Lamina lucida, 56 Lamina propria digestive system, 658, 678, 688 mucous membrane, 75 trachea, 637 Laminectomy, 222, 239 Langerhans cells (dendritic cells), 93, 107 Lanugo, 101 Large bowel See Large intestine Large granular lymphocytes (NK cells), 537, 613 Large intestine, 679–682 cecum, 679 colon, 679–681 functions, 12, 679 gross anatomy, 679, 680 histology, 681–682 lymphatic drainage, 621 rectum, 681 regulation, 682 Large vein, 576 Laryngeal elevators, 275, 276 Laryngeal muscles, 637 Laryngeal prominence, 636 Laryngopharynx, 635 Larynx, 635–637 cartilages, 635–636 functions, 11 ligaments, 636 musculature, 637 sound production, 636–637 swallowing process, 637 Lateral aperture, fourth ventricle, 414 Lateral canthus, 491 Lateral cartilage, nose, 632 Lateral direction, 17 Lateral epicondyle, femur, 199 Lateral excursion, 275 Lateral femoral cutaneous nerve, 382 Lateral flexion, 217, 218, 221 Lateral geniculate nuclei, thalamus, 419, 420 Lateral ligament ankle joint, 235 temporomandibular joint, 220 Lateral nuclei, thalamus, 419, 420 Lateral plate, 774 Lateral rectus muscle, 270, 273 Lateral rotation, 217 Lateral rotator muscles, 308 Lateral sulcus, cerebrum, 428 Lateral ventricle, brain, 408 Latex allergy, 110–111 Latissimus dorsi muscle, 260, 294, 296 LDL (low-density lipoproteins), 626 L-DOPA (levodopa), 433 Lead poisoning, 358 Left atrium, 555 Left bundle branch, 562 Left coronary artery, 558 Left lower quadrant (LLQ), 16 Left marginal branch, left coronary artery, 558 Left rotation, 217 Left upper quadrant (LUQ), 16 Left ventricle, 555–556 Leg See Lower limb Leiomyoma, 81 Leiomyosarcoma, 81 Lens, 499 Lens placode, 781 Lentiform nucleus, 431 Lesions, skin, 108 Lesser curvature, stomach, 670 Lesser horns, hyoid bone, 160, 163 Lesser omentum, 662, 673 Lesser pelvis, 193 Lesser tubercle, humerus, 185 Lesser wings, sphenoid, 153 Leukemia, 81, 626 Leukocytes (white blood cells; WBCs) abundance, 534, 536 agranular, 537 functions, 69, 530, 534 granular, 536–537 histology, 537 types, 69, 531, 534, 536 Leukocytosis, 536, 691 Leukopenia, 536 Leukopoiesis, 541 Levator anguli oris muscle, 272 Levator ani muscle, 287 Levator labii inferioris muscle, 272 Levator palpebrae superioris muscle, 272, 491 Levator scapulae muscle, 292, 293 Levator veli palatini muscle, 275, 276 Levels of organization, 5–6 Levers, 261–262, 265 LH (luteinizing hormone), 510, 511 Ligaments accessory, 214 acetabular, 229 ankle joint, 235 annular, 225, 479, 637 anterior cruciate, 231 axis, transverse, 170 broad, 729 capsular, 214 cardinal (uterus), 735 classification, 214 coccygeal, 368 collateral fibular, 231 radial, 225, 227 tibial, 231 ulnar, 225, 227 coracoacromial, 225 coracoclavicular, 225 coracohumeral, 225 coronary, 683 deltoid, 235 denticulate, 371 digitocarpal, 227 elastic, 66, 69, 70 elbow joint, 225 extracapsular, 214 extrinsic, 214 falciform, 662, 683 of the femoral head, 229 fibular collateral, 231 gastrocolic, 681 gastrosplenic, 623 hip joint, 229 histology, 66, 69, 70 intervertebral, 221 intrinsic, 214 knee joint, 231 larynx, 636 ligamentum nuchae, 170 longitudinal, 221 ovarian, 729 periodontal, 212, 666 posterior cruciate, 231 round liver, 683 uterus, 735 shoulder joint, 223, 225 sternoclavicular joint, 223 stylohyoid, 159 suspensory breast, 742 eye, 495 ovary, 729 uterus, 735 synovial joint, 214 temporomandibular joint, 220 trachea, 637 umbilical, medial/lateral, 708 vocal, 636 wrist, 225, 228 Ligamentum arteriosum, 599, 787 Ligamentum capitis femoris, 229 Ligamentum flavum, 221 Ligamentum nuchae, 170, 221 Ligamentum teres (round ligament), 686 Ligands, 35 Ligases, 48 Light microscope, scales, Light reflexes, direct/consensual, 446, 465 Limbic lobe, 433 Limbic system, 433, 434 Line (bone marking), 134, 135 Linea alba, 281, 284 Linea aspera, femur, 199 Linear motion, 215, 216 Lines of cleavage, 97, 98 ”Lingual,” dental frame of reference, 668 Lingual frenulum, 665 Lingual lipase, 665 Lingual tonsils, 615 Lipases gastric, 675 lingual, 665 pancreatic, 688 Lipid profile, 524 Lipids, in human body, Lipoma, 81 Lipoproteins, 532, 573, 626 Liposarcoma, 81 Liposuction, 69, 86 Liquor folliculi (follicular fluid), 733 Liver blood supply, 683 functions, 12, 682–683 gross anatomy, 682, 683, 684–685 histological organization, 683, 686 veins, 598 LLQ (left lower quadrant), 16 Lobar (secondary) bronchi, 639 Lobes cerebellar, 424 cerebral, 408, 426–428 lung, 639–640 renal, 698 thymus, 621 thyroid gland, 512 Lobules liver, 683 lung, 639 testes, 720 thymus, 621 Locking, of knee, 234 Long bones, 131 ”Longissimus,” muscle name, 260 Longissimus capitis muscle, 279, 280 Longissimus cervicis muscle, 279, 280 Longissimus thoracis muscle, 279, 280 Longitudinal arch, foot, 206 Longitudinal fasciculi, 430 Longitudinal fissure, cerebrum, 408, 426 Longitudinal ligament, anterior/posterior, 221 Long reflex, visceral, 466 ”Longus,” muscle name, 260 Longus capitis muscle, 279, 280, 281 Longus colli muscle, 279, 280, 281 Loop of Henle (nephron loop), 700, 702, 705 Loose connective tissue, 66–69, 84 Lordosis, 167, 177 Low-density lipoproteins (LDL), 626 Lower limb arteries, 589–591 articulations, 237 bones, 192, 199–206, 209 compartments, 327–328 lymphatic drainage, 620 muscles, 311–324, 331–332 nerves, 382–385 surface anatomy, 340–341 veins, 596–598 Lower-motor neuron, 396 Lower respiratory system, 631, 635–648, 654 Lubricin, 214 Lumbago, 222 Lumbar artery, 589 Lumbar curve, 164, 166 Lumbar plexus, 377, 382–385 Lumbar puncture, 372, 389 Lumbar trunk, 612 Lumbar vein, 596 Lumbar vertebrae, 164, 166, 169, 173 Lumbosacral enlargement, spinal cord, 368 Lumbosacral trunk, sacral plexus, 382 Lumbrical muscles, 303, 305, 314, 324 Lumen, 39 Lumen, gland, 103 Lunate bone, 190 Lunate surface, pelvic girdle, 192 Lung, 638–646, 654 blood supply, 646 bronchial tree, 640–643 development, 789 divisions, 642 functions, 11 gross anatomy, 638–639, 644 lobes, 639–640 surfaces, 639 Lung buds, 789 Lung cancer, 641, 651–653 Lunula, 106 LUQ (left upper quadrant), 16 Luteal phase, ovarian cycle, 734, 739 Luteinizing hormone (LH), 510, 511 Luxation (dislocation), 214, 239 Lymph, 71, 608 Lymphadenopathy, 618, 626 Lymphangiogram, pelvis, 619 Lymphatic capillaries, 609, 610 Lymphatic ducts, 611 Lymphatic system See Lymphoid system; Lymphoid (lymphatic) system Lymphatic trunks, 611 Lymphatic vessels, 11, 71, 609–612, 627 Lymphedema, 610 Lymph nodes, 11, 616–621 Lymphocytes abundance, 534, 537 characteristics, 534, 537 distribution and life span, 613–614 functions, 65, 66, 534, 537, 612 immune response and, 613, 614, 627 production, 541–542, 614–615 structure, 71 types, 612–613, 624 Lymphocytosis, 536 Lymphoid nodules, 613, 615–616 Lymphoid organs, 616–624 Lymphoid stem cells, 541 Lymphoid (lymphatic) system aging and, 625 clinical case (thoracic lymphoma), 625–626 development, 761, 788 functions, 608–609 lymphatic vessels, 609–612 lymphocytes See Lymphocytes lymphoid organs, 616–624 lymphoid tissues, 615–616, 627 overview, 7, 11, 537, 608, 627 Lymphoid tissues, 615–616, 627 Lymphomas, 81, 623, 625–626 Lymphopenia, 536 Lymphopoiesis, 541, 614–615 Lysosomal storage diseases, 45 Lysosomes, 30, 31, 44–45 Lysozyme, 492 M Macrophages alveolar (dust cells), 646 fixed, 65 free, 65, 66 Macroscopic anatomy, 2, 24 Macula adherens, 45 Macula densa, 705 Maculae, inner ear, 484, 485 Macula lutea, 497 Magnesium, in human body, Magnetic resonance imaging (MRI), 23, 24, 525 ”Magnus,” muscle name, 260 ”Major,” muscle name, 260 Male climacteric, 743 Male pattern baldness, 102 Male pronucleus, 750, 751 Male reproductive system accessory glands, 725–727, 746 aging and, 743 bulbo-urethral glands, 726, 727 development, 761, 796 ductus deferens, 724, 726 epididymis, 724 nurse cells, 721, 723 organization, 717 overview, 13, 717, 718, 720 reproductive tract, 724, 746 seminal glands, 725, 726 spermatogenesis and meiosis, 721 spermiogenesis, 721, 723 testes See Testes urethra, 724 Malignant melanoma, 109, 112 Malignant tumor, 47, 49 See also Cancer Malleolus, lateral/medial, 202 Malleus, 479, 480 Mamillary bodies, 421, 433 Mammary glands, 13, 106, 741–743, 747, 767 Mammography, 741 Mandible, 157–158, 161, 163, 227 Mandibular arch, 768, 775 Mandibular branch, trigeminal nerve, 441 Mandibular canal, 158 Mandibular foramen, 158, 161, 163 Mandibular fossa, temporal bone, 151, 162 Mandibular notch, 157 Mantle layer, 776, 777 Manubrium, 176 Marfan’s syndrome, 127, 136 Margin, tibia, 202 Marginal layer, 776, 777 Marrow (medullary) cavity, 118 Massa intermedia (interthalamic adhesion), 419 Masseter muscle, 274 Mass movements, 682 Mast cells, 65, 66 Mastication, 274, 666, 668, 775 Mastoid air cells, 152, 162 Mastoid fontanels, 164 Mastoid foramen, temporal bone, 152, 161, 162 Mastoiditis, 152, 481, 502 Mastoid process, temporal bone, 152, 162 Matrix bone, 116 connective tissue, 64 mitochondria, 40 Mature ovarian follicle (Graafian follicle), 733 Maturity-onset (non-insulin-dependent; type 2) diabetes mellitus, 519, 525 Maxilla, 154, 156, 161, 163, 227 Maxillary branch, trigeminal nerve, 441 Maxillary sinuses, 154, 158, 163 Maxillary vein, 594 “Maximus,” muscle name, 260 Meatus (canal), 134, 135 nasal cavity, 633 Mechanoreceptor reflex, 651 Mechanoreceptors, 473–475, 503 Media, blood vessels, 571 Medial canthus, 491 Medial direction, 17 Medial epicondyle, femur, 202 Medial geniculate nuclei, thalamus, 419, 420 Medial-lateral rule, 393 Medial lemniscal pathway (posterior columns), 394–395 Medial lemniscus, 394 Medial nuclei, thalamus, 419, 487 Medial rectus muscle, 270, 273 Medial rotation, 217 Median aperture, fourth ventricle, 414 Median fissure, anterior, 368 Median lymph sac, 788 Median nerve, 301, 379, 382 Median sagittal section, 19 Median sulcus, posterior, 368 Mediastinal artery, 587 Mediastinal surface, lung, 639 Mediastinum, 20 Mediastinum, of testis, 720 Medium-sized vein, 576 Medulla hair, 99 lymph nodes, 617 ovary, 729 renal, 696 suprarenal gland See Suprarenal gland thymus, 621 Medulla oblongata embryology, 406, 407 functions, 402, 406, 407, 415–416 gross anatomy, 416 overview, 406, 407, 448 respiratory control center, 650 sensory tracts, 394 structure, 154 859 Index Index Index 860 Index Medullary (marrow) cavity, 118 Medullary cords, lymph nodes, 617 Megakaryocytes, 540 Meibomian (tarsal) glands, 491 Meiosis, 46, 721, 733 Meissner’s (tactile) corpuscles, 98, 473, 474 Melanin, 66, 93, 95, 96 Melanocyte, 65, 66, 93, 96, 101, 766 Melanocyte-stimulating hormone (MSH), 510, 512 Melanosomes, 96 Melatonin, 418, 507, 522 Membrane, in dialysis machine, 706 Membrane (dermal) bones, 122 Membrane flow, 45 Membrane permeability See Permeability Membrane proteins, 32 Membranes, 87–88 cutaneous, 75–76 mucous, 75, 76 serous, 75, 76 synovial, 77 Membranous labyrinth, 481 Membranous organelles endoplasmic reticulum, 30, 31, 36, 39, 41–42 Golgi apparatus (Golgi complex), 30, 31, 43–44 lysosomes, 30, 31, 44–45 mitochondria, 30, 31, 36, 40 nucleus, 30, 31, 40–41 overview, 31, 37, 40, 50 peroxisomes, 30, 31, 45 Membranous urethra, 710 Memory B cells, 612 Memory T cells, 612 Menarche, 738 Ménière’s disease, 502 Meningeal layer, dura mater, 411 Meninges cranial, 368, 411, 412, 413 spinal, 368 Meniscectomy, 234, 239 Menisci (articular discs), 214, 225, 231 Menopause, 520, 729, 738, 743 Menses, 737, 739 Menstrual (uterine) cycle, 737–738, 739 Menstruation, 737 Mental foramina, 157, 161, 163 Mentalis muscle, 272 Mercury poisoning, 358 Merkel cells, 93, 473 Merkel’s (tactile) discs, 98, 473, 474 Merocrine secretion, 62, 63 Merocrine (eccrine) sweat glands, 103, 104 Mesangial cells, 702 Mesencephalon development, 406, 779 functions, 402, 406, 407, 417–418, 448 gross anatomy, 417–418, 448 motor tracts, 400 red nuclei, 401 structure, 154 Mesenchymal cells, 65, 84 Mesenchyme, 66, 67, 84 Mesenterial lymph nodes, 619, 620 Mesenterial sheet, 662 Mesenteric artery, inferior/superior, 458, 589, 676, 679, 689 Mesenteric vein, inferior/superior, 598, 676, 679 Mesentery development, 791 peritoneum, 21, 662–663 stomach, 673 Mesentery proper, 662, 676 “Mesial,” dental frame of reference, 668 Mesoappendix, 679 Mesocolon, 662 Mesoderm derivatives, 86, 755 formation, 82, 755 Mesonephric duct, 793 Mesonephros, 793 Mesosalpinx, 729 Mesothelioma, 81 Mesothelium, 57 Mesovarium, 729 Metabolism, Metacarpal bones, 190, 191 Metacarpophalangeal joints, 228, 231 Metanephric diverticulum (ureteric bud), 794 Metanephros, 793 Metaphase, 48, 49 Metaphase plate, 48 Metaphyseal vessels, 128 Metaphysis, 118 Metastasis, 47, 49, 81 Metastatic cancer, 618 See also Cancer Metatarsal bones, 205, 237 Metatarsophalangeal joints, 231, 235, 237 Metencephalon, 406, 779 Microglia, 351 Microscopic anatomy, 2, 24 Microtome, 29 Microtubule(s), 36, 37–38 Microtubule-organizing center (MTOC), 37, 39 Microtubule-targeted drugs (MTDs), 37 Microvilli, 30, 31, 36, 55 Micturition (urination), 465, 466, 696 Micturition reflex, 710, 714 Middle cardiac vein, 561 Middle ear, 479–481, 504 Middle piece, spermatozoon, 723 Midsagittal section, 18 Migraine headache, 349 Milk teeth, 666 Mineralocorticoids (MC), 515, 520 “Minimus,” muscle name, 260 “Minor,” muscle name, 260 Mitochondria, 30, 31, 36, 40 Mitosis, 46, 48–49 Mitotic rate, 49 Mitral valve (left atrioventricular valve), 555, 558 Mitral valve prolapse (MVP), 558, 566 Mixed endocrine glands, 61 Mixed nerves, 368 M line, 249 Moderator band, 555 Modiolus, 487 Molars, 666 Molecular level of organization, 5, Monaxial joint, 212, 213, 215, 218 Monocyte-macrophage system, 537 Monocytes, 66, 71, 534, 537 Monosynaptic reflex, 386, 387 Mons pubis, 741 Morula, 753 Motor end plate, 245 Motor homunculus, 398, 399, 400 Motor neurons, 252, 348, 357 Motor nuclei, 373 Motor (descending) pathways, 362 Motor (descending) tracts, 373 autonomic nervous system, 395–398 central nervous system, 395–398 corticospinal tracts, 398–400 overview, 403 somatic motor control, 401–402 subconscious, 400–401 Motor unit, 254, 255 Mouth, 12 Movements, description, 215, 240 types, 215–218, 240 M phase, 48 MRI (magnetic resonance imaging), 23, 24, 525 Mucins, 61, 666 Mucosa (mucous membranes), 75, 76 digestive system, 658 esophagus, 669 oral, 664 trachea, 637 Mucosa-associated lymphoid tissue (MALT), 615 Mucosal crypts, 688 Mucosal epithelium, digestive system, 658 Mucous cells, 62 Mucous connective tissue (Wharton’s jelly), 66, 67 Mucous glands, 61 Mucous neck cells, 675 Mucus, 61, 62 Mucus escalator, 632 Müllerian (paramesonephric) duct, 795, 797 Multiaxial joint, 218 Multicellular exocrine glands, 62 Multicellular glands, 61–62 Multifidus muscle, 279, 280 Multilocular adipose cells, 67 Multinucleate cells, 40, 78, 246 Multipennate muscle, 258, 259 Multiple motor unit summation, 255 Multiple sclerosis, 358 Multipolar neuron, 356, 357 Multipotential lymphoid stem cells, 541 Multipotential myeloid stem cells, 541 Mumps, 666, 691 Murmur, heart, 558, 566 Muscarine, 462 Muscarinic receptors, 462 Muscle atrophy, 255 Muscle cell, 5, Muscle contraction end of, 251–252 neural control, 252–253 overview, 253–254, 264 sliding filament theory, 251–252 start of, 251 Muscle cramps, 298, 330 Muscle fibers, 78 Muscle hypertrophy, 255 Muscles listed abductor digiti minimi, 303, 305, 324 abductor hallucis, 317, 324 abductor pollicis, 303, 305 adductor, magnus/brevis/longus, 199, 309, 311 adductor hallucis, 317, 324 adductor pollicis, 303, 305 anal sphincter, 287 anconeus muscle, 299, 300 arrector pili, 101 biceps brachii See Biceps brachii muscle biceps femoris, 313, 314 brachialis, 299, 300 brachioradialis, 291, 299, 300 buccinator, 261, 270, 272, 664 bulbospongiosus, 287, 727 ciliary, 495 coccygeus, 287 coracobrachialis, 294, 296 corrugator supercilii, 272 cremaster, 719 cricothyropharyngeus, 275 dartos, 719 deltoid, 185, 259, 294, 296, 298 depressor anguli oris, 272 depressor labii inferioris, 272 detrusor, 709 diaphragm, 19, 176, 281, 283, 284, 648 digastric, 277, 278 dorsal interosseous, foot, 317, 324 dorsal interosseous, hand, 303, 305, 324 erector spinae, 278, 280, 775 extensor carpi radialis, 260, 299, 300 extensor carpi ulnaris, 299, 300 extensor digiti minimi, 305 extensor digitorum, 259, 305, 314, 317, 324 extensor hallucis, 314 extensor indicis, 305 extensor pollicis, 305 extensor retinaculum, 301, 315 fibularis, 314, 315 flexor carpi radialis, 299, 300 flexor carpi ulnaris, 299, 300 flexor digiti minimi brevis, 317, 324 flexor digitorum, 305, 314, 317, 324 flexor hallucis muscles, 314, 317, 324 flexor pollicis, 305 gastrocnemius, 314, 315 gemelli, 310 genioglossus, 260, 275 geniohyoid, 277, 278 gluteus maximus, 199, 308, 310, 311 gluteus medius, 308, 310, 311 gluteus minimus, 308, 310 gracilis, 309, 310 hypaxial, 775 hypoglossus, 275 iliacus, 309, 310 iliococcygeus, 287 iliocostalis cervicis, 279, 280 iliocostalis lumborum, 279, 280 iliocostalis thoracis, 279, 280 iliopsoas, 309 inferior oblique, 270, 273 inferior rectus, 270, 273 infraspinatus, 185, 294, 296 intercostal, 175, 281, 284, 648 interspinales, 279, 280 intertransversarii, 279, 280 intervertebral, 775 ischiocavernosus, 287, 727 laryngeal, 637 laryngeal elevators, 275, 276 lateral rectus, 270, 273 lateral rotator, 308 latissimus dorsi, 260, 294, 296 levator anguli oris, 272 levator ani, 287 levator labii inferioris, 272 levator palpebrae superioris, 272, 491 levator scapulae, 292, 293 levator veli palatini, 275, 276 longissimus capitis, 279, 280 longissimus cervicis, 279, 280 longissimus thoracis, 279, 280 longus capitis, 279, 280, 281 longus colli, 279, 280, 281 lumbrical, 303, 305, 317, 324 masseter, 274 medial rectus, 270, 273 mentalis, 272 multifidus, 279, 280 mylohyoid, 158, 277, 278, 664 nasalis, 272 obliques, external/internal/transversus abdominis, 281–282, 284, 775 obturator, 309, 310 occipitofrontalis, 270, 272 omohyoid, 277, 278 opponens digiti minimi, 305 opponens pollicis, 303, 305 orbicularis oculi, 491 orbicularis oris, 259, 270, 272 palatal, 275, 276, 668 palatoglossus, 275, 664 palatopharyngeus, 275, 276, 664, 668 palmar interosseus, 303, 305 palmaris, 299, 300, 305 papillary, 554 pectinate, 554 pectineus, 199, 309, 310 pectoralis, 259 pectoralis major, 294, 296 pectoralis minor, 293, 294 peroneus, 315 pharyngeal constrictor, 275, 276, 668 piriformis, 309, 310 plantar interosseous, 317, 324 plantaris, 314 platysma, 272 popliteus, 202, 313, 314 procerus, 272 pronator quadratus, 299, 300 pronator teres, 299, 300 psoas major, 309, 310 pterygoid, 274 pubococcygeus, 287 pupillary dilator, 495 pupillary sphincter, 495 quadratus femoris, 310 quadratus lumborum, 279, 280 quadratus plantae, 317, 324 quadriceps femoris, 202, 261, 312 rectus abdominis, 176, 258, 281, 282, 284 rectus femoris, 259, 313, 314 rhomboid, 292, 293 risorius, 261, 272 rotatores, 279, 280 salpingopharyngeus, 275, 276 sartorius, 260, 313, 314 scalene, 281, 284 semimembranous, 313, 314 semispinalis capitis, 279, 280 semispinalis cervicis, 279, 280 semispinalis thoracis, 279, 280 semitendinosus, 313, 314 serratus anterior, 293, 294 serratus posterior, 278, 284 soleus, 202, 314, 315 spinal flexors, 280, 281 spinalis cervicis, 279, 280 spinalis thoracis, 279, 280 splenius capitis, 278, 279 splenius cervicis, 278, 279 stapedius, 481 sternocleidomastoid, 277, 278, 775 sternohyoid, 277 sternothyroid, 277 styloglossus, 275 stylohyoid, 277, 278 stylopharyngeus, 275, 276, 668 subclavius, 293, 294 subscapularis, 185, 294, 296 superior oblique, 270, 273 superior rectus, 270, 273 supinator, 258, 299, 300 supraspinatus, 185, 294, 296 temporalis, 148, 274 temporoparietalis, 270, 272 tensor fasciae latae, 308, 310 tensor tympani, 481 tensor veli palatini, 275, 276 teres major, 260, 294, 296 teres minor, 185, 294, 296 thyrohyoid, 277, 278 tibialis, 314, 315 tongue, 665 trachealis, 637 transverse perineal, 287 transverse thoracis, 281 transversospinalis, 280 transversus abdominis, 281, 284 trapezius, 185, 292, 293, 775 triceps brachii, 185, 260, 296, 298, 299 tympanic, 480 urethral sphincter, 287 vastus intermedius, 312, 314 vastus lateralis, 312, 314 vastus medialis, 312, 314 zygomaticus major, 272 zygomaticus minor, 272 Muscle soreness, delayed-onset, 257 Muscle spindles, 255, 387, 475 Muscle terminology, 259–261 Muscle tissue, 78, 88 cardiac See Cardiac muscle contractility, 244 See also Muscle contraction elasticity, 244 excitability, 244 extensibility, 244 properties, 244 skeletal See Skeletal muscle smooth See Smooth muscle types, 257–259 Muscle tone, 255 Muscle twitch, 254 Muscle weakness, 349 Muscular (distribution) artery, 574 Muscularis layer, vagina, 739 Muscularis mucosae, 658 Muscular system aging and, 262–263 appendicular See Appendicular musculature axial See Axial musculature clinical case (hip fracture), 329–330 development, 760, 774–775 functions, 78 overview, 7, 9, 244 skeletal See Skeletal muscle terminology, 259–261 Muscular tail, Musculocutaneous nerve, 296, 379, 382 Musculotubal canal, 152, 479 MVP (mitral valve prolapse), 558, 566 Myelin, 348, 351 Myelinated, 351 Myelin sheath gaps (nodes of Ranvier), 351 Myeloid stem cells, multipotential, 541 Myenteric plexus (plexus of Auerbach), 659 Myenteric reflex, 661 Mylohyoid line, 157, 163 Mylohyoid muscle, 158, 277, 278, 664 Myoblasts, 246 Myocardial infarction, 565, 566 Myocarditis, 553 Myocardium, 550 Myoepithelial cells, 103 Myofibrils, 249 Myofilaments, 249 Myoglobin, 255 Myoma, 81 Myometrium, 735 Myoneuronal junctions (neuromuscular synapses), 245, 253, 355, 360–361 Myosarcoma, 81 Myosatellite cells, 78, 244, 246 Myosin, 37, 78 Myotatic (deep tendon) reflex, 238, 239, 524 Myotome, 774 Myringotomy, 481, 502 Myxedema, 520, 525 N Nail, 91, 106, 766 Nail bed, 106 Nail body, 106 Nail field, 766 Nail folds, 106 Nail grooves, 106 Nail root, 106, 766 Nares, internal/external, 157, 158, 632, 633 Nasal bones, 157, 163 Nasal cavity, 11, 632–634 Nasal complex, 158, 159, 178 Nasal conchae, inferior/middle/superior, 153, 157, 163 Nasal crest, 156 Nasalis muscle, 272 Nasal placodes, 781 Nasal septum deviated, 160, 177 gross anatomy, 632 perpendicular plate, 153 structure, 157 Nasal vestibule, 632 Nasolacrimal canal, lacrimal bone, 157, 161, 163 Nasolacrimal duct, 492 Nasolacrimal groove, maxilla, 163 Nasopharynx, 634 Navicular bone, 205 Nebulin, 250 Neck gallbladder, 687 tooth, 666 urinary bladder, 709 Neck (body region) arteries, 584 bones, 169–172 lymphatic drainage, 618 muscles, 270, 271, 277–278, 288, 292 nerves, 378 respiratory structures, 633–634 surface anatomy, 334–335 Neck (bone marking), 134, 135 femur, 199 humerus, anatomical/surgical, 185 radius, 187 rib, 174 scapula, 182 Neonatal period, 750, 765 Neonatal respiratory distress syndrome (NRDS), 648, 653 Neonate cardiovascular changes, 599–600, 765 respiratory changes, 650, 765 transitions, 765 Neoplasm (tumor), 47, 49, 81 Nephrolithiasis, 710, 713 Nephron collecting system, 705 distal convoluted tubule, 700, 705 histology, 703 juxtaglomerular complex, 705 juxtamedullary, 701 nephron loop, 700, 705 proximal convoluted tubule, 700, 705 renal corpuscle, 701–702 structure and function, 698, 700–701, 702 Nephron loop (loop of Henle), 700, 703, 705 Nephrotome, 793 Nerve cells See Neurons Nerve deafness, 490, 502 Nerve fibers, 80 Nerve impulse, 359, 364 Nerve plexuses, 376–385, 390 Nerves, 348, 352 cranial See Cranial nerves spinal See Spinal nerves Nerves listed abducens (N VI), 270, 273, 436, 442 accessory (N XI), 278, 293, 436, 445–446 ansa cervicalis, 378 antebrachial cutaneous, 382 axillary, 296, 379, 382 brachial cutaneous, 382 cochlear, 443 dental, 666 facial (N VII), 152, 269, 272, 278, 436, 442–443, 478 femoral, 383 femoral cutaneous, 382, 383 fibular, 382, 383 genitofemoral, 382, 383, 717, 720 glossopharyngeal (N IX), 436, 444, 478 gluteal, 383 great auricular, 378 hypoglossal (N XII), 148, 275, 278, 436, 446 iliohypogastric, 383 ilioinguinal, 383, 717, 720 interosseous, 382 median, 301, 379, 382 musculocutaneous, 296, 379, 382 obturator, 383 occipital, 378 oculomotor (N III), 270, 272, 273, 436, 440 olfactory (N I), 153, 436, 438, 476 optic (N II), 153, 436, 439, 499–500 pectoral, 293, 296, 382 pelvic, 462 petrosal, 443 pharyngeal plexus, 275, 276 phrenic, 378 pudendal, 382, 383, 466, 720 radial, 185, 379, 382, 383 renal, 698 saphenous, 383 scapular, 293, 382 sciatic, 382, 383 splanchnic, 456 subscapular, 296, 382 supraclavicular, 378 suprascapular, 296, 382 thoracic, 293, 382 thoracodorsal, 296, 382 tibial, 382, 383 trigeminal (N V), 274, 275, 278, 436, 441 trochlear (N IV), 270, 273, 436, 440 ulnar, 185, 379, 382, 383 vagus (N X), 276, 436, 444–445, 478 vestibular, 443 vestibulocochlear (N VIII), 436, 443, 486, 487, 501–502 861 Index Index Index 862 Index Nerve tissue See Neural tissue Nervous system See also Central nervous system; Peripheral nervous system anatomical organization, 362–363, 365 clinical case (hearing loss), 501–502 development, 760, 776 motor pathways, 362 neural tissue See Neural tissue overview, 7, 9, 347–349, 362 sensory pathways See Sensory pathways terminology, 348 Nervous tissue See Neural tissue Neural circuits, 361 Neural cortex, 348, 362, 408 Neural crest, 777 Neural folds, 776 Neural groove, 776 Neural lobe, neurohypophysis, 509, 510 Neural plate, 776 Neural tissue, 88 cellular organization neuroglia, 80, 350–355, 363–364 neurons, 80, 355–358, 364 See also Neurons overview, 350 histology, 80 nerve impulse, 359, 364 regeneration, 358–359, 364 synaptic communication, 360–361, 364 Neural tube, 406, 776, 777, 779 Neural tube defects, 170, 778 Neural tunic (retina), 495–497 Neurilemma, 354 Neurocoel (ependymal layer), 406, 776, 777 Neuroeffector junctions, 360 See also Neuromuscular synapses Neuroendocrine cells, 675 Neuroepithelium, 55 Neurofibrils, 355 Neurofilaments, 37, 355 Neuroglandular synapses, 355 Neuroglia (glial cells) central nervous system, 350–352 overview, 80, 348, 350, 363–364 peripheral nervous system, 352–355 Neurohypophysis, 509, 510, 526 See also Pituitary gland Neurolemmocytes (Schwann cells), 351, 352, 354 Neurological disorders, symptoms, 349 Neuroma, 81 Neuromuscular synapses (neuromuscular junctions; myoneuronal junctions), 245, 253, 355, 360–361 Neuronal pools, 361 Neurons classification functional, 357–358, 364 structural, 356–357 functions, 80, 348 nerve impulse generation, 359 organization and processing, 361–362, 364–365 regeneration, 358–359 in sensory tracts, 393 structure, 80, 350, 355–356, 364 synaptic communication, 360–361, 364 Neurosecretions, 509 Neurotransmitters definition, 253 functions, 253 parasympathetic activation and, 462 sympathetic activation and, 459 Neurotropic factors, 351 Neurotubules, 355 Neurulation, 776 Neutrophils, 65, 66, 71 Neutrophils (polymorphonuclear leukocytes; PMNs), 534, 537 Newborn See Neonate Nexuses, 45 NHL (non-Hodgkin’s lymphoma), 623, 626 Nicotine, 462 Nicotinic receptors, 462 ϩ array, 39 ϩ array, 39 Nipple, 742 Nissl bodies (chromatophilic substance), 355 Nitrogen, in human body, NK cells (large granular lymphocytes), 537, 613 Nociceptors, 472 Nodal cells, 561 Nodes of Ranvier (myelin sheath gaps), 351 Nodose ganglion, 445 Nonaxial joints, 218 Nondisplaced fracture, 132 Nondominant (representational) hemisphere, 428, 430 Non-Hodgkin’s lymphoma (NHL), 623, 626 Non-insulin-dependent (type 2; maturityonset) diabetes mellitus, 519, 525 Nonkeratinized epithelium, 58 Nonmembranous organelles centrioles, 31, 38–39 cilia, 31, 38, 39 cytoskeleton, 31, 36, 37 flagella, 38, 39 overview, 31, 37, 50 ribosomes, 30, 31, 39 Nonstriated involuntary muscle, 78 Nonvesicular (electrical) synapses, 361 Norepinephrine (NE; noradrenaline), 452, 458, 520 Normovolemic, 530, 543 Nose, 272, 632–633 Notch (bone marking) See also Foramen frontal bone, supra-orbital, 148, 161, 162 hip bone greater/lesser sciatic, 192 iliac, 192 mandibular, 157 pelvic girdle, acetabular, 192, 228 radius, ulnar, 190, 225 scapula, suprascapular, 185 sternum, jugular, 176, 182 ulna radial, 185, 225 trochlear, 185 Notochord, 4, 770, 776 NRDS (neonatal respiratory distress syndrome), 648, 653 Nuchal lines, occipital, inferior/superior, 148, 162 Nuclear envelope, 31, 40 Nuclear matrix, 40 Nuclear pore, 31, 40 Nucleases, 689 Nucleolus, 31, 41 Nucleoplasm, 31, 40 Nucleosome, 40 Nucleus, cell, 30, 31, 40–41, 348, 362 Nucleus cuneatus, 415, 416 Nucleus gracilis, 415, 416 Nucleus pulposus, 220, 222, 771 Nucleus solitarius, 478 Nurse (sustantacular; Sertoli) cells, testes, 522, 721, 723 Nursemaid’s elbow, 225 Nutrient artery, bone, 128 Nutrient foramen, 128 Nutrient vein, bone, 128 Nystagmus, 486, 501, 502 O “Oblique,” muscle name, 260 Oblique fissure, lung, 639 Oblique muscles abdominal, 281–282, 284 cervical, 284 development, 775 extra-ocular, 270, 273 thoracic, 284 Obturator artery, 589 Obturator foramen, hip bone, 192 Obturator groove, hip bone, 192 Obturator muscles, 309, 310 Obturator nerve, 383 Obturator vein, 596 Occipital bone, 148, 149, 161, 162 Occipital condyles, 148, 162 Occipital crest, external, 148, 162 Occipital lobe, 427, 428 Occipital nerve, 378 Occipital protuberance, external, 148 Occipitofrontalis muscle, 270, 272 Occluding junction, 45 Occlusal surfaces, 668 Ocular (bulbar) conjunctiva, 491 Oculomotor (extra-ocular) muscles, 270, 273 Oculomotor nerve (N III), 270, 272, 273, 436, 440 Odontoid process, axis, 170 Oil (sebaceous) glands, 8, 102–103, 767 Olecranon fossa, humerus, 185 Olecranon process, ulna, 185 Olfaction (smell), 476–477, 503, 781 Olfactory bulbs, 438 Olfactory cortex, 427, 428 Olfactory epithelium, 476 Olfactory (Bowman’s) glands, 476 Olfactory nerve (N I), 153, 436, 438, 476 Olfactory organs, 476 Olfactory pathways, 476 Olfactory receptors, 476 Olfactory region, nasal cavity, 632 Olfactory tracts, 438 Oligodendrocytes, 351 Olivary nuclei, 415, 416 Olivary nucleus, superior, 487 Olives, medulla oblongata, 416 Omental appendices, 681 Omohyoid muscle, 277, 278 Oocyte, 732, 750–751 Oocyte activation, 750, 751 Oogenesis, 729, 732–734 Oogonia, 732 Ooplasm, 750 Open (compound) fracture, 132 Ophthalmic artery, 584 Ophthalmic branch, trigeminal nerve, 441 Opponens digiti minimi muscle, 305 Opponens pollicis muscle, 303, 305 Opposition (movement), 217, 218 Optic canal, sphenoid, 153, 161, 163 Optic chiasm, 420, 439 Optic cups, 781 Optic disc, 497 Optic groove, sphenoid, 153 Optic nerve (N II), 153, 436, 439, 499–500 Optic stalks, 781 Optic tracts, 439 Optic vesicles, 406, 781 Optimal resting length, sarcomere, 252 Oral cavity, 664–668 gross anatomy, 664–668 salivary glands, 665–666 teeth, 666–668 tongue, 664–665 Oral mucosa, 664 Ora serrata, 495 Orbicularis oculi muscle, 491 Orbicularis orbis muscle, 259, 270, 272 Orbital complex, 158, 178 Orbital fat, 492 Orbital fissures, inferior/superior, 153, 154, 161, 163 Orbital process, palatine bone, 156 Orbits, 158 Orchiectomy, 746 Organelles, 5, 31 membranous See Membranous organelles nonmembranous See Nonmembranous organelles Organism, Organization, levels of, 5–6 Organ level of organization, 5, Organ of Corti (spiral organ), 488, 489 Organogenesis, 759 Organs, 2, 24 Organ systems See also specific systems definition, development, 85–86 overview, 7–14 Orifices, 244 Origin, muscle, 259, 260 Oropharynx, 634 Osmosis, 33, 35 Osseous tissue See Bone Ossification, 122 endochondral, 123–124 intramembranous, 122–123 Ossification centers, 123 Osteoarthritis, 239, 653 Osteoblasts, 84, 116, 117 Osteoclast-activating factor, 130, 136 Osteoclasts, 117 Osteocytes, 72, 116, 117 Osteogenesis, 116, 122 Osteoid, 116 Osteolysis, 118 Osteoma, 81 Osteomalacia, 127, 136 Osteomyelitis, 130, 136 Osteon (Haversian system), 117, 118 Osteopenia, 129, 136 Osteoprogenitor cells, 117 Osteosarcoma, 81 OTC medication, 744 Otic ganglion, 441, 444, 462 Otic placodes, 782 Otic vesicles, 782 Otitis media, 481 Otoliths, 484, 485 Oval window, 482 Ovarian artery, 589, 729, 737 Ovarian cancer, 729 Ovarian cycle, 732–734, 739, 747 Ovarian follicles, 732–733 Ovarian hilum, 729 Ovarian ligament, 729 Ovarian vein, 596, 729 Ovaries endocrine functions, 10, 507, 520, 527 gross anatomy, 729, 747 ovarian cycle and oogenesis, 729, 731–734, 747 Overview, 13 Oviduct (Fallopian tube; uterine tube), 729, 731, 734–735, 747 Ovulation, 733, 750–751 Ovum, 717 Oxidases, 45 Oxygen, in hemoglobin, 34 Oxyntic (parietal) cells, 675 Oxyphil cells, 514 Oxytocin, 743 Oxytocin (OT), 420, 509, 510 P Pacemaker cells, 78, 561 Pacemakers, artificial, 564–565 Pacesetter cells, 78 Pacesetter (interstitial) cells, 660 Pacinian (lamellated) corpuscles, 473, 474 Packed cell volume (PCV), 532 Packed red blood cells (PRBCs), 539, 543 Pain fast (pricking), 472 referred, 472, 502 slow (burning, aching), 472 “Palatal,” dental frame of reference, 668 Palatal muscles, 275, 276, 668 Palatal process, maxilla, 163 Palatine bones, 156–157, 163 Palatine foramina, greater/lesser, 156, 163 Palatine processes, maxilla, 154 Palatine tonsils, 615 Palatoglossus arch, 635, 664 Palatoglossus muscle, 275, 664 Palatopharyngeal arch, 635, 664 Palatopharyngeus muscle, 275, 276, 664, 668 Palmar arch, superficial/deep, 581 Palmar interosseus muscles, 303, 305 Palmaris muscles, brevis/longus, 299, 300, 305 Palmar vein, superficial/deep, 594 Palmar venous arch, 594 Palpebrae (eyelids), 491–492 Palpebral conjunctiva, 491 Palpebral fissure, 491 Pampiniform plexus, testicular vein, 717 Pancoast tumor, 651–653 Pancreas digestive functions, 12 endocrine functions, 10, 519, 527 enzymes produced by, 689 gross anatomy, 518, 688–689 histology, 518, 689 hormones produced by, 507 regulation, 689 Pancreatic acini, 689 Pancreatic artery, 517, 589, 689 Pancreatic duct (duct of Wirsung), 688 Pancreatic islets (islets of Langerhans), 517, 689 Pancreatic juice, 689 Pancreaticoduodenal artery, inferior/superior, 517, 589, 689 Pancreaticoduodenal vein, 598 Pancreatic polypeptide (PP), 519 Pancreatic vein, 598 Papillae dermal, 94–95, 767 renal, 696 tongue, 477, 664 Papillary ducts, 700, 702, 705 Papillary layer, dermis, 91, 96–97 Papillary muscles, 554 Papillary plexus, 98 Pap smear, 736 Papule, 111, 112 Parafollicular cells (C thyrocytes; C cells), 129, 512, 514 Parahippocampal gyrus, 433 Parallel muscle, 258 Parallel processing, 361, 362 Paralysis agitans (Parkinson’s disease), 433, 447 Paramesonephric (Müllerian) duct, 795, 797 Paranasal sinuses, 11, 158, 632 Paraplegia, 373, 389 Pararenal fat, 696 Parasagittal section, 18 Parasympathetic (craniosacral) division, autonomic nervous system activation, 462 comparison with sympathetic division, 464 components, 453, 460–462 functions, 462 overview, 452, 453, 460, 462, 468 relationship with sympathetic division, 463–464, 468 visceral reflexes, 465 Parathyroid cells, 512, 514 Parathyroid glands, 10, 507, 512, 514, 525, 526 Parathyroid hormone (PTH), 129, 512, 514, 520 Paraurethral glands (Skene’s glands), 740 Paraventricular nucleus, hypothalamus, 420, 421, 509 Parenchyma, 66, 639 Paresthesias, 349, 383 Parietal bone, 148, 149, 162 Parietal (oxyntic) cells, 675 Parietal eminence, 148, 162 Parietal (capsular) epithelium, 701 Parietal layer, 774 Parietal lobe, 427, 428 Parietal pericardium, 21, 548 Parietal peritoneum, 21, 662 Parietal pleura, 21, 646 Parieto-occipital sulcus, 428 Parkinson’s disease (paralysis agitans), 433, 447 Parotid (Stensen’s) duct, 665 Parotid salivary glands, 665 Paroxysmal atrial tachycardia (PAT), 564 Pars distalis, adenohypophysis, 509, 510 Pars intermedia, adenohypophysis, 509, 510 Pars nervosa, neurohypophysis, 509 Pars tuberalis, adenohypophysis, 509 Parturition, 762 Patella, 122, 131, 202, 231 Patellar ligament, 202, 231 Patellar reflex, 387, 388, 389 Patellar surface, femur, 202 Patellofemoral joint, 231 Patent ductus arteriosus, 601 Patent foramen ovale, 601 Pathologists, 86 Pathology, 4, 24 Pathways, 348, 362 See also Sensory (ascending) pathways PCL (posterior cruciate ligament), 231 PCT (proximal convoluted tubule), 700, 702, 703, 705 Pectinate muscles, 554 Pectineal line, 192, 199 Pectineus muscle, 199, 309, 310 Pectoral fat pad, 741 Pectoral girdle bones, 182–185, 208 joints, 231 movements, 183 muscles, 291–294, 331 Pectoralis major muscle, 294, 296 Pectoralis minor muscle, 293, 294 Pectoralis muscle, 259 Pectoral nerve, 293, 296, 382 Pedicles, vertebrae, 168 PEEP (positive end-expiratory pressure), 648 Pelvic brim, 193 Pelvic cavity, 21, 345 Pelvic diaphragm, 284, 288 Pelvic floor, 284–285, 287, 775 Pelvic girdle age-related changes, 208 bones, 192–199, 209 development, 773 joints, 237 muscles, 308–311, 331–332 Pelvic inlet, 193 Pelvic nerves, 462 Pelvic outlet, 198, 199 Pelvis arteries, 589 bones, 192–199 greater/lesser, 193 lymphatic drainage, 620 muscles, 284–285, 287, 308–311, 331–332 nerves, 382–385 sectional anatomy, 709 sexual differences, 199, 207 surface anatomy, 340 veins, 596 Penile urethra (spongy urethra), 710 Penis, 13, 727–728, 746–747 Pennate muscle, 257, 258 Pepsin, 675 Pepsinogen, 675 Peptic ulcer, 675, 691 Peptidases, 689 Peptide hormones, 508 Perception, 471 Perforated ulcer, 675 Perforating (Volkmann) canals, 118 Perforating (Sharpey’s) fibers, 121 Pericardial artery, 587 Pericardial cavity, 21, 548, 549 Pericardial effusion, 76 Pericardial fluid, 550 Pericardial sac, 550 Pericarditis, 76, 86, 553 Pericardium, 21, 75, 548, 567 Perichondrium, 71 Perikaryon, 350, 355 Perilymph, 482 Perimetrium, 735 Perimysium, 244 Perineal raphe, 719 Perinephric (perirenal) fat, 696 Perineum, 199, 284–285, 287, 288 Perineurium, 375 Perinuclear space, 40 Periodontal ligament, 212, 666 Periorbital edema, 524 Periosteal vessels, 128 Periosteum, 72, 116, 118, 120, 121 Peripheral (sensory) adaptation, 471 Peripheral nerves, 352, 353, 375–377 Peripheral nervous system (PNS) anatomical organization, 365, 377 development, 778 divisions, 347 See also Autonomic nervous system; Somatic nervous system functions, 9, 347, 348, 349 Peripheral neuropathies, 383 Peripheral proteins, 32 Perirenal (perinephric) fat, 696 Peristalsis, 660–661 Peristaltic wave, 661 Peritoneal cavity, 21 Peritoneal dialysis, 706 Peritoneum, 21, 75, 662 Peritonitis, 76, 86, 662, 691 Peritubular capillaries, 701 Peritubular fluid, 705 Permeability active processes active transport, 34, 35 endocytosis, 34, 35 exocytosis, 34, 35 phagocytosis, 34 pinocytosis, 34 receptor-mediated endocytosis, 34–35 passive processes diffusion, 33, 35 facilitated diffusion, 33, 35 osmosis, 33, 35 types, 33 Peroneal palsy, 383 Peroneus muscles, 315 Peroxisomes, 30, 31, 45 Perpendicular plate nasal septum, 153, 163 palatine bone, 156 Petechia(e), 712 Petrosal ganglion, 444 Petrosal nerve, 443 Petrosal sinuses, 592 Petrous part, temporal bone, 151, 162 Peyer’s patches (aggregated lymphoid nodules), 615, 679 Phagocytosis, 34 Phagosome, 34 Phalanges of foot, 205, 237 of hand, 190, 191, 231 Pharyngeal (branchial; gill) arches, 4, 635, 664, 768, 779, 783 Pharyngeal clefts, 783 Pharyngeal constrictor muscles, 275, 276, 668 Pharyngeal phase, swallowing, 669 Pharyngeal plexus, 275, 276 Pharyngeal pouches, 783 Pharyngeal tonsil (adenoids), 615, 634 Pharyngotympanic tube See Auditory tube (Eustachian tube, pharyngotympanic tube) Pharynx digestive functions, 12 muscles, 275, 276, 668 regions, 634 respiratory functions, 11 swallowing process, 668–669 Phasic receptors, 471 Pheochromocytoma, 520 Pheromones, 104 Phospholipid bilayer, 32 Phosphorus, in human body, Photoreceptors, 497 Phrenic artery, inferior/superior, 514, 587, 589, 669 Phrenic nerve, 378 Phrenic vein, 597 863 Index Index Index 864 Index Pia mater, 371, 411 Pigment, epidermal, 96 Pigmented layer, retina, 495 Pineal gland blood–brain barrier and, 412 endocrine functions, 10, 507, 522, 527 Pinealocytes, 522 Pinocytosis, 34 Pinosomes, 34 Pin prick test, 501 Piriformis muscle, 309, 310 Pisiform bone, 190 Pituitary gland (hypophysis) adenohypophysis (anterior lobe), 509–512, 526 development, 784 diagnostic procedures, 525 endocrine functions, 10 gross anatomy, 408, 508, 509 histology, 509 hormones produced by, 507, 509–510 hypophyseal portal system and, 511 hypothalamus and, 510 neurohypophysis (posterior lobe), 509, 526 Pituitary growth failure (pituitary dwarfism), 127, 136, 512, 520 Pivot joints, 218, 219, 227 Placenta, 743, 753, 756, 758 Placental circulation, 758 Placental stage, labor, 764 Placentation, 753, 756, 757 Plane (gliding) joints, 218, 219 Planes, anatomical, 18–19 Plantar arch (arteries), 589 Plantar artery, medial/lateral, 589 Plantar flexion, 217, 218 Plantar interossei muscles, 317, 324 Plantaris muscle, 314 Plantar response (reflex), 238, 239 Plantar vein, 597 Plantar venous arch, 597 Plaque atherosclerotic, 573 coronary, 560 Plasma, 69, 530–532 Plasma expanders, 539 Plasmalemma (plasma membrane) extensions, 36 functions active processes, 34–36 overview, 31, 32–33, 50 passive processes, 33–34 receptors, 459, 462 structure, 30, 31, 32, 36 Plasma proteins, 531, 532 Plasmocytes, 66, 613 Plasticity, 660 Platelets, 71, 530, 534, 540–541 Platysma, 270, 272 Pleura, 21, 75, 646 Pleural cavity, 20, 21, 646, 654, 790 Pleural effusions, 76 Pleural fluid, 646 Pleural rub, 76 Pleurisy, 646 Pleuritis (pleurisy), 76, 86 Pleuropericardial membrane, 790 Plexus of Auerbach (myenteric plexus), 659 Plexus of Meissner (submucosal plexus), 659 Plicae circulares, 676 Pluripotential stem cells (PPSC), 541, 615 Pneumatized bones, 131 Pneumocyte type I cells, 646 Pneumocyte type II cells, 646 Pneumotaxic center, pons, 416, 651 Pneumothorax, 176, 177 Podocytes, 701, 705 Polar body, 733 Polarity, epithelial tissue, 54, 55 Polycythemia, 538, 543 Polycythemia vera, 538 Polymorphonuclear leukocytes (PMNs, neutrophils), 534, 537 Polyspermy, 750 Polysynaptic reflex, 386, 387 Polyuria, 519 Pons embryology, 406 functions, 402, 407, 416–417, 424 gross anatomy, 417, 424 overview, 406, 407, 448 respiratory control centers, 416, 650–651 structure, 154 Popliteal artery, 589 Popliteal ligaments, 231 Popliteal line, 202 Popliteal lymph nodes, 619 Popliteal surface, femur, 199 Popliteal vein, 598 Popliteus muscle, 202, 313, 314 Porta hepatis, 683 Portal areas (hepatic triads), 683 Portal system hepatic, 598 hypophyseal, 511 Portal vessels, 511 Postcentral gyrus, 428 Posterior, 17 Posterior cavity, eye, 492, 495 Posterior columns, 394–395, 396 Posterior cruciate ligament (PCL), 231 Posterior fontanel, 164 Posterior interventricular branch, right coronary artery, 558 Posterior left interventricular branch, left coronary artery, 558 Posterior nuclei, thalamus, 419, 420 Posterior section, 19 Posterior vein, left ventricle, 561 Postganglionic fibers, 358, 452 Postnatal development, 750 Postsynaptic membrane, 360 Postural reflex, 387 Potassium, in human body, Pott fracture, 133 PPSC (pluripotential stem cells), 541, 615 Precapillary sphincter, 574 Precentral gyrus, 428 Precocious puberty, 520 Pre-embryo, 752 Pre-embryonic development, 750–751 Prefrontal cortex, 428 Preganglionic fibers, 358, 452 Preganglionic neurons, 397, 452, 460 Pregnancy first trimester See First trimester folic acid in, 170 growth of uterus and fetus, 763 mammary gland development during, 743 second trimester, 751, 760–761, 760–762 spinal curves in, 164 teratogens in, 754 third trimester, 751, 760–761, 760–762 Premature delivery, 765 Premature labor, 764–765 Premature menopause, 743 Premature ventricular contractions (PVCs), 564 Prenatal development, 750, 760–761 See also Development Preoptic area, hypothalamus, 420, 421 Prepuce clitoris, 740 penis, 727 Preputial glands, 727 Pressure palsy, 349 Pressure receptors, 473, 474 Presynaptic membrane, 360 Pricking (fast) pain, 472 Primary bronchi, left/right, 638, 654 Primary curvatures, spine, 164 Primary dentition, 666 Primary follicle, 732 Primary germ layers, 82 Primary lysosome, 44 Primary motor cortex, 427, 428 Primary neoplasm, 81, 86 Primary ossification center, 123 Primary Raynaud’s phenomenon (Raynaud’s disease), 456 Primary sensory cortex, 427, 428 Primary sex cords, 795, 797 Primary taste sensations, 478 Primary teeth, 666 Primary tissue types, 54 Primary tumor, 81, 86 Primary villi, trophoblast, 755 Prime mover (muscle), 260 Primitive streak, 85, 755 Primordial germ cells, 797 Primordial lymph sacs, 788 Primordial ovarian follicle, 732 Principal cells, parathyroid, 514 PRL (prolactin), 510, 511, 743 Procerus muscle, 272 Process (bone marking), 134, 135 axis, odontoid, 170 mandible, condylar/coronoid, 157, 163 mastoid, 152, 162 maxilla alveolar, 154 frontal, 154 palatal, 163 palatine, 154 palatine bone, orbital, 156 sacrum, superior articular, 173 scapula, coracoid, 182 sphenoid clinoid, 153 pterygoid, 153, 163 sternum, xiphoid, 176 styloid, 152, 162 temporal bone, zygomatic, 151, 162 ulna, coronoid/olecranon, 185 vertebrae articular, 167, 168 costal, 169 vertebral arch spinous, 167 transverse, 167 zygomatic bone, temporal, 151, 163 “Profundus,” muscle name, 260 Progesterone, 511, 522, 733 Progestins, 511, 733 Projection fibers, 395, 430, 431 Prolactin (PRL), 510, 511, 743 Proliferative phase, uterine cycle, 737, 739 Promontory, sacral, 173 Pronation, 190, 217 Pronator quadratus muscle, 299, 300 Pronator teres muscle, 299, 300 Prone, 15 Pronephric ducts, 793 Pronephros, 793 Pronucleus, male/female, 750, 751 Prophase, 48 Proprioceptors, 357, 472, 475 Prosencephalon, 406, 779 Prostate gland, 13, 726–727 Prostatic fluid, 727 Prostatic urethra, 710 Protective reflex, 651 Proteinases, 689 Proteins carrier, 33 in human body, membrane, 32 plasma, 532 transmembrane, 32 Proteinuria, 712 Proteolytic enzymes, 689 Protraction, 217, 218 Proximal, 17 Proximal convoluted tubule (PCT), 700, 702, 703, 705 Pseudopodia, 34 Pseudostratified ciliated columnar epithelium, 60 Pseudostratified columnar epithelium, 59–60 Pseudounipolar neuron, 356, 357 Psoas major muscle, 309, 310 Psoriasis, 108, 112 Pterygoid canal, sphenoid, 153 Pterygoid muscles, lateral/medial, 274 Pterygoid process, sphenoid, 153, 163 Pterygopalatine ganglion, 441, 443, 462 PTH (parathyroid hormone), 129, 512, 514, 520 Pubic angle, 199 Pubic crest, 192 Pubic symphysis, 192, 212, 231 Pubic tubercle, 192 Pubis, 192, 199 Pubococcygeus muscle, 287 Pubofemoral ligament, 229 Pudendal artery, internal/external, 589, 720 Pudendal nerve, 382, 383, 466, 720 Pudendal vein, 596 Pulled groin, 309 Pulleys, anatomical, 262, 265 Pulmonary artery, left/right, 555, 578 Pulmonary circuit, 548, 571, 578, 579, 605 Pulmonary embolism, 602, 604, 653 Pulmonary groove, 789 Pulmonary plexus, 464 Pulmonary trunk, 555 Pulmonary valve, 555, 558 Pulmonary vein, 555, 578 Pulp, spleen, 623 Pulp cavity, tooth, 666 Pulvinar, 419, 420 Puncta, lacrimal, 492 Pupil, 495 Pupillary dilator muscles, 495 Pupillary reflex, 465 Pupillary-skin (ciliospinal) reflex, 653 Pupillary sphincter muscles, 495 Pupil miosis, 653 Purkinje cells (fibers), 424, 562 Putamen, 431 PVCs (premature ventricular contractions), 564 Pyelitis, 711 Pyelogram, 707, 713 Pyelonephritis, 711 Index Q Quadrants, abdominopelvic, 16 Quadrate lobe, liver, 683 Quadratus femoris muscle, 310 Quadratus lumborum muscle, 279, 280 Quadratus plantae muscles, 317, 324 Quadriceps femoris (quadriceps muscles), 202, 261, 312 Quadriceps tendon, 202 Quadriplegia, 373, 389 Quiet breathing (eupnea), 650 R Radial artery, 581 Radial artery, uterus, 737 Radial collateral ligament, 225, 227 Radial fossa, humerus, 185 Radial groove, humerus, 185 Radial head, radius, 187 Radial nerve, 185, 379, 382, 383 Radial nerve palsy, 383 Radial notch, ulna, 185, 225 Radial tuberosity, radius, 187, 225 Radial vein, 595 Radiation, ultraviolet, 96 Radical mastectomy, 744 Radioactive iodine uptake (RAIU) test, 525 Radiocarpal joint, 226, 231 Radiocarpal ligament, palmar/dorsal, 227 Radiodensity, 22 Radiographic anatomy, 5, 24 Radiological procedures, 22–23 Radiologists, 22, 24 Radioulnar joint, 185, 189, 225, 227, 231, 241 Radius, 187–190, 231 Ramus, 134, 135 hip bone, ischial, 192 mandible, 163 pubis, inferior/superior, 192 Raphe, 258, 719 Raynaud’s disease/syndrome, 456, 467 RBC casts, 712 RCA (right coronary artery), 558 RDS (respiratory distress syndrome), 648, 653 Receptive field, 471 Receptor-mediated endocytosis, 34–35 Receptors, 347, 349 gustatory, 477–478 olfactory, 476 sensory, 471–472 Receptor site, 34 Receptor specificity, 471 Recruitment, 255 Rectal artery, 589 Rectal vein, 598 Rectouterine pouch, 729 Rectum, 681 “Rectus,” muscle name, 260 Rectus abdominis muscle, 176, 258, 281, 282, 284 Rectus femoris muscle, 259, 313, 314 Rectus muscles abdominal, 176, 258, 281, 282, 284 cervical, 281, 284 development, 775 extra-ocular, 270, 273 thoracic, 28, 284 Red blood cells (RBCs; erythrocytes) abundance, 534 characteristics, 534 functions, 69, 530, 534 hemoglobin and, 534 histology, 69, 533 life span and circulation, 533–534 structure, 533–534 Red bone marrow, 615 Red (slow) fibers, 255, 256, 257 Red marrow, 116, 118 Red nucleus, mesencephalon, 401, 417, 418 Red pulp, spleen, 623 Referred pain, 472, 502 Reflex, 348 classification, 386, 387, 390 deep tendon, 238, 239, 524 definition, 386 endocrine, 508 integration, 388 myenteric, 661 respiratory, 651 spinal, 386–388, 387, 390 steps, 386 stretch, 387 visceral, 387, 464–466 Reflex arc, 386 Reflex centers, medulla oblongata, 416 Regeneration epithelial tissue, 54 neural tissue, 358–359 Regional anatomy, Regional sympathectomy, 458 Regulatory hormones, 508 Regulatory (suppressor) T cells, 612 Regurgitation, valve, 558 Relaxin, 743 Releasing hormones (RH), 508 Renal artery, 514, 589, 696, 698 Renal columns, 698 Renal corpuscle, 700, 701–703, 704 Renal cortex, 696, 700 Renal failure, 706 Renal fascia, 696 Renal lobe, 698 Renal medulla, 696 Renal nerves, 698 Renal papilla, 696 Renal pelvis, 698 Renal pyramids, 696 Renal sinus, 696 Renal tubule, 700 Renal vein, 597, 696, 698 Renin, 517, 705 Rennin, 675 Reposition, 217 Representational (nondominant) hemisphere, 428, 430 Reproductive system development, 761, 795 female See Female reproductive system male See Male reproductive system organization, 717, 746 overview, RER (rough endoplasmic reticulum), 30, 31, 41 Respiration, Respiratory bronchioles, 646 Respiratory centers, 650 Respiratory centers, pons, 416, 417 Respiratory defense system, 632 Respiratory distress syndrome (RDS), 648, 653 Respiratory epithelium, 631–632 Respiratory membrane, 646 Respiratory rhythmicity centers, medulla oblongata, 416, 650 Respiratory system aging and, 651 changes at birth, 650, 765 clinical case (lung cancer), 651–653 development, 761, 789–790 epithelium, 631–632 functions, 631 larynx, 635–637 lung See Lung overview, 7, 11, 630–631, 653 pleural cavities and pleural membranes, 646, 648 primary bronchi, 638 pulmonary ventilation, 648–650 respiratory centers of the brain, 650–651 respiratory movements, 649–650 respiratory muscles, 648–649 trachea, 637–638 upper, 632–634 Respiratory tract, 630 Responsiveness, “Rest and repose” division See Parasympathetic (craniosacral) division, autonomic nervous system Restenosis, 560 Rete testis, 720 Reticular cells, 622 Reticular fibers, 66 Reticular formation, 401, 418, 433, 434 Reticular layer, dermis, 91, 96–97 Reticular tissue, 68, 69 Reticulocytes, 541 Reticulospinal tracts, 399, 400, 401 Retina (neural tunic), 495–497 Retinal artery, 497 Retinal vein, 497 Retraction, 217, 218 Retroflexion, uterus, 735 Reverberation, 361, 362 Rheumatism, 237, 239 Rheumatoid arthritis, 239 Rhizotomy, 442 Rh-negative blood, 535 Rhombencephalon, 406, 779 Rhomboid muscle, 292, 293 Rh-positive blood, 535 Rib cage, 174 Ribosomes, 30, 31, 39 Ribs (costae), 174–176, 227, 771 Rickets, 127, 136 Ridge, supracondylar, medial/lateral, 202 Right atrium, 554 Right bundle branch, 562 Right coronary artery (RCA), 558 Right lower quadrant (RLQ), 16 Right lymphatic duct, 612 Right marginal branch, right coronary artery, 558 Right rotation, 217 Right upper quadrant (RUQ), 16 Right ventricle, 554–555, 556 Rigor mortis, 253, 264 Risorius muscle, 261, 272 RLQ (right lower quadrant), 16 Rods, 497 Roof plate, 777 Root lung, 638 penis, 727 tongue, 664 tooth, 666 Root canal, 666 Root hair plexus, 101, 473, 474 Root sheath, hair follicle, 99 Rotation, 215, 217, 221 Rotator cuff, 225, 296, 330 Rotatores muscles, 279, 280 Rough endoplasmic reticulum (RER), 30, 31, 41 Rouleaux, 533 Round ligament liver, 683 uterus, 735 Round window, 482 Rubrospinal tracts, 399, 400, 401 Ruffini corpuscles, 98, 473, 474 Rugae stomach, 673 urinary bladder, 709 vagina, 739 RUQ (right upper quadrant), 16 S Saccule, 482 Sacral artery, medial, 589 Sacral canal, 173 Sacral cornua, 174 Sacral crest, lateral/median, 173 Sacral curve, 164, 166 Sacral foramina, 174 Sacral hiatus, 174 Sacral plexus, 377, 382–385 Sacral promontory, 173 Sacral tuberosity, 174 Sacral vein, lateral/medial, 596 Sacral vertebrae, 164, 166 Sacrococcygeal joint, 227 Sacro-iliac joint, 174, 192, 227, 237 Sacrum, 164, 173–174, 227, 237 Saddle joints, 218, 219 Sagittal plane, 18 Sagittal sinuses, inferior/superior, 411 Sagittal suture, 148 Salivary amylase, 666 Salivary glands, 12, 158, 665–666 Salpingo-oophorectomy, 729 Salpingopharyngeus muscle, 275, 276 Saphenous nerve, 383 Saphenous vein, great/small, 598 Sarcolemma, 78, 246 Sarcomere, 248, 249, 251, 252 Sarcoplasm, 78, 246 Sarcoplasmic reticulum, 249, 252 Sarkos, 244 Sartorius muscle, 260, 313, 314 Satellite cells, 351, 352, 353 Scab, 104, 112 Scala tympani (tympanic duct), 487 Scala vestibuli (vestibular duct), 487 Scalene muscles, anterior/middle/posterior, 281, 284 Scales, in anatomy, Scalp (epicranium), 270, 272 Scanning electron microscopy, 3, 28, 29 Scaphoid bone, 190 Scapula, 182, 184, 185, 231 Scapular nerve, dorsal, 293, 382 Scapular spine, 185 Scapular triangle, 182 Scarification, 105 Scar tissue, 104–105, 537 Schwann cells (neurolemmocytes), 351, 352, 354 Sciatica, 222, 239, 383 Index Pyloric orifice, 670 Pyloric sphincter, 670 Pylorus, 670 Pyramidal cells, 398, 428 Pyramidal system, 400 Pyramidal (corticospinal) tracts, 398–399 Pyramids, 398 865 Index 866 Index Sciatic compression, 383 Sciatic nerve, 382, 383 Sciatic notch, greater/lesser, 192 SCID (severe combined immunodeficiency disease), 626 Sclera, 494, 524 Scleral venous sinus (canal of Schlemm), 499 Sclerotome, 770 Scoliosis, 167, 177 Scrotal cavity, 719 Scrotal swellings, 796 Scrotum, 13, 717, 719–720 Sebaceous follicles, 103 Sebaceous (oil) glands, 8, 102–103, 767 Seborrheic dermatitis, 108, 112 Sebum, 103 Secondary (lobar) bronchi, 639 Secondary curvatures, spine, 164 Secondary follicle, 733 Secondary lysosome, 44 Secondary oocyte, 733 Secondary ossification center, 124 Secondary processes, 702 Secondary tumor, 81, 86 Second-class lever, 261 Second-order neuron, 393, 394 Second trimester, 751, 760–761, 760–762 Secretin, 675 Secretory phase, uterine cycle, 737–738 Secretory sheet, 61, 62, 673 Secretory vesicles, 44 Sectional anatomy See Cross-sectional anatomy Sectional planes, 19 Sedimentation rate, 691 Segmental artery, kidney, 698 Segmental (tertiary) bronchi, 639 Segmentation, 661–662 Selectively permeable membrane, 33 Sella turcica, 152–153, 163 Semen, 727, 746 Semicircular canals, 482–484 Semicircular ducts, 482, 483, 484 Semilunar ganglion, 441 Semilunar notch, ulna, 185 Semilunar valves, 558 Semimembranous muscle, 313, 314 Seminal fluid, 727 Seminal glands (seminal vesicles), 13, 725, 726 Seminalplasmin, 727 Seminiferous tubules, 720, 722 Semispinalis capitis muscle, 279, 280 Semispinalis cervicis muscle, 279, 280 Semispinalis thoracis muscle, 279, 280 Semitendinosus muscle, 313, 314 Senile cataracts, 498 Senile dementia (senility), 435 Sensation, 393, 471 Sense organs, 471, 760 See also specific senses Sensible perspiration (sweat), 105 Sensitized, 535 Sensory coding, 471 Sensory homunculus, 395, 396 Sensory modality arrangement, 393 Sensory neurons, 348, 357 Sensory nuclei, 373 Sensory (ascending) pathways auditory, 487, 490 gustatory, 478 olfactory, 476 vestibular, 486 visual, 499–500 Sensory receptors, 8, 471–472, 503 Sensory (ascending; somatosensory) tracts neurons in, 393 overview, 362, 373, 393, 403 posterior columns, 393–394, 396 spinocerebellar tract, 394, 395, 397 spinothalamic tract, 394, 395, 396–397 Septum pellucidum, 408 SER (smooth endoplasmic reticulum), 30, 31, 41 Serial processing, 361, 362 Serial reconstruction, 19 Serosa (visceral peritoneum), 659, 662 Serous glands, 61 Serous membranes, 20, 75, 76 Serous otitis media, 481 Serratus anterior muscle, 293, 294 Serratus posterior muscles, inferior/superior, 278, 284 Sertoli (nurse; sustentacular) cells, testes, 522, 721, 723 Serum, 532 Sesamoid bone, 122, 131, 134 Severe combined immunodeficiency disease (SCID), 626 Sex cells (gametes; germ cells), 28, 46, 717 Sex differences pelvis, 199 skeleton, 207 Sex hormones See Estrogens; Testosterone Sexual arousal, 465 Shaft See also Body bone, 118 hair, 99 humerus, 185 penis, 727 ulna, 185 Shallow (costal) breathing, 650 Sharpey’s (perforating) fibers, 121 Short bones, 131, 134 Short reflex, visceral, 466 Shoulder (glenohumeral joint) articulations, 231 bones, 182–185 bursae, 225 injuries, 225 ligaments, 223, 225 movements, 231 muscles and tendons, 223, 292, 296, 297–298 structure, 223–225, 241 surface anatomy, 336 Shoulder separation, 240 Shunt, 426, 706 Shunt muscle, 291 SIADH (syndrome of inappropriate ADH secretion), 520 Sickle cell anemia, 538 Sigmoid artery, 589 Sigmoid colon, 662, 681 Sigmoid flexure, 681 Sigmoid mesocolon, 662 Sigmoid sinus, 592 Sign, 24 Simple alveolar gland, 62, 103 Simple branched alveolar gland, 62, 103 Simple columnar epithelium, 59 Simple cuboidal epithelium, 58 Simple duct, 62 Simple epithelium, 57 Simple (closed) fracture, 132 Simple gland, 62 Simple squamous epithelium, 57 Sinoatrial (SA) node (cardiac pacemaker), 558, 561 Sinus, 134, 135 cavernous, 592 clinical note, 160 frontal, 148, 158, 162 maxillary, 154, 158, 163 paranasal, 158 sagittal, 411, 592 sigmoid, 592 sphenoidal, 158 straight, 592 transverse, 411 Sinusitis, 160, 177 Sinusoids, 574 Skeletal muscle See also Appendicular musculature; Axial musculature actions, 260 aging and, 262–263 blood supply, 245 connective tissue, 244–245 contraction neural control, 252–253 overview, 253–254, 264 sliding filament theory, 251–252 fibers distribution, 257 microanatomy, 79, 246–250 organization, 78, 79, 257–259, 265 types, 255–256, 265 functions, 9, 79, 244, 264 gross anatomy, 244–245, 264 levers, 261–262 locations, 79 motor units and muscle control, 254–255 names, 260–261 nerves and blood vessels, 245, 246 origins and insertions, 260 properties, 244 pulleys, 262 types, 257–259 Skeletal muscle pump, 577 Skeletal system See also Bone age-related changes, 129–130, 208 appendicular division See Appendicular skeleton articulations See Joints axial division See Axial skeleton clinical case (whiplash), 238–239 congenital disorders, 127 development, 760 functions, 116 individual variation, 206 overview, 7, sexual differences, 207 Skene’s glands (paraurethral glands), 740 Skin See also Integumentary system aging and, 107 blood supply, 95, 97 cancers, 109 clinical case (latex allergy), 110–111 dermis See Dermis development, 760, 766 disorders, 108–109 epidermis See Epidermis examination, 108 glands, 102–106 nerve supply, 98 pigment content, 96 repair of injuries to, 104–105 structure and function, 92 tactile receptors, 473, 474 wrinkles, stretch marks, and lines of cleavage, 97 Skin graft, 106, 112 Skin signs, 108 Skull age-related changes, 208 anterior view, 144 articulations, 227 cranial subdivision, 141, 148–154, 162–163, 177 development, 768–769 facial subdivision, 141, 148, 154–158, 163, 177 foramina and fissures, 161 horizontal section, 146 infant, 164, 165 inferior view, 145 lateral view, 143 neonate, 768 posterior view, 142 sagittal section, 147 sexual differences, 207 superior view, 142 surface features, 162–163 Skullcap (calvaria), 148 Sliding filament theory, muscle contraction, 251–252, 264 Slipped disc, 222 Slow-adapting receptors, 471 Slow (red) fibers, 255, 256, 257 Slow (burning, aching) pain, 472 Small cardiac vein, 561 Small intestine functions, 12 gross anatomy, 676 histology, 676–679 regions, 676, 678 regulation, 679 support, 676 Smegma, 727 Smell See Olfaction Smoking lung cancer and, 641 in pregnancy, fetal effects, 754 Smooth endoplasmic reticulum (SER), 30, 31, 41 Smooth muscle digestive system, 659–660 functions, 79, 244 histology, 78, 79 locations, 79 Sodium, in human body, Soft keratin, 99 Soft palate, 634, 664 Soleal line, 202 Soleus muscle, 202, 314, 315 Soma, 80, 348 Somatic, 348 Somatic cells, 28 See also Cell Somatic motor association area, 428 Somatic motor control, 401–402 Somatic nervous system (SNS) functions, 347, 348 motor tracts, 395, 398 vs peripheral nervous system, 452 Somatic reflex, 386, 387 Somatic reflexes, 446 Somatic sensory association area, 428 Somatic sensory neurons, 357 Somatic sensory receptors, 347, 349 Somatosensory tracts See Sensory (ascending; somatosensory) tracts Somatostatin, 519 Somatotropes, 511 Somatotropic arrangement, 393 Somatotropin See Growth hormone Somites, 4, 770, 776 Sound detection, 487 See also Hearing Spasticity, 433, 447 Special senses, 471, 781–782 See also specific senses Special sensory receptors, 349 Specific immunity, 537 Sperm See Spermatozoon Spermatic cords, 286, 717 Spermatids, 721 Spermatocytes, primary/secondary, 721 Spermatogenesis, 721 Spermatogonia, 721 Spermatozoon, 717, 721, 723, 746 Sperm count, 727, 750 Sperm duct (ductus deferens; vas deferens), 13, 724, 726 Spermiation, 721 Spermiogenesis, 721, 723 S phase, 47 Sphenoid (sphenoidal bone), 152–153, 161, 163 Sphenoidal fontanels, 164 Sphenoidal sinuses, 158 Sphenoidal spine, 153 Sphenomandibular ligament, 220 Sphincter, 258, 259 esophageal, 669 of Oddi (hepatopancreatic), 687 Spicules, 118, 123 Spina bifida, 170, 177, 778 Spinal anesthesia, 372 Spinal compression, 373 Spinal concussion, 373 Spinal contusion, 373 Spinal cord cross-sectional anatomy, 373–374, 389 development, 770–771, 777–778 functions, gross anatomy, 368–371, 389 injuries, 373, 466 Spinal curves, 164, 166 Spinal flexors, 280, 281 Spinalis cervicis muscle, 279, 280 Spinalis thoracis muscle, 279, 280 Spinal laceration, 373 Spinal meninges, 368, 369, 389 Spinal nerves gross anatomy, 368, 371, 375, 389 nerve plexuses, 376–385 peripheral distribution, 375–377, 389–390 in urination, 466 Spinal reflex, 386, 387, 390 Spinal shock, 373, 389 Spinal tap, 372, 389 Spinal transection, 373 Spindle apparatus, 38, 48 Spindle fibers, 48 Spine See Vertebral column Spine (bone marking), 134, 135 Spinocerebellar tract, anterior/posterior (anterolateral system), 393, 394, 395, 397 Spinothalamic tracts, lateral/anterior, 394, 395, 396, 397 Spinous process, vertebrae, 168, 169 Spiral artery, uterus, 737 Spiral-CT scan, 23, 24 Spiral fracture, 132 Spiral ganglion, 487 Spiral organ (organ of Corti), 487, 489 Splanchnic nerves, greater/lesser/lumbar, 456 Spleen, 11, 623–624 Splenic artery, 589, 623, 673, 689 Splenic cords, 623 Splenic vein, 598, 623 Splenius capitis muscle, 278, 279 Splenius cervicis muscle, 278, 279 Split skin graft, 106, 112 Spongy (cancellous; trabecular) bone, 72, 74, 118–119 Spongy urethra (penile urethra), 710 Spontaneous abortion, 765 Spontaneous mutations, 752 Sports injuries, 75, 298 Sprain, 207, 208, 298, 330 Spurt muscle, 291 Squama, 151, 162 Squamous cell carcinoma, 109, 112 Squamous epithelium, 57–58 Squamous part, temporal bone, 151, 162 Squamous suture, 148 Stapedius muscle, 481 Stapes, 479, 480 Statoconia, 484 Stellate cells, 65 Stellate ganglion, 456 Stellate reticuloendothelial cells (Kupffer cells), 683 Stem (basal; germinative) cells, 49, 56, 93 development, 766 epidermal, 93 gustatory, 477 multipotential lymphoid, 541 multipotential myeloid, 541 olfactory, 476 pluripotential, 541, 615 Stensen’s (parotid) duct, 666 Stent, coronary, 560 Stereocilia, 55 Sterile, 750 Sternal end, clavicle, 182 Sternoclavicular joint, 182, 223, 231, 241 Sternoclavicular ligament, anterior/posterior, 223 Sternocleidomastoid muscle, 277, 278, 775 Sternocostal joint, 227 Sternocostal surface, heart, 552 Sternohyoid muscle, 277 Sternothyroid muscle, 277 Sternum, 176, 231 Steroid hormones, 508 Stethoscope, 558 Stomach blood supply, 673 functions, 12 gross anatomy, 670–673 histology, 673–675 mesenteries, 673 musculature, 673 regulation, 675 Straight artery, uterus, 737 Straight sinus, 592 Straight tubule, testis, 720 Strain, 298, 309, 330 Stratified columnar epithelium, 59 Stratified cuboidal epithelium, 58 Stratified epithelium, 57 Stratified squamous epithelium, 57, 58 Stratum basale, 93, 94 Stratum corneum, 94 Stratum germinativum, 93 Stratum granulosum, 93–94 Stratum lucidum, 93, 94 Stratum spinosum, 93, 94 Stress fracture, 298, 330 Stress incontinence, 744 Stretch marks, 97 Stretch reflex, 387, 388 Striated, 78 Striated involuntary muscle, 78 Striated voluntary muscle, 78 Stroke (cerebrovascular accident), 415 Stroma, 66 Sty, 491 Styloglossus muscle, 275 Stylohyoid ligament, 159 Stylohyoid muscle, 277, 278 Styloid process radius, 187 temporal bone, 152, 162 ulna, 185 Stylomandibular ligament, 220 Stylomastoid foramen, temporal bone, 152, 161, 162 Stylopharyngeus muscle, 275, 276, 668 Subacromial bursa, 225 Subarachnoid space, 371, 411 Subcapsular space, 617 Subcardinal vein, 786 Subclavian artery, 581 Subclavian steal syndrome, 602–604 Subclavian trunk, 612 Subclavian vein, 594, 595 Subclavius muscle, 293, 294 Subconscious, 348 Subcoracoid bursa, 225 Subcutaneous injection, 98 Subcutaneous layer, 77, 97, 98, 113, 766 Subdeltoid bursa, 225 Subdural hematoma, acute/chronic, 410 Subdural hemorrhage, 410, 447 Subdural space, 371, 411 Sublingual ducts (ducts of Rivinus), 665 Sublingual salivary glands, 665–666 Subluxation, 214, 239 Submandibular ducts (Wharton’s ducts), 666 Submandibular fossa, 158 Submandibular ganglion, 441, 443, 462 Submandibular salivary glands, 158, 666 Submucosa digestive system, 658–659 esophagus, 669 trachea, 637 Submucosal plexus (plexus of Meissner), 659 Subpapillary plexus, 98 Subscapular bursa, 225 Subscapular fossa, scapula, 182 Subscapularis muscle, 185, 294, 296 Subscapular nerve, 296, 382 Subserous fascia, 77, 324 Substantia nigra, 417, 418 Sulcus cerebrum, 408, 426, 428 coronary, 552 Sulcus (bone marking), 134, 135 See also Groove Sulfa drug, 744 Sulfur, in human body, Sunblock, 109 Superciliary arches, 148 Superficial, 17 Superficial anatomy, 14–18 See also Surface anatomy Superficial fascia, 77, 324 “Superficialis,” muscle name, 260 Superficial lymphatics, 611 Superior, 17 Superior ganglion glossopharyngeal nerve, 444 vagus nerve, 445 Superior mesenteric artery, 589 Superior mesenteric ganglion, 456, 458 Superior mesenteric vein, 598 Superior oblique muscle, 270, 273 Superior rectus muscle, 270, 273 Superior sagittal sinus, 592 Superior vena cava, 554, 592, 595–596 Supination, 190, 217 Supinator muscle, 258, 299, 300 Supine, 15 Supporting cells inner ear, 482 olfactory, 476 Supporting connective tissue cartilage, 71–74 definition, 64 development, 84 functions, 71 Suppressor (regulatory) T cells, 612 Suprachiasmatic nucleus, hypothalamus, 420, 421, 500 Supraclavicular fossa, 604 Supraclavicular nerve, 378 Supracondylar ridge, medial/lateral, 199 Supraglenoid tubercle, scapula, 185 Supraoptic nucleus, hypothalamus, 420, 421, 509 Supra-orbital foramen (notch), frontal bone, 148, 161, 162 Supra-orbital margins, frontal bone, 148, 162 Suprarenal artery, 514, 589 Suprarenal (adrenal) gland cortex, 515–516 development, 784 diagnostic procedures, 525 endocrine functions, 10, 507, 517 gross anatomy, 514, 516 histology, 516 medulla, 515, 516–517 medullae, 454, 455, 458 overview, 527 Suprarenal vein, 514, 597 Suprascapular nerve, 296, 382 Suprascapular notch, scapula, 185 Supraspinatus muscle, 185, 294, 296 Supraspinous fossa, scapula, 185 Supraspinous ligament, 221 Surface anatomy, 2, 24, 334 abdomen, 337 back and shoulders, 336 head and neck, 334–335 heart, 552–554 lower limb, 340–341 pelvis, 340 skull, 162–163 thorax, 336 upper limb, 338–339 Surface antigens (agglutinogens), 534 Surface features (bone markings), 134–135 Surfactant, 646, 648 Surgical anatomy, 2, 24 Surgical neck, humerus, 185 Suspensory ligament breast, 742 eye, 495 ovary, 729 uterus, 735 Sustentacular (nurse; Sertoli) cells, testes, 522, 721, 723 Sutural (Wormian) bone, 131, 148 Sutural ligament (membrane), 212 Sutures, 148, 212, 213 Swallowing, 637, 668–669 Swallowing reflex, 465 Sweat (sensible perspiration), 105 Sweat glands, 8, 103–104 Sympathectomy, regional, 458 867 Index Index 868 Index Sympathetic activation, 458 Sympathetic (thoracolumbar) division, autonomic nervous system collateral ganglia, 455, 456–458 comparison with parasympathetic division, 464, 467 components, 453 functions, 458–459 overview, 452, 453–454, 459, 467–468 relationship with parasympathetic division, 463–464, 468 suprarenal medullae, 458 sympathetic chain ganglia, 454–456 visceral reflexes, 466 Symphysis, 212, 213 Symptom, 24 Synapse, 355, 356 axoaxonic, 360 axodendritic, 360 axosomatic, 360 neuroglandular, 355 neuromuscular, 245, 253, 355, 360–361 nonvesicular (electrical), 361 vesicular (chemical), 360–361 Synaptic cleft, 253 Synaptic knob (terminal bouton), 350, 356 Synaptic terminal, 253, 350, 356 Synaptic vesicles, 253 Synarthrosis, 212, 213, 227 Synchondrosis, 212, 213, 227 Syncytial trophoblast, 754 Syndesmosis, 212, 213 Syndrome of inappropriate ADH secretion (SIADH), 520 Synergist, muscle, 260 Synostosis, 212, 213 Synovial fluid, 77, 213–214 Synovial joints, 118 accessory structures, 214 dislocation, 214 functional classification, 212 functions, 213 strength vs mobility in, 214 structural classification, 213, 218, 219, 240 structure, 213 synovial fluid, 213–214 types, 212, 213 Synovial membrane, 76, 77, 213, 214 Synovial tendon sheaths, 214, 301 Systemic anatomy, 2, 24 Systemic circuit, 571 arteries, 578–592 overview, 548, 578, 580, 605 veins, 592–598 Systole, 561 Systolic bruit, 603 Index T T3 (triiodothyronine), 512, 520 T4 (tetraiodothyronine), 512, 520 Table, flat bones external, 131 internal, 131 Tachycardia, 561, 564, 566 Tactile (Meissner’s) corpuscles, 98, 473, 474 Tactile (Merkel’s) discs, 98, 473, 474 Tactile receptors, 473 Taeniae coli, 679 Tail epididymis, 724 pancreas, 688 spermatozoon, 723 Tail fold, 756 Talocrural joint, 202, 235, 237 See also Ankle joint Talus, 202, 205 Target cells, 508 Tarsal bones, 205–206, 237 Tarsal (Meibomian) gland, 491 Tarsal plate, 491 Tarsometatarsal joints, 235 Tarsus, 205–206 Taste (gustation), 477–478, 503, 760, 781 Taste buds, 477 Taste hair, 477 Taste pore, 477 Tattoos, 105 TBI (traumatic brain injury), 410, 447 T cell lymphoma (T cell leukemia), 626 T cells, 537, 612 Tear (lacrimal) gland, 492 Tectorial membrane, 487 Tectospinal tracts, 399, 400 Tectum, mesencephalon, 417, 418 Teeth, 666–668 dental frame of reference, 668 dental succession, 666–668 gross anatomy, 666–667 mastication, 666, 668 types, 666–667 Telencephalon, 406, 779 Telodendria (terminal arborization), 356 Telophase, 48, 49 Temporal bone, 151–152, 161, 162, 227, 480 Temporalis muscle, 148, 274 Temporal line, inferior/superior, 148, 162 Temporal lobe, 427, 428 Temporal process, zygomatic bone, 151, 163 Temporal vein, 594 Temporomandibular joint, 157, 219–220, 227 Temporoparietalis muscle, 270, 272 Tendinitis, 298, 330 Tendinous inscriptions, 281 Tendons functions, 9, 214 histology, 66, 69, 70 shoulder joint, 225 structure, 245 synovial joint, 214 Tensile strength, 66 Tension, 66, 121, 251 Tension-type headache, 349 Tensor fasciae latae muscle, 308, 310 Tensor tympani muscle, 481 Tensor veli palatini muscle, 275, 276 Tentorium cerebelli, 411 Teratogens, 754, 798 “Teres,” muscle name, 260 Teres major muscle, 260, 294, 296 Teres minor muscle, 185, 294, 296 Terminal arborization (telodendria), 356 Terminal bouton (synaptic knob), 350, 356 Terminal bronchioles, 641 Terminal cisternae, 249 Terminal ganglia, 452 Terminal hairs, 101 Terminal lymphatics, 609, 610 Terminal segment, aorta, 587 Terminal web, 36 Tertiary (segmental) bronchi, 639 Tertiary follicle, 733 Testes, 717–723, 746 blood–testis barrier, 721 descent, 717, 719 development, 796 endocrine functions, 10, 507, 520, 527 histology, 720 position, 719 structure, 720, 721 Testicular artery, 589, 717 Testicular cancer, 724 Testicular vein, 596, 717 Testis cords, 796 Testosterone bone growth and, 129 functions, 720 secretion, 511, 520 Tetraiodothyronine (T4), 512, 520 Tetralogy of Fallot, 601 Thalamus, 394, 402 functions, 419–420, 433, 434, 487 gross anatomy, 419–420 overview, 406, 407 Thecal cells, 732 Theophylline, 645 Thermoreceptors, 473 Thermoregulation, 105 Thick filaments, 37, 249, 250 Thick segment, nephron loop, 705 Thick skin, 92, 94, 95 Thigh, 192 See also Lower limb Thin filaments, 249, 250 Thin segment, nephron loop, 705 Thin skin, 92–93, 94, 95 Third-class lever, 261 Third-order neuron, 393, 394 Third trimester, 751, 760–761, 760–762 Third ventricle, brain, 408 Thirst center, 420 Thoracentesis (thoracocentesis), 176, 177, 653 Thoracic aorta, 584 Thoracic artery, internal, 581 Thoracic artery, internal/external, 742 Thoracic cage, 174–176, 178 Thoracic cavity contents, 20–21 cross-sectional anatomy, 343, 344 heart location, 549 sectional anatomy, 648 Thoracic curve, 164, 166 Thoracic duct, 612 Thoracic lymph nodes, 619 Thoracic nerve, 293, 382 Thoracic vein, 595 Thoracic vertebrae, 164, 166, 169, 172 “Thoracis,” muscle name, 280 Thoracodorsal nerve, 296, 382 Thoracolumbar division, autonomic nervous system See Sympathetic (thoracolumbar) division, autonomic nervous system Thorax arteries, 582–583 surface anatomy, 336, 338 Thoroughfare channel, 575 Threshold, 359 Thrombocytes, 540 Thrombocytopenia, 540 Thrombocytosis, 540 Thrombus, 565, 602, 604 Thumb, 190 Thymic corpuscles, 622 Thymosin, 514 Thymus, 507, 512, 514, 526, 615, 621–622 endocrine functions, 10 lymphoid functions, 11 Thyrocervical trunk, 581, 646, 669 Thyroglobulin, 512 Thyrohyoid muscle, 277, 278 Thyroid artery, 512, 669 Thyroid cartilage, 512, 635–636 Thyroid follicles, 58, 512, 513 Thyroid gland clinical case (Hashimoto’s thyroiditis), 523–525 C thyrocytes, 514 development, 783 diagnostic procedures, 525 endocrine functions, 10 gross anatomy, 512, 513 histology, 513 hormones produced by, 507, 512, 514 overview, 526 regulation, 514 Thyroid-stimulating hormone (TSH), 510, 511 Thyroid vein, 512 Thyrotropin-releasing hormone (TRH), 512 Thyroxine (TX), 58, 129, 512, 520 Tibia, 202, 203–204, 237 Tibial artery, posterior/anterior, 589 Tibial collateral ligament, 231 Tibialis muscle, anterior/posterior, 314, 315 Tibial nerve, 382, 383 Tibial tuberosity, tibia, 202 Tibial vein, anterior/posterior, 597 Tibiofemoral joint, 231 Tibiofibular joint, proximal/distal, 202, 235, 237 Tibiotalar joint, 235 Tic douloureux (trigeminal neuralgia), 442, 447 Tight junction, 45 Tinnitus, 502 Tissue cholinesterase, 462 Tissue level of organization, 5, Tissues aging and, 80 connective See Connective tissue definition, 2, 24, 28, 54 development, 83–84 epithelial See Epithelial tissue membranes, 75–77 nutrition and, 80 overview, 54 primary types, 54 Titin, 250 Toes See Foot Tongue, 275, 664–665 Tongue muscles, extrinsic/intrinsic, 665 Tonic receptors, 471 Tonofibrils, 93 Tonsillectomy, 613 Tonsillitis, 613, 615 Tonsils, 613, 615, 634 Tooth See Teeth Total hysterectomy, 729 Touch receptors, 473, 474 Trabeculae, 639 Trabeculae carneae, 555 Trabecular artery, 623 Trabecular (cancellous; spongy) bone, 72, 74, 118–119 Trabecular vein, 624 Trachea, 11, 637–638, 654 Tracheal cartilages, 637 Trachealis, 637 Tracheostomy, 639, 653 Trachoma, 498 Tracts (fasciculi) ascending/descending, 373 definition, 348, 362 spinal nerve, 375 Transfer vesicles, 44 Transfusions, 539, 543 Transitional cells, parathyroid, 514 Transitional epithelium, 60–61 Transmembrane potential, 37 Transmembrane proteins, 32 Transmission electron microscopy, 3, 28, 29 Transplantation, kidney, 706 Transport globulins, 532 Transport vesicles, 41 Transposition of great vessels, 601 Transudate, 75 Transverse acetabular ligament, 229 Transverse arch, foot, 206 Transverse cervical nerve, 378 Transverse colon, 662, 681 Transverse fibers, pons, 416, 417 Transverse foramina, vertebrae, 169 Transverse fracture, 132 Transverse humeral ligament, 223 Transverse ligament, axis, 170 Transverse mesocolon, 662 Transverse muscles, 281, 775 Transverse perineal muscles, superficial/deep, 287 Transverse plane, 18 Transverse process, vertebrae, 168, 169 Transverse section, 18 Transverse sinus, 411 Transverse thoracis muscle, 281 Transverse tubules (T tubules), 246, 252 Transversospinalis muscles, 280 “Transversus,” muscle name, 260 Transversus abdominis muscles, 281, 284 Trapezium bone, 190 Trapezius muscle, 185, 292, 293, 775 Trapezoid bone, 190 Traumatic brain injury (TBI), 410, 447 Tremor, 433, 447 Tretinoin (Retin-A), 97 TRH (thyrotropin-releasing hormone), 512 Triad, 249 Triaxial joint, 212, 213, 215 Triceps brachii muscle, 185, 260, 296, 298, 299 Trichinella spiralis, 263 Trichinosis, 263 Trick knee, 234 Tricuspid valve, 554 Trigeminal nerve (N V), 274, 275, 278, 436, 441 Trigeminal neuralgia (tic douloureux), 442, 447 Triglyceride, 524 Trigone, 709 Triiodothyronine (T3), 512, 520 Trimesters See Pregnancy Triquetrum, 190 Trochanter, 134, 135 femur, greater/lesser, 199 Trochlea, 134, 135 humerus, 185 talus, 205 Trochlear nerve (N IV), 270, 273, 436, 440 Trochlear notch, ulna, 185 Trophoblast, 82, 753 Tropic hormones, 511 Tropomyosin, 250 Troponin, 250 True pelvis, 193 True ribs, 174 True vocal cords, 636 Trunk arteries, 587 lymphatic vessels, 611–612 muscles, 295 veins, 595 T thyrocytes, 512 T tubules (transverse tubules), 246, 252 Tuberal area, hypothalamus, 420, 421 Tubercle (bone marking), 134, 135 atlas, anterior/posterior, 170 clavicle, conoid, 182 femur, adductor, 199 humerus, greater/lesser, 185 pubic, 192 rib, 174 scapula, supraglenoid/infraglenoid, 185 temporal bone, articular, 151, 162 tibia, medial/lateral, 202 Tuberculum sellae, 153 Tuberosity (bone marking), 134, 135 clavicle, costal, 182 femur, gluteal, 199 hip bone, iliac/ischial, 192 humerus, deltoid, 185 radius, radial, 187, 225 sacrum, sacral, 174 tibia, tibial, 202 Tubular glands, 62 Tubular pole, renal corpuscle, 705 Tubulin, 37 Tubuloacinar glands, 62 Tubuloalveolar glands, 62, 727 Tumor (neoplasm), 47, 49, 81 Tunica vaginalis, 719 Turbinate bone, 633 TX (thyroxine), 58, 129, 512, 520 Tympanic cavity, 152, 479 Tympanic duct (scala tympani), 487 Tympanic membrane, 151, 479, 480 Tympanic muscle, 480 Tympanic part, temporal bone, 151 Tympanic reflex, 447 Tympanum See Tympanic membrane Type (insulin-dependent) diabetes mellitus, 519, 525 Type (non-insulin-dependent) diabetes mellitus, 519, 525 Type AB blood, 535, 536 Type A blood, 535, 536 Type B blood, 535, 536 Type O blood, 535, 536 U Ulcer, 675 Ulcerative colitis, 691 Ulna, 185, 188–189, 231 Ulnar artery, 581 Ulnar collateral ligament, 225, 227 Ulnar head, 185 Ulnar nerve, 185, 379, 382, 383 Ulnar notch, radius, 187 Ulnar palsy, 383 Ulnar vein, 595 Ultrasound, 23, 24, 525 Ultraviolet (UV) radiation, 96 Umami, 478 Umbilical artery, 599, 708, 756, 786 Umbilical cord (umbilical stalk), 756, 792 Umbilical ligament, medial/lateral, 708 Umbilical vein, 599, 756, 786 Unencapsulated receptors, 473, 474 Unicellular glands, 61 Unilocular adipose cell, 67 Unipennate muscle, 258, 259 Unmyelinated, 351 Upper limb, 182, 209 arteries, 582–583 articulations, 231 bones, 185–191 compartments, 324–327 development, 773 lymphatic drainage, 619 muscles, 294–307, 331 nerves, 379–382 surface anatomy, 338–339 veins, 595 Upper-motor neuron, 396 Upper respiratory system, 631, 632–634, 653–654 Ureteral opening, 706 Ureteric bud (metanephric diverticulum), 794 Ureters, 12, 696, 706–707, 714 Urethra, 12, 13, 696, 709–710, 714, 724, 794 Urethral folds, 795 Urethral orifice, 709 Urethral sphincter, internal/external, 287, 709 Urethritis, 711, 713 Urinary bladder, 12, 696, 707–709, 714, 794 Urinary obstruction, 710, 713 Urinary retention, 711 Urinary system aging and, 710–711 clinical case (hemolytic uremic syndrome), 711–713 development, 761, 793–794 functions, 696 histology, 709 imaging, 707 kidneys See Kidney overview, 7, 12, 696, 697, 698 structures for urine transport, storage, and elimination, 706–710, 714 Urinary tract, 696 Urinary tract infection (UTI), 711, 713 Urination (micturition), 465, 466, 696 Urine, 696 Urogenital diaphragm, 284 Urogenital membrane, 795 Urogenital ridge, 793 Urogenital sinus, 792, 794 Urogenital triangle, 284–285, 287 Uterine cancers, 736 Uterine cavity, 735 Uterine (menstrual) cycle, 735, 737–738, 739 Uterine tube (Fallopian tube; oviduct), 729, 731, 734–735, 747 Uterine tubes, 13 Uterosacral ligament, 735 Uterovaginal prolapse, 744–745 Uterus, 13, 729, 731, 747 blood supply, 737 cancers of, 736 gross anatomy, 735–736 histology, 737 internal anatomy, 735 in pregnancy, 763 suspensory ligament, 735 wall, 735, 737 Utricle, 482 UV (ultraviolet) radiation, 96 Uvula, 635, 664 V Vagina, 13, 729, 747 functions, 738 gross anatomy, 738 histology, 739–740 Vaginal canal, 738 Vagus nerve (N X), 276, 436, 444–445, 478 Valves digestive system, 659 heart, 556–558 lymphatic vessels, 610 venous, 577 Valvular stenosis, 566 Varicose vein, 604 Varicosity, 459 Vasa recta, 705 Vasa vasorum, 571 Vascular pole, 701 Vascular tunic, eye, 495 Vas deferens (ductus deferens; sperm duct), 13, 724, 726 Vasoconstriction, 574 Vasodilation, 574 Vasomotor reflex, 465 Vastus intermedius muscle, 312, 314 Vastus lateralis muscle, 312, 314 Vastus medialis muscle, 312, 314 Veins abdomen, 596 brain, 592–594 functions, 10, 71, 548 head and neck, 594 histology, 571–572 large, 576 liver, 598 lower limb, 596–598 medium-sized, 576 nutrient, 128 pelvis, 596 systemic circuit, 582–598 trunk, 595–596 upper limb, 595 venous valves, 577 venules, 98, 576 vs arteries, 572 Veins listed antebrachial, 594 arcuate, 698 axillary, 595 azygos, 595, 669 basilic, 594 brachial, 595 brachiocephalic, 592, 595 cardiac, 561 cardinal, 786 central, 683 cephalic, 594 cerebral, 592 colic, 598 coronary, 554, 561 cubital, 594 cystic, 598 dental, 666 digital, 594, 597 dorsal venous arch, 597 esophageal, 596 facial, 594 femoral, 598 femoral circumflex, 598 fibular, 597 gastric, 598, 673 gastroepiploic, 598, 673 gluteal, 596 gonadal, 596 hemiazygos, 596 hepatic, 596, 598, 683 hepatic portal, 517, 683 ileocolic, 598 iliac, 596, 598 inferior vena cava, 554, 596 intercostal, 596 interlobar, kidney, 698 interlobular, kidney, 698 internal jugular, 411 intestinal, 598 jugular, 148, 592, 594 lumbar, 596 maxillary, 594 869 Index Index 870 Index Index Veins listed, continued mesenteric, 598, 676, 679 obturator, 596 ovarian, 596, 729 palmar, 594 palmar venous arch, 594 pancreatic, 598 pancreaticoduodenal, 598 phrenic, 597 plantar, 597 popliteal, 598 posterior vein of left ventricle, 561 pudendal, 596 pulmonary, 555, 578 radial, 595 rectal, 598 renal, 597, 696, 698 retinal, 497 sacral, 596 saphenous, 598 splenic, 598, 623 subcardinal, 786 subclavian, 594, 595 superior vena cava, 554, 592, 595–596 suprarenal, 514, 597 temporal, 594 testicular, 596, 717 thoracic, 595 thyroid, 512 tibial, 597 trabecular, 624 ulnar, 595 umbilical, 599, 756, 786 vertebral, 169, 592 Vellus hairs, 101 Venoconstriction, 577 Venous reserve, 577 Ventral, 18 Ventral body cavity, 19–21 Ventral nuclei, thalamus, 419, 420 Ventral posterolateral nucleus, thalamus, 394 Ventral ramus, 376 Ventral respiratory group, 650 Ventral root, 368 Ventricles brain, 347, 408, 409 heart, 548 Ventricular diastole, 558 Ventricular fibrillation, 564 Ventricular septal defect, 601 Ventricular systole, 558 Ventricular tachycardia (VT; V-tach), 564 Ventrolateral plate, 777 Venules, 8, 576 Vermiform appendix, 613, 615, 679 Vermis, 424 Vertebrae, 2, 4, 167–174, 208 Vertebral arches, 167, 170 Vertebral artery, 169, 414, 581 Vertebral articulation, 168 Vertebral body (centrum), 167, 169 Vertebral canal, 168 Vertebral column See also Intervertebral discs articulations, 220–221, 227 bones, 167–174, 178 clinical note, 167 curves, 164, 166 development, 770–771 movements, 221, 227 muscles, 278–281, 288 regions, 164, 166, 169–174, 371 Vertebral end plates, 220 Vertebral foramen, 167, 169 Vertebral osteoarthritis, 653 Vertebral vein, 169, 592 Vertebra prominens, 170 Vertebrates, 2, Vertebrochondral ribs, 174 Vertebrocostal joint, 227 Vertebrosternal ribs, 174 Vesicle, 111, 112 Vesicouterine pouch, 729 Vesicular (chemical) synapses, 360–361 See also Neuromuscular synapses Vestibular bulbs, vagina, 739 Vestibular complex, 484–486 Vestibular duct (scala vestibuli), 487 Vestibular folds, 636 Vestibular ganglia, 486 Vestibular gland, lesser/greater, 741 Vestibular ligament, 636 Vestibular nerve, 443 Vestibular nuclei, 443 Vestibular pathways, 486 Vestibular schwannoma, 501–502 Vestibule, 443 female genitalia, 738 inner ear, 482, 485 oral cavity, 664 vagina, 740 Vestibulocochlear (acoustic) nerve (N VIII), 436, 443, 486, 487, 501–502 Vestibulo-ocular reflex, 446, 447 Vestibulospinal tracts, 393, 399, 400, 486 Vibrissae, 632 Viscera, 20 Visceral, 348 Visceral (glomerular) epithelium, 701, 702 Visceral layer, 774 Visceral motor neurons, 357 Visceral motor system See Autonomic nervous system (ANS) Visceral pericardium (epicardium), 21, 548, 550 Visceral peritoneum, 21 Visceral peritoneum (serosa), 659, 662 Visceral pleura, 21, 646 Visceral reflex, 386, 387, 464–466 Visceral reflexes, 446 Visceral sensory neuron, 357 Visceral sensory receptor, 347, 349 Visceral smooth muscle tissue, 659 Viscosity, 530 Visible Human Project, 19 Vision See also Eye brain stem in, 500 cortical integration, 499–500 development, 760, 781 overview, 504 visual pathways, 499–500, 504 Visual association area, 428 Visual cortex, 427, 428 Visual pathways, 499–500, 504 Vitamin A, in bone growth, 128 Vitamin B12, 541 Vitamin C, in bone growth, 128 Vitamin D, 517 aging and, 107 in bone growth, 128–129 deficiency, 127 ultraviolet radiation and, 96 Vitreous body (vitreous humor), 492, 499 Vitreous chamber, 492 Vocal folds, 636 Vocal ligament, 636 Volkmann (perforating) canals, 118 Volume of packed red cells (VPRC), 532 Voluntary, 348 Voluntary muscles, 245 See also Skeletal muscle Vomer, 157, 163 Vomiting reflex, 465 VT (ventricular tachycardia), 564 V-tach (ventricular tachycardia), 564 Vulva, 740 W Wallerian degeneration, 358–359 Wandering cells, connective tissue, 65–66 Water, in human body, Water receptors, 478 WBCs (white blood cells) See Leukocytes (white blood cells; WBCs) Wharton’s ducts (submandibular ducts), 666 Wharton’s jelly (mucous connective tissue), 66, 67 What’s New in Anatomy See Hot Topics: What’s New in Anatomy Whiplash, 172, 177, 238–239 White adipose cells, 67 White blood cells (WBCs) See Leukocytes (white blood cells; WBCs) White commissure, 373 White fat, 67 White (fast) fibers, 255, 256, 257 White matter cerebellum, 424 cerebrum, 430–431 definition, 348, 351 medulla oblongata, 416 mesencephalon, 418 organization, 408 pons, 417 spinal cord, 373–374 White pulp, spleen, 623 White ramus, 376, 454 Whole blood, 530, 531, 532 See also Blood Wing, sacral, 174 Wisdom teeth, 668 Wormian (sutural) bone, 131, 148 Wrapping muscle, 258 Wrinkles, 97 Wrist (carpus) bones, 190, 191 joints, 226, 228, 241 ligaments, 227, 228 muscles, 299–301 stability, 226–227 surface anatomy, 339 X Xerosis, 108, 112 Xiphoid process, sternum, 176 X-rays, 22, 24 Y Yellow marrow, 118, 541 Yolk sac, 756, 791 Yolk stalk, 756, 791 Z Z lines (Z discs), 249, 250 Zona fasciculata, suprarenal gland, 515, 517 Zona glomerulosa, suprarenal gland, 515, 517 Zona pellucida, 732 Zona reticularis, suprarenal gland, 516, 517 Zone of overlap, 249 Zonula adherens (adhesion belt), 45 Zygapophysial joints, 220 Zygomatic arch, 151 Zygomatic bone, 151, 157, 161, 163 Zygomaticofacial foramen, 157, 161 Zygomatic process, temporal bone, 151, 162 Zygomaticus major muscle, 272 Zygomaticus minor muscle, 272 Zygote, 82, 717, 750 Zymogen (chief) cells, 675 ... dermatome C2–C3 NV C2–C3 C2 C3 T2 C6 L1 L2 C8 C7 T1 L3 L4 C3 C4 C5 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T 12 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T 12 L1 L2 L4 L3 L5 C4 Cervical plexus C5 Brachial plexus T2 C6... the neck (∞ pp 27 1, 27 7 27 8), the sternocleidomastoid, scalene, levator scapulae, and trapezius muscles of the neck and shoulder (∞ pp 27 0, 27 1, 29 2 29 5, 29 7), and the diaphragm ∞ p 28 3 The phrenic... lies deep to the sternocleidomastoid muscle (∞ pp 27 0, 27 1), and anterior to the middle scalene and levator scapulae muscles ∞ pp 28 0, 28 1, 29 2, 29 3 The cutaneous branches of this plexus innervate